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"Masyarakat perkotaan berisiko mengalami kecelakaan yang menyebabkan fraktur.  Peningkatan jumlah kendaraan  bermotor  dan  padatnya  populasi serta pola aktivitas masyarakat perkotaan yang serba terburu-buru menyebabkan fraktur seperti fraktur hip.  Salah satu upaya manajemen fraktur yaitu Total Hip Replacement (THR) yakni pergantian tulang  sendi  yang patah dengan protesis. Karya ilmiah ini disusun berdasarkan asuhan keperawatan yang dilakukan mahasiswa selama 3 minggu di lantai 4 Gedung A RS Ciptomangunkusumo Jakarta. Tulisan ini difokuskan pada pasien fraktur femur post Total Hip Replacement. Adapun teknik pengumpulan data yang digunakan meliputi wawancara, abservasi klien, catatan individu, rekam medik dan dokumentasi proses keperawatan yang dilakukan selama 4 hari (8-11 Mei 2019). Data yang telah dikumpul dianalisis untuk  melihat masalah keperawatan yang dialami klien serta meninjau keefektian intervensi edukasi pencegahan dislokasi yaitu memberikan pendidikan kesehatan kepada klien terkait hal apa yang perlu diperhatikan dan dihindari agar tidak terjadi dislokasi dan melakukan latihan kekuatan otot seperti : angkle pump, quad sets, glut sets, heel sets, dan short arc quad. Hasil yang didapatkan klien mampu melakukan latihan kekuatan otot dan mempercepat mobilisasi serta klien tidak terjadi dislokasi hip replacement. Latihan  kekuatan otot sangat bermanfaat untuk mencegah terjadinya dislokasi pada pasien post THR dan meningkatkan kekuatan otot dalam melakukan mobilisasi klien serta meminimalkan komplikasi dari fraktur. Dalam memberikan asuhan keperawatan pasien post THR perawat memberikan asuhan keperawatan dengan berulang kali dan menggunakan leflet agar klien mudah mengingat dan melakukannya kembali dan sebaiknya edukasi dilakukan saat pasien preoperasi dan post operasi THR.

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Urban communities are at risk of having an accident that causes a fracture. Increasing the number of motorized vehicles and the density of the population and the pattern of activities of urban communities that are in a hurry cause fractures such as hip fractures. One attempt at fracture management is Total Hip Replacement (THR), which is a broken joint replacement with a prosthesis. This scientific work was prepared based on nursing care carried out by students for 3 weeks on the 4th floor of Building A, Ciptomangunkusumo Hospital, Jakarta.

This paper focuses on femur fracture patients post Total Hip Replacement. As for the data collection techniques used include interviews, client attendance, individual records, medical records and documentation of the nursing process carried out for 4 days (8-11 May 2019). Data that has been collected is analyzed to see the nursing problems experienced by the client and review the effectiveness of dislocation prevention education interventions, namely providing health education to clients regarding what needs to be considered and avoided so as not to dislocate and do muscle strength training such as angkle pump, quad sets, glut sets, heel sets, and quad short arc.

The results obtained by the client are able to do muscle strength training and accelerate mobilization and the client does not have a hip replacement dislocation. Muscle strength training is very useful for preventing dislocation in post THR patients and increasing muscle strength in mobilizing clients and minimizing complications from fractures. In providing nursing care for post-THR patients nurses provide nursing care repeatedly and use leaflets so that clients are easy to remember and do it again and education should be done when the patient is preoperative and post-THR surgery."

"Fraktur merupakan salah satu masalah perkotaan akibat cedera fisik. Penatalaksanaan fraktur patologis cukup kompleks dan mengakibatkan imobilisasi yang lama. Tingkat kemampuan mobilisasi pasien pasca total hip replacement dapat ditingkatkan melalui therapeutic exercise yang meliputi latihan range of motion, angkle pump, quads statis dan gluteal statis, serta latihan ambulasi menggunakan alat bantu yang telah diajarkan selama masa rawat. Hasil latihan menunjukkan meningkatnya kemampuan mobilisasi secara bertahap dan aman. Therapeutic exercise merupakan latihan efektif untuk meningkatkan mobilisasi dan mendukung ambulasi. Perawat perlu meningkatkan pengetahuan dan kemampuan melakukan therapeutic exercise untuk meningkatkan mobilisasi dan dibarengi peningkatan status kesehatan dengan perbaikan masalah kesehatan pasca THR.

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The most frequent problem of urban health is fractures due to physical injuries. The management of pathological fracture is complex and leads to prolong immobilization. Patients ability level after total hip replacement surgery can be enhanced by therapeutic exercise that includes range of motion, ankle pump, quads and gluteal static exercise, and ambulatory exercises using walker in rehabilitation phase while hospital stays.

