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"Penyakit endokrin merupakan penyebab kematian dengan angka yang cukup tinggi baik secara nasional maupun global. Hal ini menjadi tantangan bagi seluruh tenaga kesehatan khususnya bagi perawat spesialis medikal bedah peminatan endokrin dalam ikut membantu menurunkan tingkat komplikasi yang terjadi. Praktik ilmu keperawatan yang berkualitas berdasarkan evidence base nursing terbaru menjadi landasan dalam melaksanakan peran sebagai pemberi asuhan, peneliti, pendidik dan inovator. Praktik residensi perawat spesialis peminatan endokrin berlangsung dalam dua semester telah memberikan pengalaman dan kesempatan untuk menerapkan teori keperawatan secara menyeluruh dalam mengelola asuhan kepada pasien. Penerapan model teori adaptasi Roy dilakukan oleh residen terhadap 30 kasus resume dan satu kasus kelolaan utama yaitu pada pasien Diabetes Melitus type 2 dengan riwayat KAD, akut on CKD, hipertensi, dyslipidemia dan pankreatitis akut. Peran peneliti dilakukan dengan menerapkan evidence base nursing yaitu melalui inlows sixty second sebagai alat screening risiko terjadinya luka kaki pada pasien Diabetes Melitus. Inovasi pelayanan yang dilakukan residen adalah membuat alat simulation tool yaitu alat edukasi untuk pasien Diabetes Melitus yang menerima terapi insulin pertama kali. Protokol ini mampu memberikan panduan secara sistematis, mudah dipahami, serta mudah dilaksanakan oleh perawat kepada pasien sehingga diharapkan pasien dengan terapi insulin tidak merasa ketakutan saat mendapatkan insulin pertama kali.

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Endocrine disease is a cause of death with a fairly high number both nationally and globally. This is a challenge for all health workers, especially for medical surgical specialist nurses specializing in endocrine in helping to reduce the rate of complications that occur. Quality nursing science practice based on the latest nursing evidence base is the cornerstone in carrying out the role as a caregiver, researcher, educator and innovator. The endocrine specialist nurse residency practice which takes place over two semesters has provided experience and opportunity to apply nursing theory as a whole in managing care for patients. Residents applied Roy's adaptation theory model to 30 resume cases and one main managed case, namely type 2 Diabetes Melitus patients with a history of DKA, acute CKD, hypertension, dyslipidemia and acute pancreatitis. The role of the researcher is carried out by applying evidence-based nursing, namely through sixty second inlows as a screening tool for the risk of foot injuries in patients with Diabetes Melitus. The resident's service innovation is to make a simulation tool, which is an educational tool for Diabetes Melitus patients who receive insulin therapy for the first time. This protocol is able to provide guidance in a systematic, easy to understand, and easily implemented by nurses to patients so that patients on insulin therapy are expected not to feel afraid when they get insulin for the first time."

"Residensi keperawatan medikal bedah dengan peminatan keperawatan endokrin merupakan kelanjutan dari pendidikan magister keperawatan yang bertujuan memberikan kesempatan kepada mahasiswa residen perawat spesialis untuk mengaplikasikan ilmu dan teknologi keperawatan. Program residensi difokuskan pada pemberian asuhan keperawatan lanjutan dan kompleks dalam menyelesaikan masalah keperawatan endokrin di fasilitas pelayanan kesehatan. Praktik klinik ini dilakukan di berbagai unit, termasuk gawat darurat, perawatan intensif, rawat inap, dan rawat jalan di RS Universitas Indonesia Depok dan RSUPN Dr. Cipto Mangunkusumo Jakarta. Dalam praktiknya, residen menggunakan teori Model Adaptasi Roy untuk menangani 30 kasus resume dan 1 kasus utama, yaitu pasien dengan Diabetes Melitus Tipe 2 (DMT2), Diabetic Foot Ulcer (DFU), Osteomielitis Pedis Sinistra, Selulitis Pedis Sinistra, PAD Tungkai Sinistra, CLTI Ekstremitas Inferior Sinistra, dan Neuropati Perifer. Asuhan keperawatan berbasis bukti (EBN) diterapkan berupa pengkajian risiko hipoglikemia pada pasien DMT2 dengan instrumen HYDHO Score. Sebagai bagian dari inovasi pelayanan keperawatan, residen mengembangkan Buku Harian Diabetes (BHD) berupa booklet yang berfungsi sebagai media komunikasi dan edukasi untuk mendukung manajemen diri pasien diabetes melitus (DM). BHD ini menjadi panduan bagi pasien, perawat, dan tenaga kesehatan lainnya dalam kolaborasi pengobatan dan perawatan pasien DM.

