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"ABSTRAKPneumonia merupakan peradangan pada parenkim paru yang sering terjadi pada masaanak-anak dan masa bayi. Peradangan tersebut menyebabkan sputum terkumpul diparu, yang membuat sulit untuk bernafas. Salah satu cara untuk mengeluarkansputum adalah CPT. Tujuan dari penelitian ini adalah untuk mengetahui pengaruhchest physiotherapy (CPT) terhadap status pernafasan anak balita pnemonia. Desainpenilitan ini menggunakan quasi eksperiment post test only dengan grup kontrol.Hasil penelitian menunjukkan bahwa ada pengaruh CPT terhadap suara nafas (pvalue= 0,008), retraksi dada (p value= 0,008), frekuensi pernafasan (p value= 0,001)dan saturasi oksigen (p value= 0,01) pada balita. Penelitian ini merekomendasikanCPT sebagai intervensi keperawatan untuk memperbaiki status pernafasan anak.

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ABSTRACTPneumonia is an inflammantory condition of the lung. Child and infant included agroup that have risk to get pneumoni. The inflammantion causes pulmonary sputumcollection and this make difficult to breath. One of the ways to take out the sputum isby doing chest physiotherapy (CPT). The purpose of this research was to find out theeffect of chest physiotherapy (CPT) toward respiratory status of children pnemonia.Design of this study used quasi eksperiment post test only non equivalent group. Theresult of the study showed there was significant effect of CPT againts breath sounds(p value= 0,008), chest retraction (p value= 0,008), respiratory rate (p value= 0,001)and oxygen saturation (p value= 0,010) on children. This research recommend CPTas a nursing intervention to recover children respiratory status."

"Di Indonesia pneumonia merupakan penyebab kematian kedua tertinggi pada bayi dan balita. Pneumonia berdampak terhadap status pernapasan karena terjadi obstruksi jalan napas akibat peningkatan produksi sekret. Penelitian ini bertujuan mengetahui efektivitas nebulisasi dan fisioterapi dada terhadap status pernapasan pada balita dengan pneumonia. Rancangan penelitian ini menggunakan quasi eksperiment pre and post test non equivalent control group design dengan 34 responden yang diambil secara consecutive sampling. Analisis data menggunakan independent t test. Hasil penelitian menunjukkan perbedaan selisih rata-rata HR, RR, dan SpO2 antara kelompok kontrol dan kelompok intervensi (p=0.000). Karakteristik responden (status gizi, status ASI eksklusif, status imunisasi, lama sakit, dan jenis obat nebulisasi) tidak berpengaruh terhadap HR, RR, dan SpO2 namun usia memberikan pengaruh terhadap HR. Tindakan nebulisasi yang dilanjutkan fisioterapi dada lebih efektif dibandingkan dengan tindakan nebulisasi saja. Tindakan ini juga dapat dijadikan kebijakan yang perlu dilakukan dalam memberikan asuhan keperawatan pada anak pneumonia.

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Pneumonia is the second leading cause of death in children under age five in Indonesia. It affects respiratory status due to airway obstruction caused by increased secretions. This study aimed to determine effectiveness of nebulization and chest physiotherapy on respiratory status of children under age five with pneumonia. This study was quasi-experimental with pre and post test nonequivalent control group design with 34 respondents choosen by consecutive sampling. Analysis result using independent t test showed differences in the average gaps in HR, RR and SpO2 of control group and intervention group (p=0.000). The characteristics of respondents (nutritional status, breastfeeding, vaccination history, length of illness and type of nebulization medication) had no effect on HR, RR and SpO2. However, age affects the HR. Nebulization followed by chest physiotherapy is more effective than nebulization. It can be used as a policy in providing nursing care for children with pneumonia."

"Manifestasi klinis anak dengan pneumonia adalah peningkatan produksi sputum yang kental, dan sulit dikeluarkan. Salah satu terapi suportif yang diberikan adalah fisioterapi dada. Fisioterapi dada diberikan untuk mengalirkan, mengeluarkan sekresi pada saluran pernapasan. Tujuan penelitian ini mengetahui dampak fisioterapi dada terhadap status pernapasan (RR, HR, SpO2) anak balita pneumonia. Desain penelitian yang digunakan kuasi eksperimen dengan pre test dan post test without control. Methode consecutive sampling, dengan 35 jumlah responden di RSUD Wilayah Jakarta. Hasil analisis penelitian menunjukkan adanya perbedaan sebelum dan sesudah intervensi pada RR, HR dan SpO2 dengan signifikansi p = 0.001. Hasil penelitian merekomendasikan penelitian selanjutnya memakai sampel lebih banyak dan menggunakan desain time series pada fisioterapi dada.

