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"Analisis Praktik Residensi Keperawatan Medikal Bedah dan Studi Kasus Pemberian Asuhan Keperawatan Pada Pasien Akalasia Esofagus Dengan Pendekatan Model Adaptasi Roy Di Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo Jakarta Abstrak Pendahuluan: Pelaksanaan praktek klinik selama masa residensi keperawatan peminatan digestif bertujuan untuk mampu menampilkan peran perawat spesialis sebagai pemberi asuhan keperawatan lanjut, pendidik, advokat, konselor, kolaborator, pembaharu dan peneliti. Peran pemberi asuhan keperawatan lanjut dilakukan dengan menggunakan Model Adaptasi Roy pada pasien Akalasia Esofagus dan 30 pasien lainnya. Perilaku maladaptif paling banyak adalah mode adaptasi fisiologis dengan diagnosa keperawatan ketidakseimbangan nutrisi kurang dari kebutuhan tubuh. Intervensi keperawatan berupa manajemen nutrisi ditujukan untuk meningkatkan adaptasi pasien dalam mencapai status nutrisi. Evidence Based Nursing dilakukan dengan menerapkan pemberian minuman maltodekstrin pada pasien pra operasi elektif pada dua pasien untuk mengatasi mual, muntah dan nyeri pasca operasi, diperoleh hasil keluhan mual dan muntah tidak ada sama sekali pada 0-24 jam pasca operasi, sedangkan keluhan nyeri ringan masih dirasakan pada satu pasien. Program inovasi kelompok berupa penerapan protokol ERAS yaitu pemberian maltodekstrin pra operasi, mengunyah permen karet pasca operasi dan mobilisasi dini 2 jam pasca operasi terbukti efektif mengatasi keluhan mual dan muntah pasca operasi, meningkatkan motilitas usus dan mencegah nyeri bahu pasca operasi.

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Analysis of Medical Surgical Nursing Residency Practice and Case Study of Nursing Care Delivery on Achalasia Oesophagoes Using Roy Adaptation Model ApproachAbstractImplementation of clinical practice during the residency of digestive nursing aims to be able to showcase the role of specialist nurse as advanced nursing care provider, educator, advocator, counselor, collaborator, innovator and researcher. Role of specialist as advance nursing care provider was done by using Roy Adaptation Model on Achalasia Oesophagus and 30 other patients. Maladaptive behavior at most is a physiological adaptation mode with imbalanced nutrition: less than body requirement nursing diagnosis. Nursing outcome of nutrition management is aimed at improving patient adaptation in gaining nutrition status. Evidence Based Nursing was performed by applying preoperative oral carbohydrate loading to two patients undergoing laparoscopy cholesystectomy for relieving post operative nausea and vomiting. The innovation program was implementing ERAS protocol e.g preoperative oral carbohydrate loading, chewing gum and early mobilization proved effective as nursing intervention in pre and post operative management. "

"Achalasia is defined as a motor disorder of I he esophageal smooth muscle in which the lower esophageal sphincter does not relax properly with swallowing and the normal peristalsis of the esophageal body is replaced by abnormal contractions. The definite etiology is unknown. The incident is infrequent. The diagnosis of achalasia was established by clinical, radiological investigation, and manometric data. The management of achalasia consists of conservative treatment, dilation and surgical treatment. Esophageal dilation is the technique used to stretch open the blocked portion of the esophagus. Balloon dilation is a form of definite treatment beside myotomy or Heller's operation. We hereby report a case managed by balloon dilation catheter after failure by means of conservative treatment."

"Achalasia merupakan salah satu penyakit saluran pencernaan yang dapat terjadi pada masyarakat perkotaan. Pola diet tidak sehat diperkirakan menjadi faktor risiko terjadinya masalah pencernaan yang dapat berkembang menjadi Achalasia. Dampak dari Achalasia adalah asupan makanan yang sulit baik secara oral ataupun enteral. Salah satu usaha untuk menangani Achalasia adalah dengan tindakan operasi. Tatalaksana pra operasi untuk persiapan fisik klien adalah dengan meningkatkan asupan nutrisi ke dalam tubuh melalui pemberian terapi nutrisi parenteral. Tujuan karya ilmiah ini adalah untuk menganalisis intervensi keperawatan yaitu pemberian nutrisi parenteral pada klien dengan Achalasia. Penulisan ini menggunakan pendekatan studi kasus klinik. Intervensi yang dilakukan selama 17 hari perawatan pra operasi menunjukan bahwa terapi nutrisi parenteral melalui vena perifer mampu memberikan asupan nutrisi yang adekuat dan membuat klien menjadi lebih berenergi dari sebelumnya. Namun disamping itu, klien juga mengalami phlebitis sebanyak 3 kali selama masa perawatan. Rekomendasi studi kasus ini dalam mengoptimalkan asupan nutrisi parenteral pada klien dengan Achalasia adalah dengan melakukan perawatan akses vena perifer secara rutin dan memperhatikan faktor-faktor yang dapat memunculkan phlebitis.

