Chapter I-II-III Sastra - Tata New

CHAPTER I
INTRODUCTION
A. Background
Liver cirrhosis disease is the biggest cause of death after cardiovascular
diseases and cancer. Liver cirrhosis worldwide ranks seventh leading cause of
death. Approximately 25,000 people death each year from the disease. Liver
cirrhosis is a liver disease that is often found in space in the disease. Clinical
symptoms of liver cirrhosis are highly variable, ranging from no symptoms until
the symptoms are very obvious. If noted, the reports in developed countries, the
case of liver cirrhosis medicine for treatment, only about 30% of the entire
population of this disease and more than 30% more were found by chance when
the medical treatment, the remainder was found during autopsy (Sutadi, 2003).
According to World Health Organization (WHO), in Sutadi (2003), in 2000
approximately 170 million human beings infected with liver cirrhosis. This
figure includes about 3% of the entire human population in the world and each
year new liver cirrhosis infection increased 3-4 million people. Liver cirrhosis
disease prevalence rate in Indonesia, definitely have not known a disease
prevalence of liver cirrhosis in 2003 in Indonesia ranges from 1 to 2.4%. Than
average prevalence (1.7%), estimated at more than 7 million population of

Indonesia suffered from liver cirrhosis.
According to Sudoyo, (2006: 443), the rate of chronic liver disease cases in
Indonesia is very high. If not treated promptly, the disease can progress to
cirrhosis or liver cancer, about 20 million Indonesian population have chronic
liver disease. This figure is a calculation of the prevalence of patients with
hepatitis B infection in Indonesia, which ranges from 40-50% and hepatitis C,
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approximately 30-40%. While 10-20%, the causes are not viruses B and C.
Alcohol as a cause cirrhosis in Indonesia may be small because the frequency
does not exist, only the reports from several educational centers. In Dr. Sarjito
Yogyakarta hospital the patient number of liver cirrhosis ranged from 4.1% from
the patient who cared in Internal Medicine Section, within a period of one year
(2004). In Medan in the past four years looked the patient liver cirrhosis in 4%
of all patients in Section disease. In the phatofisiology of the disease, 20-40% of
patients with chronic liver disease that would be cirrhosis of the liver in about 15
years, depending on how many old man was suffering from chronic hepatitis.
Cirrhosis term was given by Laence in 1819, which comed from the word
meaning Khirros yellow orange (orange yellow), because the color changes in
nodules are formed. Definition of liver cirrhosis following can be said that
chronic liver disease in which the state of disorganization that diffuse of normal
liver structure to regenerative nodules surrounded by fibrotic tissue. These cases
were more common in men than women with a comparison of 2 until 4.5 : 1
(Noer, 2004: 271).

In appropriate with the introduction study obtained in the preliminary
Getasan Health Center, in 2010 in the last three months of data showed that
people suffered from liver cirrhosis in Getasan sub district in February 13 cases,
11 cases in March and April, 10 cases. From these data showed 8 cases of liver
cirrhosis had suffered from the disease in the Nogosaren village, which in the last
three months of this amount still remaied the case until April 2010. From the
assessment results conducted in Nogosaren Village that was on Mr. K which was
currently suffered liver cirrhosis, which was estimated to cause illness was a
pattern of unhealthy eating, and too many activities and a lack of knowledge.
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Based on data obtained at the Getasan primary Health Center, Getasan sub
district, Semarang regency the patients with liver cirrhosis disease could
be viewed on the diagram below :

Table . 1 . 1. Distribution of liver cirrhosis events in Getasan primary health
center, Getasan sub district, Semarang regency.
From the data above indicated that the prevalence of liver cirrhosis disease
in Getasaan Primary Health Center, Getasan sub district, Semarang Regency in
February were 13 cases, the month of March had decreased experience as many
as 11 cases, and in April declined experience as many as 10 cases. Based on the
background of the problems mentioned above the author would like to know
more information about nursing care at Mr. K liver cirrhosis disease. Which was
currently suffered from liver cirrhosis disease at the Nogosaren Village, Getasan
sub district, Semarang regency.

