Rhematoid Arthritis Rematik

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\af8 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\b1 \fs22 \dbch \af2 \hich
\af9 \loch \f9 \lang1033 \langnp1033 \langfe1033 \langfenp1033 A.PENGERTIAN}{\b1
\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033
\langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \s16 \qj \fi-360
\li1080 \ri0 \lisb0 \sa200 \lisa0 \pnrnot0 \sl360 \slmult1 \widctlpar \aspalpha
\aspnum \adjustright \lin1080 \rin0 \itap0 \ls1 \fs22 \dbch \af2 \hich \af0
\loch \af8 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\listtext \pard
\plain \fs22 \dbch \af2 \hich \af0 \loch \af8 \lang1033 \langnp1033 \langfe1033
\langfenp1033 \f2 1.\tab }{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033
\langnp1033 \langfe1057 \langfenp1057 Artritis reumatoid adalah suatu penyakit
inflamasi sistemik kronik yang tidak diketahui penyebabnya, dikarakteristikan oleh
kerusakan dan proliferasi membran sinovial, yang menyebabkan,kerusakan pada sendi
tulang ankilosis, dan deformitas. (Doenges, E Marilynn, 2000 : hal 859).}{\b1 \fs22
\dbch \af2 \hich \af9 \loch \f9 \lang1033 \langnp1033 \langfe1033 \langfenp1033
\par }\pard \plain \s16 \qj \fi-360 \li1080 \ri0 \lisb0 \sa200 \lisa0 \pnrnot0
\ls1 \fs22 \dbch \af2 \hich \af0 \loch \af8 \lang1033 \langnp1033 \langfe1033
\langfenp1033 {\listtext \pard \plain \fs22 \dbch \af2 \hich \af0 \loch \af8
\lang1033 \langnp1033 \langfe1033 \langfenp1033 \f2 2.\tab }{\fs22 \dbch \af2 \hich
\af9 \loch \f9 \lang1033 \langnp1033 \langfe1057 \langfenp1057 Rematoid Artritis
merupakan suatu penyakit inflamasi sistemik kronik yang manifestasi utamanya adalah
poliartritis yang progresif, akan tetapi penyakit ini juga melibatkan seluruh organ
tubuh.(Hidayat, 2006)}{\b1 \fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033
\li1080 \ri0 \lisb0 \sa200 \lisa0 \pnrnot0 \sl360 \slmult1 \widctlpar \aspalpha
\aspnum \adjustright \lin1080 \rin0 \itap0 \ls1 \fs22 \dbch \af2 \hich \af0
\loch \af8 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\listtext \pard
\langnp1033 \langfe1057 \langfenp1057 Artritis Reumatoid adalah gangguan autoimun
kronik yang menyebabkan proses inflamasi pada sendi (Lemone & Burke, 2001 : 1248).}
{\b1 \fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033 \langnp1033 \langfe1033
B.KLASIFIKASI}{\b1 \fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033 \langnp1033
\langfe1057 \langfenp1057 \par }\pard \plain \qj \fi720 \li0 \ri0 \lisb0 \sa0
\langfenp1033 {\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033 \langnp1033
\langfe1057 \langfenp1057 Klasifikasi Rheumatoid Arthritis :}{\fs22 \dbch \af2
\hich \af9 \loch \f9 \lang1033 \langnp1033 \langfe1057 \langfenp1057 \par }\pard
\plain \qj \fi76 \li0 \ri0 \lisb0 \sa0 \lisa0 \sl360 \slmult1 \widctlpar \lin0
\rin0 \itap0 \fs22 \dbch \af2 \hich \af0 \loch \af8 \lang1033 \langnp1033
\langfe1033 \langfenp1033 {\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033
\langnp1033 \langfe1033 \langfenp1033 \cf1 Buffer (2010) mengklasifikasikan
rheumatoid arthritis menjadi 4 tipe, yaitu:}{\fs22 \dbch \af2 \hich \af9 \loch
\f9 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \cf1 }{\fs22 \dbch \af2
\plain \s16 \qj \fi-360 \li1080 \ri0 \lisb0 \sa0 \lisa0 \sl360 \slmult1
\widctlpar \lin1080 \rin0 \itap0 \ls2 \fs22 \dbch \af2 \hich \af0 \loch \af8
\lang1033 \langnp1033 \langfe1033 \langfenp1033 {\listtext \pard \plain \fs22 \dbch
\af2 \hich \af0 \loch \af8 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \f2
1.\tab }{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033 \langnp1033 \langfe1033
\langfenp1033 \cf1 Rheumatoid arthritis klasik pada tipe ini harus terdapat 7
kriteria tanda dan gejala sendi yang harus berlangsung terus menerus, paling
sedikit dalam waktu 6 minggu.}{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033
\li1080 \ri0 \lisb0 \sa0 \lisa0 \sl360 \slmult1 \widctlpar \lin1080 \rin0 \itap0
\af9 \loch \f9 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \cf1 Rheumatoid
arthritis defisit pada tipe ini harus terdapat 5 kriteria tanda dan gejala sendi
yang harus berlangsung terus menerus, paling sedikit dalam waktu 6 minggu. }
{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033 \langnp1033 \langfe1057
\langfenp1057 \par }\pard \plain \s16 \qj \fi-360 \li1080 \ri0 \lisb0 \sa0
\lisa0 \sl360 \slmult1 \widctlpar \lin1080 \rin0 \itap0 \ls2 \fs22 \dbch \af2 \hich
\af0 \loch \af8 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\listtext \pard
\langfenp1033 \f2 3.\tab }{\i1 \fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033
\langnp1033 \langfe1033 \langfenp1033 \cf1 Probable }{\fs22 \dbch \af2 \hich
\af9 \loch \f9 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \cf1 rheumatoid
arthritis pada tipe ini harus terdapat 3 kriteria tanda dan gejala sendi yang harus
berlangsung terus menerus, paling sedikit dalam waktu 6 minggu.}{\fs22 \dbch
\par }\pard \plain \s16 \qj \fi-360 \li1080 \ri0 \lisb0 \sa0 \lisa0 \sl360 \slmult1
4.\tab }{\i1 \fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033 \langnp1033
\langfe1033 \langfenp1033 \cf1 Possible }{\fs22 \dbch \af2 \hich \af9 \loch \f9
\lang1033 \langnp1033 \langfe1033 \langfenp1033 \cf1 rheumatoid arthritis pada tipe
ini harus terdapat 2 kriteria tanda dan gejala sendi yang harus berlangsung terus
menerus, paling sedikit dalam waktu 3 bulan.}{\fs22 \dbch \af2 \hich \af9 \loch \f9
\lang1033 \langnp1033 \langfe1057 \langfenp1057 \par }\pard \plain \li0 \ri0 \lisb0
\sa0 \lisa0 \sl360 \slmult1 \widctlpar \lin0 \rin0 \itap0 \fs22 \dbch \af2 \hich
\par }\pard \plain \li0 \ri0 \lisb0 \sa0 \lisa0 \sl360 \slmult1 \widctlpar \lin0
\langfe1033 \langfenp1033 {\b1 \fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033
\langnp1033 \langfe1057 \langfenp1057 \par }\pard \plain \li0 \ri0 \lisb0 \sa0
\lisa0 \sl360 \slmult1 \widctlpar \lin0 \rin0 \itap0 \fs22 \dbch \af2 \hich \af0
\loch \af8 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\b1 \fs22 \dbch \af2
\hich \af9 \loch \f9 \lang1033 \langnp1033 \langfe1057 \langfenp1057 C.ETIOLOGI}
\langfenp1057 \par }\pard \plain \qj \li720 \ri0 \lisb0 \sa0 \lisa0 \sl360 \slmult1
\widctlpar \lin720 \rin0 \itap0 \fs22 \dbch \af2 \hich \af0 \loch \af8 \lang1033
\langnp1033 \langfe1033 \langfenp1033 {\fs22 \dbch \af2 \hich \af9 \loch \f9
\lang1033 \langnp1033 \langfe1057 \langfenp1057 \par }\pard \plain \qj \fi720
\cufi0 \li0 \culi0 \ri0 \lisb0 \sa0 \lisa0 \pnrnot0 \sl360 \slmult1 \widctlpar
\lin0 \rin0 \itap0 \ls0 \fs22 \dbch \af2 \hich \af0 \loch \af8 \lang1033
\lang1033 \langnp1033 \langfe1057 \langfenp1057 Penyebab utama penyakit reumatik
masih belum diketahui secara pasti.Biasanya merupakan kombinasi dari faktor
genetik, lingkungan, hormonal dan faktor sistem reproduksi.Namun faktor pencetus
terbesar adalah faktor infeksi seperti bakteri, mikoplasma dan virus (Lemone &
Burke, 2001).}{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033 \langnp1033
\langfe1057 \langfenp1057 \line }{\fs22 \dbch \af2 \hich \af9 \loch \f9
\lang1033 \langnp1033 \langfe1057 \langfenp1057 Ada beberapa teori yang dikemukakan
sebagai penyebab artritis reumatoid, yaitu:}{\fs22 \dbch \af2 \hich \af9 \loch
\f9 \lang1033 \langnp1033 \langfe1057 \langfenp1057 \par }\pard \plain \qj \fi15
\cufi0 \li425 \culi0 \ri0 \lisb0 \sa0 \lisa0 \pnrnot0 \sl360 \slmult1 \widctlpar
\langnp1033 \langfe1033 \langfenp1033 {\listtext \pard \plain \fs22 \dbch \af2
\hich \af0 \loch \af8 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \f2 1.\tab }
\langfenp1057 Infeksi Streptokkus hemolitikus dan Streptococcus non-hemolitikus.}
\langfenp1057 \par }\pard \plain \qj \fi15 \cufi0 \li425 \culi0 \ri0 \lisb0 \sa0
\lisa0 \pnrnot0 \sl360 \slmult1 \widctlpar \lin425 \rin0 \itap0 \ls3 \fs22 \dbch
\af2 \hich \af0 \loch \af8 \lang1033 \langnp1033 \langfe1033 \langfenp1033