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The Medical-Surgical Nursing Residency with a specialization in Endocrine Nursing is an extension of the Master’s degree in Nursing, aimed at providing nurse specialist residents with the opportunity to apply nursing science and technology. The residency program focuses on delivering advanced and complex nursing care to address endocrine nursing problems in healthcare facilities. Clinical practice is conducted in various units, including emergency care, intensive care, inpatient, and outpatient settings at Universitas Indonesia Hospital in Depok and RSUPN Dr. Cipto Mangunkusumo in Jakarta. During the practice, residents utilize the Roy Adaptation Model theory to manage 30 case summaries and one main case: a patient with Type 2 Diabetes Mellitus, Diabetic Foot Ulcer (DFU), Osteomyelitis Pedis Sinistra, Cellulitis Pedis Sinistra, PAD (Peripheral Artery Disease) in the Left Limb, CLTI (Chronic Limb-Threatening Ischemia) in the Left Lower Extremity, and Peripheral Neuropathy. Evidence-Based Nursing (EBN) was applied by assessing the risk of hypoglycemia in Type 2 Diabetes Mellitus patients using the HYDHO Score instrument. As part of nursing service innovation, residents developed a Diabetes Diary (BHD) in the form of a booklet that serves as a communication and educational medium to support self- management in diabetic patients. The Diabetes Diary acts as a guide for patients, nurses, and other healthcare professionals in collaborative treatment and care of diabetes patients."

"diwujudkan melalui proses pendidikan berkelanjutan setelah magister keperawatan. Program praktik residensi ners spesialis keperawatan medikal bedah peminatan endokrin, bertujuan agar para residen memiliki tingkat kompetensi profesional, berpikir kritis dan reflektif serta komunikasi interpersonal yang lebih tinggi ketika dihadapkan pada situasi klinis yang kompleks. Praktik dilakukan di ruang gawat darurat, ruang intensif, rawat inap, dan rawat jalan RSUPN Dr Cipto Mangunkusumo Jakarta dengan mengaplikasikan teori Model Adaptasi Roy pada 30 kasus resume dan 1 kasus utama pada pasien diabetes melitus tipe 2 dengan komplikasi peripheral arterial disease dan ulkus kaki diabetik. Penerapan evidence based nursing Short Form Berg balance Scale telah terbukti sebagai alat skrining yang mudah, murah, hemat waktu dan memiliki reliabilitas Intraclass Correlation Coefisien yang baik untuk pengkaji keseimbangan dan resiko jatuh pada pasien DM yang sudah lanjut usia. Penerapan inovasi New Simulation Tools terbukti efektif mengurangi rasa takut pasien terhadap jarum suntik dan meningkatkan keterampilan menyuntik pada pasien yang baru pertama kali menerima terapi insulin.

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The nursing profession always develops following the latest science. This is realized through a process of continuing education after the master of nursing. The residency practice program for medical surgical nursing specialists specializing in endocrine, aims to make residents have a higher level of professional competence, critical and reflective thinking and interpersonal communication when faced with complex clinical conditions. The practice was carried out in the emergency room, intensive care unit, inpatient and outpatient care at RSUPN Dr Cipto Mangunkusumo Jakarta by applying Roy's Adaptation Model theory to 30 resume cases and 1 main case in patients with type 2 diabetes melitus with complications of peripheral arterial disease and diabetic foot ulcers. . The application of evidence-based nursing Short Form Berg balance Scale has been proven as a screening tool that is easy, inexpensive, time-saving and has good Intraclass Correlation Coefficient reliability for assessing balance and risk of falling in elderly DM patients. The application of the innovative New Simulation Tools has been proven to be effective in reducing patients' fear of needles and improving injecting skills in patients who are receiving insulin therapy for the first time."