B. Writing Purpose
1. General Purpose
Knowing about the care of a family with liver cirrhosis disease at
Nogosaren Village, Getasan sub district, Semarang regency.
2. Specific Purpose
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a. The author was able to assess the family to Mr. K’s family about
liver cirrhosis that suffered by Mr. K.

b. The author was able to assign family nursing problems to Mr. K’s family
about liver cirrhosis that suffered by Mr. K.

c. The author was able to determine nursing interventions to Mr. K’s family
about liver cirrhosis that suffered by Mr. K which included five family
duties ware:
1) The family was able to know family health problems.
2) The family was able to take decisions related to liver cirrhosis.
3) The family was able to modify the environment for patients with liver
cirrhosis.
4) The family was able to care the sick family member esfecially
liver cirrhosis.
5) Families were able to use health care facilities.
d. The author was able to give family nursing implementation to Mr. K’s
family about liver cirrhosis that suffered by Mr. K.

e. The author was able able to evaluate the family nursing implementation to
Mr. K’s family about liver cirrhosis that suffered by Mr. K.
C. Benefit Writing
1. For Family
Could increase knowledge and experience of health education about the
liver cirrhosis so it could identify health problems both family and society.
2. For Community
As consideration for the increase of health education about health
problems that exist in society, especially liver cirrhosis and community
participation in providing support.

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3. Nursing profession
Particularly for nursing community as an input in improving the
provision of health services associated with information providing about
health education especially liver cirrhosis.
4. Development of Science and Technology (Science and Technology)
Expected to contribute the development of science and technology
(Science and Technology). In the case of family care, especially families with
family members that suffered liver cirrhosis.
5. For Authors
Could add knowledge and experience in assessing, liver cirrhosis
especially factors that cause liver cirrhosis and management its disease.
CHAPTER II
THEORY REVIEW
A. Basic Concept of Family
1. Family Definition
Family according to WHO (1969) in Mubarak, (2006: 255), the family
is a members of the household who are related by consanguinity, adoption or
marriage. Family according to the Ministry of Health (1998) in Mubarak

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(2006: 255), the family is the smallest unit of a society which consists of head
of households and some people who gathered and lived under a roof
somewhere in a state of dependency.
Bailon and Maglaya (1978) in Murwani Setyowati and (2008: 24),
describes a family is two or more individual living in one household because
to blood relationship, marriage or adoption. Sayekti (1994) in Setiadi (2008:
3), family is a bond, or the fellowship of life based on marriage between
adults of different species living together or a person male or female person
who was alone with or without children, both his own son or adoption and
live in household.
Family According to Friedman (1998) in Achjar (2010: 1), family is a
group of people related by marriage, adoption and birth which aims to create
and maintain a common culture, improve the physical, mental emotional and
social development of individuals in it seen from the pattern of
interdependence interaction to achieve common goals.
Some of the definitions above we can conclude that the family is the
smallest unit of society which consists of head of family who live in one
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household or some people collected and living somewhere under a roof that
has the blood relationship, marriage or adoption and interdependence to
achieve common goals .
2. Family Characteristics
According to Setyowati and Muwani (2008: 25-26), family
characteristics are as follows:
a. Consist of two or more individuals who are bound by relationships.

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b. The family members usually live together or if they remain separate
notice to each other.
c. Family members interact with one another and each has a social role of
husband, wife, children, brothers, sisters.
d. Having a purpose; (1) create and maintain the culture, (2) improve the
physical, psychological, and social members.
3. Type of Family
Family types according to Setiadi (2008: 4-6) depends on the context of
scientific and people who are classified as follows:
a. Traditional
1) Nuclear family is a family that consists only of father, mother and
child received from his descendants or adoption, or both.
2) Large family (Extended Family) is a nuclear family add to other
family members who still have blood relationship (grandparents,
uncles, aunts).
b. Modern
1) Traditional Nuclear
Nuclear family (father, mother and children) living in one home
defined by the legal sanctions within a marriage bond, one or both can
work outside the home.
2) Nuclear reconstituted
New formation from the nuclear family through marriage again
husband / wife lived in the formation of one house with their children,
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either congenital from long marriage of new marriage the result, one
or both can work outside the home.
3) Niddle Age / Aging cauple
Husband as that searches of money, a wife at home / are both working
at home, the children have left home because of school / marriage /
career.
4) Nuclear Dyadic
Husband and wife who have not had a second child or one working
outside the home.
5) Single perent
One parent as a result of divorce or death of spouse and children can
stay at home or outside the home.
6) Dual Carrier
Husband and wife or two person carrier and without children.
7) Commuter Married
Husband and wife or two person Carrier and stay at a certain distance
apart. Both find each other at certain times.
8) Single Adult
Adult man or woman living alone with no desire be married
9) Three Generetion
Three or more generations living in one home.
10) Institutional
Children or adults living in an asylums.
11) Communal
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One house consists of two more couples to monogamy with the childs
and sames together in supply of the facility.
12) Group Marriage
A housing consists of parents and congenital in one family unit and
each individual is married with another and all daalah parents of the
children.
13) Unmarried Parent and Child
Mother and child in which unwanted marriage, child adoption.
14) Cohibing coiple
Two people or a couple who live together without marriage.
15) Gay and Lasbian Family
Family formed by same-sex couples.
4. Family Structure
According to Setiadi (2008: 6-7), family structure is as follows:
a. Patrilineal
Is a family consist of blood relatives within a few generations, where the
relation is arranged through the father line.
b. Matrilineal
Is a family consist relative a few generations, where the relationship was
arranged through the maternal line.
c. Matriolokal
Is a husband and wife who lived with wife's blood relatives.
d. Patriolokal
Were a married couple who lived with husbands blood relatives.