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Clinical manifestations of children with pneumonia is increased production of viscous sputum, and difficult to remove. One of supportive treatment given is chest physiotherapy. Chest physiotherapy is given to drain secretion in the respiratory tract. The purpose of this study to know the effect of chest physiotherapy on respiratory status (RR, HR, SpO2) children pneumonia. The study design used a quasi experimental with pre test and post test without control. Sampling methode is consecutive sampling, with 35 respondents in Jakarta Regional Hospital. Results of the analysis showed that there was a diffrence before and after intervention in RR, HR and SpO2 with significance p = 0.001. the results of the study recommends further research taking more samples and using time series design on chest physiotherapy."

"Fisioterapi dada merupakan tindakan mandiri perawat yang bertujuan melancarkan jalan napas pada anak pneumonia. Tujuan penelitian untuk mengetahui dampak fisioterapi dada terhadap perubahan status pernapasan (Krissjansen Respiratory Score, Spo2, dan HR) anak balita pneumonia. Desain yang digunakan kuasi eksperimen pre test dan post test control group design, melibatkan 32 responden untuk masing-masing kelompok 16 anak dengan teknik consecutive di ruang anak RSUD Pasar Rebo dan Koja Jakarta. Hasil analisis statistik menunjukkan perbedaan signifikan status pernapasan (saturasi oksigen) sesudah fisioterapi dada pada kelompok intervensi (p=0,001), begitu juga pada status pernapasan (saturasi oksigen dan denyut nadi) menunjukkan perbedaan signifikan kelompok intervensi p=0,001 dan p=0,039 daripada kelompok kontrol. Hasil penelitian ini merekomendasikan untuk penelitian selanjutnya menggunakan desain eksperimen murni dengan tahapan prosedur lengkap fisioterapi dada.

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Chest physiotherapy is an independent nursing intervention to loosen the airway in children with pneumonia disease. The aimed is to explore the effect of chest physiotherapy in change of respiratory status (Krissjansen Respiratory Score, Spo2, dan HR) children with pneumonia. The research design is quasi experiment pre test and post test control group design. The respondents are 32 patients which divide into 2 groups: 16 patients for group control and 16 patients for intervention group used consecutive sampling technique in children nursing ward Pasar Rebo hospital and Koja hospital.

Statistical analysis showed the significant differences in respiratory status (oxygen saturation) after chest physiotherapy in intervention group (p=0,001), it also different in respiratory status (oxygen saturation and pulse) in intervention group (p=0,001;p=0,039) respectively compare to control group. Further study the recommendation from this research is need to continue research used experimental method and complete chest physiotherapy procedure."

"Pneumonia menjadi salah satu penyakit yang paling sering terjadi pada anak-anak berusia kurang dari 5 tahun. Gejala yang paling umum muncul pada anak dengan pneumonia adalah batuk, berdahak yang sulit dikeluarkan. Menurut beberapa penelitian fisioterapi dada menjadi intervensi keperawatan yang dapat diterapkan pada anak untuk membantu mengeluarkan sekret yang menghambat jalan napas. Tujuan penulisan ini adalah untuk menganalisis asuhan keperawatan pada pasien anak dengan pneumonia yang mengalami masalah bersihan jalan napas tidak efektif melalui penerapan intervensi fisioterapi dada. Terdapat 2 pasien yang diintervensi, masing-masing berusia 1 tahun 5 bulan dan 1 tahun 1 bulan. Intervensi dilakukan selama selama 3 hari. Setiap hari dilakukan fisioterapi dada sebanyak 2 kali (pagi dan sore) dengan durasi masing-masing 15 sampai 20 menit. Dari hasil evaluasi didapatkan adanya perbaikan status pernapasan pada pasien meliputi penurunan frekuensi napas dan denyut nadi, serta peningkatan saturasi oksigen. Selain itu, hasil auskultasi paru juga menunjukkan adanya penurunan suara ronchi.

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Pneumonia is one of the most common diseases in children under five years old. Coughing and phlegm that is difficult to expel are the most common symptoms of pneumonia in children. Chest physiotherapy can be applied to children to help expel secretions that block airways, according to several studies. The purpose of this paper is to analyze nursing care in pediatric patients with pneumonia who have problems with ineffective airway clearance through the application of chest physiotherapy interventions. There were 2 patients who intervened, each aged 1 year 5 months and 1 year 1 month. The intervention was carried out for 3 days. The chest physiotherapy was conducted twice a day for 15 to 20 minutes each. According to the evaluation results, the patient's respiratory status improved, including a decrease in respiratory rate and pulse, as well as an increase in oxygen saturation. In addition, the results of auscultation of the lungs also showed a decrease in the sound of rhonchi."