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Achalasia is one of the gastrointestinal diseases that can occur in urban communities. Unhealthy diet patterns are estimated to be a risk factor for digestive problems that can develop into Achalasia. The impact of Achalasia is a difficult dietary intake both orally and enterally. One attempt to deal with Achalasia is by surgery. Preoperative management for the client 39;s physical preparation is by increasing the intake of nutrients into the body through the provision of parenteral nutrition therapy. The purpose of this scientific paper is to analyze the nursing intervention that is giving parenteral nutrition to the client with Achalasia. This writing uses a clinical case study approach. Interventions performed during the 17 days of preoperative treatment show that parenteral nutrition therapy through peripheral vein can provide adequate nutritional intake and make the client more energetic than before. In addition, clients also experience phlebitis 3 times during the treatment period. The recommendation of this case study in optimizing the intake of parenteral nutrition on clients with Achalasia is by routinely perform peripheral venous access treatments and notice the factors that causes phlebitis. "

"Pelaksanaan praktek klinik selama masa residensi Keperawatan Medikal Bedah peminatan Digestif bertujuan untuk mampu menampilkan peran perawat spesialis sebagai pemberi asuhan keperawatan lanjut, pendidik, advokat, konselor, kolaborator, pembaharu dan peneliti secara khusus pada keahlian Digestif. Peran pemberi asuhan keperawatan lanjut dilakukan dengan menggunakan Model Adaptasi Roy pada pasien dengan kanker pankreas dan 30 kasus pasien dengan masalah digestif lainnya. Salah satu karaktristik perawat spesialis adalah memberikan intervensi keperawatan berbasis bukti Evidence-based Nursing practice , yang dilakukan melalui penggunaan Animal Naming Test ANT untuk mengidentifikasi gangguan fungsi kognitif pada pasien sirosis hepatis yang sedang dirawat. Animal Naming Test ANT yang diterapkan pada 16 pasien sirosis telah berhasil mengidentifikasi lebih banyak pasien yang mengalami gangguan kognitif dibandingkan dengan asesmen klinis yang sudah ada di ruang perawatan. Inovasi dalam pelayanan keperawatan yang dilakukan melalui program inovasi kelompok berupa penerapan kegiatan ERAS yakni memberikan minuman karnohidrat Maltodextrin, mobilisasi dini dan mengunyah permen, terbukti berhasil meningkatkan pemulihan perawatan pasien pembedahan sistem pencernaan.

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The purpose of Clinical learning practice during Medical Surgical Nursing Residency Program, with specialisation in digestive, is to facilitate the student in developing capability to perform the roles of nurse specialist as advanced nursing care provider, educator, advocator, counselor, collaborator, innovator and researcher. Advance nursing care provider role is implemented by using Roy Adaptation Model on pancreatic carcinoma patiet and 30 other digestive cases. Evidence Based Nursing Practice as other character of nurse specialist practice was performed by applying animal naming test ANT to identify cognitive problem in hospitalized cirrhotic patients. It is based on the importance for nurse to recognize early cognitive dysfunction to provide better nursing care especially in latent asymptomatic hepatic encephalopathy that common happens in cirrhosis patient. ANT was tested on 16 hospitalized cirrhotic patients and succeeded in identifying more cirrhosis patient with cognitive dysfunction compared to available assessments in ward. The innovation program which was implementing ERAS activities carbohydrate loading, early mobilization and chewing gum have proven to be effective perioperative management in digestive surgery. "

"Analisis praktik residensi merupakan laporan rangkaian kegiatan Ners SpesialisKeperawatan Medikal Bedah dengan penerapan Model Adaptasi Roy pada prosesasuhan keperawatan pasien gangguan sistem pencernaan, penerapan praktikkeperawatan berdasarkan evidence based serta melakukan inovasi keperawatan.Pengkajian kasus utama terhadap pasien karsinoma gaster dan 30 kasus resume pasienbedah digestif, gastrointestinal serta hepatobilier berfokus pada respon adaptif darimodel adaptasi Roy. Pelaksanaan evidence based dilakukan untuk mengelolakecemasan pasien sebelum menjalani operasi bedah digestif sebanyak 8 orang, denganintervensi mendengarkan Al-Qur`an Surah Al Waqi’ah dan terjemahannya selama 30menit. Program inovasi keperawatan dilakukan, terhadap 7 orang pasien yangdirencanakan menjalani operasi kolostomi berupa optimalisasi pemberian edukasimelalui media video. Kesimpulan: mendengarkan Al-Qur`an Surah Al Waqi’ah danterjemahannya dapat menurunkan tingkat kecemasan pasien sebelum operasi danedukasi melalui media video terhadap pasien yang akan menjalani operasi kolostomidapat meningkatkan pengetahuan pasien yang sangat memengaruhi terhadap keputusanpersetujuan pasien menjalani operasi.

