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"Bayi yang dirawat di unit perawatan intensif sangat mudah terpengaruh oleh lingkungan yang asing dan gangguan terhadap rutinitas harian normal mereka. Bahkan setelah tidak dirawatpun bayi-bayi ini akan menghadapi tantangan baru selama berbulan-bulan bahkan bertahun-tahun setelahnya. Baby liberation merupakan hasil adaptasi dari PICU liberation dan telah diidentifikasi sebagai strategi utama untuk mengurangi morbiditas dan meningkatkan hasil jangka panjang bagi para penyintas PICU. Teori Henderson bersifat fundamental memenuhi 14 kebutuhan dasar individu yang holistik dan komprehensif, teori ini sudah banyak dipakai di berbagai populasi individu namun belum pada ruang perawatan intensif anak. Tujuan penulisan karya ilmiah ini untuk memberikan gambaran aplikasi teori kebutuhan Henderson dalam asuhan keperawatan pada bayi sakit kritis sekaligus melihat efektivitas penerapan Baby Liberation Bundles Care untuk mendukung status fungsional bayi sakit kritis di ruang perawatan intensif anak. Terdapat lima kasus bayi yang mengalami masalah pada pemenuhan kebutuhan dasar dan diberikan asuhan keperawatan melalui pendekatan teori kebutuhan Henderson. Aplikasi teori kebutuhan Henderson cocok digunakan di PICU karena teori ini bersifat holistik dan komprehensif yang terdiri dari sembilan kebutuhan dasar fungsional tubuh dan lima kebutuhan dasar kenyamanan meliputi psikologis, sosial dan spiritual. Penerapan Baby Liberation Bundles Care efektif untuk mendukung status fungsional bayi sakit kritis dan diharapkan intervensi ini dapat diaplikasikan oleh perawat ruangan.

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Babies treated in intensive care units are easily affected by unfamiliar environments and disruptions to their daily normal routines. Even after not being cared for, these babies will face new challenges for months or even years afterward. Baby liberation is an adaptation of PICU liberation and has been identified as a key strategy to reduce morbidity and improve long-term outcomes for PICU survivors. Henderson's theory is fundamental in fulfilling 14 basic individual needs in a holistic and comprehensive manner, this theory has been widely used in various individual populations but not in pediatric intensive care unit yet. The purpose of writing this scientific work is to provide an overview of the application of Henderson's theory of needs in the care of critically ill babies and see the effectiveness of implementing Baby Liberation Bundles Care to support the functional status of critically ill babies in the Pediatric Intensive Care Unit. There were five cases of babies who experienced problems in providing basic needs and were given nursing care using Henderson's needs theory approach. The application of Henderson's needs theory is suitable for use in the PICU because this theory is holistic and comprehensive, consisting of nine basic functional body needs and five basic comfort needs including psychological, social and spiritual. The implementation of Baby Liberation Bundles Care is effective in supporting the functional status of critical babies and it is hoped that this intervention can be implemented by nursing staff."

"Janin dan bayi prematur menghabiskan sebagian besar waktunya untuk tidur di dalam dan di luar rahim. Tidur dianggap sebagai aktivitas penting pada periode neonatal, serupa dengan pernapasan dan nutrisi. Kebisingan merupakan salah satu penyebab gangguan pola tidur pada bayi prematur di ruang perawatan intensif neonatal dan berdampak pada gangguan tumbuh kembang. Studi ini memberikan gambaran penerapan Model Adaptasi Callista Roy dalam asuhan keperawatan pada lima kasus bayi prematur dengan risiko gangguan pola tidur. Desain yang digunakan adalah studi kasus yang didapatkan dari lima kasus terpilih. Teori Adaptasi Callista Roy mampu memfasilitasi perawat untuk menggali masalah keperawatan pada bayi prematur secara komprehensif. Pemberian edukasi Bundles Alert to Alarm kepada seluruh perawat neonatal menggunakan media pitstop dapat menurunkan angka kebisingan diruang perawatan neonatal. Penerapan teori Adaptasi Callista Roy dan penerapan Bundles allert to alarm dapat direkomendasikan untuk diterapkan dalam asuhan keperawatan yaitu dapat memfasilitasi istirahat tidur bayi prematur yang dirawat di ruang perawatan neonatal.