"Ketidakefektifan bersihan jalan napas menjadi salah satu masalah respirasi paling umum terjadi pada anak dengan pneumonia akibat terjadinya inflamasi pada alveolus. Pada anak-anak, peningkatan produksi sekret dan ketidakefektifan batuk semakin memperparah kepatenan jalan napas sehingga memerlukan bantuan dalam sekresi sputum. Karya ilmiah ini bertujuan untuk menganalisis efektivitas fisioterapi dada pada pasien anak dengan pneumonia yang mengalami masalah bersihan jalan napas. Pasien An. D (11 tahun) dengan pneumonia mengalami takipnea dengan frekuensi napas 31x/menit, saturasi oksigen 95-97% dengan nasal kanul 2 liter per menit, frekuensi nadi 128x/menit, ronkhi pada kedua lapang paru, dan tingkat kesadaran stupor GCS E1M2V1. Setelah diberikan fisioterapi dada selama 4 hari, terdapat perbaikan pada frekuensi napas pasien, frekuensi nadi, saturasi oksigen, suara ronkhi yang berkurang, dan sekresi sputum mencapai 60 cc pada hari terakhir intervensi. Hasil penelitian ini diharapkan mampu menjadi referensi tambahan bagi ners untuk memberikan fisioterapi dada sebagai intervensi keperawatan mandiri pada pasien dengan masalah bersihan jalan napas.

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Ineffective airway clearance is one of the most common respiratory problems in children with pneumonia due to inflammation of the alveoli. In children, increased production of secretions and ineffective coughing further exacerbate airway patency, hence sputum secretion assistance is required. This study aims to analyze the effectiveness of chest physiotherapy in children with pneumonia with airway clearance problems. Patient D (11 years old) with pneumonia had tachypnea with a respiratory rate of 31x/minute, oxygen saturation 95-97% with nasal cannula 2 liters per minute, pulse rate 128x/minute, rhonchi, and LOC stupor GCS E1M2V1. The patient's respiratory rate, pulse rate, oxygen saturation, ronchi, and sputum secretion is improved during 4 days of administered chest physiotherapy. The results of this study are expected to be an additional reference for nurses to provide chest physiotherapy as an independent nursing intervention for patients with airway clearance problems."

"Bersihan jalan napas tidak efektif merupakan masalah utama yang sering muncul pada anak dengan pneumonia. Tindakan clapping adalah salah satu intervensi mandiri keperawatan untuk masalah bersihan jalan napas. Studi ini bertujuan untuk mengetahui efektivitas clapping dalam penanganan masalah bersihan jalan napas. Intervensi berupa tindakan clapping untuk penanganan bersihan jalan napas diharapkan dapat menggerakkan sekret yang tertahan pada jalan napas. Metode yang digunakan berupa edukasi, pendampingan, memantau status respirasi, serta evaluasi. Hasil ditemukan bahwa ada perbaikan status respirasi setelah pemberian clapping dan terapi jalan napas lainnya. Berdasarkan studi ini diharapkan institusi rumah sakit memaksimalkan peran perawat untuk memberikan edukasi, pendampingan, dan evaluasi mengenai clapping sebagai tindakan penting untuk meningkatkan perbaikan masalah bersihan jalan napas.

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Ineffective airway clearance is a major problem that often occurs in children with pneumonia. Clapping chest physiotherapy is one of nursing interventions for improving airway clearance. This study aims to determine the effectivity of clapping chest physiotherapy for improving airway clearance. Clapping chest physiotherapy techniques are expected to move secretion out of the lungs. The methods used are education, assistance, and evaluation of clapping chest physiotherapy, and monitoring status of respiration. The result found that there was an improvement in respiratory status after administration of clapping and other airway clearance therapy. This paper is expected to be the hospitals consideration in maximizing nurses role in education, assistance, and evaluation of clapping as an important measure to improve airway clearance. "

