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"ABSTRAKPerilaku dan gaya hidup masyarakat perkotaan dalam mengkonsumsi makanan cepat saji yang tinggi lemak dan kolesterol merupakan faktor risiko terjadinya kolelitiasis. Karya ilmiah akhir Ners ini menggambarkan pelaksanaan asuhan keperawatan pada pasien pascabedah kolesistektomi. Peran perawat sangat penting untuk memberikan edukasi tentang diet rendah lemak pada pasien kolelitiasis. Pembatasan asupan kolesterol untuk mencegah terjadinya hipersaturasi cairan empedu yang akan memicu terbentuknya batu empedu kembali setelah pengangkatan kandung empedu. Peningkatan pemahaman pasien tentang diet rendah lemak untuk mengubah perilaku pasien setelah pulang dari rumah sakit. Pengaturan lingkungan dan penggunaan media yang lebih bervariasi dalam edukasi pada pasien.

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ABSTRACT

Urban behavior and lifestyle in consumpting fast food which contains high fat and cholesterol was a risk factor for cholelithiasis. This Ners paper described the implementation of nursing care for post cholecystectomy patients. Nurse's role was very important to give education about low-fat dietary for cholelithiasis patient. Cholesterol intake restriction to prevent hipersaturasion of bile which would trigger the formation of new gallstones after gallblader removal. Improvement of patient understanding about the low-fat diet to change the patient behavior after discharge from hospital. Environment settings and more varied use of media in educating the patient."