The results of exercise show patients ability had increased gradually and secure to perform mobilizations. Therapeutic exercise is an effective exercise to improve mobilization and support ambulation. Nurses need to improve their knowledge and ability to perform therapeutic exercise as treatment of mobilization and be accompanied by improved patient health status from potential health problems after total hip replacement."

"Prosedur penggantian sendi lutut Total Knee Replacement dilakukan pada penderita Osteoarthritis yang tidak dapat ditangani dengan metode non-pembedahan. Setelah dilakukan prosedur pembedahan, klien umumnya akan mengalami nyeri akut yang menjadi salah satu masalah keperawatan yang muncul pada klien post operasi. Nyeri akut dapat ditangani secara farmakologi menggunakan obat-obatan analgesic sesuai dengan tingkat nyeri dan secara non-farmakologi menggunakan beberapa terapi modalitas. Salah satu terapi modalitas yang banyak digunakan untuk mengurangi nyeri yaitu teknik relaksasi nafas dalam. Teknik relaksasi nafas dalam dengan perhitungan 4-2-8 tarik nafas selama empat detik, tahan dua detik, dan hembuskan selama delapan detik terbukti dalam memberikan efeknya terhadap penurunan skala nyeri dan meningkatkan kenyamanan pada klien post pembedahan penggantian sendi lutut yang dibahas pada penulisan karya ilmiah ini.

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Total Knee Replacement procedure is performed on Osteoarthritis patients who can not be treated by non-surgical methods. After the surgical procedure is done, the client will generally experience acute pain which is becomes one of the nursing problems that appear on postoperative clients. Acute pain can be treated pharmacologically using analgesic medication according to the level of pain and non-pharmacologically using some of modallities therapies.

One of the many modallities therapies used to reduce pain is deep breathing relaxation technique. The deep breathing relaxation technique with 4-2-8 calculations breath for four seconds, hold for two seconds, and exhale for eight seconds is proven to have an effect to decrease the pain scale and improve comfort of the postoperative total knee replacement surgical clients which is discussed on this scientific paper."

"Osteoartritis merupakan penyakit degeneratif sendi yang dapat mempengaruhi kualitas hidup terutama pada pasien lansia. Lansia yang mengalami osteoarthritis mengeluh nyeri pada lutut sehingga sulit digunakan untuk berjalan. Salah satu tindakan pembedahan untuk mengurangi nyeri pada osteoarthritis yaitu Total Knee Replacement TKR . Peran keperawatan sebelum dan sesudah pembedahan TKR mengutamakan pada promosi kesehatan. Perawat memberikan asuhan keperawatan dengan melakukan latihan ambulasi dini. Hasil latihan ini klien mampu melakukan ambulasi dari tempat tidur hingga jalan menggunakan walker pada hari kedua. Salah satu faktor yang mendukung klien mampu melakukan mobilisasi dengan cepat dikarenakan rasa nyeri yang sudah berkurang dan adanya dukungan keluarga

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Osteoarthritis is a degenerative disease of joints that can affect the quality of life, especially in elderly patients. Elderly people with osteoarthritis complain of knee pain, making it difficult to walk. One of the surgical measures to reduce pain in osteoarthritis is Total Knee Replacement TKR . The role of nursing before and after TKR surgery is prioritized on health promotion. Nurses provide nursing care by doing early ambulation exercises. The results of this exercise the client is able to ambulate from bed to walkway using the walk on the second day. One factor that supports the client is able to mobilize quickly due to the pain that has been reduced and the support of the family."

"Osteoartritis adalah penyakit degenerasi pada sendi yang melibatkan kartilago, lapisan sendi, ligamen, dan tulang karena proses inflamasi kronis pada sendi dan tulang disekitar sendi, sehingga dapat menyebabkan fraktur dengan angka kejadian yang meningkat ketika disertai dengan obesitas. Obesitas terjadi karena gaya hidup yang kurang baik, seperti menurunnya minat dalam berolah raga. Individu dengan osteoartritis pada sendi panggul dan disertai obesitas mudah mengalami fraktur collum femur sehingga ketika sudah terjadi fraktur maka diperlukan tindakan operasi THR Total Hip Replacement . Pada post operasi Total Hip Replacement harus segera dilakukan mobilisasi dengan latihan kekuatan otot seperti ankle pump, pengesetan quadtriseps, gluteal, hip and knee flexion, short arc quad, bed mobility exercise dan latihan penggunaan alat walker. Hasil yang didapatkan, klien mendapatkan tingkat ambulasi yang diharapkan, tidak terjadi komplikasi pada berbagai sistem tubuh serta tidak memperpanjang masa rawat.