{\listtext \pard \plain \fs22 \dbch \af2 \hich \af0 \loch \af8 \lang1033
\langnp1033 \langfe1033 \langfenp1033 \f2 2.\tab }{\fs22 \dbch \af2 \hich \af9
\loch \f9 \lang1033 \langnp1033 \langfe1057 \langfenp1057 Endokrin}{\fs22 \dbch
\par }\pard \plain \qj \fi15 \cufi0 \li425 \culi0 \ri0
\lisb0 \sa0 \lisa0 \pnrnot0 \sl360 \slmult1 \widctlpar \lin425 \rin0 \itap0
\af9 \loch \f9 \lang1033 \langnp1033 \langfe1057 \langfenp1057 Autoimmun}{\fs22
\par }\pard \plain \qj \fi15 \cufi0 \li425 \culi0 \ri0 \lisb0 \sa0 \lisa0
\pnrnot0 \sl360 \slmult1 \widctlpar \lin425 \rin0 \itap0 \ls3 \fs22 \dbch \af2
\hich \af0 \loch \af8 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\listtext
\pard \plain \fs22 \dbch \af2 \hich \af0 \loch \af8 \lang1033 \langnp1033
\langfe1033 \langfenp1033 \f2 4.\tab }{\fs22 \dbch \af2 \hich \af9 \loch \f9
\lang1033 \langnp1033 \langfe1057 \langfenp1057 Metabolik}{\fs22 \dbch \af2
\plain \qj \fi13 \cufi6 \li425 \culi193 \ri0 \lisb0 \sa0 \lisa0 \pnrnot0 \sl360
\slmult1 \widctlpar \lin425 \rin0 \itap0 \ls3 \fs22 \dbch \af2 \hich \af0 \loch
\af8 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\listtext \pard \plain
\langnp1033 \langfe1057 \langfenp1057 Faktor}{\fs22 \dbch \af2 \hich \af9 \loch \f9
\lang1033 \langnp1033 \langfe1057 \langfenp1057 }{\fs22 \dbch \af2 \hich \af9
\loch \f9 \lang1033 \langnp1033 \langfe1057 \langfenp1057 genetik serta pemicu
lingkungan}{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033 \langnp1033 \langfe1057
\langfenp1057 \line }{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033
\langnp1033 \langfe1057 \langfenp1057 Pada saat ini artritis reumatoid diduga
disebabkan oleh faktor autoimun dan infeksi. Autoimun ini bereaksi terhadap kolagen
tipe II; faktor infeksi mungkin disebabkan oleh karena virus dan organisme
mikroplasma atau grup difterioid yang menghasilkan antigen tipe II kolagen dari
tulang rawan sendi penderita.}{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033
\langnp1033 \langfe1057 \langfenp1057 \par }\pard \plain \fi13 \cufi6 \li425
\culi193 \ri0 \lisb0 \sa0 \lisa0 \pnrnot0 \sl360 \slmult1 \widctlpar \lin425
\langnp1033 \langfe1057 \langfenp1057 \par }\pard \plain \qj \li0 \ri0 \lisb0
\sa0 \lisa0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin0
\langnp1033 \langfe1057 \langfenp1057 D.PATOFISIOLOGI}{\b1 \fs22 \dbch \af2
\hich \af9 \loch \f9 \lang1033 \langnp1033 \langfe1057 \langfenp1057 \line }{\b1
\langfenp1057 \tab }{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033 \langnp1033
\langfe1057 \langfenp1057 Antigen mengaktivasi CD4+ sel T yang menstimulasi
monosit, makrofag dan syinovial fibroblas untuk memproduksi interleukin-1,
interleukin-6 dan TNF-\uc1 \u945 ? untuk mensekresikan matrik metaloproteinase
melalui hubungan antar sel dengan bantuan CD69 dan CD11 melalui pelepasan mediator-
mediator pelarut seperti interferon-\uc1 \u947 ? dan interleukin-17. Interleukin-1,
interlukin-6 dan TNF-\uc1 \u945 ? merupakan kunci terjadinya infla}{\fs22 \dbch
\af2 \hich \af9 \loch \f9 \lang1033 \langnp1033 \langfe1057 \langfenp1057 masi pada
rheumatoid arthritis.}{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033
\langnp1033 \langfe1057 \langfenp1057 \par }\pard \plain \qj \fi540 \li0 \ri0
\lisb0 \sa0 \lisa0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright
\lin0 \rin0 \itap0 \fs22 \dbch \af2 \hich \af0 \loch \af8 \lang1033 \langnp1033
\langnp1033 \langfe1057 \langfenp1057 Arktifasi CD4+ sel T juga menstimulasi sel B
melalui kontak sel secara langsung dan ikatan dengan \uc1 \u945 ?}{\fs22 \dbch \af2
\hich \af9 \loch \f9 \lang1033 \langnp1033 \langfe1057 \langfenp1057 \sub2 1}{\fs22
\uc1 \u946 ?}{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033 \langnp1033
\langfe1057 \langfenp1057 \sub2 2}{\fs22 \dbch \af2 \hich \af9 \loch \f9
\lang1033 \langnp1033 \langfe1057 \langfenp1057 integrin, CD40 ligan dan CD28
untuk memproduksi immunoglobulin meliputi rheumatoid faktor. Sebenarnya fungsi dari
rhumetoid faktor ini dalam proses patogenesis reumatoid artritis tidaklah diketahui
secara pasti, tapi kemungkinan besar reumatoid faktor mengaktiflkan berbagai
komplemen melalui pembentukan immun kompleks.aktifasi CD4+ sel T juga
mengekspresikan osteoclastogenesis yang secara keseluruhan ini menyebabkan gangguan
sendi. Aktifasi makrofag, limfosit dan fibroblas juga menstimulasi angiogenesis
sehingga terjadi peningkatan vaskularisasi yang ditemukan pada synovial penderita
reumatoid artritis.}{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033 \langnp1033
\langfe1057 \langfenp1057 \par }\pard \plain \qj \fi540 \li0 \ri0 \lisb0 \sa0
\langfe1057 \langfenp1057 \page }{\fs22 \dbch \af2 \hich \af9 \loch \f9
\lang1033 \langnp1033 \langfe1057 \langfenp1057 \par }\pard \plain \qj \fi-90
\li0 \ri0 \lisb0 \sa0 \lisa0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum
\adjustright \lin0 \rin0 \itap0 \fs22 \dbch \af2 \hich \af0 \loch \af8 \lang1033
\langnp1033 \langfe1033 \langfenp1033 {\b1 \fs22 \dbch \af2 \hich \af9 \loch \f9
\lang1033 \langnp1033 \langfe1057 \langfenp1057 E.PATHWAY}{\b1 \fs22 \dbch \af2
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\aspnum \adjustright \lin0 \rin0 \itap0 \fs22 \dbch \af2 \hich \af0 \loch \af8
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366590e72a172587b573baa69daccbe14f16dcda59ce2f2eaf06d8b1f3cb146c01dbf55ce2ba3b9d5e1
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1462801b9a0e697028da31400dc9a70273cd1814b814000a28a2800a28a2800a28a2800a28a2800a28a
2800a0f4a28a0066702b1fc49e16d2fc5b60969ac2cad1a3ef530ca63607ea2b6b028da280452d2b4cb
5d1b4d834fd3d3cbb78102a82724fd4f73ef56fa0e29d8146d143d44203cd1934b814b8a0630934a33c
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5145001451450014514500145145001451450021e949df8a7119a31400de7b9aa1ac68d65aed88b3d4e
33341e62c85376012a7233ea3dab43028c0cd2b011a2ac69b540555180074029fd78cd2ed18c51b4530
42649e40a39fce9d8a4c0a04264e734739cd3b028c0a0666e97a2d868c2e4d843b1aea669a672725dcf
a9f4ad0e452e052e39cd00273499cd3b1498140099e28c1f5a5c0cd181400a3a5145140051451400514
51400514514005145140051451400514514005145140051451400514514005145140051451400514514
00514514005145140051451400514514005145140051451400514514005145140051451400514514005
14514005145140051451400514514005145140051451400514514005145140051451400514514005145
14005145140051451400514514005145140051451400514514005145140051451400514514005145140
05145140051451400514514005145140051451401fffd9}}}}}{\fs22 \dbch \af2 \hich \af9
\loch \af9 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \cf13 }{\fs22 \dbch \af2
\plain \li0 \ri0 \lisb0 \sa0 \lisa0 \sl360 \slmult1 \widctlpar \lin0 \rin0
\itap0 \fs22 \dbch \af2 \hich \af0 \loch \af8 \lang1033 \langnp1033 \langfe1033
\langfe1057 \langfenp1057 \par }\pard \plain \li0 \ri0 \lisb0 \sa0 \lisa0 \sl360
\slmult1 \widctlpar \lin0 \rin0 \itap0 \fs22 \dbch \af2 \hich \af0 \loch \af8
\lang1033 \langnp1033 \langfe1033 \langfenp1033 {\b1 \fs22 \dbch \af2 \hich \af9
\loch \f9 \lang1033 \langnp1033 \langfe1057 \langfenp1057 \line }{\fs22 \dbch
\langnp1033 \langfe1057 \langfenp1057 \page }{\fs22 \dbch \af2 \hich \af9 \loch \f9
\lang1033 \langnp1033 \langfe1057 \langfenp1057 \par }\pard \plain \li0 \ri0 \sb100
\lisb0 \sa100 \lisa0 \sbauto1 \saauto1 \sl360 \slmult1 \widctlpar \aspalpha \aspnum
\langnp1033 \langfe1033 \langfenp1033 {\b1 \fs22 \dbch \af2 \hich \af9 \loch \f9
\lang1033 \langnp1033 \langfe1057 \langfenp1057 F.MANIFESTASI KLINIS}{\b1 \fs22
\par }\pard \plain \li0 \ri0 \sb100 \lisb0 \sa100 \lisa0 \sbauto1 \saauto1
\langfe1057 \langfenp1057 Pasien-pasien dengan RA akan menunjukan tanda dan gejala
seperti :}{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033 \langnp1033
\langfe1057 \langfenp1057 \par }\pard \plain \s16 \fi-360 \li1440 \ri0 \sb100