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The residency practice analysis is a series of reports on the activities of Surgical

Medical Nursing Specialists with the application of Roy's Adaptation Model in the

nursing care process of patients with digestive system disorders, the application of

evidence-based nursing practices and nursing innovations. Major case studies of gastric

carcinoma patients and 30 cases of digestive, gastrointestinal and hepatobiliary surgery

resumes focused on the adaptive response of Roy's adaptation model. Evidence based

implementation was carried out to manage the anxiety of patients before undergoing

digestive surgery as many as 8 people, with the intervention of listening to Al-Qur'an

Surah Al Waqi'ah and its translation for 30 minutes. Nursing innovation program

carried out, for 7 patients who were planned to undergo colostomy surgery in the form

of optimizing the provision of education through video media. Conclusion: listening to

Al-Qur'an Surah Al Waqi'ah and its translation can reduce the level of patient anxiety

before surgery and education through video media for patients who will undergo

colostomy surgery can increase patient knowledge which greatly influences the decision

of consent for patients undergoing surgery."

"Ners spesialis adalah pemimpin klinis dalam bidang praktik keperawatan. Pengetahuan dan keterampilan tingkat lanjut sebagai Ners Spesialis ini mencakup keahlian klinis,  evidence based nursing, kolaborasi, konsultasi, pendidikan, pendampingan, dan perubahan kepemimpinan. Ners spesialis bertanggung jawab untuk berkolaborasi dengan anggota tim perawatan kesehatan untuk merancang, mengimplementasikan, dan mengukur strategi perawatan berbasis bukti yang aman, efektif biaya, dan terbukti. Kegiatan yang dilakukan dalam menjalani praktik residensi Ners Spesialis Keperawatan Medikal Bedah peminatan respirasi terdiri dari mengelola kasus kanker paru menggunakan model adaptasi Roy, mengelola tiga puluh resume kasus, melaksanakan evidence based nursing (EBN) efektifitas Foot Reflexologi terhadap tingkat kecemasan dan perubahan fisiologis pada pasien yang akan dilakukan tindakan Bronkoskopi, serta melakukan penerapan inovasi keperawatan penggunaan Respiratory Distres Observation Scale (RDOS) untuk menilai berat ringannya dispnea pasien dengan gangguan pernapasan.

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Specialist nurses are clinical leaders in the field of nursing practice. Advanced knowledge and skills as Ners Specialists include clinical expertise, evidence based nursing, collaboration, consultation, education, mentoring, and leadership change. Specialists are responsible for collaborating with members of the health care team to design, implement, and measure evidence-based care strategies that are safe, cost-effective and proven. Activities carried out in undergoing residency practice Ners Medical Nursing Specialists Respiratory specialization surgery consists of managing lung cancer cases using Roy`s adaptation model, managing thirty case resumes, implementing evidence based nursing (EBN) Foot Reflexology effectiveness against anxiety levels and physiological changes in patients who Bronchoscopy will be carried out, as well as implementing nursing innovations using the Respiratory Distres Observation Scale (RDOS) to assess the mild severity of dyspnea in patients with respiratory disorders."

"Pendahuluan:perforasi ileum merupakan suatu kegawatdaruratan dalam sistem gastrointestinal. Perforasi ileum terjadi akibat tumor ileum. Tujuan:untuk menampilkan asuhan keperawatan, penerapan evidence based nursing dan proyek inovasi. Peran perawat spesialis sebagai pemberi asuhan keperawatan lanjut, edukator, advokat, konselor, kolaborator, pembaharu dan peneliti. Metode:karya ilmiah ini menggunakan pendekatan studi kasus. Hasil: ada 1 kasus utama yaitu perforasi massa ileum dan 30 kasus resume sistem gastrointestinal dan hepatobilier. Ada 2 pasien dilakukan penerapan evidence based nursing practice mengunyah permen karet. Adanya efektifitas dari pemberian mengunyah permen karet untuk meningkatkan motilitas usus. Program inovasi kelompok berupa panduan peningkatan pemulihan setelah operasi enhanced after recovery surgery pada pasien yang menjalani pembedahan sistem pencernaan berupa pemberian maltodekstri sebelum operasi yaitu berjumlah 2 pasien, dan mobilisasi dini post operasi berjumlah 4 orang serta mengunyah permen karet setelah operasi berjumlah 2 orang. Kesimpulan: perilaku maladaptif pasien Tn.SMS yaitu gangguan body image. Mengunyah permen karet dapat meningkatkan motilitas usus, pemberian maltodektsrin pre operasi dapat mengurangi mual dan muntah serta nyeri post operasi dan mobilisasi dini 2 jam post operasi dapat mengurangi nyeri bahu pasien.