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Fetuses and premature babies spend most of their time sleeping inside and outside the womb. Sleep is considered an important activity in the neonatal period, similar to breathing and nutrition. Noise is one of the causes of disturbed sleep patterns in premature babies in the neonatal intensive care room and has an impact on growth and development disorders. This study provides an overview of the application of the Callista Roy Adaptation Model in nursing care in five cases of premature babies at risk of sleep pattern disorders. The design used is a case study obtained from five selected cases. Callista Roy's Adaptation Theory is able to facilitate nurses to comprehensively explore nursing problems in premature babies. Providing Bundles Alert to Alarm education to all neonatal nurses using pitstop media can reduce noise levels in the neonatal care room. The application of Callista Roy's Adaptation theory and the application of Bundles alert to alarm can be recommended for application in nursing care, namely it can facilitate sleep for premature babies who are cared for in the neonatal care room."

"Latar belakang. Prematuritas adalah salah satu kondisi yang menyebabkan gagalnya pemberian air susu ibu (ASI). Program peningkatan kualitas (quality improvement) seperti bundles care intervensi berbasis bukti telah terbukti dapat memberikan luaran yang lebih baik dan meningkatkan kesempatan pemberian ASI pada bayi prematur.Metode. Penelitian quasy experimental yang dilakukan di Unit Neonatal RSCM pada 51 subyek maternal dan bayi dengan usia gestasi <32 minggu selama periode Maret-Juni 2024. Intervensi bundles care dilakukan dengan menggunakan daftar tilik pemberian ASI prematur yang dikembangkan. Intervensi dilakukan sejak 24 jam pertama pasca-persalinan. Luaran intervensi dinilai dari rerata angka cakupan ASI prematur di Unit Neonatal RSCM sesudah intervensi dibandingkan dengan sebelum intervensi.Hasil penelitian. Cakupan pemberian ASI selama periode intervensi pada bayi <32 minggu yang lahir di RSCM di bulan April meningkat menjadi 74,69% dan 74,94% di bulan Mei dibandingkan dengan bulan Februari (40,55%) dan Maret (37,42%), p = 0,009. Rerata volume ASI dalam satu minggu pertama adalah 213,34 ± 61,13 ml, dengan waktu mencapai full feeding adalah 8 (5-32) hari pada bayi very preterm dan 11,5 (8-21) hari pada bayi extreme preterm. Faktor yang memengaruhi keberhasilan ASI adalah inisiasi perah dini dalam 24 jam pertama pasca-persalinan.Kesimpulan. Penerapan bundles care ASI melalui penggunaan daftar tilik pemberian ASI prematur dapat meningkatkan cakupan pemberian ASI bayi prematur di Unit Neonatal RSUPN Cipto Mangunkusumo. Penelitian ini merupakan penelitian pertama yang mengajukan penggunaan daftar tilik terstandard dalam bundles care pemberian ASI pada bayi prematur.

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Background. Prematurity is one of adverse conditions that causes failure to provide breast milk (BM). Quality improvement (QI) programs such as evidence-based intervention care bundles have been proven to provide better outcomes and increase opportunities for having mother’s breastmilk in premature babies.

Method. Quasy-experimental study that was conducted at the Cipto Mangunkusumo Hospital Neonatology Unit to 51 maternal and babies with gestational age below 32 weeks. We developed a breastmilk checklist for premature baby and care bundles intervention was implemented using that checklist since the first 24 hours after delivery. The rate of breast milk in Neonatology Unit after intervention was compared with the rate before intervention.