\adjustright \lin1440 \rin0 \itap0 \ls4 \fs22 \dbch \af2 \hich \af0 \loch \af8
\langfenp1057 Nyeri persendian}{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033
\langnp1033 \langfe1057 \langfenp1057 \par }\pard \plain \s16 \fi-360 \li1440
\ri0 \sb100 \lisb0 \sa100 \lisa0 \sbauto1 \saauto1 \sl360 \slmult1 \widctlpar
\aspalpha \aspnum \adjustright \lin1440 \rin0 \itap0 \ls4 \fs22 \dbch \af2 \hich
\langnp1033 \langfe1057 \langfenp1057 Bengkak (Rheumatoid nodule)}{\fs22 \dbch \af2
\plain \s16 \fi-360 \li1440 \ri0 \sb100 \lisb0 \sa100 \lisa0 \sbauto1 \saauto1
\af9 \loch \f9 \lang1033 \langnp1033 \langfe1057 \langfenp1057 Kekakuan pada sendi
terutama setelah bangun tidur pada pagi hari}{\fs22 \dbch \af2 \hich \af9 \loch \f9
\lang1033 \langnp1033 \langfe1057 \langfenp1057 \par }\pard \plain \s16 \fi-360
\li1440 \ri0 \sb100 \lisb0 \sa100 \lisa0 \sbauto1 \saauto1 \sl360 \slmult1
\widctlpar \aspalpha \aspnum \adjustright \lin1440 \rin0 \itap0 \ls4 \fs22 \dbch
\loch \f9 \lang1033 \langnp1033 \langfe1057 \langfenp1057 Terbatasnya pergerakan}
\langfenp1057 \par }\pard \plain \s16 \fi-360 \li1440 \ri0 \sb100 \lisb0 \sa100
\lisa0 \sbauto1 \saauto1 \sl360 \slmult1 \widctlpar \aspalpha \aspnum
\langfenp1057 Sendi-sendi
terasa panas}{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033 \langnp1033
\langfenp1057 Demam (pireksia)}{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033
\langnp1033 \langfe1057 \langfenp1057 Anemia}{\fs22 \dbch \af2 \hich \af9 \loch \f9
\loch \f9 \lang1033 \langnp1033 \langfe1057 \langfenp1057 Berat badan menurun}
\langfenp1057 Kekuatan berkurang}{\fs22 \dbch \af2 \hich \af9 \loch \f9
\loch \f9 \lang1033 \langnp1033 \langfe1057 \langfenp1057 Tampak warna kemerahan di
sekitar sendi}{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033 \langnp1033
11.\tab }{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033 \langnp1033
\langfe1057 \langfenp1057 Perubahan ukuran pada sendi dari ukuran normal}{\fs22
\par }\pard \plain \li0 \ri0 \sb100 \lisb0 \sa100 \lisa0 \sbauto1 \saauto1
\langfe1057 \langfenp1057 Pada tahap yang lanjut akan ditemukan tanda dan gejala
seperti :}{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033 \langnp1033
\langfenp1057 Gerakan menjadi terbatas}{\fs22 \dbch \af2 \hich \af9 \loch \f9
\loch \f9 \lang1033 \langnp1033 \langfe1057 \langfenp1057 Adanya nyeri tekan}{\fs22
\par }\pard \plain \s16 \fi-360 \li1440 \ri0 \sb100 \lisb0 \sa100 \lisa0
\sbauto1 \saauto1 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright
\langfenp1057 Deformitas bertambah pembengkakan}{\fs22 \dbch \af2 \hich \af9
\loch \f9 \lang1033 \langnp1033 \langfe1057 \langfenp1057 \par }\pard \plain
\s16 \fi-360 \li1440 \ri0 \sb100 \lisb0 \sa100 \lisa0 \sbauto1 \saauto1 \sl360
\slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin1440 \rin0 \itap0 \ls5 \fs22
\dbch \af2 \hich \af0 \loch \af8 \lang1033 \langnp1033 \langfe1033 \langfenp1033
\loch \f9 \lang1033 \langnp1033 \langfe1057 \langfenp1057 Kelemahan}{\fs22 \dbch
\langfenp1057 Depresi}{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033
\langnp1033 \langfe1057 \langfenp1057 \par }\pard \plain \li0 \ri0 \sb100 \lisb0
\sa100 \lisa0 \sbauto1 \saauto1 \sl360 \slmult1 \widctlpar \aspalpha \aspnum
\lang1033 \langnp1033 \langfe1057 \langfenp1057 Gejala Extraartikular :}{\fs22
\line }{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033 \langnp1033 \langfe1057
\langfenp1057 a. pada jantung :}{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033
\langfenp1033 \f3 \'b7\'00\tab }{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033
\langnp1033 \langfe1057 \langfenp1057 Rheumatoid heard diseasure}{\fs22 \dbch
\hich \af0 \loch \af8 \lang1033 \langnp1033 \langfe1033 \langfenp1033
\f3 \'b7\'00\tab }{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033 \langnp1033
\langfe1057 \langfenp1057 Valvula lesion (gangguan katub)}{\fs22 \dbch \af2
\lang1033 \langnp1033 \langfe1033 \langfenp1033 \f3 \'b7\'00\tab }{\fs22 \dbch \af2
\hich \af9 \loch \f9 \lang1033 \langnp1033 \langfe1057 \langfenp1057 Pericarditis}
\langfenp1057 \par }\pard \plain \s16 \fi990 \li90 \ri0 \sb100 \lisb0 \sa100 \lisa0
\langfe1057 \langfenp1057 Myocarditis}{\fs22 \dbch \af2 \hich
\af9 \loch \f9 \lang1033 \langnp1033 \langfe1057 \langfenp1057 \line }{\fs22 \dbch
\af2 \hich \af9 \loch \f9 \lang1033 \langnp1033 \langfe1057 \langfenp1057 b. pada
mata :}{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033 \langnp1033 \langfe1057
\langfenp1057 \par }\pard \plain \s16 \fi990 \li90 \ri0 \sb100 \lisb0 \sa100 \lisa0
\langfe1057 \langfenp1057 Keratokonjungtivitis}{\fs22 \dbch \af2 \hich \af9
\s16 \fi990 \li90 \ri0 \sb100 \lisb0 \sa100 \lisa0 \sbauto1 \pnrnot0 \saauto1
\hich \af9 \loch \f9 \lang1033 \langnp1033 \langfe1057 \langfenp1057 Scleritis}
\langnp1033 \langfe1057 \langfenp1057 c. pada lympa : Lhymphadenopathy}{\fs22 \dbch
\af2 \hich \af9 \loch \f9 \lang1033 \langnp1033 \langfe1057 \langfenp1057 \line }
\langfenp1057 d. pada thyroid : Lyphocytic thyroiditis}{\fs22 \dbch \af2 \hich \af9
\af2 \hich \af9 \loch \f9 \lang1033 \langnp1033 \langfe1057 \langfenp1057 e. pada
otot : Mycsitis}{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033 \langnp1033
\langfe1057 \langfenp1057 \par }\pard \plain \li-90 \ri0 \sb100 \lisb0 \sa100
\adjustright \lin-90 \rin0 \itap0 \fs22 \dbch \af2 \hich \af0 \loch \af8
\loch \f9 \lang1033 \langnp1033 \langfe1057 \langfenp1057 G.KOMPLIKASI}{\b1
\langfenp1057 \par }\pard \plain \s16 \fi-250 \cufi0 \li880 \culi0 \ri0 \lisb0 \sa0
\lisa0 \pnrnot0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright
\lin880 \rin0 \tql \tx810 \itap0 \ls7 \fs22 \dbch \af2 \hich \af0 \loch \af8
\langfe1057 \langfenp1057 Dapat menimbulkan perubahan pada jaringan lain seperti
adanya proses}{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033 \langnp1033
\langfe1057 \langfenp1057 }{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033
\langnp1033 \langfe1057 \langfenp1057 granulasi di bawah kulit yang disebut
subcutan nodule.}{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033 \langnp1033
\langfe1057 \langfenp1057 \par }\pard \plain \s16 \fi-810 \li1440 \ri0 \lisb0
\rin0 \tql \tx810 \itap0 \ls7 \fs22 \dbch \af2 \hich \af0 \loch \af8 \lang1033
\langfe1057 \langfenp1057 Pada otot dapat terjadi myosis, yaitu proses granulasi
jaringan otot.}{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033 \langnp1033
\langfe1057 \langfenp1057 Pada pembuluh darah terjadi tromboemboli.}{\fs22 \dbch
\par }\pard \plain \fi110 \cufi50 \li630 \ri0 \lisb0 \sa0 \lisa0 \sl360 \slmult1
\widctlpar \aspalpha \aspnum \adjustright \lin630 \rin0 \itap0 \fs22 \dbch \af2
\hich \af0 \loch \af8 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs22
Tromboemboli adalah adanya sumbatan pada pembuluh darah yang disebabkan oleh adanya
darah yang membeku.}{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033 \langnp1033
\langfe1057 \langfenp1057 Terjadi splenomegali.}{\fs22 \dbch \af2 \hich \af9
\loch \f9 \lang1033 \langnp1033 \langfe1057 \langfenp1057 \par }\pard \plain \li630
\ri0 \lisb0 \sa0 \lisa0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum
\adjustright \lin630 \rin0 \itap0 \fs22 \dbch \af2 \hich \af0 \loch \af8
\lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs22 \dbch \af2 \hich \af9
\loch \f9 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Slenomegali merupakan
pembesaran limfa,jika limfa membesar kemampuannya untuk\uc1 \u160 ? menyebabkan
berkurangnya jumlah sel darah putih dan trombosit dalam sirkulasi menangkap dan
menyimpan sel-sel darah akan meningkat.}{\b1 \fs22 \dbch \af2 \hich \af9 \loch
\f9 \lang1033 \langnp1033 \langfe1057 \langfenp1057 \par }\pard \plain \li0 \ri0
\lisb0 \sa0 \lisa0 \sl360 \slmult1 \widctlpar \lin0 \rin0 \itap0 \fs22 \dbch
\af2 \hich \af0 \loch \af8 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\b1