"Perawat Spesialis Medikal Bedah berperan penting dalam praktik keperawatan sebagai pemberi asuhan keperawatan kompleks, melakukan analisa ilmiah dan pembuktian ilmiah serta sebagai agen pembaharu. Melalui tulisan ini digambarkan pemberian asuhan keperawatan kepada pasien dengan diagnosis Chronic Limb Threatening Ischemia. Tujuan dari penulisan ini adalah memberikan gambaran praktek keperawatan spesialis medikal bedah menggunakan pendekatan Model Adaptasi Roy. Dari hasil pengumpulan data dan pemeriksaan fisik didapatkan 10 diagnosis keperawatan. Pemberian asuhan keperawatanpun dilakukan kepada 30 pasien sebagai kasus resume, diperoleh perilaku maladaptif pada mode fisiologis dengan diagnose terbanyak yaitu resiko infeksi dan nyeri kronik. Evidence Based Nursing dengan melakukan foot exercises kepada 8 pasien yang mengalami ulkus kaki diabetik dengan hasil yang signifikan terhadap perubahan ukuran luka. Program inovasi menerapkan Hypoglycemia-Nursing Early Warning Score System pada pasien diabetes melitus tipe 2 yang terbukti memudahkan perawat menilai resiko kejadian hipoglikemi berat selama 1 tahun. Pendekatan Model Adaptasi Roy berpengaruh besar terhadap profesi keperawatan. Model ini menjadi salah satu yang banyak digunakan dalam penelitian, pendidikan dan pelayanan keperawatan.

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Surgical Medical Specialist Nurses play an important role in nursing practice as a provider of advanced nursing care, conduct scientific analysis and scientific evidence and as a reforming agent. Through of this paper we describe the provision of nursing care to patients with a diagnosis of Chronic Limb Threatening Ischemia. The purpose of this paper is to provide an overview of the nursing practice of Surgical Medical Specialists using Roy's Adaptation Model approach. From the results of data collection and physical examination obtained 10 nursing diagnoses. In nursing care was provided to 30 patients as a case of resume, obtained maladaptive behavior in physiological mode with the most diagnoses, the risk of infection and chronic pain. Evidence Based Nursing by performing foot exercises on 8 patients who suffered diabetic foot ulcers with significant results on changes in wound size. The innovative program implementated the Hypoglycemia-Nursing Early Warning Score System in patients with type 2 diabetes mellitus which was proven to make it easier for nurses to assess the risk of severe hypoglycemic events for 1 year. Roy's Adaptation Model approach greatly influencing the nursing profession. This model is one that was widely used in research, education and nursing services"

"Praktik residensi keperawatan medikal bedah peminatan keperawatan endokrin merupakan kelanjutan dari pendidikan magister keperawatan yang dilaksanakan dalam rangka memberikan kesempatan dan pengalaman kepada residen perawat untuk menerapkan ilmu dan teknologi keperawatan khususnya memberi asuhan keperawatan lanjut dan kompleks dalam menyelesaikan permasalahan keperawatan endokrin pada fasilitas pelayanan kesehatan. Praktik klinik dilaksanakan di setting gawat darurat, perawatan intensif, rawat inap, dan rawat jalan di RSUPN Dr Cipto Mangunkusumo Jakarta. Penerapan teori Model Adaptasi Roy dilakukan oleh residen pada 30 kasus resume dan 1 kasus utama yaitu pada pasien SIDA on ARV, Diabetes mellitus tipe 2, Selulitis regio colli, Hepatitis C, Sirosis hepatis. Asuhan keperawatan berbasis bukti diterapkan berupa latihan Passive Stretching untuk menurunkan gula darah pada pasien yang tidak mampu melakukan latihan fisik mandiri. Inovasi pelayanan keperawatan dilakukan dengan menyusun media edukasi simulasi suntik insulin yang terdiri dari alat New Simulation Tools (alat peraga suntik insulin) video dan buku panduan edukasi suntik insulin (buklet) yang digunakan sebagai panduan dan media edukasi bagi perawat dalam memberikan edukasi suntik insulin, mengurangi rasa takut pasien terhadap penyuntikan, memberikan lebih banyak latihan, dan meningkatkan keterampilan penyuntikan insulin pasien.