Result. Breastmilk rate during the intervention period for babies <32 weeks born at hospital increased to 74.69% and 74.94% respectively in April and May, compared with February (40.55%) and March (37.42%), p = 0.009. The average volume of breast milk in the first week was 213.34 ± 61.13 ml, with the time to reach full feeding being 8 (5-32) days in very preterm babies and 11.5 (8-21) days in extreme preterm babies.

Conclusion. The implementation of breast milk care bundles by using a breastmilk checklist for premature baby can increase the rate of breastmilk for premature babies in the Neonatal Unit of Cipto Mangunkusumo Hospital. This is the first study to propose the use of a standardized checklist in breastfeeding care bundle for premature babies."

"Gangguan oksigenasi merupakan masalah yang sering dialami oleh pasien yang dirawat di ruang perawatan intensif anak. Oksigen merupakan kemponen yang penting dalam pembentukan energi sehingga gangguan oksigenasi dapat memengaruhi keseimbangan energi. Teori Konservasi Levine bertujuan untuk mempertahankan keutuhan pasien melalui empat prinsip konservasi yaitu konservasi energi, konservasi integritas strukrutal, konservasi integritas personal dan konservasi integritas sosial sehingga dapat diaplikasikan pada anak dengan gangguan oksigenasi. Salah satu intervensi keperawatan yang sesuai dengan prinsip konservasi energi pada pasien dengan masalah oksigenasi adalah pengaturan posisi lateral kanan. Tujuan dari karya ilmiah ini adalah memberikan gambaran mengenai aplikasi teori Konservasi Levine dalam pemenuhan kebutuhan oksigenasi dan pengaruh pengaturan posisi lateral kanan pada anak yang dirawat di ruang perawatan intensif. Asuhan keperawatan dengan pendekatan teori Konservasi Levine diberikan kepada lima anak yang terpasang ventilator. Proses keperawatan mulai dari pengkajian sampai evaluasi dilakukan berdasarkan empat prinsip konservasi. Evaluasi keperawatan menunjukkan adanya perbaikan kondisi pada beberapa pasien. Demikian halnya dengan pengaturan posisi lateral kanan dengan kemiringan 30° terbukti efektif meningkatkan saturasi oksigen pada anak yang terpasang ventilasi mekanik. Penulis merekomendasikan penggunaan teori Konservasi Levine dalam memberikan asuhan keperawatan kepada anak dengan gangguan oksigenasi di ruang perawatan intensif. Selain itu penulis merekomendasikan pengaturan posisi lateral kanan dengan kemiringan 30° untuk dapat diaplikasikan di ruang perawatan intensif anak serta dilakukan uji klinik lebih lanjut dengan sampel yang lebih besar sehingga dapat dijadikan dasar penyusunan standar operasional prosedur.

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Oxygenation impairment is one of the problems that is often experienced by patients treated in pediatric intensive care units. Oxygen is an important component in energy formation.  Oxygenation impairment can affect energy balance. Levine's Conservation theory focuses on maintaining patient wholeness through four conservation principles, namely conservation of energy, conservation of structural integrity, conservation of personal integrity, and conservation of social integrity so that it can be applied to children with oxygenation impairment. One of the nursing interventions that relate to the conservation of energy in patients with oxygenation impairment is the positioning with the right lateral position. The purpose of this scientific paper is to provide an overview of the application of Levine's Conservation theory in meeting oxygenation needs and the effect of right lateral position in children treated in intensive care units. Nursing care with the application Levine Conservation theory was given to five children who were on ventilators. The nursing process from assessment to evaluation was carried out based on four conservation principles. Nursing evaluation showed an improvement in the condition of several patients. Likewise, the right lateral position setting with a 30° tilt has shown to be effective in increasing oxygen saturation in children who are on mechanical ventilation. The author recommends the use of Levine's Conservation theory in providing nursing care to children with impaired oxygenation in intensive care units. In addition, the author recommends setting the right lateral position with a 30° tilt to be applied in the pediatric intensive care room and conducting further clinical trials with larger samples so that it can be used as a basis for compiling standard operating procedures."