\langfenp1057 H.PEMERIKSAAN DIAGNOSTIK}{\b1 \fs22 \dbch \af2 \hich \af9 \loch
\f9 \lang1033 \langnp1033 \langfe1057 \langfenp1057 \par }\pard \plain \s16 \fi-360
\langnp1033 \langfe1033 \langfenp1033 \f3 \'b7\'00\tab }{\fs22 \dbch \af2 \hich
\af9 \loch \f9 \lang1033 \langnp1033 \langfe1057 \langfenp1057 Faktor Reumatoid :
positif pada 80-95% kasus}{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033
\langnp1033 \langfe1057 \langfenp1057 Fiksasi lateks: Positif pada 75 % dari kasus-
kasus khas.}{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033 \langnp1033
\langfe1057 \langfenp1057 Reaksi-reaksi aglutinasi : Positif pada lebih dari 50%
kasus-kasus khas.}{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033 \langnp1033
\langfe1057 \langfenp1057 LED : Umumnya meningkat pesat ( 80-100 mm/h) mungkin
kembali normal sewaktu gejala-gejala meningkat}{\fs22 \dbch \af2 \hich \af9
\langnp1033 \langfe1033 \langfenp1033 \f3 \'b7\'00\tab }{\fs22 \dbch \af2 \hich
\af9 \loch \f9 \lang1033 \langnp1033 \langfe1057 \langfenp1057 Protein C-reaktif:
positif selama masa eksaserbasi.}{\fs22 \dbch \af2 \hich \af9 \loch \f9
\li1440 \ri0 \sb100 \lisb0 \sa100 \lisa0
\langfe1057 \langfenp1057 SDP: Meningkat pada waktu timbul prosaes inflamasi.}
\langfe1057 \langfenp1057 JDL : umumnya menunjukkan anemia sedang.}{\fs22 \dbch
\langfe1057 \langfenp1057 Ig ( Ig M dan Ig G); peningkatan besar menunjukkan proses
autoimun sebagai penyebab AR.}{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033
\langnp1033 \langfe1057 \langfenp1057 Sinar X dari sendi yang sakit : menunjukkan
pembengkakan pada jaringan lunak, erosi sendi, dan osteoporosis dari tulang yang
berdekatan ( perubahan awal ) berkembang menjadi formasi kista tulang, memperkecil
jarak sendi dan subluksasio. Perubahan osteoartristik yang terjadi secara
bersamaan.}{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033 \langnp1033 \langfe1057
\langfe1057 \langfenp1057 Scan radionuklida : identifikasi peradangan sinovium}
\langfe1057 \langfenp1057 Artroskopi Langsung : Visualisasi dari area yang
menunjukkan irregularitas/ degenerasi tulang pada sendi}{\fs22 \dbch \af2 \hich
\af9 \loch \f9 \lang1033 \langnp1033 \langfe1057 \langfenp1057 \par }\pard
\hich \af9 \loch \f9 \lang1033 \langnp1033 \langfe1057 \langfenp1057 Aspirasi
cairan sinovial : mungkin menunjukkan volume yang lebih besar dari normal: buram,
berkabut, munculnya warna kuning ( respon inflamasi, produk-produk pembuangan
degeneratif ); elevasi SDP dan lekosit, penurunan viskositas dan komplemen ( C3 dan
C4 ).}{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033 \langnp1033 \langfe1057
\langfe1057 \langfenp1057 Biopsi membran sinovial : menunjukkan perubahan
inflamasi dan perkembangan panas.}{\fs22 \dbch \af2 \hich \af9 \loch \f9
\lang1033 \langnp1033 \langfe1057 \langfenp1057 \par }\pard \plain \qj \fi720
\af0 \loch \af8 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs22 \dbch
\af2 \hich \af9 \loch \f9 \lang1033 \langnp1033 \langfe1057 \langfenp1057 Kriteria
diagnostik Artritis Reumatoid adalah terdapat poli- arthritis yang simetris yang
mengenai sendi-sendi proksimal jari tangan dan kaki serta menetap sekurang-
kurangnya 6 minggu atau lebih bila ditemukan nodul subkutan atau gambaran erosi
peri-artikuler pada foto rontgen.}{\fs22 \dbch \af2 \hich \af9 \loch \f9
\lang1033 \langnp1033 \langfe1057 \langfenp1057 \par }\pard \plain \li0 \ri0 \sb100
\lang1033 \langnp1033 \langfe1057 \langfenp1057 Kriteria Artritis rematoid menurut
American Reumatism Association ( ARA ) adalah:}{\fs22 \dbch \af2 \hich \af9
\af2 \hich \af9 \loch \f9 \lang1033 \langnp1033 \langfe1057 \langfenp1057 1.
Kekakuan sendi jari-jari tangan pada pagi hari ( Morning Stiffness ).}{\fs22
\langfenp1057 2. Nyeri pada pergerakan sendi atau nyeri tekan sekurang-kurangnya
pada satu sendi.}{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033 \langnp1033
\lang1033 \langnp1033 \langfe1057 \langfenp1057 3. Pembengkakan ( oleh penebalan
jaringan lunak atau oleh efusi cairan ) pada salah satu sendi secara terus-menerus
sekurang-kurangnya selama 6 minggu.}{\fs22 \dbch \af2 \hich \af9 \loch \f9
\lang1033 \langnp1033 \langfe1057 \langfenp1057 \line }{\fs22 \dbch \af2 \hich \af9
\loch \f9 \lang1033 \langnp1033 \langfe1057 \langfenp1057 4. Pembengkakan pada
sekurang-kurangnya salah satu sendi lain.}{\fs22 \dbch \af2 \hich \af9 \loch \f9
\loch \f9 \lang1033 \langnp1033 \langfe1057 \langfenp1057 5. Pembengkakan sendi
yanmg bersifat simetris.}{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033
\langnp1033 \langfe1057 \langfenp1057 \line }{\fs22 \dbch \af2 \hich \af9 \loch \f9
\lang1033 \langnp1033 \langfe1057 \langfenp1057 6. Nodul subcutan pada daerah
tonjolan tulang didaerah ekstensor.}{\fs22 \dbch \af2 \hich \af9 \loch \f9
\loch \f9 \lang1033 \langnp1033 \langfe1057 \langfenp1057 7. Gambaran foto rontgen
yang khas pada arthritis rheumatoid}{\fs22 \dbch \af2 \hich \af9 \loch \f9
\loch \f9 \lang1033 \langnp1033 \langfe1057 \langfenp1057 8. Uji aglutinnasi faktor
rheumatoid}{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033 \langnp1033 \langfe1057
\langnp1033 \langfe1057 \langfenp1057 9. Pengendapan cairan musin yang jelek}{\fs22
\langfenp1057 10. Perubahan karakteristik histologik lapisan sinovia}{\fs22
\langfenp1057 11. gambaran histologik yang khas pada nodul.}{\fs22 \dbch \af2 \hich
\plain \li0 \ri0 \sb100 \lisb0 \sa100 \lisa0 \sbauto1 \saauto1 \sl360 \slmult1
Berdasarkan
kriteria ini maka disebut :}{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033
\lang1033 \langnp1033 \langfe1057 \langfenp1057 Klasik : bila terdapat 7 kriteria
dan berlangsung sekurang-kurangnya selama 6 minggu}{\fs22 \dbch \af2 \hich \af9
\af2 \hich \af9 \loch \f9 \lang1033 \langnp1033 \langfe1057 \langfenp1057 Definitif
: bila terdapat 5 kriteria dan berlangsung sekurang-kurangnya selama 6 minggu.}
\langnp1033 \langfe1057 \langfenp1057 Kemungkinan rheumatoid : bila terdapat 3
kriteria dan berlangsung sekurang-kurangnya selama 4 minggu.}{\fs22 \dbch \af2
\plain \qj \fi360 \li0 \ri0 \lisb0 \sa0 \lisa0 \sl360 \slmult1 \widctlpar \aspalpha
\li0 \ri0 \lisb0 \sa0 \lisa0 \sl360 \slmult1 \widctlpar \lin0 \rin0 \itap0 \fs22
\langfenp1057 I.}{\b1 \fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033
\langnp1033 \langfe1057 \langfenp1057 }{\b1 \fs22 \dbch \af2 \hich \af9 \loch
\f9 \lang1033 \langnp1033 \langfe1057 \langfenp1057 PENATALAKSANAAN}{\b1 \fs22
\langnp1033 \langfe1033 \langfenp1033 \f0 1.\tab }{\b1 \fs22 \dbch \af2 \hich
\af9 \loch \f9 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Medis}{\fs22
\par }\pard \plain \qj \fi360 \li360 \ri0 \lisb0 \sa0 \lisa0 \sl360 \slmult1
Penatalaksanaan medik pada pasien RA diantaranya :}{\fs22 \dbch \af2 \hich \af9
\s16 \qj \fi-360 \li1440 \ri0 \lisb0 \sa0 \lisa0 \sl360 \slmult1 \widctlpar
\aspalpha \aspnum \adjustright \lin1440 \rin0 \tql \tx1710 \tql \tx1800 \itap0 \ls7
\hich \af9 \loch \f9 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Termoterapi}
\langfenp1057 \par }\pard \plain \s16 \qj \fi-360 \li1440 \ri0 \lisb0 \sa0
\lisa0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin1440 \rin0
\tql \tx1710 \tql \tx1800 \itap0 \ls7 \fs22 \dbch \af2 \hich \af0 \loch \af8
\langfe1033 \langfenp1033 Gizi yaitu dengan memberikan gizi yang tepat}{\fs22 \dbch
\widctlpar \aspalpha \aspnum \adjustright \lin1440 \rin0 \tql \tx1710 \tql
\tx1800 \itap0 \ls7 \fs22 \dbch \af2 \hich \af0 \loch \af8 \lang1033 \langnp1033
\langfe1033 \langfenp1033 {\listtext \pard \plain \fs22 \dbch \af2 \hich \af0 \loch
\af8 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \f3 \'b7\'00\tab }{\fs22 \dbch
\af2 \hich \af9 \loch \f9 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Pemberian
Obat-obatan :}{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033 \langnp1033