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Analysis of Medical Surgical Nursing Residency Practice and Case Study of Nursing Care Delivery on Patient with Perforated Ileal Mass Using Roy Adaptation Model RohmaniJuly 2018 Introduction: ileal perforation is an emergency in the gastrointestinal system. Perforation of ileum occurs due to ileal tumors. Purpose: to present nursing care, the application of evidence-based nursing and innovation projects. The role of specialist nurse as a nursing care nurse, educator, advocate, counselor, collaborator, reformer and researcher. Method: This paper uses a case study approach. Results: There were 1 major cases of ileal mass perforation and 30 cases of gastrointestinal and hepatobilier resume systems. There were 2 patients conducted the application of evidence based nursing practice chewing gum. The effectiveness of chewing gum to increase bowel motility. The group innovation program is an enhanced after recovery surgery guideline for patients undergoing gastrointestinal surgery in the form of preoperative maltodextrine, 2 patients, and postoperative early mobilization of 4 people and chewing gum after surgery of 2 people. Conclusion: maladaptive behavior of patient of Mr.SMS are body image disorder. Chewing gum can improve bowel motility, preoperative maltodextrine administration may reduce nausea and vomiting and postoperative pain and early mobilization 2 hours postoperatively may reduce shoulder pain of the patient. Key words: Roy adaptation model, Tumour of Ileum, Chewing Gum, Maltodextrin, D early mobilization, Enhanced recovery After Surgery. "

"We report a case of carcinoma of the esophagus in a 58 years old woman with achalasia, who has been diagnosed since 30 years ago, which initiated by surgical treatment (myotomy) and the symptoms recurred since 3 years ago. According to the progress of the disease, malignancy was strongly suspected due to prolonged stasis and mucosal irritation caused by achalasia (achalasia carcinoma sequence). Because of these contributing factors for the development of serious complications such as malignancy the diagnosis of achalasia must be systematically diagnosed and treated agressively. Surveillance endoscopy in patients with achalasia should be performed every 1-2 years."

"Saat ini profesi keperawatan telah mengalami perkembangan. Munculnya seorang perawat spesialis diharapkan dapat meningkatkan mutu pelayanan keperawatan dalam bidang kekhususannya, salah satu bidangnya yaitu keperawatan digestif. Program pendidikan spesialis keperawatan diadakan untuk memenuhi harapan tersebut. Penulisan KIAS bagi mahasiswa residen peminatan digestif, berisi tentang pengalamannya merawat 30 pasien dengan masalah sistem pencernaan menggunakan pendekatan teori model adaptasi Roy, penerapan intervensi keperawatan berdasarkan bukti ilmiah (evidence based practice), serta pelaksanaan proyek inovasi. Melakukan studi kasus dengan 30 pasien kelolaan menggunakan pendekatan teori model adaptasi roy, sesuai untuk digunakan pada pasien dengan kanker kolorektal. Penerapan evidence based nursing aromatherapy massage cukup efektif menurunkan kecemasan dan peningkatan kualitas tidur pasien pra-operasi kolorektal. Penerapan video edukasi efektif meningkatkan pengetahuan pasien pra-operasi kolostomi. Perawat yang berkompetensi massage diperlukan, agar ada alternatif intervensi keperawatan yang berkaitan dengan kecemasan dan kualitas tidur. Pemberian video edukasi stoma, diharapkan menjadi satu paket perawatan pasien stoma.

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Nowadays the nursing profession has developed. The emergence of a specialist nurse is expected to improve the quality of nursing services in their specialty areas, one of the fields being digestive nursing. Nursing specialist education programs are held to meet these expectations. The writing of KIAS for digestive resident students contains the experience of treating 30 patients with digestive system problems using Roy's adaptation model theory approach, the application of evidence-based nursing interventions, and the implementation of innovation projects. Conducted a case study with 30 patients under management using a theoretical approach to the Roy adaptation model, suitable for use in patients with colorectal cancer. The application of evidence based nursing aromatherapy massage is quite effective in reducing anxiety and improving sleep quality in colorectal preoperative patients. The application of educational videos effectively increases the patient's knowledge of pre-colostomy surgery. Nurses with competence in massage are needed, so that there are alternative nursing interventions related to anxiety and sleep quality. Providing stoma education videos, is expected to be a package of stoma patient care."