"[ABSTRAKLatar Belakang. Penilaian derajat kesadaran penting dilakukan pada pasien di Unit Gawat Darurat untuk memperkirakan prognosis. Banyak sistem penilaian dipakai untuk mengevaluasi pasien, masing-masing dengan kelebihan dan kekurangannya. Sistem penilaian yang baru, yaitu Full Outline of Unresponsiveness (FOUR )Score, dapat digunakan menilai derajat kesadaran dan memprediksi prognosis pasien. FOUR Score dapat memberikan data neurologis yang lebih detail dan dapat digunakan pada pasien yang terintubasi. Belum ada penelitian yang menilai validitas FOUR Score sebagai prediktor outcome pada pasien dengan penurunan kesadaran di IGD RSCM sebelumnya.Metode. Penelitian kohort prospektif observasional pada pasien dengan penurunan kesadaran yang dirawat di IGD RSCM. Evaluasi FOUR Score dilakukan terhadap 120 pasien baru yang dirawat di IGD RSCM. Outcome pasien dicatat setelah perawatan 72 jam. Analisis bivariat digunakan untuk menentukan hubungan FOUR Score terhadap outcome. Analisis regresi logistik untuk menentukan hubungan komponen FOUR Score terhadap outcome. Nilai area di bawah kurva (AUC) digunakan untuk sebagai uji dsikriminasi FOUR Score terhadap outcome.Hasil. Terdapat hubungan yang bermakna antara nilai FOUR Score dengan outcome (p <0,001). Komponen respon membuka mata (FOUR-E) dan pola respirasi (FOUR-R) adalah komponen yang mempunyai nilai prediksi terhadap outcome. AUC FOUR Score adalah 0,864 (95% IK 0,784-0,928).Uji kesesuaian antarpenilai antara dokter dan perawat menunjukkan kesesuaian yang sangat baik dengan κ = 0,836 (95% IK 0,786- 0,894), p <0,001.

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ABSTRACTBackground. Asssessment of conciousness is important in patients in emergency room to estimate prognosis. Many scoring systems used to evaluate patients? level of conciousness, each with their advantages and disadvantages Full Outline of Unresponsiveness (FOUR) Score is a new system to assess patients?s level of conciousness and future prognosis. FOUR Score can provide a detailed neurological data and can be used in patients who are intubated. There have never been done a research on validity of FOUR Score as a predictor of outcome in RSCM?s ER before.Method. Observational, prospective cohort study in patients with decreased of conciousness treated in the RSCM?s ER. FOUR Score?s evaluation conducted on 120 new patients. Patient?s outcome was recorded after 72 hours of treatment, and classified as dead or alive. Bivariate analysis conducted to determine the relation between FOUR Score and outcome. Logistic regression analysis was performed to determine the relation between components of the FOUR Score and the outcome, and the value of area under the curve (AUC) of the FOUR Score to outcome was determined to measure discrimination of FOUR Score.Results. There is a significant correlation statistically between the value of the FOUR Score with the outcome (p <0.001). From all the components had been measured, the eye response (FOUR-E) and respiratory pattern (FOUR-R) had predictive value related to the outcome. AUC of the FOUR Score is 0,864 (95% CI 0,784-0,928). Inter-rater agreement between doctor and nurse shows a very good strength of agreement wtith κ = 0,836 (95% CI 0,786- 0,894), p <0,001.Conclusion. FOUR Score can accurately predict the outcome of patients with decreased of consciousness in the RSCM?s ER after 72 hours of treatment.;Background. Asssessment of conciousness is important in patients in emergency room to estimate prognosis. Many scoring systems used to evaluate patients? level of conciousness, each with their advantages and disadvantages Full Outline of Unresponsiveness (FOUR) Score is a new system to assess patients?s level of conciousness and future prognosis. FOUR Score can provide a detailed neurological data and can be used in patients who are intubated. There have never been done a research on validity of FOUR Score as a predictor of outcome in RSCM?s ER before.Method. Observational, prospective cohort study in patients with decreased of conciousness treated in the RSCM?s ER. FOUR Score?s evaluation conducted on 120 new patients. Patient?s outcome was recorded after 72 hours of treatment, and classified as dead or alive. Bivariate analysis conducted to determine the relation between FOUR Score and outcome. Logistic regression analysis was performed to determine the relation between components of the FOUR Score and the outcome, and the value of area under the curve (AUC) of the FOUR Score to outcome was determined to measure discrimination of FOUR Score.Results. There is a significant correlation statistically between the value of the FOUR Score with the outcome (p <0.001). From all the components had been measured, the eye response (FOUR-E) and respiratory pattern (FOUR-R) had predictive value related to the outcome. AUC of the FOUR Score is 0,864 (95% CI 0,784-0,928). Inter-rater agreement between doctor and nurse shows a very good strength of agreement wtith κ = 0,836 (95% CI 0,786- 0,894), p <0,001.Conclusion. FOUR Score can accurately predict the outcome of patients with decreased of consciousness in the RSCM?s ER after 72 hours of treatment., Background. Asssessment of conciousness is important in patients in emergency room to estimate prognosis. Many scoring systems used to evaluate patients? level of conciousness, each with their advantages and disadvantages Full Outline of Unresponsiveness (FOUR) Score is a new system to assess patients?s level of conciousness and future prognosis. FOUR Score can provide a detailed neurological data and can be used in patients who are intubated. There have never been done a research on validity of FOUR Score as a predictor of outcome in RSCM?s ER before.Method. Observational, prospective cohort study in patients with decreased of conciousness treated in the RSCM?s ER. FOUR Score?s evaluation conducted on 120 new patients. Patient?s outcome was recorded after 72 hours of treatment, and classified as dead or alive. Bivariate analysis conducted to determine the relation between FOUR Score and outcome. Logistic regression analysis was performed to determine the relation between components of the FOUR Score and the outcome, and the value of area under the curve (AUC) of the FOUR Score to outcome was determined to measure discrimination of FOUR Score.Results. There is a significant correlation statistically between the value of the FOUR Score with the outcome (p <0.001). From all the components had been measured, the eye response (FOUR-E) and respiratory pattern (FOUR-R) had predictive value related to the outcome. AUC of the FOUR Score is 0,864 (95% CI 0,784-0,928). Inter-rater agreement between doctor and nurse shows a very good strength of agreement wtith κ = 0,836 (95% CI 0,786- 0,894), p <0,001.Conclusion. FOUR Score can accurately predict the outcome of patients with decreased of consciousness in the RSCM?s ER after 72 hours of treatment.]"