\langfe1057 \langfenp1057 \par }\pard \plain \qj \fi720 \cufi0 \li720 \culi0
\loch \f9 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Anti Inflamasi non
steroid (NSAID) contoh:aspirin yang diberikan pada dosis yang telah ditentukan.}
\langfenp1057 \par }\pard \plain \qj \fi720 \cufi0 \li720 \culi0 \ri0 \lisb0
\sa0 \lisa0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin720 \rin0
\langfe1033 \langfenp1033 Obat-obat untuk Reumatoid Artitis : Acetyl salicylic
acid, Cholyn salicylate (Analgetik, Antipyretik, Anty Inflamatory). }{\fs22
\par }\pard \plain \qj \li0 \ri0 \lisb0 \sa0 \lisa0 \sl360 \slmult1 \widctlpar
\aspalpha \aspnum \adjustright \lin0 \rin0 \itap0 \fs22 \dbch \af2 \hich \af0 \loch
\af8 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs22 \dbch \af2 \hich
\af9 \loch \f9 \lang1057 \langnp1057 \langfe1033 \langfenp1033 \tab \tab }{\fs22
Pembedahan menjadi pilihan apabila pemberian obat-obatan tidak berhasil mencegah
dan memperlambat kerusakan sendi. Pembedahan dapat mengembalikan fungsi dari sendi
anda yang telah rusak. Prosedur yang dapat dilakukan adalah artroplasti, perbaikan
tendon, sinovektomi.}{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033
2.\tab }{\b1 \fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033 \langnp1033
\langfe1033 \langfenp1033 Keperawatan }{\fs22 \dbch \af2 \hich \af9 \loch \f9
\adjustright \lin1920 \rin0 \tql \tx2160 \tql \tx2880 \tql \tx3060 \itap0 \ls9
\hich \af9 \loch \f9 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Pendidikan}
\langfe1033 \langfenp1033 :meliputi tentang pengertian, patofisiologi, penyebab,
dan prognosis penyakit ini}{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033
\adjustright \lin1920 \rin0 \tql \tx2160 \tql \tx2880 \tql \tx3060 \itap0 \ls9
\hich \af9 \loch \f9 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Istirahat}
\langfe1033 \langfenp1033 : karena pada RA ini disertai rasa lelah yang hebat}
\langfenp1057 \par }\pard \plain \s16 \fi-360 \li1920 \ri0 \lisb0 \sa0 \lisa0
\sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin1920 \rin0 \tql
\tx2160 \tql \tx2880 \tql \tx3060 \itap0 \ls9 \fs22 \dbch \af2 \hich \af0 \loch
\af8 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\listtext \pard \plain
\langnp1033 \langfe1033 \langfenp1033 Latihan}{\fs22 \dbch \af2 \hich \af9
\loch \f9 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \tab }{\fs22 \dbch
\af2 \hich \af9 \loch \f9 \lang1033 \langnp1033 \langfe1033 \langfenp1033 : pada
saat pasien tidak merasa lelah atau inflamasi berkurang, ini bertujuan untuk
mempertahankan fungsi sendi pasien.}{\fs22 \dbch \af2 \hich \af9 \loch \f9
\lang1033 \langnp1033 \langfe1057 \langfenp1057 \par }\pard \plain \qj \li0 \ri0
\lisb0 \sa0 \lisa0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright
\lin0 \rin0 \itap0 \fs22 \dbch \af2 \hich \af0 \loch \af8 \lang1033 \langnp1033
\lisa0 \sl360 \slmult1 \widctlpar \lin0
\langnp1033 \langfe1057 \langfenp1057 KONSEP ASKEP}{\b1 \fs22 \dbch \af2 \hich \af9
\li0 \ri0 \lisb0 \sa0 \lisa0 \sl360 \slmult1 \widctlpar \lin0 \rin0 \itap0 \fs22
\langfenp1057 A.PENGKAJIAN}{\b1 \fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033
\langnp1033 \langfe1057 \langfenp1057 \par }\pard \plain \qj \li360 \ri0 \lisb0
\sa0 \lisa0 \sl360 \slmult1 \widctlpar \lin360 \rin0 \itap0 \fs22 \dbch \af2
Data dasar pengkajian pasien tergantung padwa keparahan dan keterlibatan organ-
organ lainnya ( misalnya mata, jantung, paru-paru, ginjal ), tahapan misalnya
eksaserbasi akut atau remisi dan keberadaaan bersama bentuk-bentuk arthritis
lainnya.}{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033 \langnp1033
\sa0 \lisa0 \sl360 \slmult1 \widctlpar \lin1080 \rin0 \itap0 \ls10 \fs22 \dbch \af2
\lang1033 \langnp1033 \langfe1057 \langfenp1057 Aktivitas/ istirahat}{\fs22
\par }\pard \plain \ql \li1080 \ri0 \lisb0 \sa0 \lisa0 \sl360 \slmult1
\widctlpar \lin1080 \rin0 \itap0 \fs22 \dbch \af2 \hich \af0 \loch \af8
\loch \f9 \lang1033 \langnp1033 \langfe1057 \langfenp1057 Gejala : Nyeri sendi
karena gerakan, nyeri tekan, memburuk dengan stres pada sendi; kekakuan pada pagi
hari, biasanya terjadi bilateral dan simetris.}{\fs22 \dbch \af2 \hich \af9
\af2 \hich \af9 \loch \f9 \lang1033 \langnp1033 \langfe1057 \langfenp1057 Limitasi
fungsional yang berpengaruh pada gaya hidup, waktu senggang, pekerjaan, keletihan.}
\langnp1033 \langfe1057 \langfenp1057 Tanda : Malaise}{\fs22 \dbch \af2 \hich
\af9 \loch \f9 \lang1033 \langnp1033 \langfe1057 \langfenp1057 \line }{\fs22
Keterbatasan rentang gerak; atrofi otot, kulit, kontraktur/ kelaianan pada sendi.}
\langfenp1057 \par }\pard \plain \s16 \fi-360 \li1080 \ri0 \lisb0 \sa0 \lisa0
\sl360 \slmult1 \widctlpar \lin1080 \rin0 \itap0 \ls10 \fs22 \dbch \af2 \hich
\langnp1033 \langfe1057 \langfenp1057 Kardiovaskuler}{\fs22 \dbch \af2 \hich
Gejala : Fenomena Raynaud jari tangan/ kaki ( pucat intermitten, sianosis, kemudian
kemerahan pada jari sebelum warna kembali normal)}{\b1 \fs22 \dbch \af2 \hich
\plain \s16 \fi-360 \li1080 \ri0 \lisb0 \sa0 \lisa0 \sl360 \slmult1 \widctlpar
\langfenp1057 Integritas ego}{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033
\lang1033 \langnp1033 \langfe1057 \langfenp1057 Gejala : Faktor-faktor stres akut/
kronis: mis; finansial, pekerjaan, ketidakmampuan, faktor-faktor hubungan.}
\langnp1033 \langfe1057 \langfenp1057 Keputusan dan ketidakberdayaan ( situasi
ketidakmampuan )}{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033 \langnp1033
\lang1033 \langnp1033 \langfe1057 \langfenp1057 Ancaman pada konsep diri, citra
tubuh, identitas pribadi ( misalnya ketergantungan pada orang lain).}{\b1 \fs22
\par }\pard \plain \s16 \fi-360 \li1080 \ri0 \lisb0 \sa0 \lisa0 \sl360 \slmult1
\langfenp1057 Makanan/ cairan}{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033
\lang1033 \langnp1033 \langfe1057 \langfenp1057 Gejala ; Ketidakmampuan untuk
menghasilkan/ mengkonsumsi makanan/ cairan adekuat: mual, anoreksia}{\fs22 \dbch
\af2 \hich \af9 \loch \f9 \lang1033 \langnp1033 \langfe1057 \langfenp1057 \line }
\langfenp1057 Kesulitan untuk mengunyah ( keterlibatan TMJ )}{\fs22 \dbch \af2
\hich \af9 \loch \f9 \lang1033 \langnp1033 \langfe1057 \langfenp1057 \line }
\langfenp1057 Tanda : Penurunan berat badan}{\fs22 \dbch \af2 \hich \af9 \loch
\f9 \lang1033 \langnp1033 \langfe1057 \langfenp1057 \line }{\fs22 \dbch \af2
\hich \af9 \loch \f9 \lang1033 \langnp1033 \langfe1057 \langfenp1057 Kekeringan
pada membran mukosa.}{\b1 \fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033
\ri0 \lisb0 \sa0 \lisa0 \sl360 \slmult1 \widctlpar \lin1080 \rin0 \itap0 \ls10
\af9 \loch \f9 \lang1033 \langnp1033 \langfe1057 \langfenp1057 Hygiene}{\fs22
\langfenp1057 Gejala : Berbagai kesulitan untuk melaksanakan aktivitas perawatan
pribadi. Ketergantungan}{\b1 \fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033
\ri0 \lisb0 \sa0 \lisa0 \sl360 \slmult1 \widctlpar \lin1080 \rin0 \itap0 \ls10
\af9 \loch \f9 \lang1033 \langnp1033 \langfe1057 \langfenp1057 Neurosensori}
\langnp1033 \langfe1057 \langfenp1057 Tanda: Kebas, semutan pada tangan dan kaki,
hilangnya sensasi pada jari tangan.}{\fs22 \dbch \af2 \hich \af9 \loch \f9
\loch \f9 \lang1033 \langnp1033 \langfe1057 \langfenp1057 Gejala : Pembengkakan
sendi simetris.}{\b1 \fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033 \langnp1033
\sa0 \lisa0 \sl360 \slmult1 \widctlpar \lin1080 \rin0 \itap0 \ls10 \fs22 \dbch \af2
\lang1033 \langnp1033 \langfe1057 \langfenp1057 Nyeri/ kenyamanan}{\fs22 \dbch \af2
\langfenp1057 Gejala : Fase akut dari nyeri ( mungkin tidak disertai oleh
pembengkakan jaringan lunak pada sendi )}{\b1 \fs22 \dbch \af2 \hich \af9 \loch \f9
\af9 \loch \f9 \lang1033 \langnp1033 \langfe1057 \langfenp1057 Keamanan}{\fs22
\langfenp1057 Gejala : Kulit mengkilat,
tegang, nodul subkutaneus.}{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033