"ABSTRAK Latar belakang: Kolesistektomi merupakan tindakan abdomen tersering dan saat inikolesistektomi laparoskopi (KL) merupakan baku emas dan telah dilakukan pada 90% kasuskolesistitis simtomatik. Tujuan penelitian ini adalah untuk mengetahui hasil KL di RSCM,Jakarta. Metode: Penelitian retrospektif observasional ini menggunakan data dari departemen bedahdivisi digestif RSCM dari bulan Januari hingga Desember 2014. Partisipan penelitian iniadalah pria atau wanita yang berusia 23-66 tahun yang menjalani KL. Tindakan bedahdilakukan baik berupa perawatan 1 hari (one day care (ODC)) maupun elektif. Data yangdikaji adalah temuan preoperatif dan intraoperatif, durasi operasi, lama rawat inap, dan angkakonversi ke tindakan kolesistektomi terbuka (open). Kemudian kami menganalisis faktoryang mempengaruhi angka konversi. Hasil: Jumlah pasien yang masuk inklusi adalah 90 orang. Usia rata-rata 43,9 tahun (SE=1,26tahun) dengan jumlah pasien wanita 61 orang (67,8%). Median durasi operasi adalah 90±36,9menit dimana pasien yang konversi membutuhkan operasi lebih dari 2 jam lebih banyak(12% vs 1,5%), namun tidak bermakna secara statistik (p= 0,63). Median lama rawat inapadalah 9±27.2 hari dan meningkat bermakna pada kasus yag konversi (24±9 hari, p = 0.011).Median lama pre-operasi = 7±26,8 hari, dan pasca-operasi = 2±3.8 hari, dengan 13,3% pasiendilakukan endoscopic retrograde cholangio-pancreatography (ERCP) sebelum KL. Cederaduktus biliaris komunis (CBDK) ditemukan pada 3 kasus (3,33%). Konversi menjadilaparotomi dibutuhkan pada 4,44% kasus. Faktor yang mempengaruhi angka konversi hanyapada kasus adhesi (RR (95%IK) = 25,7 (2,4-273,5); p=0,007. Kesimpulan temuan: kolesistektomi laparoskopi menawarkan lama rawat inap yang lebihsingkat. Durasi operasi pendek dan prosedur ini standard, aman, dan efektif di institusi kami. ABSTRACT Background: Cholecystectomy is the most frequently performed abdominal operation andcurrently laparoscopic cholecystectomy (LC) is considered gold standard being performed in90% cases of symptomatic gallstones. The aim of the study was to determine results obtainedwith LC at our hospital, RSCM, Jakarta. Methods: This retrospective observational study was conducted in digestive divison insurgery department of RSCM using data from January to December 2014. The studyparticipants were patients of both gender aged 23?66 years undergoing LC. Surgery wasperformed either in one day care (ODC) or elective schedule. Demographic variables,preoperative and intraoperative findings, mean operation time, hospital stay, and conversionrate were evaluated. Factors influencing rate of conversion were also studied. Results: A total of 90 patients were included. Mean age was 43.9 years (SE=1.26 years) witha female 61 (67.8%). Median operative time was 90±36.9 minutes which converted casespatient needed to operate in more than 2 hours (12% vs 1.5%), but not statistically significant(p= 0.63). Median hospital stay was 9±27.2 days that significantly increased in convertedcases (24±9 days, p-value= 0.011). Median of pre-operation = 7±26.8 days, and postoperation= 2±3.8 days, with 13.3% patients underwent endoscopic retrograde cholangiopancreatography(ERCP). Common bile duct injury (CBDI) was found in 3 cases (3.33%).Conversion to laparotomy was required in 4.44% cases. Factors that influenced the rate ofconversion included was only adhesion (RR (95%CI) = 25.7 (2.4-273.5), p=0.007. Findings: Laparoscopic cholecystectomy offers shorter hospital stay. The operative time isshort and procedure is standard, safe and effective in our institution.;Background: Cholecystectomy is the most frequently performed abdominal operation andcurrently laparoscopic cholecystectomy (LC) is considered gold standard being performed in90% cases of symptomatic gallstones. The aim of the study was to determine results obtainedwith LC at our hospital, RSCM, Jakarta. Methods: This retrospective observational study was conducted in digestive divison insurgery department of RSCM using data from January to December 2014. The studyparticipants were patients of both gender aged 23?66 years undergoing LC. Surgery wasperformed either in one day care (ODC) or elective schedule. Demographic variables,preoperative and intraoperative findings, mean operation time, hospital stay, and conversionrate were evaluated. Factors influencing rate of conversion were also studied. Results: A total of 90 patients were included. Mean age was 43.9 years (SE=1.26 years) witha female 61 (67.8%). Median operative time was 90±36.9 minutes which converted casespatient needed to operate in more than 2 hours (12% vs 1.5%), but not statistically significant(p= 0.63). Median hospital stay was 9±27.2 days that significantly increased in convertedcases (24±9 days, p-value= 0.011). Median of pre-operation = 7±26.8 days, and postoperation= 2±3.8 days, with 13.3% patients underwent endoscopic retrograde cholangiopancreatography(ERCP). Common bile duct injury (CBDI) was found in 3 cases (3.33%).Conversion to laparotomy was required in 4.44% cases. Factors that influenced the rate ofconversion included was only adhesion (RR (95%CI) = 25.7 (2.4-273.5), p=0.007. Findings: Laparoscopic cholecystectomy offers shorter hospital stay. The operative time isshort and procedure