"Lingkungan perawatan intensif anak dapat menjadi stimulus yang memengaruhi proses adaptasi anak maupun orang tua/wali. Orang tua akan mengalami tekanan psikologis yang berat seperti stres dan kecemasan. Asuhan keperawatan dengan pendekatan model adaptasi Roy diharapkan dapat membantu proses adaptasi orang tua ketika anak menjalani perawatan di ruang intensif. Tujuan karya tulis ilmiah ini untuk memberikan gambaran aplikasi teori model adaptasi Roy pada orang tua yang mengalami stres dan kecemasan di ruang perawatan intensif anak serta mengembangkan inovasi orientasi pasien baru melalui video untuk menurunkan stres dan kecemasan orang tua. Proses keperawatan digambarkan pada lima kasus dengan menggunakan model adaptasi Roy. Proses keperawatan yang khas pada model adaptasi Roy terdapat pada pengkajian yang dilakukan dua tahap yaitu pengkajian perilaku dan stimulus. Proses selanjutnya menyusun diagnosis, tujuan, dan implementasi keperawatan. Hasil evaluasi akhir diketahui empat dari lima orang tua memiliki respons konsep diri yang adaptif. Kecemasan orang tua menurun setelah mendapatkan video orientasi pada hari pertama anak dirawat. Oleh sebab itu, model adaptasi Roy dapat diaplikasikan pada orang tua yang mengalami stres dan kecemasan di ruang perawatan intensif anak. Inovasi video orientasi dapat dijadikan alternatif media penyampaian informasi yang konsisten kepada orang tua pada saat hari pertama anak dirawat di ruang intensif

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The paediatric intensive care unit can be a stimulus that influences the adaptation process of children and their parents or guardians. Parents will experience severe psychological pressure, such as stress and anxiety. Nursing care using the Roy adaptation model approach is expected to help parents' adaptation processes when children undergo treatment in intensive care. The aim of this scientific paper is to provide an overview of the application of Roy's adaptation model theory to parents who experience stress and anxiety in paediatric intensive care and to develop new patient orientation innovations via video to reduce parental stress and anxiety. The nursing process is described in five cases using Roy's adaptation model. The typical nursing process in the Roy adaptation model consists of an assessment carried out in two stages, namely behavioural and stimulus assessment. The next process develops a diagnosis, goals, and implementation of nursing. The final evaluation results showed that four out of five parents had an adaptive self-concept response. Parental anxiety decreased after receiving an orientation video on the child's first day of care. Therefore, Roy's adaptation model can be applied to parents who experience stress and anxiety in paediatric intensive care. The orientation video innovation can be used as an alternative medium for delivering consistent information to parents on the child's first day of care in the intensive care unit."

"Gangguan cairan dan elektrolit merupakan masalah yang sering  mendasari anak dirawat di Gangguan cairan dan elektrolit merupakan masalah yang sering mendasari anak dirawat di ruang perawatan intensif anak dan datang dalam kondisi hipovolemia, sehingga membutuhkkan cairan intravena. Pemberian cairan intravena pada anak agar volume sirkulasi tercapai dan mencegah terjadinya syok. Tujuan Karya Ilmiah Akhir ini yaitu memberikan gambaran asuhan keperawatan pada anak dengan gangguan cairan dan elektrolit dan perawatan CVC menggunakan bundle CVC melalui pendekatan Model Konservasi Levine di ruang perawatan intensif anak. Model Konservasi Levine digambarkan pada 5 kasus anak. Pengkajian berdasarkan 4 prinsip konservasi yaitu konservasi energi, konservasi integritas struktural, konservasi integritas personal, konservasi integritas sosial. Trophicognosis dan hipotesis disusun berdasarkan masalah anak. Kemudian dilakukan intervensi agar anak mampu adaptasi sehingga mencapai keutuhan (wholeness). Model Konservasi Levine efektif dalam memberikan asuhan keperawatan pada anak dengan gangguan cairan dan elektrolit di ruang intensif. Implementasi Evidence Based Nursing menggunakan desain Pra-eksperimen, one group pre-posttest design, dengan besar sampel 20 anak di ruang intensif anak selama bulan Maret-April 2024. Hasil analisis dengan uji Cochran, menunjukkan bahwa setelah dilakukan perawatan CVC menggunakan bundle CVC tidak ada perbedaan bermakna terhadap kejadian infeksi CVC (p-value: 0,321).

