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"Anak-anak merupakan kelompok yang berisiko mengalami gangguan pemenuhan kebutuhan oksigenasi. Tujuan studi kasus ini adalah untuk memberikan gambaran pemenuhan kebutuhan oksigenasi pada anak melalui penerapan intervensi modifikasi pursed lips breathing menggunakan pendekatan teori kenyamanan Kolcaba. Pengkajian dilakukan berdasarkan taxonomy of comfort terhadap lima kasus terpilih yang menunjukkan gangguan pemenuhan kebutuhan oksigenasi. Intervensi dan implementasi ditujukan untuk meningkatkan kenyamanan serta membuat klien berada pada level transcendence terhadap kondisi ketidaknyamanan yang dirasakan. Intervensi modifikasi pursed lips breathing sebagai intervensi comfort food for the soul terbukti efektif meningkatkan status oksigenasi anak dan dapat diaplikasikan pada anak yang mengalami gangguan pemenuhan kebutuhan oksigenasi.

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Children are groups at risk of impaired fulfillment of oxygenation requirement. This case study was aimed to describe the oxygenation fulfillment requirements in children using the pursed lips breathing modification interventions through the Kolcaba's comfort theory approach. The assessment was conducted based on the taxonomy of comfort on five selected cases indicating impaired fulfillment of oxygenation requirement. Interventions and implementations are aimed at increasing comfort and making clients transcendence against the perceived discomfort. The intervention of pursed lips breathing modification as comfort food for the soul intervention has proven to be effective in improving the oxygenation status of children and can be applied to children with impaired fulfillment of oxygenation requirement."

"Latar Belakang: Morbiditas dan mortalitas akibat renjatan pada anak di seluruh dunia dilaporkan masih tinggi. Pengenalan dini dan tatalaksana yang tepat penting untuk menurunkan morbiditas dan mortalitas akibat renjatan. Indikator penting untuk mendeteksi hipoksia jaringan global adalah pengukuran saturasi oksigen mixed vein (SmvO₂) dari kateter arteri pulmonal atau vena sentral namun kedua pemeriksaan ini sulit dan invasif sehingga tidak rutin dilakukan. Near infrared spectroscopy (NIRS) merupakan alternatif pemeriksaan non invasif, real time, kontinu dan praktis untuk mengukur saturasi oksigen regional sekaligus menggambarkan saturasi oksigen vena global.Tujuan: Mengetahui kenaikan nilai NIRS serebral pascarenjatan teratasi serta korelasinya dengan perubahan parameter hemodinamik non invasif.

Metoda: Penelitian potong lintang pada anak usia 1 bulan-18 tahun yang mengalami renjatan di RSUPN Cipto Mangunkusumo, RSUD Pasar Rebo dan RSUD Tarakan pada bulan Maret-Juni 2019. Terhadap subjek yang mengalami renjatan dilakukan pengukuran NIRS serebral, MAP, serta pengukuran non invasif Cardiac Index (CI), Systemic Vascular Resistance Index (SVRI), Delivery Oxygen (DO₂), Inotrophy Index (INO), Stroke Volume Index (SVI) menggunakan Ultrasonic Cardiac Output Monitoring (USCOM) pada saat renjatan dan diulang ketika renjatan teratasi. Uji korelasi dilakukan untuk menilai hubungan antara perubahan nilai NIRS serebral dan parameter hemodinamik non invasif.

Hasil: Dari 32 subjek yang diteliti ditemukan peningkatan nilai NIRS serebral sebesar 27,7% pascarenjatan teratasi. Parameter hemodinamik, kecuali untuk SVRI, juga mengalami peningkatan pasca renjatan namun tidak berkorelasi dengan peningkatan nilai NIRS.

Simpulan: Hasil pengukuran NIRS serebral menggambarkan perfusi dan oksigenasi ke jaringan perifer namun tidak berkorelasi dengan parameter hemodinamik non invasif pada penelitian ini.

Kata kunci: Near infrared spectroscopy; parameter hemodinamik non invasif; renjatan; USCOM

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Background: Pediatric shock accounts for significant morbidity and mortality worldwide. Early recognition and timely intervention are critical for successful treatment of pediatric shock. A strong indicator of global tissue hypoxia by measuring mixed venous oxygen saturation from pulmonary artery catheter (PAC) or central vein catheter (CVC) is rarely used due to its highly invasive character. Near infrared spectroscopy (NIRS) is a noninvasive, real time, continuous and practical modality is a safe alternative for regional and global oxygen saturation measurement.

Objective: To evaluate the increment of cerebral NIRS post-resuscitation in pediatric shock and its correlation with noninvasive hemodynamic measurements.