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Osteoarthritis is a degenerative disease of the joint involving the cartilage, lining of the joints, ligaments, and bones due to chronic inflammatory processes in the joints and bones around the joint, thus causing fractures with increased incidence rates when accompanied by obesity. Obesity occurs due to poor lifestyle, such as decreased interest in exercise. Individuals with osteoarthritis of the hip joint and with obesity are susceptible to fracture of the femur collum so that when a fracture occurs it is necessary to perform THR Total Hip Replacement surgery. In post operation Total Hip Replacement should be mobilized with muscle strength training such as ankle pump, quadtriseps setup, gluteal, hip and knee flexion, short arc quad, bed mobility exercise and walker tool usage exercise. The results obtained, the client gets the expected level of ambulation, no complications occur on various body systems and does not extend the length of stay."

"During the 2011 EFORT Congress in Copenhagen, many interesting topics relating to tribology in total hip arthroplasty were discussed during a special day devoted entirely to the subject. EFORT decided that, given the wide interest in these discussions, publication of the presentations would be warmly welcomed by all fellow professionals who were unable to attend. This book is the result. It provides detailed information on currently used articulating materials and their wear performance. Clinical outcomes are discussed, and important new frontiers are carefully considered. "

"ABSTRAKPendahuluan: Total Hip Replacement THR disebut sebagai operasi abad ini karena menunjukan hasil yang memuaskan walaupun memiliki harga yang relatif mahal. THR telah dilakukan lebih dari 1 juta kali/tahun secara global dan diperkirakan akan meningkat dua kali pada dekade depan. Pada institusi kami, permintaan THR meningkat 313 dari tahun 2011 -2016. Kini telah banyak hadir berbagai jenis desain implant terutama tipe bearing surface dengan kelebihan dan kekurangan masing-masing. Namun pemilihannya masih menjadi kontroversial. Metode: Kami melaporkan penelitian potong lintang terhadap tiga tipe bearing surface yang sering digunakan di institusi kami; ceramic on polyethylene CoP , metal on polyethylene MoP dan ceramic on ceramic CoC . Enam puluh tiga pasien berhasil dilakukan review dengan usia rata-rata 45 tahun dan follow up rata-rata 2,5 tahun. Kami menilai luaran fungsional dengan Harris Hip Score HHS dan radiologis. Hasil dan Pembahasan: Pada follow up terakhir, rata-rata HHS pascaoperasi yaitu 87,1 10,2 p=0,79 yang menunjukan tidak ada perbedaan antar kelompok. Rata-rata perbedaan HHS pascaoperasi ndash; praoperasi yaitu 46,48 14,1 p=0,005 yang menunjukan adanya perbedaan signifikan di dalam kelompok oleh analisis one-way ANOVA. Analisa post hoc menunjukan rata-rata perbedaan HHS pascaoperasi ndash; praoperasi secara statistik lebih tinggi pada kelompok CoC 56,82 12,7 dibandingkan dengan CoP 44,29 14,1, p = 0,007 dan MoP 42,05 11,9, p = 0,015 . Tidak ada perbedaan antara kelompok MoP dan CoP p = 1,000 . Tidak ditemukan perbedaan luaran radiologis pada ketiga kelompok. dimungkinkan karena follow up yang relatif pendek sehingga dibutuhkan studi dengan follow up yang lebih lama.

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ABSTRACTIntroduction Total Hip Replacement THR is considered to be the operation of the century with a high level of satisfactory result even though it has relatively high cost. It has been performed more than 1 million times year worldwide and its demand is estimated to double within decade. In our institution, its demand already increased by 313 from 2011 2016. Nowadays, we are faced with various implant design especially bearing surface with its benefits and weaknesses. But the ideal preference of bearing surface in THR remains a controversy. Methods We report a cross sectional study of three type of THR bearing surface which are ceramic on polyethylene CoP , metal on polyethylene MoP and ceramic on ceramic CoC , that was frequently used in our institution. Total patient of 63 were available for review with mean age of 45 years old and mean follow up of 2,5 years. We assessed their functional outcome with Harris Hip Score HHS and radiological outcome. Results and Discussion At the final follow up, mean post operative HHS was 87,1 10,2 p 0,79 that showed there were no difference between groups. Mean post operative ndash pre operative HHS differences was 46,48 14,1 p 0,005 that showed there were statically significant difference between groups as determined by one way ANOVA. A post hoc analysis revealed that postoperative ndash preoperative HHS differences were statistically significantly higher in CoC group 56,82 12,7 compared to CoP group 44,29 14,1, p 0,007 and MoP group 42,05 11,9, p 0,015 . There was no statistically significant difference between the CoP and MoP p 1,000 . Radiological outcomes reveal no loosening in all groups. This is predicted due to relatively short follow up time, thus longer follow up is needed. "