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Fluid and electrolyte disorders are common problem which exists in children with hypovolemic under pediatric intensive care unit, so they need intravena fluid. The purpose of giving intravena fluid is to reach the volume circulation and to avoid shock conditions. The purpose of this paper is giving the description of nursing care for children with the case of fluid and electrolyte disorders and CVC care using a CVC bundle through the Levine Conservation Model approach. Levine Conservation Model is described in five pediatric cases. The assessment is based on four principles of conservation, namely energy conservation, structural integrity, personal integrity and social integrity. Trophicognosis and hypothesis is arranged based on pediatric problems. After that, intervention needs to be done so that children are able to adapt  to reach the wholeness. Levine Conservation Model is effective to give nursing care for the pediatric with fluid and electrolyte disorders in the Pediatric Intensive Care Unit. The implementation of Evidence Based Nursing uses Pra-experiment design, one group pre-posttest design, twenty pediatric patients under intensive care unit during March-April 2024. The results of the analysis using the Cochran test showed that after CVC care using the CVC bundle, there was no significant difference in the incidence of CVC infection (p-value: 0.321)."

"Gangguan integritas kulit merupakan salah satu permasalahan yang dapat dialami oleh anak dengan penggunaan alat bantu napas invasif, yaitu endotracheal tube (ETT). Alat bantu napas memerlukan perekat medis untuk menjaga posisi dalam keadaan aman. Perekat ini dapat menimbulkan cedera kulit yang dikenal dengan medical adhesive related skin injury (MARSI). Tujuan penulisan karya ilmiah ini adalah untuk memaparkan pencegahan gangguan integritas kulit menggunakan profilaksis hidrokoloid dengan pendekatan teori Kolcaba. Asuhan keperawatan menggunakan teori Kolcaba dipaparkan dalam studi kasus lima orang anak dengan rawatan intensif anak. Aplikasi teori Kolcaba menciptakan kenyamanan dari empat aspek yakni fisik, psikospiritual, sosiokultural, dan lingkungan. Penerapan profilaksis hidrokoloid terbukti mampu mencegah kejadian gangguan integritas kulit (MARSI). Berdasarkan hasil ini, perawat dapat menerapkan aspek kenyamanan untuk memberikan asuhan secara holistik, termasuk untuk mencegah terjadinya cedera pada kulit.

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Impaired skin integrity is one of the problems that can be experienced by children using invasive mechanical ventilation, such as endotracheal tube (ETT). Endotracheal tube requires medical adhesives to maintain a safe position. These adhesives can cause skin injuries known as medical adhesive-related skin injury (MARSI). The purpose of this scientific paper is to explain the prevention of impaired skin integrity using hydrocolloid prophylaxis with the Kolcaba theory approach. Nursing care using Kolcaba's theory is reported in a case study of five children in pediatric intensive care. The application of Kolcaba's theory creates comfort from four aspects: physical, psychospiritual, sociocultural, and environmental. The application of hydrocolloid prophylaxis has been shown to prevent the occurrence of impaired skin integrity (MARSI). Based on these results, nurses can apply the comfort aspect to provide holistic care, including preventing skin injury."