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e. Family Married
Is the relationship of husband and wife as a basis for family formation,
and several relatives who become part of the family because of the
relationship with husband or wife.
5. Family Function
According to Friedman (1998) in Suprajitno (2004: 13), family
functions are as follows:
a. Affective function (the affective function)
Are the main functions of the family to teach you everything to prepare
for family members relate to other people. This function is required for
the psychosocial development of individuals and family members.
b. The function of socialization and a place to socialize (socialization and
social pleacement)
Is a function to develop and train the child to place social life before
leaving the house to related to others outside the home.
c. Reproductive functions (the reproductive function)
Is the function of maintaining the continuity of generations and maintain
the family.
d. Function of Economy (the economic function)
Is a family of functions to meet the economic needs of families and places
to illustrate the ability of individuals to increase income to meet family
needs.
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e. Function maintenance / maintenance (the Heath care fuction)
Is a function to maintain the health of family members that still have high
productivity. This function is developed to work in the field of family
health.
6. Family Duties
According Achjar (2010: 9), is a family task of collecting data related to
the inability of family to include five family duties, namely:
a. Inability to recognize family health issues, including how the family
perception of the severity of the disease, understanding the signs and
symptoms, causes and family perception of the nature of family problems.
b. Family's inability to take decisions, including the extent to which family
understand about the nature and extent of the problem, how the problems
felt by the family, the family gave up or not with their problems, are there
or are there due to fear of negative attitudes towards family health issues,
how the decision-making system conducted the family of a sick family
members.
c. Inability of family caring for sick family members like how family
understand the situation of his illness, the nature and development of the
necessary maintenance of existing resources within family and family
attitudes toward the sick.
d. Family's inability to modify the environment, such as the importance of
hygiene and sanitation for family, disease prevention efforts by family,

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cohesiveness of family members in managing the environment within and
outside the home that impact on family health.
e. Inability to take advantage of the family health services, such as a family
trust of health workers and health care facility, the presence of existing
health facility, family benefits to the use of health facility, whether health
care affordable for family, is there any unfavorable experiences that
perceived family.
7. Family Development Stage
According to Duvall (1985) in Setiadi (2008: 14-15), stages of family
development are as follows:
a. New Family (beginning family)
Newly married couples who don’t have children. The task of this stage of
development of family are:
1) Maintain a satisfactory intimate relationship.
2) Decide common goal.
3) Maintain relations with other family, friends and social groups.
4) Discussing the plan to have children or family planning.
5) Prepare to become parents.
6) Understand the prenatal care (understanding of pregnancy, childbirth
and parenthood).
b. Families with first child <30 months (child Bering)
This period represents the transition of parenthood that would cause
family crisis. The task of this stage of development are:

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1) Adapting changes in family members (roles, interactions, and sexual
activity).
2) Maintaining a satisfactory relationship with their spouse.
3) Dividing the roles and responsibilities.
4) Counseling parents about growth and development.
5) Counselling 6 weeks post partum family planning.
6) Arranging the room for the child.
7) Facilitating the learning role family members.
8) Conducting regular religious practice.
c. Family with Children Pre School
The task at this stage of family development are:
1) Fulfilling the needs of family members.
2) Helping children socializing.
3) Adapting to the new born child, other children who also fulfilled
4) The division of time, individuals, couples and children.
5) The division of responsibility to plan activities and time of stimulation
to growth and develotmen children.
d. Family with school age children (6-13 years)
1) Helping children to socialize outside the home environment, school,
and the wider environment.
2) Encourage the child to achieve the development of intellectual power.