Methods: This cross sectional study was conducted at Cipto Mangunkusumo Hospital, Pasar Rebo Hospital and Tarakan Hospital between March and June 2019. Children whose age ranged from1 month to 18 years admitted to Emergency Department (ED) or Pediatric Intensive Care Unit (PICU) due to shock were included. Measurement of cerebral NIRS, MAP, as well as Cardiac Index (CI), Systemic Vascular Resistance Index (SVRI), Delivery Oxygen (DO₂), Inotrophy Index (INO), Stroke Volume Index (SVI) using Ultrasonic Cardiac Output Monitoring (USCOM) were performed on admission and after resuscitation when the shock has resolved and the patients were stable. Correlation between cerebral NIRS and other noninvasive hemodynamic parameters were then analysed.

Results: There were 32 subjects participated in this research. Following resuscitation, cerebral NIRS measurements showed an increment of 27,7% compared to cerebral NIRS in shock state. All non invasive hemodynamic parameters, except for SVRI, were also increased after resuscitation but no correlation observed between these parameters to cerebral NIRS (p>0,005).

Conclusion: Cerebral NIRS is a sensitive parameter of peripheral perfusion but showed not correlation with hemodynamic parameters in this research."

"Pneumonia masih menjadi penyebab pertama kematian anak secara global dan nasional. Manajemen yang akurat diperlukan dalam mengatasi gangguan pemenuhan kebutuhan oksigen berupa bersihan jalan nafas tidak efektif pada anak dengan pneumonia untuk meningkatkan kepatenan jalan nafas. Model konservasi Levine berfokus pada pemeliharaan energi individu dengan pendekatan empat konservasi, yaitu konservasi energi, integritas personal, struktural, dan sosial. Tujuan penulisan karya ilmiah akhir spesialis ini adalah memberikan gambaran mengenai aplikasi teori konservasi Levine dalam pemenuhan kebutuhan oksigen anak yang dirawat di ruang rawat inap infeksi. Proses keperawatan menggunakan model konservasi Levine digambarkan dalam lima kasus pasien anak, yang meliputi pengkajian, trophycognosis, hipotesis, intervensi, dan respon organismik. Berdasarkan hasil pengkajian pada anak dengan gangguan pemenuhan kebutuhan oksigen ditemukan trophycognosis bersihan jalan nafas tidak efektif (100%), risiko aspirasi (100%), gangguan pertukaran gas (20%) dan pola nafas tidak efektif (20%). Intervensi berdasar konservasi Levine ditujukan untuk membantu anak beradaptasi terhadap kondisi sakit dan ditemukan 60% anak mengalami perbaikan dan 40% mengalami perburukan kondisi sehingga membutuhkan perawatan intensif. Penerapan quality improvement project dengan pemberian posisi semi-Fowler 45o saat dilakukan terapi kolaborasi inhalasi untuk meningkatkan bersihan jalan nafas pada anak pneumonia dengan gangguan pemenuhan kebutuhan oksigen menunjukkan efektif yang ditunjukkan dengan penurunan suara nafas ronkhi, penurunan frekuensi pernapasan dan peningkatan saturasi oksigen. Kesimpulan: aplikasi model konservasi Levine dapat diterapkan pada anak dengan gangguan pemenuhan kebutuhan oksigen di area perawatan akut di ruang rawat inap infeksi.

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Pneumonia is still the first cause of children death globally and nationally. Accurate management is needed to overcome disturbances in meeting oxygen needs in the form of ineffective airway clearance in children with pneumonia to improve airway patency. Levine’s conservation model focuses on maintaining individual energy with a four-conservation approach, namely energy conservation, structural, personal, and, social integrity conservation. The aim of writing the final specialist scientific paper is to provide an overview of the application of Levine’s conservation theory in meeting the oxygen needs of children treated in the infection inpatient wards. The nursing process using Levine’s conservation model is described in five cases of pediatric patients, which include assessment, trophycognosis, hypothesis, intervention, and organismic response. Based on the result of the assessment of children with impaired oxygen needs, trophycognosis found ineffective airway clearance (100%), risk of aspiration (100%), impaired gas exchange (20%), and ineffective breathing pattern (20%). Levine’s conservation-based interventions are aimed at helping children adapt to sick conditions and it was found that 60% of children experienced improvement and 40% experienced worsening condition requiring intensive care. The implementation of the quality improvement project by providing a semi-Fowler 45o position when carrying out collaborative inhalation therapy to increase airway clearance in children with pneumonia who have problems meeting oxygen needs has shown to be effective as indicated by a decrease in ronchi breath sounds, a decreased in respiratory frequency and an increase in oxygen saturation. Conclusion, the application of the Levine’s conservation model can be applied to children with problems meeting oxygen needs in the acute care area in the infection inpatient room."