"Latar Belakang : Laporan kasus ini merupakan bentuk aplikatif penerapan asuhan keperawatan dengan pendekatan teori Virginia Henderson. Pasien dirawat dengan keluhan awal sesak napas yang semakin memberat dalam satu minggu terakhir sebelum masuk rumah sakit. Pasien memiliki riwayat TB yang terkonfirmasi pada tahun 2017 dan melakukan pengobatan rutin selama satu tahun hingga dinyatakann sembuh. Pasien terkonfirmasi positif HIV sejak tahun 2015 tetapi baru melakukan pengobatan rutin dengan ARV pada tahun 2018. Hasil pengkajian dengan pendekatan 14 kebutuhan dasar menurut Handerson didapatkan bahwa pasien memiliki masalah keperawatan utama pada pemenuhan kebutuhan bernapas secara normal pasien. Tujuan : Diharapkan dapat memberikan gambaran proses pemberian asuhan keperawatan dengan pendekatan teori Virginia Henderson pada pasien TB Paru Klinis dengan HIV yang berfokus pada tatakelola asuhan keperawatan dengan gangguan sistem respirasi. Hasil : Selama proses keperawatan ditemukan 7 diagnosis keperawatan utama serta dilakukan proses asuhan baik secara mandiri maupun kolaboratif selama 5 hari masa perawatan. Pasien tampak mengalami perbaikan kondisi pada akhir masa perawatan walaupun masih terdapat beberapa masalah keperawatan yang memerlukan tatalaksana lanjut ( discharge planning ) selama proses perawatan dirumah. Kesimpulan : Dalam pemberian asuhan keperawatan dengan pendekatan teori Henderson proses pengkajian memegang peranan penting dalam mengenali adanya kesenjangan terhadap pemenuhan 14 kebutuhan dasar pasien. Selain itu selama proses pemberian asuhan dapat dilihat peran serta perawat yang bertindak sebagai pengganti, penolong dan mitra bagi pasien dalam menyempurnakan, meningkatkan, mempertahankan kemandirian pasien.

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Background: This case report is an applicative form of application of nursing care with the Virginia Henderson theoretical approach. The patient was admitted with initial complaints of shortness of breath that had worsened in the last week before admission. The patient has a history of TB which was confirmed in 2017 and took routine treatment for one year until he was declared cured. The patient has been confirmed HIV positive since 2015 but has only started routine treatment with ARVs in 2018. The results of the assessment with the 14 basic needs approach according to Handerson found that the patient has a major nursing problem in meeting the patient's normal breathing needs. Objective: It is hoped that it can provide an overview of the process of providing nursing care with Virginia Henderson's theoretical approach in patients with Clinical Pulmonary TB with HIV which focuses on managing nursing care with respiratory system disorders. Results: During the nursing process, 7 main nursing diagnoses were found and the care process was carried out both independently and collaboratively for 5 days of care. Patients appear to have improved conditions at the end of the treatment period although there are still some nursing problems that require further management (discharge planning) during the home care process. Conclusion: In providing nursing care with the Henderson theory approach, the assessment process plays an important role in recognizing gaps in the fulfillment of the patient's basic needs. In addition, during the process of providing care, it can be seen the role of nurses who act as substitutes, helpers and partners for patients in perfecting, improving, maintaining patient independence.