\lang1033 \langnp1033 \langfe1057 \langfenp1057 Lesi kulit, ulkus kaki.}{\fs22
\langfenp1057 Kesulitan dalam ringan dalam menangani tugas/ pemeliharaan rumah
tangga.}{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033 \langnp1033 \langfe1057
\langnp1033 \langfe1057 \langfenp1057 Demam ringan menetap}{\fs22 \dbch \af2
\langfenp1057 Kekeringan pada meta dan membran mukosa.}{\b1 \fs22 \dbch \af2
\langfenp1057 Interaksi sosial}{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033
\lang1033 \langnp1033 \langfe1057 \langfenp1057 Gejala : Kerusakan interaksi sosial
dengan keluarga/ orang lain; perubahan peran; isolasi}{\b1 \fs22 \dbch \af2
\plain \s16 \li90 \ri0 \lisb0 \sa0 \lisa0 \sl360 \slmult1 \widctlpar \lin90
\langnp1033 \langfe1057 \langfenp1057 B.DIAGNOSA YANG MUNGKIN MUNCUL}{\b1 \fs22
\par }\pard \plain \s16 \fi-360 \li1080 \ri0 \lisb0 \sa0 \lisa0 \sl360 \slmult1
\langfenp1057 Nyeri berhubungan dengan agen pencedera, distensi jaringan oleh
akumulasi cairan/ proses inflamasi, destruksi sendi.}{\b1 \fs22 \dbch \af2 \hich
\langfenp1057 Gangguan mobilitas fisik berhubungan dengan deformitas skeletal,}
\langnp1033 \langfe1057 \langfenp1057 nyeri, penurunan kekuatan otot.}{\b1 \fs22
\langfenp1057 Gangguan Citra Tubuh / Perubahan Penampilan Peran berhubungan dengan
perubahan kemampuan untuk melaksanakan tugas-tugas umum, peningkatan penggunaan
energi, ketidakseimbangan mobilitas.}{\fs22 \dbch \af2 \hich \af9 \loch \f9
\af9 \loch \f9 \lang1033 \langnp1033 \langfe1057 \langfenp1057 Defisit perawatan
diri berhubungan dengan kerusakan musculoskeletal, penurunan kekuatan, daya tahan,
nyeri pada waktu bergerak, depresi.}{\b1 \fs22 \dbch \af2 \hich \af9 \loch \f9
\sa0 \lisa0 \sl360 \slmult1 \widctlpar \lin0 \rin0 \itap0 \fs22 \dbch \af2 \hich
\langnp1033 \langfe1057 \langfenp1057 C.INTERVENSI KEPERAWATAN}{\fs22 \dbch \af2
\plain \fi-360 \li630 \ri0 \sb100 \lisb0 \sa100 \lisa0 \sbauto1 \saauto1 \sl360
\slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin630 \rin0 \itap0 \fs22 \dbch
\langfenp1057 1. Nyeri berhubungan dengan agen pencedera, distensi jaringan oleh
akumulasi cairan/ proses inflamasi, destruksi sendi.}{\fs22 \dbch \af2 \hich
Dapat dibuktikan oleh : Keluhan nyeri, ketidaknyamanan, kelelahan, berfokus pada
diri sendiri, Perilaku distraksi/ respons autonomic}{\fs22 \dbch \af2 \hich \af9
\af2 \hich \af9 \loch \f9 \lang1033 \langnp1033 \langfe1057 \langfenp1057 Perilaku
yang bersifat hati-hati/ melindungi.}{\fs22 \dbch \af2 \hich \af9 \loch \f9
\loch \f9 \lang1033 \langnp1033 \langfe1057 \langfenp1057 Hasil yang diharapkan/
kriteria evaluasi pasien akan:}{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033
\lang1033 \langnp1033 \langfe1057 \langfenp1057 \uc1 \u8226 ? Menunjukkan nyeri
hilang/ terkontrol}{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033 \langnp1033
\lang1033 \langnp1033 \langfe1057 \langfenp1057 \uc1 \u8226 ? Terlihat rileks,
dapat tidur/beristirahat dan berpartisipasi dalam aktivitas sesuai kemampuan.}
\langnp1033 \langfe1057 \langfenp1057 \uc1 \u8226 ? Mengikuti program farmakologis
yang diresepkan}{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033 \langnp1033
\lang1033 \langnp1033 \langfe1057 \langfenp1057 \uc1 \u8226 ? Menggabungkan
keterampilan relaksasi dan aktivitas hiburan ke dalam program kontrol nyeri.}{\fs22
\par }\pard \plain \li360 \ri0 \sb100 \lisb0 \sa100 \lisa0 \sbauto1 \saauto1 \sl360
\slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin360 \rin0 \itap0 \fs22 \dbch
\langfenp1057 Intervensi dan Rasional :}{\fs22 \dbch \af2 \hich \af9 \loch \f9
\widctlpar \aspalpha \aspnum \adjustright \lin1080 \rin0 \itap0 \ls12 \fs22
\loch \f9 \lang1033 \langnp1033 \langfe1057 \langfenp1057 Selidiki keluhan nyeri,
catat lokasi dan intensitas (skala 0-10). Catat faktor-faktor yang mempercepat dan
tanda-tanda rasa sakit non verbal (R/ Membantu dalam menentukan kebutuhan manajemen
nyeri dan keefektifan program}{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033
\aspalpha \aspnum \adjustright \lin1080 \rin0 \itap0 \ls12 \fs22 \dbch \af2
\lang1033 \langnp1033 \langfe1057 \langfenp1057 Berikan matras/ kasur keras,
bantal kecil,. Tinggikan linen tempat tidur sesuai kebutuhan (R/Matras yang lembut/
empuk, bantal yang besar akan mencegah pemeliharaan kesejajaran tubuh
yang tepat, menempatkan stress pada sendi yang sakit. Peninggian linen tempat
tidur menurunkan tekanan pada sendi yang terinflamasi/nyeri)}{\fs22 \dbch \af2
\af9 \loch \f9 \lang1033 \langnp1033 \langfe1057 \langfenp1057 Tempatkan/ pantau
penggunaan bantl, karung pasir, gulungan trokhanter, bebat, brace. (R/
Mengistirahatkan sendi-sendi yang sakit dan mempertahankan posisi netral.
Penggunaan brace dapat menurunkan nyeri dan dapat mengurangi kerusakan pada sendi)}
\langfenp1057 Dorong untuk sering mengubah posisi,. Bantu untuk bergerak di tempat
tidur, sokong sendi yang sakit di atas dan bawah, hindari gerakan yang menyentak.
(R/ Mencegah terjadinya kelelahan umum dan kekakuan sendi. Menstabilkan sendi,
mengurangi gerakan/ rasa sakit pada sendi)}{\fs22 \dbch \af2 \hich \af9 \loch
\loch \f9 \lang1033 \langnp1033 \langfe1057 \langfenp1057 Anjurkan pasien untuk
mandi air hangat atau mandi pancuran pada waktu bangun dan/atau pada waktu tidur.
Sediakan waslap hangat untuk mengompres sendi-sendi yang sakit beberapa kali
sehari. Pantau suhu air kompres, air mandi, dan sebagainya. (R/ Panas meningkatkan
relaksasi otot, dan mobilitas, menurunkan rasa sakit dan melepaskan kekakuan di
pagi hari. Sensitivitas pada panas dapat dihilangkan dan luka dermal dapat
disembuhkan)}{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033 \langnp1033
\langfenp1057 Berikan masase yang lembut (R/meningkatkan relaksasi/ mengurangi
nyeri)}{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033 \langnp1033 \langfe1057
\langfenp1057 Dorong penggunaan teknik manajemen stres, misalnya relaksasi
progresif,sentuhan terapeutik, biofeed back, visualisasi, pedoman imajinasi,
hypnosis diri, dan pengendalian napas. (R/ Meningkatkan relaksasi, memberikan rasa
kontrol dan mungkin meningkatkan kemampuan koping)Libatkan dalam aktivitas hiburan
yang sesuai untuk situasi individu. (R/ Memfokuskan kembali perhatian, memberikan
stimulasi, dan meningkatkan rasa percaya diri dan perasaan sehat)}{\fs22 \dbch \af2
\af9 \loch \f9 \lang1033 \langnp1033 \langfe1057 \langfenp1057 Beri obat sebelum
aktivitas/ latihan yang direncanakan sesuai petunjuk. (R/ Meningkatkan realaksasi,
mengurangi tegangan otot/ spasme, memudahkan untuk ikut serta dalam terapi)}
\langfenp1057 Kolaborasi: Berikan obat-obatan sesuai petunjuk (mis:asetil
salisilat) (R/ sebagai anti inflamasi dan efek analgesik ringan dalam mengurangi
kekakuan dan meningkatkan mobilitas.)Berikan kompres dingin jika dibutuhkan (R/
Rasa dingin dapat menghilangkan nyeri dan bengkak selama periode akut)}{\fs22 \dbch
\par }\pard \plain \s16 \li90 \ri0 \sb100 \lisb0 \sa100 \lisa0 \sbauto1 \saauto1
\sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin90 \rin0 \itap0 \fs22
\langfenp1057 3.Gangguan mobilitas fisik berhubungan dengan deformitas skeletal,}
\langnp1033 \langfe1057 \langfenp1057 nyeri, penurunan kekuatan otot.}{\fs22
\langfenp1057 Dapat dibuktikan oleh : Keengganan untuk mencoba bergerak/
ketidakmampuan untuk dengan sendiri bergerak dalam lingkungan fisik.}{\fs22
\langfenp1057 Membatasi rentang gerak, ketidakseimbangan koordinasi, penurunan
kekuatan otot/ kontrol dan massa ( tahap lanjut ).}{\fs22 \dbch \af2 \hich \af9
\af2 \hich \af9 \loch \f9 \lang1033 \langnp1033 \langfe1057 \langfenp1057 Hasil
yang diharapkan/ kriteria Evaluasi-Pasien akan :}{\fs22 \dbch \af2 \hich \af9 \loch
\f9 \lang1033 \langnp1033 \langfe1057 \langfenp1057 \line }{\fs22 \dbch \af2
\hich \af9 \loch \f9 \lang1033 \langnp1033 \langfe1057 \langfenp1057 \uc1 \u8226 ?