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3) To provide activities for children.
4) Adapting to community activities by involving children.
5) Fulfilling the increased need for including the cost life of family
health members.
e. Family with adolescent Children (13-20 years)
1) The development of young adult (give freedom a balanced and
responsible).
2) Maintain open communication (gep prevent communication).
3) Maintain of intim relationships within the family.
4) Prepare the system changes the role and regulation of family members
to meet the needs of growth and development of family members.
f. Family with adult children (first child abandon the house)
1) Extending the nuclear family into a large family.
2) Maintaining intimacy.
3) Helping children to be independent and accept his son's departure.
4) Contribute husband and wife, grandfather and grandmother.
5) Creating a home environment that can become examples for their
children.
g. Midlle Age Family
Family development task at this stage are:
1) Having more time and freedom in the process of social interests and
relaxed time.
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2) Restoring the relationship between the generation young old
3) Familiarity with the couple.
4) Maintaining the relationship / contact with children and families.
5) Preparation of old age / retirement.
h. Elderly family
1) The adjustment phases of the pension with the change of life style.
2) Receive the death of mate, and preparing for death.
3) Maintaining couple pair and treat each other.
4) Undertake a review of the past life
8. Family nursing Concept
a. Definition
Nursing is a professional service which forms an integral part of health
care based on science and art of nursing services in the form of bio-
psycho-social-spiritual that komprehesif addressed to individual, family,
groups and society both healthy and sick that covers the entire process
human life (Setiadi, 2008: 25-26). Family health care is that health care
intended or focused on the family as a unit or a unit that was treated, the
healthy as a goal made by a person of professional nurses with nursing
process which is guided by practices based on ethical and nursing ethics
and the authority and responsibility nursing (Setiadi, 2008: 26). While
according Setyowati and Murwani (2008: 75) family of nursing care is a
series of activities provided by nursing practice to family to help family
completed the approach, the nursing process.

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b. Goal
According to Setyowati and Nurwani (2008: 75), family nursing purpose
consists of:
1) General Purpose
Increased ability of families to cope with health problems
independently.
2) Specific Purpose
a) Recognize family health problems.
b) Decide on appropriate action to overcome the problem of family
health.
c) Conducting health nursing action to members who are sick.
c. Target
According to Setyowati and Murwani (2008: 75) target of family nursing
care is a families health prone namely families who have health problems
or who are at risk to incidence of health problems.
d. Stages of the process of family nursing
Stages of the family nursing process accourding to Muwarni and
Setyowati (2008: 75) is:
1) Assessment of families and individuals in the family is included in the
family assessment is to identify demographic and socio-cultural data,
environmental data, structure and function of family, stress and coping
strategies used by family, family development.
While included in the assessment of an individual as a member of the
family is the assessment of physical, mental, emotional, social,

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spiritual, formulation of nursing diagnosis, arranging planning,
implementation of nursing care, evaluation.
e. The role of nurses in family nursing
According to Setiadi (2008: 27-28), give to family nursing care there are
some roles that can be done by nurses, among others, identification of
health (health promotion), the service providers on a sick family member,
coordinator of health services and family health nursing, facilities, health
education outreach, education and consulting.
B. Elderly Basic Concepts
1. Definition of Elderly
According to the law No.4 of 1965 article 1 in Mubarak (2006: 181), the
elderly are aged or elderly people concerned after reaching the age of 55
years, not having or powerless to make a living alone for the purposes of
everyday life and receive their living from other people.
According to WHO, in Bandiyah (2009: 19), the elderly, is someone
whose age is between 60 and 74 years. CHAPTER I Article 1 paragraph (2)
Law No.13 year 1998, and in Tamher Noorkasiani (2009: 2), explaining the
elderly is someone who reaches the age of 60 years or older. Setyonegoro
(1984) in Tamher and Noorkasiani (2009: 2), the elderly are those aged over
65 years.
2. Limitations Elderly
According to the Ministry Of Health Mubarak, (2006: 181), are as follows:
a. Approaching old age groups (45-54 years) as the vibrilitas