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"[ABSTRAKLatar belakang: Hiponatremia pasca tindakan operasi mayor pada populasi anak merupakan gangguan elektrolit yang sering terjadi. Penggunaan cairan yang belum tepat sering menimbulkan peningkatan kejadian hiponatremia yang berhubungan erat dengan meningkatnya berbagai komplikasi seperti edema otak, kejang, bahkan kematian. Populasi anak merupakan risiko tinggi karena perbandingan jaringan otak dan tulang tengkorak yang lebih besar sehingga ruang yang tersedia saat terjadi edema otak lebih sempit.Tujuan: Mengetahui insidens hiponatremia pada anak pasca tindakan operasi mayor.Metode: Studi retrospektif potong lintang dilakukan terhadap anak usia 1 bulan hingga 18 tahun yang menjalani tindakan operasi mayor dan masuk ruang perawatan intensif. Penelusuran status medik sesuai kriteria inklusi dilakukan sampai jumlah sampel terpenuhi. Pencatatan terhadap subjek yang meliputi data praoperasi, intraoperasi, serta pemantauan pascaoperasi dilakukan. Subjek yang memenuhi definisi hiponatremia (<135 mEq/L) diklasifikasikan sesuai derajat hiponatremia dan dilakukan pencarian lebih lanjut terhadap komplikasi.Hasil : Studi dilakukan terhadap 90 subjek yang terdiri dari 56,7% lelaki, dengan 51,1% memiliki rentang usia 1 bulan hingga 4 tahun. Sebanyak 47,8% subjek menjalani tindakan laparatomi dengan berbagai indikasi. Hampir semua subjek (93,3%) mendapat cairan hipotonik pascaoperasi. Insidens hiponatremia pascaoperasi sebesar 28,9% dengan 11,1% diantaranya merupakan hiponatremia sedang-berat. Rerata kadar natrium pascaoperasi adalah 130,1 ± 4,1 mEq/L dengan rerata total cairan 79,8 ± 27,4 ml/kg. Sebesar 30,9% subjek yang mendapatkan cairan hipotonik pascaoperasi mengalami kejadian hiponatremia dengan rerata lama rawat 5,6 ± 4 hari. Terdapat 1/26 subjek yang mengalami komplikasi berupa kejang dan edema otak.Simpulan: Insidens hiponatremia pasca tindakan operasi mayor di ruang perawatan intensif hampir mencapai 30% dan sebagian besar mendapat cairan hipotonik pascaoperasi. Penelitian lebih lanjut perlu dilakukan untuk mengevaluasi pemberian cairan pascaoperasi yang tepat untuk mencegah hiponatremia.

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ABSTRACTBackground: Hyponatremia is commonly found post major surgery in pediatric population. The use of improper fluid often leads to increasing incidence of hyponatremia which causes complications such as cerebral edema, seizure, and death. Pediatric is a high risk population due to the large ratio between the brain tissue and skull, so that the availability space.Hyponatremia after major surgery in pediatric population is a common electrolyte disorder. The use of improper fluid often lead to increased incidence of hyponatremia which is closely linked to the increasing variety of complications such as cerebral edema, seizures, and even death. Pediatric is high risk population due to the larger comparison of brain tissue and the skull so that the space available in the event of brain edema narrower.Objective: To describe the incidence of hyponatremia in children after major surgery.Methods: A retrospective cross-sectional study was conducted on children aged 1 month to 18 years who underwent major surgery and entered the intensive care ward. The inclusion subjects was traced from medical records. The data was recorded from preoperative, intraoperative, and postoperative monitoring. Subjects who met hyponatremia (<135 mEq/L) were classified according to the severity of hyponatremia and its complications.Results: Ninety subjects were enrolled in this study (56.7% male, 51.1% age 1 month-4 years). There were 47.8% subjects underwent laparotomy with a variety of indications. Almost all subjects (93.3%) received postoperative hypotonic fluid. The incidence of postoperative hyponatremia was 28.9%, while 11.1% among them were moderate-severe hyponatremia. The mean postoperative sodium levels was 130.1 ± 4.1 mEq/L with a mean total fluid 79.8 ± 27.4 ml/kg. There were 30.9% subjects who received hypotonic fluids and experienced hyponatremia with a mean length of stay 5.6 ± 4 days. One of 26 subjects with hyponatremia suffered from seizures and brain edema.Conclusions: The incidence of postoperative hyponatremia in pediatric intensive care reached nearly 30%, and almost all of them received hypotonic fluid. Therefore, further research should be performed to evaluate the appropriate fluid in order to anticipating postoperative hyponatremia, Background: Hyponatremia is commonly found post major surgery in pediatric population. The use of improper fluid often leads to increasing incidence of hyponatremia which causes complications such as cerebral edema, seizure, and death. Pediatric is a high risk population due to the large ratio between the brain tissue and skull, so that the availability space.Hyponatremia after major surgery in pediatric population is a common electrolyte disorder. The use of improper fluid often lead to increased incidence of hyponatremia which is closely linked to the increasing variety of complications such as cerebral edema, seizures, and even death. Pediatric is high risk population due to the larger comparison of brain tissue and the skull so that the space available in the event of brain edema narrower.Objective: To describe the incidence of hyponatremia in children after major surgery.Methods: A retrospective cross-sectional study was conducted on children aged 1 month to 18 years who underwent major surgery and entered the intensive care ward. The inclusion subjects was traced from medical records. The data was recorded from preoperative, intraoperative, and postoperative monitoring. Subjects who met hyponatremia (<135 mEq/L) were classified according to the severity of hyponatremia and its complications.Results: Ninety subjects were enrolled in this study (56.7% male, 51.1% age 1 month-4 years). There were 47.8% subjects underwent laparotomy with a variety of indications. Almost all subjects (93.3%) received postoperative hypotonic fluid. The incidence of postoperative hyponatremia was 28.9%, while 11.1% among them were moderate-severe hyponatremia. The mean postoperative sodium levels was 130.1 ± 4.1 mEq/L with a mean total fluid 79.8 ± 27.4 ml/kg. There were 30.9% subjects who received hypotonic fluids and experienced hyponatremia with a mean length of stay 5.6 ± 4 days. One of 26 subjects with hyponatremia suffered from seizures and brain edema.Conclusions: The incidence of postoperative hyponatremia in pediatric intensive care reached nearly 30%, and almost all of them received hypotonic fluid. Therefore, further research should be performed to evaluate the appropriate fluid in order to anticipating postoperative hyponatremia]"