Mempertahankan fungsi posisi dengan tidak hadirnya/ pembatasan kontraktur.}
\langnp1033 \langfe1057 \langfenp1057 \uc1 \u8226 ? Mempertahankan ataupun
meningkatkan kekuatan dan fungsi dari dan/ atau kompensasi bagian tubuh.}{\fs22
\langfenp1057 \uc1 \u8226 ? Mendemonstrasikan tehnik/ perilaku yang memungkinkan
melakukan aktivitas}{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033 \langnp1033
\lang1033 \langnp1033 \langfe1057 \langfenp1057 Intervensi dan Rasional:}{\fs22
\par }\pard \plain \s16 \fi-425 \cufi0 \li425 \culi0 \ri0 \sb100 \lisb0 \sa100
\lisa0 \sbauto1 \pnrnot0 \saauto1 \sl360 \slmult1 \widctlpar \aspalpha \aspnum
a.\tab }{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033 \langnp1033 \langfe1057
\langfenp1057 Evaluasi/ lanjutkan pemantauan tingkat inflamasi/ rasa sakit pada
sendi (R/ Tingkat aktivitas/ latihan tergantung dari perkembangan/ resolusi}
\langfenp1057 }{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033 \langnp1033
\langfe1057 \langfenp1057 dari peoses inflamasi)}{\fs22 \dbch \af2 \hich \af9 \loch
\cufi0 \li425 \culi0 \ri0 \sb100 \lisb0 \sa100 \lisa0 \sbauto1 \pnrnot0 \saauto1
\langfenp1033 {\listtext \pard \plain
\langfenp1033 \f2 b.\tab }{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033
\langnp1033 \langfe1057 \langfenp1057 Pertahankan istirahat tirah baring/ duduk
jika diperlukan jadwal aktivitas untuk memberikan periode istirahat yang terus
menerus dan tidur malam hari yang tidak terganmggu.(R/ Istirahat sistemik
dianjurkan selama eksaserbasi akut dan seluruh fase penyakit yang penting untuk
mencegah kelelahan mempertahankan kekuatan)}{\fs22 \dbch \af2 \hich \af9 \loch
\lang1033 \langnp1033 \langfe1033 \langfenp1033 \f2 c.\tab }{\fs22 \dbch \af2 \hich
\af9 \loch \f9 \lang1033 \langnp1033 \langfe1057 \langfenp1057 Bantu dengan rentang
gerak aktif/pasif, demikiqan juga latihan resistif dan isometris jika memungkinkan
(R/ Mempertahankan/ meningkatkan fungsi sendi, kekuatan otot dan stamina umum.
Catatan : latihan tidak adekuat menimbulkan kekakuan sendi, karenanya aktivitas
yang berlebihan dapat merusak sendi)}{\fs22 \dbch \af2 \hich \af9 \loch \f9
\lang1033 \langnp1033 \langfe1033 \langfenp1033 \f2 d.\tab }{\fs22 \dbch \af2 \hich
\af9 \loch \f9 \lang1033 \langnp1033 \langfe1057 \langfenp1057 Ubah posisi dengan
sering dengan jumlah personel cukup. Demonstrasikan/ bantu tehnik pemindahan dan
penggunaan bantuan mobilitas, mis, trapeze (R/ Menghilangkan tekanan pada jaringan
dan meningkatkan sirkulasi. Mempermudah perawatan diri dan kemandirian pasien.
Tehnik pemindahan yang tepat dapat mencegah robekan abrasi kulit)}{\fs22 \dbch \af2
\plain \s16 \fi-425 \cufi0 \li425 \culi0 \ri0 \sb100 \lisb0 \sa100 \lisa0
\sbauto1 \pnrnot0 \saauto1 \sl360 \slmult1 \widctlpar \aspalpha \aspnum
e.\tab }{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033 \langnp1033 \langfe1057
\langfenp1057 Posisikan dengan bantal, kantung pasir, gulungan trokanter, bebat,
brace (R/ Meningkatkan stabilitas ( mengurangi resiko cidera ) dan memerptahankan
posisi sendi yang diperlukan dan kesejajaran tubuh, mengurangi kontraktor)}
\langfenp1057 \par }\pard \plain \s16 \fi-425 \cufi0 \li425 \culi0 \ri0 \sb100
\lisb0 \sa100 \lisa0 \sbauto1 \pnrnot0 \saauto1 \sl360 \slmult1 \widctlpar
\langfenp1033 \f2 f.\tab }{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033
\langnp1033 \langfe1057 \langfenp1057 Gunakan bantal kecil/tipis di bawah leher.
(R/ Mencegah fleksi leher}{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033
\langnp1033 \langfe1057 \langfenp1057 \par }\pard \plain \s16 \fi-425 \cufi0 \li425
\culi0 \ri0 \sb100 \lisb0 \sa100 \lisa0 \sbauto1 \pnrnot0 \saauto1 \sl360
\langnp1033 \langfe1033 \langfenp1033 \f2 g.\tab }{\fs22 \dbch \af2 \hich \af9
\loch \f9 \lang1033 \langnp1033 \langfe1057 \langfenp1057 Dorong pasien
mempertahankan postur tegak dan duduk tinggi, berdiri, dan berjalan (R/
Memaksimalkan fungsi sendi dan mempertahankan mobilitas)}{\fs22 \dbch \af2 \hich
\plain \s16 \fi-425 \cufi0 \li425 \culi0 \ri0 \sb100 \lisb0 \sa100 \lisa0
\sbauto1 \pnrnot0 \saauto1 \sl360 \slmult1 \widctlpar \aspalpha \aspnum
h.\tab }{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033 \langnp1033 \langfe1057
\langfenp1057 Berikan lingkungan yang aman, misalnya menaikkan kursi, menggunakan
pegangan tangga pada toilet, penggunaan kursi roda. (R/ Menghindari cidera akibat
kecelakaan/ jatuh)}{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033 \langnp1033
\langfe1057 \langfenp1057 \par }\pard \plain \s16 \fi-425 \cufi0 \li425 \culi0 \ri0
\sb100 \lisb0 \sa100 \lisa0 \sbauto1 \pnrnot0 \saauto1 \sl360 \slmult1
\langnp1033 \langfe1033 \langfenp1033 \f2 i.\tab }{\fs22 \dbch \af2 \hich \af9
\loch \f9 \lang1033 \langnp1033 \langfe1057 \langfenp1057 Kolaborasi: konsul dengan
fisoterapi. (R/ Berguna dalam memformulasikan program latihan/ aktivitas yang
berdasarkan pada kebutuhan individual dan dalam mengidentifikasikan alat}{\fs22
\par }\pard \plain \s16 \fi-425 \cufi0 \li425 \culi0 \ri0 \sb100 \lisb0 \sa100
\lisa0 \sbauto1 \pnrnot0 \saauto1 \sl360 \slmult1 \widctlpar \aspalpha \aspnum
j.\tab }{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033 \langnp1033 \langfe1057
\langfenp1057 Kolaborasi: Berikan matras busa/ pengubah tekanan. (R/ Menurunkan
tekanan pada jaringan yang mudah pecah untuk mengurangi risiko imobilitas)}
\langfenp1057 \par }\pard \plain \s16 \fi-425 \cufi0 \li425 \culi0 \ri0 \sb100
\lisb0 \sa100 \lisa0 \sbauto1 \pnrnot0 \saauto1 \sl360 \slmult1 \widctlpar
\langfenp1033 \f2 k.\tab }{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033
\langnp1033 \langfe1057 \langfenp1057 Kolaborasi: berikan obat-obatan sesuai
indikasi (steroid). (R/ Mungkin dibutuhkan untuk menekan sistem inflamasi akut).}
\langfenp1057 \par }\pard \plain \li0 \ri0 \sb100 \lisb0 \sa100 \lisa0 \sbauto1
\saauto1 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin0 \rin0
\langfe1057 \langfenp1057 3. Gangguan Citra Tubuh / Perubahan Penampilan Peran
berhubungan dengan perubahan kemampuan untuk melaksanakan tugas-tugas umum,
peningkatan penggunaan energi, ketidakseimbangan mobilitas.}{\fs22 \dbch \af2 \hich
Dapat dibuktikan oleh : Perubahan fungsi dari bagian-bagian yang sakit.}{\fs22
\langfenp1057 Bicara negatif tentang diri sendiri, fokus pada kekuatan masa lalu,
dan penampilan.}{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033 \langnp1033
\lang1033 \langnp1033 \langfe1057 \langfenp1057 Perubahan pada gaya hidup/ kemapuan
fisik untuk melanjutkan peran, kehilangan pekerjaan, ketergantungan pada orang
terdekat.}{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033 \langnp1033
\lang1033 \langnp1033 \langfe1057 \langfenp1057 Perubahan pada keterlibatan sosial;
rasa terisolasi.}{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033 \langnp1033
\lang1033 \langnp1033 \langfe1057 \langfenp1057 Perasaan tidak berdaya, putus asa.}
\langfenp1057 \par }\pard \plain \li630 \ri0 \sb100 \lisb0 \sa100 \lisa0
\sbauto1 \saauto1 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin630
\langnp1033 \langfe1057 \langfenp1057 Hasil yang diharapkan / kriteria Evaluasi-
Pasien akan :}{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033 \langnp1033
\lang1033 \langnp1033 \langfe1057 \langfenp1057 \uc1 \u8226 ? Mengungkapkan
peningkatan rasa percaya diri dalam kemampuan untuk menghadapi penyakit, perubahan
pada gaya hidup, dan kemungkinan keterbatasan.}{\fs22 \dbch \af2 \hich \af9
\af2 \hich \af9 \loch \f9 \lang1033 \langnp1033 \langfe1057 \langfenp1057 \uc1
\u8226 ? Menyusun rencana realistis untuk masa depan.}{\fs22 \dbch \af2 \hich
Intervensi dan Rasional:.}{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033
\lang1033 \langnp1033 \langfe1057 \langfenp1057 Dorong pengungkapan mengenai
masalah tentang proses penyakit, harapan masa depan. (R/Berikan kesempatan untuk
mengidentifikasi rasa takut/ kesalahan konsep dan menghadapinya secara langsung)}
\langfenp1057 Diskusikan arti dari kehilangan/ perubahan pada pasien/orang
terdekat. Memastikan bagaimana pandangaqn pribadi pasien dalam memfungsikan gaya
hidup sehari-hari, termasuk aspek-aspek seksual. (R/Mengidentifikasi bagaimana
penyakit mempengaruhi persepsi diri dan interaksi dengan orang lain akan menentukan