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The medical surgical nursing residency program specializing in endocrine nursing is a continuation of nursing master education which is carried out in order to provide opportunities and experience to nurse residents to apply nursing science and technology, especially providing advanced and complex nursing care in solving endocrine nursing problems in health care facilities. Clinical practice is carried out in emergency, intensive care, inpatient, and outpatient settings at Dr. Cipto Mangunkusumo Hospital Jakarta. The application of the Roy Adaptation Model theory was carried out by residents in 30 resume cases and 1 main case, namely in patients with SIDA on ARV, Diabetes mellitus type 2, Cellulitis regio colli, Hepatitis C, Cirrhosis hepatis. Evidence-based nursing care is applied in the form of Passive Stretching exercises to reduce blood sugar in patients who are unable to do independent physical exercise. Nursing service innovation is carried out by compiling educational media consisting of insulin injection simulation tools consisting of New Simulation Tools (insulin injection tool) videos and insulin injection education guidebooks (booklets) which are used as guidelines and educational media for nurses in providing insulin injection education, reducing patient fear of injections, providing more practice, and improving patient insulin injection skills."

"Analisis praktik residensi keperawatan medikal bedah terdiri atas analisis kasus kelolaan pada pasien dengan gangguan sistem endokrin melalui pendekatan Model Adaptasi Roy, penerapan evidence-based nursing practice (EBN), dan penerapan proyek inovasi. Laporan ini bertujuan untuk menganalisis penerapan asuhan keperawatan pada pasien Diabetes Melitus (DM) dengan kadar glukosa tidak terkontrol menggunakan pendekatan Model Adaptasi Roy serta penerapan EBN berupa skrining neuropati perifer menggunakan The Michigan Neuropathy Screening Instrument Questionnaire (MNSIq) dan inovasi berupa Buku Harian Diabetisi. Hasil menunjukkan bahwa (1) Model Adaptasi Roy merupakan pendekatan yang sesuai untuk diterapkan dalam asuhan keperawatan pada pasien DM terutama dalam pengkajian stimulus dan perilaku; (2) MNSIq dapat diterapkan sebagai alat skrining DPN; (3) Proyek inovasi Buku Harian Diabetisi berpotensi menjadi sarana edukasi dan monitoring kontrol glikemik pasien DM dengan perbaikan pada aspek desain dan persiapan sumber daya pendukung.

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Analysis of medical surgical nursing residency practice consists of case analysis of patients with endocrine system disorders using the Roy Adaptation Model approach, application of evidence-based nursing practice (EBN), and implementation of innovation projects. This report aims to analyze the implementation of nursing care in patients with diabetes mellitus (DM) with uncontrolled glucose levels using the Roy Adaptation Model approach, the implementation of EBN for peripheral neuropathy screening using The Michigan Neuropathy Screening Instrument Questionnaire (MNSIq), and innovation project of the Buku Harian Diabetisi. The results show that (1) The Roy Adaptation Model is an appropriate approach for nursing care in DM patients, especially in assessing stimuli and behavior; (2) MNSIq can be applied as a DPN screening tool; (3) Buku Harian Diabetisi has the potential to be a means of education and monitoring of glycemic control in diabetic patients with improvements in the design aspects and preparation of supporting resources."

"[ABSTRAKGangguan pada sistem endokrin merupakan masalah kesehatan yang cukup tinggi di Indonesia, khususnya Diabetes Melitus (DM) tipe 2 dengan prevalensinya mencapai 2,1% dari total penduduk, dengan 60% dari total prevalensi adalah kasus neuropati. Kadar glukosa darah yang tidak terkontrol menyebabkan tingginya kejadian komplikasi DM baik akut maupun kronis. Pencegahan komplikasi tersebut memerlukan penanganan yang tepat dari berbagai multidisiplin ilmu, salahsatunya adalah peran perawat ners spesialis medikal bedah kekhususan endokrin sebagai praktisi keperawaan untuk ikut memberikan asuhan melalui berbagai pendekatan teori keperawatan seperti penerapan model adaptasi Roy secara holistik menggunakan pengkajian perilaku dan stimulus sehingga tercapai perilaku adaptif. Selain itu penerapan praktek keperawatan berbasis pembuktian ilmiah (evidence based nursing) seperti senam kaki diabetes dapat menjadi acuan intervensi dalam mencegah terjadinya polineuropati dan komplikasi lanjut seperti ulkus diabetik. Sebagai agen pembaharu/inovator, perawat spesialis juga membuat inovasi tentang self health assesment dan booklet sahabat diabetes bagi para diabetesi untuk meningkatkan promosi kesehatan terhadap pengelolaan dan penatalaksanaan DM.