"Nyeri merupakan salah satu gejala yang paling sering dialami oleh pasien anak di ruang perawatan intensif yang dilakukan prosedur tindakan pengambilan darah. Perawat perlu memberikan asuhan keperawatan dengan menitikberatkan pada kenyamanan anak selama prosedur tindakan pengambilan darah di rumah sakit karena kenyamanan adalah hal penting dalam kualitas hidup pasien anak. Tujuan karya ilmiah ini adalah untuk menganalisis penerapan Teori Kenyamanan Kolcaba dalam proses asuhan keperawatan pada anak di ruang perawatan intensif yang mengalami nyeri saat pengambilan darah melalui pemberian intervensi terapi musik. Metode karya ilmiah ini adalah studi kasus pada lima pasien anak yang dirawat di ruang perawatan intensif yang mendapatkan prosedur tindakan pengambilan darah. Terdapat lima kasus pasien anak yang terpasang ventilasi mekanik yang diberikan asuhan keperawatan dengan pendekan Teori Kenyamanan Kolcaba dengan intervensi kenyamanan yang berbasis bukti yaitu intervensi terapi musik. Hasil menunjukkan bahwa Teori Kenyamanan Kolcaba dapat diterapkan dalam asuhan keperawatan anak dan terapi musik  efektif dalam menurunkan nyeri  pada anak yang dilakukan tindakan pengambilan darah.

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Pain is one of the most common symptoms experienced by pediatric patients in intensive care unit who are undergoing blood collection procedures. Nurses need to provide nursing care with an emphasis on children's comfort during blood collection procedures in hospitals because comfort is important in the quality of life of pediatric patients. The aim of this scientific work is to analyze the application of Kolcaba's Comfort Theory in the care process for children in intensive care who experience pain when taking blood through providing music therapy interventions. The method of this scientific work is a case study of five pediatric patients treated in intensive care who received a blood collection procedure. There were five cases of pediatric patients on mechanical ventilation who were given treatment using Kolcaba's Comfort Theory approach with evidence-based comfort interventions, namely music therapy interventions. The results show that Kolcaba's Comfort Theory can be applied in childcare and music therapy is effective in reducing pain in children who undergo blood sampling."