is standard, safe and effective in our institution.;Background: Cholecystectomy is the most frequently performed abdominal operation andcurrently laparoscopic cholecystectomy (LC) is considered gold standard being performed in90% cases of symptomatic gallstones. The aim of the study was to determine results obtainedwith LC at our hospital, RSCM, Jakarta. Methods: This retrospective observational study was conducted in digestive divison insurgery department of RSCM using data from January to December 2014. The studyparticipants were patients of both gender aged 23?66 years undergoing LC. Surgery wasperformed either in one day care (ODC) or elective schedule. Demographic variables,preoperative and intraoperative findings, mean operation time, hospital stay, and conversionrate were evaluated. Factors influencing rate of conversion were also studied. Results: A total of 90 patients were included. Mean age was 43.9 years (SE=1.26 years) witha female 61 (67.8%). Median operative time was 90±36.9 minutes which converted casespatient needed to operate in more than 2 hours (12% vs 1.5%), but not statistically significant(p= 0.63). Median hospital stay was 9±27.2 days that significantly increased in convertedcases (24±9 days, p-value= 0.011). Median of pre-operation = 7±26.8 days, and postoperation= 2±3.8 days, with 13.3% patients underwent endoscopic retrograde cholangiopancreatography(ERCP). Common bile duct injury (CBDI) was found in 3 cases (3.33%).Conversion to laparotomy was required in 4.44% cases. Factors that influenced the rate ofconversion included was only adhesion (RR (95%CI) = 25.7 (2.4-273.5), p=0.007. Findings: Laparoscopic cholecystectomy offers shorter hospital stay. The operative time isshort and procedure is standard, safe and effective in our institution.;Background: Cholecystectomy is the most frequently performed abdominal operation andcurrently laparoscopic cholecystectomy (LC) is considered gold standard being performed in90% cases of symptomatic gallstones. The aim of the study was to determine results obtainedwith LC at our hospital, RSCM, Jakarta. Methods: This retrospective observational study was conducted in digestive divison insurgery department of RSCM using data from January to December 2014. The studyparticipants were patients of both gender aged 23?66 years undergoing LC. Surgery wasperformed either in one day care (ODC) or elective schedule. Demographic variables,preoperative and intraoperative findings, mean operation time, hospital stay, and conversionrate were evaluated. Factors influencing rate of conversion were also studied. Results: A total of 90 patients were included. Mean age was 43.9 years (SE=1.26 years) witha female 61 (67.8%). Median operative time was 90±36.9 minutes which converted casespatient needed to operate in more than 2 hours (12% vs 1.5%), but not statistically significant(p= 0.63). Median hospital stay was 9±27.2 days that significantly increased in convertedcases (24±9 days, p-value= 0.011). Median of pre-operation = 7±26.8 days, and postoperation= 2±3.8 days, with 13.3% patients underwent endoscopic retrograde cholangiopancreatography(ERCP). Common bile duct injury (CBDI) was found in 3 cases (3.33%).Conversion to laparotomy was required in 4.44% cases. Factors that influenced the rate ofconversion included was only adhesion (RR (95%CI) = 25.7 (2.4-273.5), p=0.007. Findings: Laparoscopic cholecystectomy offers shorter hospital stay. The operative time isshort and procedure is standard, safe and effective in our institution.;Background: Cholecystectomy is the most frequently performed abdominal operation andcurrently laparoscopic cholecystectomy (LC) is considered gold standard being performed in90% cases of symptomatic gallstones. The aim of the study was to determine results obtainedwith LC at our hospital, RSCM, Jakarta. Methods: This retrospective observational study was conducted in digestive divison insurgery department of RSCM using data from January to December 2014. The studyparticipants were patients of both gender aged 23?66 years undergoing LC. Surgery wasperformed either in one day care (ODC) or elective schedule. Demographic variables,preoperative and intraoperative findings, mean operation time, hospital stay, and conversionrate were evaluated. Factors influencing rate of conversion were also studied. Results: A total of 90 patients were included. Mean age was 43.9 years (SE=1.26 years) witha female 61 (67.8%). Median operative time was 90±36.9 minutes which converted casespatient needed to operate in more than 2 hours (12% vs 1.5%), but not statistically significant(p= 0.63). Median hospital stay was 9±27.2 days that significantly increased in convertedcases (24±9 days, p-value= 0.011). Median of pre-operation = 7±26.8 days, and postoperation= 2±3.8 days, with 13.3% patients underwent endoscopic retrograde cholangiopancreatography(ERCP). Common bile duct injury (CBDI) was found in 3 cases (3.33%).Conversion to laparotomy was required in 4.44% cases. Factors that influenced the rate ofconversion included was only adhesion (RR (95%CI) = 25.7 (2.4-273.5), p=0.007. Findings: Laparoscopic cholecystectomy offers shorter hospital stay. The operative time isshort and procedure is standard, safe and effective in our institution."