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b. Old age group (55-64 years) as presenium
c. Elderly group (65 years>) as seneum
According to WHO in Mubarak (2006: 181); Bandiyah (2009: 19), the
boundaries of the elderly are as follows:
a. Middle age is the age group 45-59 years
b. Elderly is the age group 60-74 years
c. Advanced old age (old) age group 76-90 years
d. Very old age (very old) age group above 90 years
According to the smith and smith (1999) in Tember and Noorkasiani (2009:
2), the elderly were classified into three namely:
a. Young old is the age group 65-74 years
b. Midlle are a group of 75-84 years old
c. Old is the age group of more than 85 years
3. Aging Process
The process of aging is a natural process after the third stage of life that
is adulthood and old age can not be avoided by every individual. Age will
cause changes to the structure and physiology of various cells / tissues /
organs and systems that exist in the human body. This process makes the
physical and psychological deterioration. Fsikis setbacks signed by skin relax,
graying hair, decreased hearing, eyesight deteriorating, slow motion and
abnormalities of function of vital organs. While the decline of psychological
emotional sesitivitas increased, decreased arousal, increased interest in the
self, loss of interest in appearance, increased material and the interests of

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recreational activities do not change only the orientation and different
subjects (Mubarak, 2006: 182).
According to Constantinides (1994) in Darmojo (2009: 3) aging (=
become old = aging) is a process of gradual disappearance of the tissu
capacity to improve / replace ourselves and maintain normal structure and
function so it can not withstand the lesion (including infection) and improve
the damage suffered.
4. Theories of Aging Process
There are several theories explaining the process of aging, according to
Mubarak, et al. (2006: 186-187) are as follows:
a. Biological Theory
Theory which is a biological theory, namely:
1) The theory of genetic clock
According to this theory of aging has genetic progarammed manner
certain species. Each spisies have nuclear cell within an hour that has
been genetically screened by a replication.
2) Theory of Error Catastrophe (somatic mutation theory)
According to this theory, aging is caused successive errors in a long
time in traskripsi and translation.
3) The theory of auto-immune
In this theory be explained that in the process of metabolism of a
particular substance when produced. There are certain body tissues are
resistant to these substances so that the body's tissues become weak
and sick.
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4) The theory of free radicals
Free radicals can be formed in the nature free, unstable free radicals
(groups of atoms) of oxygen resulted in oxidation of organic materials
such as carbohydrates and protein.
5) Usage and damaged
The excess of effort and stress causes the body cells is damaged.
6) The theory of "Imonology slow virus"
Immune system becomes less effective with increasing age and the
entry of viruses into the body can cause damage to organs.
7) The theory of stress
Aging occurs cause to loss of cells commonly used in the body.
8) Theory of cross chain
Cells that are old or obsolete, chemical reactions cause a strong bond,
especially the collagen tissu. This bond causes a lack of elasticity,
strength and loss of function.
9) Theory courses
Ability fatherly organism determines the number of cells dividing, the
cells die.
b. Psychosocial Theory
According Tumher and Noorkasiani (2009: 19-21) As for the
psychosocial theory of groups, successively put forward several theories
which are as follows :
1) Disengagements Theory
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The theory states that individuals and society experiencing a mutual
disengagement in withdrawl (pull away). Enter to ald age, individuals
begin withdrawing from society to enable individuals to save more
activities focused on your self in meeting the stability in this stadium.
2) Activity theory
Is the importance of participation in society activities for the elderly
people life.
3) The theory of continuity
According to this theory, individual personality traits following
strategies coping have been formed long before a person enters old
age, but also the personality description is dynamic and continuously
development.
4) The theory of subculture
In this theory has to say as a group have norm of hope, trust and
customs that can be classified as a separate subculture.
5) The theory of strati cation age
This theory was proposed by Riley (1972) says the interdependence
between the ages of the social structure.
6) The theory of individual adjustment to the environment
According to this theory that, there is a relationship between
individual compertesiwith the environment . Compertensi here in the
form of all the processes that are the functional characteristics of