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ABSTRACTDisorders of the endocrine system is a health problem that is quite high in Indonesia, in particular diabetes mellitus (DM) type 2 prevalence was at 2.1% of the total population, with 60% of the total prevalence of neuropathy cases. Blood glucose levels are poorly controlled diabetes leading to high incidence of complications both acute and chronic. Prevention of these complications requires proper handling of various multidisciplinary, one of them is the role of medical-surgical nurse specialist nurses endocrine specificity as keperawaan practitioners to help provide care through a variety of approaches such as the application of nursing theory holistically Roy adaptation model uses behavioral assessment and stimulus in order to reach adaptive behavior, Besides the application of scientific evidence-based nursing practice (evidence-based nursing) such as diabetic foot gymnastics can be a reference for intervention in preventing the occurrence opolyneuropathy and further complications such as diabetic ulcers. As an agent reformer/innovators, nurse specialist also made innovations on health self-assessment and companion booklet diabetes for diabetics to improve health promotion for the management and treatment of diabetes., Disorders of the endocrine system is a health problem that is quite high in Indonesia, in particular diabetes mellitus (DM) type 2 prevalence was at 2.1% of the total population, with 60% of the total prevalence of neuropathy cases. Blood glucose levels are poorly controlled diabetes leading to high incidence of complications both acute and chronic. Prevention of these complications requires proper handling of various multidisciplinary, one of them is the role of medical-surgical nurse specialist nurses endocrine specificity as keperawaan practitioners to help provide care through a variety of approaches such as the application of nursing theory holistically Roy adaptation model uses behavioral assessment and stimulus in order to reach adaptive behavior, Besides the application of scientific evidence-based nursing practice (evidence-based nursing) such as diabetic foot gymnastics can be a reference for intervention in preventing the occurrence opolyneuropathy and further complications such as diabetic ulcers. As an agent reformer/innovators, nurse specialist also made innovations on health self-assessment and companion booklet diabetes for diabetics to improve health promotion for the management and treatment of diabetes.]"

"Gangguan sistem endokrin yang terbanyak dipelayanan kesehatan adalah pada kasus Diabetes Mellitus (DM) dan DM tipe 2 presentasenya mencapai 95%. Pada perkembangnnya gula darah yang tidak terkontrol akan menimbulkan berbagai komplikasi, baik pada mikrovaskuler maupun makrovaskuler. Pencegahan dan penanganan komplikasi DM, dilakukan oleh multidisiplin keilmuan yang dilakukan secara terpadu. Peran perawat spesialis medikal bedah pada kekhususan endokrin diharapkan mampu melakukan asuhan keperawatan secara holistik hingga pasien DM mampu beradaptasi dengan penyakitnya dan mampu mengontrol gula darahnya. Model Adaptasi Roy,dapat digunakan sebagai landasan perawat melakukan asuhan yang komprehensif dengan mengurangi stimulus yang ada dan meningkatkan koping individu sehingga tercapai perilaku yang adaptif. Melalui penerapan praktek keperawatan berbasis pembuktian (evidence based practice), pengkajian kaki diabetik dilakukan untuk pencegahan terjadinya komplikasi ulkus kaki diabetik. Pada peran perawat sebagai innovator pengkajian kaki dapat digunakan sebagai salah satu standar pengkajian keperawatan pada pasien DM, sehingga tercapai peningkatan asuhan keperawatan khususnya pada pasien dengan DM.

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Endocrine System Disorder mostly occurs in health service on Diabetes Mellitus, especially the DM Type-2, in which the percentage reach 95%. Furthermore, uncontrolled blood sugar causes several micro vascular or macro vascular complications. The DM prevention and treatment should be done by means of integrated multi-discipline efforts. It is expected that medical surgical nurses who are majoring in endocrine will be able to conduct a holistic nursing so that the DM patients are able to adapt to his illness and control his blood sugar. Roy Adaptation Model is applied as the basis for the nurses to conduct comprehensive care by reducing existing stimulus and increasing individual coping in order to generate adaptive behaviors. Through the application of evidence-based practice, diabetic foot research is conducted to prevent diabetic foot ulcers complication. In the nurse's role as an innovator, foot assessment can be utilized as a standard for nursing assessment on DM patient and, therefore, increasing nursing treatment for them."