"Pneumonia merupakan penyebab utama morbiditas dan mortalitas pada usia dewasa, yang disebabkan oleh agen infeksius seperti bakteri, mycoplasma, dan virus, termasuk Coronavirus Disease-19 (Covid-19) yang saat ini menjadi pandemic. Klinis pasien dengan pneumonia akibat infeksi Covid-19 adalah demam, batuk, kesulitan bernapas, dan keluhan sesak memberat. Salah satu masalah keperawatan yang adalah ketidakefektifan bersihan jalan napas dikarenakan akumulasi sekret berlebih sebagai akibat reaksi inflami jaringan paru, yang ditandai dengan batuk, keluhan susah mengeluarkan dahak, terdengar ronchii, hingga timbulnya sesak napas. Tujuan penulisan Karya Ilmiah Akhir Ners ini adalah untuk menganalisis asuhan keperawatan pada pasien pneumonia terkonfirmasi positif Covid-19, dengan penerapan fisioterapi dada dan batuk efektif sebagai upaya meningkatkan bersihan jalan napas. Setelah dilakukan tindakan keperawatan secara reguler dan kontinyu yaitu 2kali dalam sehari (pagi pukul 06.00 dan sore pukul 16.00) maka terjadi perbaikan kondisi dan masalah teratasi di hari ke III rawat inap dibuktikan dengan frekuensi napas 20x.menit, irama napas reguler, kedalaman napas normal, suara napas vesikuler, tidak terdapat keluhan sesak, dan pasien mampu melakukan batuk efektif dengan baik dan benar. Hal ini menunjukkan bahwa Fisioterapi Dada dan Batuk Efektif dapat diberikan pada pasien Covid-19 dan menjadi intervensi mandiri bagi perawat isolasi kepada pasien sesuai indikasi.

Pneumonia is the main cause of morbidity and mortality in adulthood, caused by infectious agents such as bacteria, mycoplasma, and viruses, including Coronavirus Disease-19 (Covid-19) which is currently becoming a pandemic. Clinical signs of patients with pneumonia due to Covid-19 infection are fever, cough, difficulty breathing,and severe shortness of breath. One of the nursing problems is the ineffective airway clearance caused by accumulation of excess secretions as the result of the reaction of lung tissue inflami, which is characterized by coughing, difficulty in expelling phlegm, sound of ronchii, to the onset of shortness of breath. This paper aims to analyze nursing care in patients with pneumonia confirmed positive for Covid-19, with the application of chest physiotherapy and effective-cough as the nursing intervention for improving the airway clearance. After regular and continuous nursing intervention, which 2 times a day (morning at 6:00 a.m. and 4:00 p.m. in the afternoon), there was an improvement in the conditionThe problems resolved in the third day of hospitalization evidenced by the frequency of breath 20x.minutes, regular breathing rhythm, normal breathing depth, vesicular breath sounds, no complaints of shortness of breath, and the patient is able to cough effectively properly and correctly. This shows that chest physiotherapy and effective-cough can be given to Covid-19 patients and become an independent intervention for isolation nurses to patients as indicated."