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individual, among others: ego strength, skill, motor health, biological,
cognitive capacity and sensory function.
5. Factors Affecting Aging
According Bandiyah (2009: 19) the factors that affect aging is heredity
= descent or genetic, nutritional = food, health status, life experience,
environment, stress.
6. Changes that Occurred In Elderly
According to Mary, (2008: 55-62) changes in the elderly, are as follows:
a. Physical Changes
1) Tues/cells
The number is reduced, enlarged size, body fluids and intra-cellular
fluid decreases.
2) Cardiovascular
Heart valves to thicken and the nails, the blood's ability decreases, the
elasticity of blood vessels decreased.
3) Respiration
Decreased respiratory muscles, as well as bronchial constriction
occurs.
4) Nerves
Sensory nerve decreases, decreases and loss of axons mealin layer.
5) Musculoskeletal
Fluid decreases bone, joints stiff and enlarged, cramps, tremors,
tendons constrict and experience sclerosis.
6) Gastrointestinal
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Widened esophagus, side acid decreases, hunger decreases and
peristaltic decline, shrinking the side size.
7) Genitourinaria
Smaller kidneys, blood current to kidney decreases, the filtering
glomerulus decreased and decreased body functions.
8) Vesika urinary
The muscles weaken, the capacity decreased, and urinary retention,
prostatic hypertrophy.
9) Vagina
Lenders dried membrane and secretion decrease.
10) Hearing
Tympanic membrane atrophy and bone loss experienced stiffness.
11) Sight
Declining light toward response, decreased dark adaptation, the field
of view decreases and cataracts.
12) Endocrine
Hormone production decreases.
13) Skin
Wrinkles along with head skin scalp and hair thinning, elasticity
decreases.
14) Learning and memory
Learning ability is still there, but relative decreases.
15) Intelligence
In general, nothing has changed.

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b. Social Change
1) The role, post-power syndrome, single women and single parents.
2) Family, loneliness, emptiness.
3) Frend, when other elderly people died there appears a sense of when
to die, was at home, continuously, senile.
4) Economics, the opportunity to get a suitable job and income security
for the elderly.
5) Recreation, for inner Cananga.
6) Security, fell from slipping.
7) Education, in association with illiteracy.
8) Religions, fulfilling their worship.
9) Nursing home, feel disposed / aside.
c. Psychosocial Changes
Psychological changes in the elderly include short term memory,
frustration, loneliness, fear of losing freedom, fear of facing death, change
of loss, depression and anxiety.
Common problems that are often experienced by the elderly:
1) The physical condition of weak and helpless, so dependent on others.
2) The economic status of critically endangered so it is quite reasonable
to perform a variety of major changes in the pattern of his life.
3) Therefore learning to treat children who grow up as adults.
4) Determine the appropriate conditions with changes in economic status
and physical changes.

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5) Starting involved in community activities that are specifically
designed for adults.
7. Elderly Nursing Process
According to Mary, (2008: 76) in elderly nursing process include the
following:
a. Assessment
Assessment of the elderly in the family by involving the family as
the nearest person who knows about the problem kesehatn elderly. For
this assessment format used is the assessment of the elderly developed in
accordance with the existence of the elderly. Assessment format
developed at least consist of: the data base (identity, address, age,
educational background, occupation, religion, and ethnicity); data bio-
psycho-socio-cultural, environmental, functional status, existing health
facilities; a physical examination .
b. Nursing diagnosis
Nursing diagnosis can be either individual nursing diagnosis,
nursing diagnosis with the elderly, or nursing diagnosis in the elderly
group.
c. Nursing Plan
Nursing care plan helps patient obtain and maintain state at the
highest levels, prosperity and quality can be achieved, as well as for
dying peacefully. goals, priorities, and approaches used in nursing nursing
plan includes terapiutik interests, promotive, preventive, and
rehabilitative.
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d. Nursing Actions
Nurses perform nursing nursing action with nursing plans that have
been made. Nurses provide health services to maintain the functional
ability of elderly and to prevent complications and improve the disability.
Nursing actions based on the nursing plan of every nursing diagnosis has
been made based on the concept of nursing care gerontic.
e. Nursing Evaluation
Nurses need to evaluate on a continuals patient respons and families
of nursing actions that have been done to achieve the purpose of updating
dams nursing diagnosis and nursing care plan nursing actions undertaken
if not achieved the expected goals. Evaluation was made in the progress
notes using the SOAP (subjective, objective, analysis, planning).
C. Basic Concepts Hepatic Cirrhosis
1. Definition
Hepatic cirrhosis is a chronic liver disease characterized by the
establishment of diffuse connective tissue with nodules (Noer, 2004: 271).
Liver cirrhosis is a chronic liver disease and liver distersi normal
architecture by sheets of connective tissue and nodules regenerating liver
cells, which do not relate to normal vaskulatur. Nodules this regeneration may
be small (mikronudular) or large (makronudular) (Price, 2006: 493).
Cirrhosis is a condition siepatis fibrosis and scarring that diffuse in the
liver. Normal liver tissue is replaced by the nodes hard fibrous, and fibrous
bands that constrict and surrounding hepatocytes (Corwin, 2009: 660).