"Peran perawat spesialis diperlukan untuk peningkatan kualitas pelayanan asuhan keperawatan yang kompleks dan akurat sebagai pemberi asuhan keperawatan tingkat lanjut kasus neurosain, pendidik, advokat, serta agen pembaharu melalui penerapan evidence based nursing (EBN) dan proyek inovasi. Asuhan keperawatan tingkat lanjut menggunakan teori Adaptasi Roy yaitu pengelolaan pasien meningitis tuberkulosis sebagai kasus utama dan 30 resume gangguan sistem neurologi. Teori Roy banyak bertujuan meningkatkan perilaku adaptif dan mengubah perilaku inefektif. Diagnosis keperawatan yang paling banyak ditemukan pada pasien gangguan sistem neurologi adalah ketidakefektifan perfusi jaringan serebral dan hambatan mobilitas fisik. Penerapan EBN dilakukan pada pasien stroke yang mengalami disfagia. Pasien diberikan latihan menelan shaker exercise hasilnya menunjukkan peningkatan kemampuan menelan dan tidak terjadi aspirasi. Proyek inovasi kelompok menerapkan Pengembangan Media Edukasi Perawatan Pasien Brain Tumor Craniotomy. Penerapan proyek inovasi meningkatkan pengetahuan pasien, keterampilan pasien latihan napas dalam dan mobilisasi setelah operasi, dan menambah kepercayaan diri perawat saat memberikan edukasi. Pengalaman praktik residensi diharapkan menambah kompetensi dan peran perawat spesialis di lahan klinik.

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The role of nurse specialists is needed to improve the quality of complex and accurate nursing care services as providers of advanced nursing care in cases of neuroscience, educators, advocates, and agents of reform through the application of evidence based nursing (EBN) and innovation projects. Advanced nursing care uses Roy's Adaptation theory, which is the management of meningitis tuberculosis patients as the main case and 30 resumes of neurological system disorders. Roys theory aims to improve adaptive behavior and change ineffective behavior. The most common nursing diagnoses found in patients with neurological system disorders are ineffective perfusion of cerebral tissue and barriers to physical mobility.

EBN application is performed on stroke patients who have dysphagia. The patient is given training to swallow the exercise shaker, which results in increased swallowing ability and no aspiration. The group innovation project applies Development of Educational Media for Nursing Brain Tumor Craniotomy Patients. The application of innovation projects increases patient knowledge, the skills of patients in deep breathing exercises and mobilization after surgery, and increases nurse confidence when providing education. The residency practice experience is expected to increase the competency and role of specialist nurses on the clinic grounds."

"Keganasan kolorektal membuat pasien mengalami perubahan status kesehatan yang signifikan dan sangat mempengaruhi kehidupannya. Status kesehatan pasien mengarah kepada kondisi kronis dan membutuhkan adaptasi dari pasien terhadap keadaannya untuk bisa memperoleh kondisi kesehatan yang maksimal. Pasien Tn. S dengan kanker kolorektal post laparatomi hemikolektomi, stoma ileokolotransversal dengan komplikasi efusi pleura mengalami perdarahan pada haluaran stoma, dan alkalosis respiratorik. Diagnosa keperawatan utama yang diangkat adalah gangguan pertukaran gas dan kekurangan volume cairan, dengan intervensi manajemen asam basa dan manajemen cairan dan elektrolit.

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Colorectal malignancies make patients experience significant changes in health status and greatly affect their lives. The patient's health status leads to chronic conditions and requires adaptation from the patient to his condition to be able to obtain maximum health conditions. Patient Mr. S with post laparatomy hemicolectomy colorectal cancer, ileokolotransversal stoma with complications of pleural effusion experiencing bleeding at the stoma output, and respiratory alkalosis. The main nursing diagnoses raised were interruption of gas exchange and lack of fluid volume, with acid base management interventions and fluid and electrolyte management."