"Kekurangan asupan iodium dan polusi logam berat seperti timbal Pb dan kadmium Cd di perkotaan menyebabkan gangguan fungsi kelenjar tiroid. Struma atau goiter merupakan gangguan fungsi tiroid yang banyak dijumpai di masyarakat. Tiroidektomi menjadi salah satu penatalaksanaan pada struma yang beresiko menimbulkan komplikasi dan keluhan nyeri dan kaku leher pada pasien. Asuhan keperawatan perioperatif dengan pemberian edukasi dan latihan peregangan sendi leher dan bahu sebelum dan setelah operasi, terbukti efektif mengurangi keluhan nyeri dan kaku leher pada pasien tiroidektomi. Perawat diharapkan melakukan edukasi dan latihan peregangan sendi leher dan bahu untuk mengurangi komplikasi dan keluhan pasca tiroidektomi

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Insufficient intake of iodine and heavy metal pollution such as lead Pb and Cadmium Cd in urban areas may lead to thyroid disorder. Struma or goiter is a common thyroid disorder in community. Thyroidectomy is usually performed to treat struma which may result in complications and neck pain. Perioperative care by providing education and neck and shoulder stretching exercise prior to and following surgery was proven to be effective in relieving neck pain and stiffness in post-thyroidectomy patient. Nurses are suggested to implement this exercise for perioperative patient with thyroidectomy to mitigate its complications."

"Pendahuluan: Total Hip Replacement (THR) merupakan prosedur pembedahan tersering pada ekstremitas bawah. Kemajuan teknik operasi dan semakin canggihnya instrumen bedah meluaskan indikasi THR primer pada pasien yang sebelumnya tidak mungkin dilakukan dan memiliki angka komplikasi tinggi pasca operasi. Prosedur ini disebut THR primer sulit yang dilakukan pada kelompok pasien dengan kelainan panggul kompleks seperti defek tulang panggul, fusi panggul atau kontraktur jaringan lunak. Metode: 81 prosedur THR primer yang dikerjakan di RSUPN Dr. Cipto Mangunkusumo antara Januari 2012-Juni 2017. Kelompok THR primer sulit terdiri dari 29 pasien dan 52 pasien lainnya merupakan kelompok sederhana. Parameter intraoperatif seperti jumlah perdarahan, durasi operasi, ketepatan penempatan komponen, tingkat komplikasi dan luaran fungsional pasca operasi (Harris Hip Score) pada akhir follow up dicatat dan dilakukan analisis dengan membandingkan kedua kelompok tersebut.Hasil: Kelompok sulit memiliki jumlah perdarahan (p=<0.001), durasi operasi (p=<0.001) tingkat komplikasi (p=<0.012) lebih besar dibanding kelompok sederhana. Luaran radiologis berupa ketepatan penempatan orientasi komponen pada zona aman tidak memiliki perbedaan antar kedua kelompok (p=0.333). Luaran fungsional pada follow up akhir kelompok sulit (88.67) tidak memiliki perbedaan bermakna (p=0.080) dibandingkan kelompok sederhana (91.50). Pembahasan: Prosedur THR primer sulit yang dikerjakan di RSUPN Dr. Cipto Mangunkusumo walau memiliki parameter kesulitan dan tingkat komplikasi lebih besar tidak memiliki perbedaan luaran radiologis maupun fungsional dibandingkan THR primer sederhana. Perlu dilakukan identifikasi setiap prosedur THR primer apakah ada, jenis dan tingkat penyulit yang akan dihadapi saat intraoperasi untuk dilakukan perencanaan operasi yang baik sehingga didapatkan hasil luaran yang maksimal.

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Introduction: Total hip replacement (THR) is the most common surgery in lower extremities. Improvement in surgical technique and advancement of surgical instrumentation extended the indications for primary THR in previously impossible to treat. This procedure is known as primary difficult THR which performed in patients with complex hip disorders including hip bone defect, hip fusion, or soft tissue contracture. Methods: 81 primary THR procedures were performed in Cipto Mangunkusumo National Hospital from January 2012 until June 2017. Primary difficult THR group consisted of 29 patients and 52 patients in simple group. Intraoperative parameters including bleeding volume, operation time, complication rate, radiological outcome and functional outcome (Harris Hip Score) were recorded at the end of follow up and analyzed.Result: Difficult group had bleeding volume (p=<0.001), operation time (p=<0.001), complication rate (p=<0.012), higher than simple group. Radiological outcome is measured by accuracy of component orientation placement in the safe zone resulted no significant difference between two groups (p=0,333). Functional outcome at the end of follow up in difficult group (88.67) did not have significant difference (p=0.080) with simple group (91.50). Discussion: Primary difficult THR procedure performed in Cipto Mangunkusumo National Hospital although have higher difficulty parameters and complication rates, didn't have significant difference in radiologic and functional outcome compared to simple group. It was necessary to identify each primary THR procedures whether there were any, types and levels of difficulties that would be faced intraoperatively in order to improve preoperative planning so the outcome would be optimal."