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Liver cirrhosis is a disease characterized by diffuse and chronic
inflammation of the liver, followed by proliporasi connective tissue,
degeneration and regeneration of liver cells causing chaos in the composition
of the liver parenchyma (Mansjoer, et al. 2000: 508).
Several definitions can be concluded that liver cirrhosis is a chronic
liver disease characterized by diffuse inflammation and scarring in the liver
are accompanied by nodules.
2. Type of scar formation in cirrhosis or liver
According to Smeltzer (2002: 1178) type of cirrhosis is as follows:
a. Laennec portal cirrhosis (alcoholic, nutritional), in which scar tissue
typically surrounding the portal areas. Cirrhosis is most commonly caused
by chronic alcoholism and is the type most commonly found in western
countries.
b. Post-necrotic cirrhosis, where there is a wide band of scar tissue as a
result-up of acute viral hepatitis that occurred previously.
c. Biliary cirrhosis, where the formation of scar tissue occurs around the bile
ducts within the liver.
3. Etiology
According to Noer (2004: 272), etiology serosis hepatis is a type of viral
hepatitis B and C, alcohol, metabolic.
Hemokromatosis idiopathic, Wilson's disease, alpha 1 difisiensi
antitripsi, galactosemia, congenital tirosinemia, diabetes mellitus, diseases of
glycogen accumulation.
a. Chronic Cholestasis / billiards serosis secondary intra ekstrahepatik

28
b. Obstruction of hepatic venous flow
c. Imonologis Disorders
d. Intestinal bypass operation in obese
e. Malnutrition, infections, like malaria, sistosomiasis
4. Pathophysiology
According to Smeltzer (2002: 1178), pathophysiology of liver cirrhosis
was as follows:
Although there are several factors involved in the a etiology of cirrhosis,
alcohol consumption is considered as a major factor. Cirrhosis occurs with
high frequency in most liquor drinkers even though nutritional deficiencies
contribute to the decrease in protein intake in the cirrhotic liver damage, but
excessive alcohol intake was the main cause and consequences of fatty liver
caused. However, cirrhosis has also occurred in individuals who do not have
the habit of drinking and in individuals with normal diet but with high normal
consumption. Most individuals seem more susceptible to this disease
compared to other individuals without find whether the individual has the
habit of drinking or suffering from malnutrition. Other factors can lead role,
including exposure to certain chemicals (carbon tetrachloride, naphthalene
terklorenasi, arsenic or phosphorus) or skistosoniasis a contagious infection.
Laennec cirrhosis is a disease marked by episodes involving necrosis of
liver cells are destroyed gradually replaced by scar tissue, eventually the
amount of scar tissue exceeded the amount of liver tissue that are still
functioning. The islands of remaining normal tissue and liver tissue
regeneration may result from the salient parts of the contract so that the heart
29
which shows the picture looked like a nail sirotik soles typical big headed.
Liver cirrhosis usually have a insidius awitan and travel a very long illness.
5. Clinical Manifestations
According Mansjoer (2000: 508) clinical manifestation sirosisi hepatis
is as follows:
a. Gastrointestinal symptoms are not typical, such as anorexia, nausea,
vomiting and diarrhea
b. Fever, weight loss, rapid fatigue
c. Ascites, hidrotoraks, and edema
d. Jaundice, the urine sometimes get old or brownish color
e. Hepatomegaly, when it has continued to shrink due to liver fibrosis. When
clinically show the fever, jaundice and ascites would caution potential
hepatikum prekoma and coma.
f. Vascular disorders such as collateral-collateral in the abdominal wall and
thorax, the head of medusa, haemorrhoids and oesophageal varices.
g. Endocrine abnormalities are a sign of impotence hiperestrogenusme ie,
atrophy, gynecomastia, loss of axillary hair, and pubic, amenorrhea,
hyperpigmentation, mammary areola, Spider Nevi and erythema.
6. Examination Support
According to Noer, et al. (2004: 275) liver cirrhosis investigation are as
follows:
a. Blood, can be found lower Hb, anemia normokrom normositer, hipokrom
makrosister.
30
b. The increase in transaminase enzyme levels / SGPT is not about weight
and breadth pointer parenchymal liver damage.
c. Albumin, albumin levels are low is a reflection of the lack of the ability of
liver cells.
d. CHE Investigation (cholinesterase), important in assessing the ability of
liver cells in case of liver cell damage CHE levels will drop.
e. Checking electrolyte levels, important in the use of diuretics and
restriction of salt in the diet.
f. Protombin elongation period, is an indication of impairment of liver
function. Provision of parenteral vitamin K can improve the protombin.
g. Elevated blood sugar levels in advanced stage liver cirrhosis due to lack
of ability of cells to form liver glycogen.
h. Examination of serological markers as a sign of viral HBsAg / HbsAb.
7. Treatment
Medical Treatment by Mansjoer (2000: 509) is as follows:
a. Low-protein diet (diet heart III: 1 g protein / kg, 55 g protein, 2000
calories). If there was ascites given low-salt diet II (600-800 mg) or III
(1000-2000 mg). When the process is not active, it needs high-calorie diet
(2000-3000 calories) and high in protein (80-125 g / day)
b. Overcome the infection with antibiotics cultivated memakain drugs which
obviously is not hepatotoxic
c. Improving the nutritional situation, if necessary by providing branch
chain essential amino acids and glucose