"ABSTRAKNama : Muhammad ZakiProgram Studi : Magister Ilmu KeperawatanJudul : Pengaruh Mobilisasi Dini dan Konsumsi Air Mineral Dua Jam Post Laparoskopik Kolesistektomi Terhadap Penurunan Skala Nyeri Bahu Pasien. Pembedahan laparoskopik kolesistektomi dapat menimbulkan pneumoperitonium yang akan menimbulkan efek nyeri pada bahu pasien yang secara nyata banyak muncul pada jam ke enam setelah pembedahan selesai. Penelitian ini bertujuan mengetahui pengaruh mobilisasi dini dan konsumsi air mineral saat diberikan dua jam post laparoskopik kolesistektomi terhadap penurunan skala nyeri bahu pasien. Desain penelitian ini menggunakan quasy experimental pre ndash; post with control group, metode pengumpulan sampel dilakukan secara purposive sampling. Sampel penelitian terdiri atas 18 orang tiap kelompok intervensi dan kelompok kontrol. Uji statistik menggunakan friedman test dan uji wilcoxon didapatkan hasil pengukuran skala nyeri bahu dengan menggunakan Numeric Rating Scale NRS pada jam ke 2, 6 dan jam ke 24 post laparoskopik kolesistektomi menunjukkan secara statistik dan klinis signifikan dalam menurunkan skala nyeri bahu pasien pada kedua kelompok. Sehingga dapat disimpulkan bahwa terdapat perbedaan signifikan pada kelompok kontrol dibandingkan kelompok intervensi pada pengaruh perubahan skala nyeri bahu responden setelah diberi tindakan mobilisasi dini dan konsumsi air mineral dengan p value= 0, 0001; ?