"[ABSTRAK Tuberkulosis paru merupakan salah satu masalah kesehatan masyarakat perkotaandan penyebab kematian tertinggi di Indonesia. Penulisan karya ilmiah bertujuanuntuk menganalisis asuhan keperawatan pada pasien TB Paru dengan kontekskeperawatan kesehatan masyarakat perkotaan. Asuhan keperawatan diberikansesuai dengan proses keperawatan. Masalah keperawatan utama yang munculadalah bersihan jalan nafas tidak efektif, intoleransi aktifitas dan kurangpengetahuan tentang TB dan pengobatannya. Intervensi yang diberikan adalahmemberikan posisi semipowler, latihan ROM secara aktif, dan intervensi khususpemberian pendidikan kesehatan tentang kepatuhan minum Obat AntiTuberkulosis. Hasil evaluasi dari asuhan keperawatan menunjukkan jalan nafasadekuat, aktivitas mandiri, dan peningkatan pengetahuan klien tentang Obat AntiTuberkulosis. Karya ilmiah ini diharapkan menjadi gambaran bagi perawatmedikal bedah dalam pemberian asuhan keperawatan pada pasien dengan TBparu.ABSTRACT Tuberculosis TB is one of the disease that caused high mortality inIndonesia The aim of this paper is to analyze nursing care on TB patient usingconcept of urban nursing Nursing problem that occur were in effective airwayclearance intolerance activity and inadequate knowledge about TB treatment Nursing interventions that were given semifowler position active ROM andhealth education about TB treatment The result shown improvement on airwayclearance independent activity and better client rsquo s knowledge about tuberculosismedication The outcome of this nursing care can be used to improve the qualityof nursing care for TB patient in the hospital Keyword Adherence TB patient nursing;Tuberculosis TB is one of the disease that caused high mortality inIndonesia The aim of this paper is to analyze nursing care on TB patient usingconcept of urban nursing Nursing problem that occur were in effective airwayclearance intolerance activity and inadequate knowledge about TB treatment Nursing interventions that were given semifowler position active ROM andhealth education about TB treatment The result shown improvement on airwayclearance independent activity and better client rsquo s knowledge about tuberculosismedication The outcome of this nursing care can be used to improve the qualityof nursing care for TB patient in the hospital Keyword Adherence TB patient nursing;Tuberculosis TB is one of the disease that caused high mortality inIndonesia The aim of this paper is to analyze nursing care on TB patient usingconcept of urban nursing Nursing problem that occur were in effective airwayclearance intolerance activity and inadequate knowledge about TB treatment Nursing interventions that were given semifowler position active ROM andhealth education about TB treatment The result shown improvement on airwayclearance independent activity and better client rsquo s knowledge about tuberculosismedication The outcome of this nursing care can be used to improve the qualityof nursing care for TB patient in the hospital Keyword Adherence TB patient nursing;Tuberculosis TB is one of the disease that caused high mortality inIndonesia The aim of this paper is to analyze nursing care on TB patient usingconcept of urban nursing Nursing problem that occur were in effective airwayclearance intolerance activity and inadequate knowledge about TB treatment Nursing interventions that were given semifowler position active ROM andhealth education about TB treatment The result shown improvement on airwayclearance independent activity and better client rsquo s knowledge about tuberculosismedication The outcome of this nursing care can be used to improve the qualityof nursing care for TB patient in the hospital Keyword Adherence TB patient nursing, Tuberculosis TB is one of the disease that caused high mortality inIndonesia The aim of this paper is to analyze nursing care on TB patient usingconcept of urban nursing Nursing problem that occur were in effective airwayclearance intolerance activity and inadequate knowledge about TB treatment Nursing interventions that were given semifowler position active ROM andhealth education about TB treatment The result shown improvement on airwayclearance independent activity and better client rsquo s knowledge about tuberculosismedication The outcome of this nursing care can be used to improve the qualityof nursing care for TB patient in the hospital Keyword Adherence TB patient nursing]"