kebutuhan terhadap intervensi/ konseling lebih lanjut)}{\fs22 \dbch \af2 \hich \af9
\slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin1440 \rin0 \itap0 \ls14
\af9 \loch \f9 \lang1033 \langnp1033 \langfe1057 \langfenp1057 Diskusikan persepsi
pasienmengenai bagaimana orang terdekat menerima keterbatasan. (R/ Isyarat
verbal/non verbal orang terdekat dapat mempunyai pengaruh mayor pada bagaimana
pasien memandang dirinya sendiri)}{\fs22 \dbch \af2 \hich \af9 \loch \f9
\loch \f9 \lang1033 \langnp1033 \langfe1057 \langfenp1057 Akui dan terima perasaan
berduka, bermusuhan, ketergantungan. (R/ Nyeri konstan akan melelahkan, dan
perasaan marah dan bermusuhan umum terjadi}{\fs22 \dbch \af2 \hich \af9 \loch
\loch \f9 \lang1033 \langnp1033 \langfe1057 \langfenp1057 Perhatikan perilaku
menarik diri, penggunaan menyangkal atau terlalu memperhatikan perubahan. (R/ Dapat
menunjukkan emosional ataupun metode koping maladaptive, membutuhkan intervensi
lebih lanjut)}{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033 \langnp1033
\langfenp1057 Susun batasan pada perilaku mal adaptif. Bantu pasien untuk
mengidentifikasi perilaku positif yang dapat membantu koping. (R/ Membantu pasien
untuk mempertahankan kontrol diri, yang dapat meningkatkan perasaan harga diri)}
\langfenp1057 Ikut sertakan pasien dalam merencanakan perawatan dan membuat jadwal
aktivitas. (Meningkatkan perasaan harga diri, mendorong kemandirian, dan mendorong
berpartisipasi dalam terapi}{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033
\lang1033 \langnp1033 \langfe1057 \langfenp1057 Bantu dalam kebutuhan perawatan
yang diperlukan.(R/ Mempertahankan penampilan yang dapat meningkatkan citra diri)}
\langfenp1057 Berikan bantuan positif bila perlu. (R/ Memungkinkan pasien untuk
merasa senang terhadap dirinya sendiri. Menguatkan perilaku positif. Meningkatkan
rasa percaya diri)}{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033 \langnp1033
10.\tab }{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033 \langnp1033
\langfe1057 \langfenp1057 Kolaborasi: Rujuk pada konseling psikiatri, mis: perawat
spesialis psikiatri, psikolog. (R/ Pasien/orang terdekat mungkin membutuhkan
dukungan selama berhadapan dengan proses jangka panjang/ ketidakmampuan)}{\fs22
\langfenp1057 Kolaborasi: Berikan obat-obatan sesuai petunjuk, mis; anti ansietas
dan obat-obatan peningkat alam perasaan. (R/ Mungkin dibutuhkan pada sat munculnya
depresi hebat sampai pasien mengembangkan kemapuan koping yang lebih efektif)}
\langfenp1057 \par }\pard \plain \li0 \ri0 \sb100 \lisb0 \sa100 \lisa0 \sbauto1
\langfe1057
\langfenp1057 4. Defisit perawatan diri berhubungan dengan kerusakan
musculoskeletal, penurunan kekuatan, daya tahan, nyeri pada waktu bergerak,
depresi.}{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033 \langnp1033
\langfe1057 \langfenp1057 \par }\pard \plain \fi360 \li0 \ri0 \sb100 \lisb0
\lang1033 \langnp1033 \langfe1057 \langfenp1057 Dapat dibuktikan oleh :
Ketidakmampuan untuk mengatur kegiatan sehari-hari.}{\fs22 \dbch \af2 \hich \af9
\loch \f9 \lang1033 \langnp1033 \langfe1057 \langfenp1057 \par }\pard \plain \fi-
180 \li360 \ri0 \sb100 \lisb0 \sa100 \lisa0 \sbauto1 \saauto1 \sl360 \slmult1
Hasil yang diharapkan/ kriteria Evaluasi-Pasien akan :}{\fs22 \dbch \af2 \hich \af9
\af2 \hich \af9 \loch \f9 \lang1033 \langnp1033 \langfe1057 \langfenp1057 \uc1
\u8226 ? Melaksanakan aktivitas perawatan diri pada tingkat yang konsisten dengan
kemampuan individual.}{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033
\lang1033 \langnp1033 \langfe1057 \langfenp1057 \uc1 \u8226 ? Mendemonstrasikan
perubahan teknik/ gaya hidup untuk memenuhi kebutuhan perawatan diri.}{\fs22
\langfenp1057 \uc1 \u8226 ? Mengidentifikasi sumber-sumber pribadi/ komunitas yang
dapat memenuhi kebutuhan perawatan diri.}{\fs22 \dbch \af2 \hich \af9 \loch \f9
\lang1033 \langnp1033 \langfe1057 \langfenp1057 \par }\pard \plain \fi-180
\par }\pard \plain \fi-180 \li360 \ri0 \sb100 \lisb0 \sa100 \lisa0 \sbauto1
\langfe1057 \langfenp1057 \par }\pard \plain \fi-270 \li450 \ri0 \sb100 \lisb0
\loch \f9 \lang1033 \langnp1033 \langfe1057 \langfenp1057 Intervensi dan Rasional:}
\langfenp1057 Diskusikan tingkat fungsi umum (0-4) sebelum timbul awitan/
eksaserbasi penyakit dan potensial perubahan yang sekarang diantisipasi. (R/
Mungkin dapat melanjutkan aktivitas umum dengan melakukan adaptasi yang diperlukan
pada keterbatasan saat ini).}{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033
\lang1033 \langnp1033 \langfe1057 \langfenp1057 Pertakhankan mobilitas, kontrol
terhadap nyeri dan program latihan. (R/ Mendukung kemandirian fisik/emosional)}
\langfenp1057 Kaji hambatan terhadap partisipasi dalam perawatan diri. Identifikasi
/rencana untuk modifikasi lingkungan. (R/ Menyiapkan untuk meningkatkan
kemandirian, yang akan meningkatkan harga diri)}{\fs22 \dbch \af2 \hich \af9
\slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin1170 \rin0 \itap0 \ls15
\af9 \loch \f9 \lang1033 \langnp1033 \langfe1057 \langfenp1057 Kolaborasi: Konsul
dengan ahli terapi okupasi. (R/ Berguna untuk menentukan alat bantu untuk memenuhi
kebutuhan individual. Mis; memasang kancing, menggunakan alat bantu memakai sepatu,
menggantungkan pegangan untuk mandi pancuran)}{\fs22 \dbch \af2 \hich \af9 \loch
\loch \f9 \lang1033 \langnp1033 \langfe1057 \langfenp1057 Kolaborasi: Atur evaluasi
kesehatan di rumah sebelum pemulangan dengan evaluasi setelahnya. (R/
Mengidentifikasi masalah-masalah yang mungkin dihadapi karena tingkat kemampuan
aktual)}{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033 \langnp1033 \langfe1057
\langfenp1057 Kolaborasi : atur konsul dengan lembaga lainnya, mis: pelayanan
perawatan rumah, ahli nutrisi. (R/ Mungkin membutuhkan berbagai bantuan tambahan
untuk persiapan situasi di rumah)}{\fs22 \dbch \af2 \hich \af9 \loch \f9
\lang1033 \langnp1033 \langfe1057 \langfenp1057 \line }{\b1 \fs22 \dbch \af2
\hich \af9 \loch \f9 \lang1033 \langnp1033 \langfe1057 \langfenp1057 \page }{\b1
\langfenp1057 \par }\pard \plain \qc \li0 \ri0 \lisb0 \sa0 \lisa0 \sl480
\slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin0 \rin0 \itap0 \fs22
\langfenp1057 DAFTAR PUSTAKA}{\b1 \fs22 \dbch \af2 \hich \af9 \loch \f9
\langfe1057 \langfenp1057 Anderson, Sylvia Price. Pathofisiologi: Konsep Klinis
proses-proses penyakit}{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033 \langnp1033
\langfe1057 \langfenp1057 \par }\pard \plain \fi720 \li0 \ri0 \lisb0 \sa0 \lisa0
\langfe1057 \langfenp1057 edisi 6 volume II. ECG. Jakarta : 2006}{\fs22 \dbch
\af2 \hich \af9 \loch \f9 \lang1033 \langnp1033 \langfe1057 \langfenp1057 \par
}\pard \plain \li0 \ri0 \lisb0 \sa0 \lisa0 \sl480 \slmult1 \widctlpar \aspalpha
\loch \f9 \lang1033 \langnp1033 \langfe1057 \langfenp1057 Herdman, Heather.2010. }
{\i1 \fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033 \langnp1033 \langfe1057
\langfenp1057 Diagnosis Keperawatan}{\fs22 \dbch \af2 \hich \af9 \loch \f9
\lang1033 \langnp1033 \langfe1057 \langfenp1057 . Jakarta : Penerbit Buku
Kedokteran}{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033 \langnp1033 \langfe1057
\af2 \hich \af9 \loch \f9 \lang1033 \langnp1033 \langfe1057 \langfenp1057 Morhead,
Sue. 2008. }{\i1 \fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033 \langnp1033
\langfe1057 \langfenp1057 Nursing Outcomes Classification (NOC)}{\fs22 \dbch
\af2 \hich \af9 \loch \f9 \lang1033 \langnp1033 \langfe1057 \langfenp1057 . America
: Mosby}{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033 \langnp1033 \langfe1057
\af2 \hich \af9 \loch \f9 \lang1033 \langnp1033 \langfe1057 \langfenp1057 Mc
Closkey Dochterman, Joanne. 2004. }{\i1 \fs22 \dbch \af2 \hich \af9 \loch \f9
\lang1033 \langnp1033 \langfe1057 \langfenp1057 Nursing Interventions
Classification (NIC)}{\fs22 \dbch \af2 \hich \af9 \loch \f9 \lang1033
\langnp1033 \langfe1057 \langfenp1057 . America : Mosby}{\fs22 \dbch \af2 \hich
\plain \li0 \ri0 \lisb0 \sa0 \lisa0 \sl480 \slmult1 \widctlpar \aspalpha \aspnum
\lang1033 \langnp1033 \langfe1057 \langfenp1057 Mansjoer, arif. Dkk.2009, kapita
selekta kedokteran . Jakarta. Media aesculapius}{\fs22 \dbch \af2 \hich \af9
\langfe1057 \langfenp1057 \par }}

Rhematoid Arthritis Rematik

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