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ABSTRACTName Muhammad ZakiStudy Program Master of Nursing ScienceTitle The effectiveness of early mobilization and mineral water Consumption two hours post laparoscopic cholecystectomy on decreasing shoulder pain. Laparoscopic Cholecystectomy is at risk for pneumoperitoneum that lead patients to feel pain on the shoulder after six hours post surgery. This study aimed to determine the effectiveness of early mobilization and consumption of mineral water two hours post laparoscopic cholecystectomy on decreasing the scale of shoulder pain. This queasy experimental study conducted pre post testing that involved 18 intervention groups and control groups. All subjects were chosen based on purposive sampling method. Data were analyzed by using test Friedman and Wilcoxon. The statistical test using Friedman test and Wilcoxon test showed the measurement of shoulder pain scale by using Numeric Rating Scale NRS at 2, 6 and 24 hours post laparoscopic cholecystectomy showed statistically and clinically significant in decreasing patient shoulder pain scale in both groups. So it can be concluded that there are significant differences in the control group compared to the intervention group on the effect of the change of shoulder pain scale after giving the action of early mobilization and mineral water consumption with p value 0, 0001 "

"Batu empedu /cholelithiawls' adalah suatu penyakit yang cukup banyak terjadi, di Indonesia dilaporkan ada 268 kasus dalam empat tahun (1991-l994). Dimana kasus ini mcmerlukan operasi. Dengan majunya téknologi alat kedokteran dan ilmu kedokteran serta pengetahuan kesehatan rnasyarakat yang terus berkembang, mcnambah keinginan doktcr untuk mernbcrikan pelayanan pembedahan minimal invasy seiring tuntutan pasien akan tindakan pembedahan yang lebih nyaman. Tindakan bedah dengan tehnik Laparoscopic memberikan pilihan altematif bagi penderita karena tindakan pembedahan dengan can ini hanya diperlukan Iuka opcrasi yang minimal/ kwa. 'rmaakan ms memcrlukan biaya yang besar dan sangat bervariasi, tergautungjenis tindakan yang dilakukan. Pada umumnya nnnah sakit di Indonesia mempunyai masalah mengenai informasi biaya yang disebabkan oleh sistem pembayaran langsung pexjasa pelayanan (pee jbr ser-vice).Biaya pelayanan kesehatan yang bervariasi dan scmakin meningkat dikarenakan belum adanya harga standar berdasarkan unit cost untuk berhagai pelayanan kesehatan yang dibedkan. Pengendalian biaya dari bentukfzejbr service ke Prospective Payment System (PPS) perlu dilakukan. Salah satu bentuk PPS adalah Diagnosis Related Grolgps (DRG’S).DRG’s adalah sistem pembayamn perkelompok pcnyakit tanpa melihat tindakan yang cljberikan atau lamanya perawatan di rumah sakit. Tujuan penelitian ini adalah untuk melihat bagaimana pengelompokan, Clinical Pathway dan cost of treatment Cholelirhiasis dengan Laparoscopic Cholecysreclomy berdasarkan DRG’s di Rumah Sakit Gading Pluit tahun 2007. Penelitian ini merupakan penelitian kuantitatif deskriptif dengan rancangan crossecrional retrospekryf Penelitian dilaksanaknn sejak awal Februari 2008 sampai dengan April 2000 dengan' mcnggunakan data sekunder dari kamar opcrasi dan rekam meaik pasien mwar inap dmgan aiggnosa chozezffhfasfr Salam tahun 2001. Unit cost dihitimg dengan manggunakan Activity Based Costing. Analisa data dilakukan secara univariat untuk melihat distribusi Bekuensi, nilai mean, median, modus, nilai minimum dan nilai maksimurn. Pengelompokan Cfialelilhiasis dengan Lqpmoscopic Cholecyszecrorrrv berdasarkan DRG’s di Rumah Sakit Gading Pluit adalah : Laparoscopic Cholecysteclomy mumi, Laparoscopab Chnlecystectomy dengan Penyerta, Laparoscopxb Cholecystectomy dengan Penyulit dan Laparoscopic Cholecysteciomy dengan Penyerta dan Penyulit Berdasarkan basil penclitian diketahui clinical pathway Cholelfrhiasis dengan Laparoscopic Cholecysteciorny terdiri dari 9 tahapan yaitu : pendaiiaran poliklinik, penegakan diaguosa, Admision , penerimaan pasien, pm-oprasi, Operasi, post operasi, pulang dan Billing. Cost of treatment Cholelithiaais dengan Iaparoscopic ChoIecy.s-rectomy di Rumah Sakit Gading Pluit tahun 2007 adalah sebagai berikut : (1) Biaya Laparoscopic Cholecystectomy Rp.8.222.412.- (2) Biaya Laparoscopic Cholecysrectomy dengan Penyerta Rp.9.309.I64,- (3) Biaya Laparoscopic Cfrolecystectomy dengan Penyulit np.13.4a3_3o3,- (4) Biaya Laparoscopic Qliolecystecrorny aengan Pmyuliz can Penyertzi Rp.17.596.6o5,- Ijengan cost recovery rate rumah sdkit rata-rata nilainya 230%.Dari hasil penelitian terlihat manfaatnya melakukan perhitungan biaya rawat ihap berdasarkan Diagnosis Related Groups sebagai dasar penetapan tarif rawat inap.

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Gall-stone/ cholelithiasis is a commonly occurred disease. In Indonesia, there had been 2687 cases of this disease occurred for the last four years (1991 - 1994) that needed surgeries. The advancement of health instruments, medical knowledge, and continuously growing of health awareness in the society, motivate medical practitioner to give a minimally invasive surgery service, inlining with the patients needs ofa more convenient surgery.

The Laparoscopic surgery technique gives adds alternative choice to the patient, as this technique only needs a minimum surgical wound. This technique, however, require a large amount of costs; and it will vary according to the medical measure needed.

Generaly, Indonesian Hospitals will have a problem in providing infomration about the service fee, due to the direct fee for service payment system.The absence of standard unit costs for many medical services caused the costs of medical services varied and increasing.

Therefore, a change of cost control fiom fee per service to Prospective Payment System (PPS) is needed. One type of PPS is Diagnosis Related Groups (DRG’s) .DRG’s is a payment system per type of disease, without looking at the type of measurement given, or treatment dur°ation in the hospital. The objective of this research is to obtain the classification of Clinical Pathway and treatment cost of Cholelithiasis with Laparoscopic Cholecystectomy using DRG's at Gading Pluit Hospital in 2007.

This research is uses quantitative descriptive research with a cross-sectional retrospective method. The research was held from Febnrary - April 2008, by using a secondary data 'fiom one surgery room and inpatients medical records diagnosed with Cholclithiasis in 2007. The unit costs were measured by Activity Based Costing.

Univariate data analyses were used to see the iiequent distribution, means, median, modus, minimum and maximum value. The groupings of Cholelithiasis with Laparoscopic Cholecystectomy according to DRG's in Gading Pluit Hospital are: pure laparoscopic Cholecystectomy, Laparoscopic Cholccystectomy with complicating disease, Laparoscopic Cholecystectomy with associated condition and Laparoscopic Cholecystectomy with both complicating disease and associated condition.

According to the research, it is concluded that there are 9 steps in Cholelithiasis clinical pathway with laparoscopic Cholecystectomy: polyclinic registration, diagnosis, admission, patient acceptance, pre-surgery, surgery, post surgery, discharge and billing.

The Costs of Cholelithiasis treatment with Laparoscopic Cholecystectomy at Gading Pluit Hospital in 2007 are as foIlows:(l) Pune Laparoscopic Cholecystcctomy: Rp.8.222.4l2,-(2) Laparoscopic Cholecystectomy with complicating disease: Rp.9,309,l64,- (3)Laparoscopic Cholecystectomy with associated condition Rp.13.483.303,- (4)Laparoscopic Cholecystectomy with both complicating disease and associated condition :Rp. l'7.596.605,-.cost recovery rate for the hospital is approximately 230%. From the research, we can see the benefit of cost calculation using Diagnosis Related Groups as a way to dctcnnine the hospitalization costs."

"Kolelitiasis menjadi salah satu masalah kesehatan sistem gastrointestinal utama di tingkat global. Hal ini disebabkan karena adanya perubahan gaya hidup masyarakat meliputi penurunan aktivitas fisik dan pola diet yang kurang tepat. Salah satu penatalaksanaan pembedahan yang dilakukan pada pasien kolelitiasis ialah laparoskopi kolesistektomi. Karya Ilmiah Akhir Ners ini bertujuan untuk menyajikan hasil analisis asuhan keperawatan pada pasien kolelitiasis pre laparoskopi kolesistektomi dengan menerapkan intervensi keperawatan teknik relaksasi napas dalam guna mengatasi ansietas preoperasi. Adapun intervensi lain yang direkomendasikan berdasar pada kajian praktik berbasis bukti meliputi penerapan intervensi penggunaan terapi musik guna menurunkan kecemasan pada pasien pra pembedahan laparoskopi kolesistektomi. Penggabungan penerapan relaksasi napas dalam dan terapi musikdiharapkan dapat diaplikasikan oleh perawat di ruangan khususnya pada pasien yang akan menjalankan operasi laparoskopi kolesistektomi untuk mengatasi masalah ansietas preoperasi.

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Cholelithiasis is one of the major health problems of gastrointestinal system at the global level. This is due to changes in peoples lifestyles including decreased physical activity and inappropriate dietary patterns. One of the surgical treatments performed on cholelithiasis patients is laparoscopic cholecystectomy. The aims of this study is to analyse the nursing care of pre-laparoscopic cholecystectomy patients by applying deep breathing relaxation intervention to overcome the preoperative anxiety problem. Besides that, another intervention that is recommended based on evidence-based practice studies is the use of intervention of music therapy to reduce anxiety in pre-laparoscopic cholecystectomy patients. Combining the application of deep breathing relaxation and music therapy is expected to be applied by nurses, especially for patients who will undergo laparoscopic cholecystectomy to overcome the problem of preoperative anxiety."