31
d. Control of ascites fluid. Expected for weight loss 1 kg / 2 days or a
negative fluid balance 600-800 ml / day. Be careful when too much fluid
removed, can spark hepatic encephalopathy.
e. Treatment nursing according Mansjoer (2000: 509), are as follows:
1) RestAlkoholisme
in bed until sleep until there is improvement Hepatitis
Malnutrition of jaundice, ascites
virus
  hemocrematosis, toxic
and fever
Liver cells are destroyed Decrease in protein subtaces, vena hepatica,
 intake Willson desease
2) Do not eat or drink
Liver imflamation substances containing
 alcohol. 
 Liver damage Enlarged liver
8. Complication 
Comfortable Necrosis of liver
feeling pain Accordingparenchym Irregular hard
to Noer (2004: 277), complication of liver cirrhosis was as
disorders  
follows: Scar tissue Atrophy

Connective
a. The failure of thetissue
liver (hepatocellular)
formation
b. Portal hypertension
c. Heart
Parenchym liverfailure, resulting Nevi spiders, palmar erythema, Discomfort,
portal Hypertension testicular atrophy,
Ensepalopa
Acites
failer   nausea, ti
gynecomastia, jaundice, encephalopathy
 esofageal Varices Emphasis vomiting 
Difisiensi Vit K.  diaphragm stomach Decreased
d. Portal hypertension may cause spelenomegali, expansion veins
 Pressure increase   consciousne
Haemorage  Pulmonary Anorexia 
oesophageal / cardia, caput medusae, hemorrhoids
 Rupture of blood space  Risk of
Anemia
e. Ascites vessels narrowing Nutritional injury
  requirement of
Deficiensy O2 in
f. Encephalopathy (neurological death) asphyxiate less than good
Hematemesis Melena
the tissue impaired does your Resiko
g.  Bacterial Peritonitis / spontaneous breathing body cedera
Activity intolerance Tissue perfution pattern
h. Sindorm hepatorenaldistubence
i. Towards the transformation of primary liver cancer (hepatoma)
9. Pathway
Bagan .52family duties
. 1 Pathway. Patient respons
1.Ability to recognize health problems the Asphyxiat
family Upper right
abdominal pain
2. Ability to decide appropriate health Sclera ikteric
measures Limp
3. Ability of caring for a sick member
4. ability of modifying the family

environment
(Smeltzer, 2002 : 1178) ; (Mansjoer, 2005 : 508) ; (Noer, 2004 : 272)
facilities
32
10. Focused Intervention
a. Ineffective breathing pattern disorders associated with (Nanda, 2007 to
2008: 68).
33
Ineffective breathing pattern is inspired or expired air exchange is not
adequate.
1) Inability to recognize family or family health problems
2) inability of families to make decisions appropriate health measures
3) Inability to families caring for sick family members
4) Inability to modify the family environment
5) Inability of families utilizing the existing health care facilities
General objective: To maintain effective breathing patterns
Specific objectives:
1) The family is able to know family health problems
Intervention :
a) Assess family knowledge about ineffective breathing pattern
b) Explain the process of ineffective breathing pattern.
c) Auscultation of breath sounds, record the existence of allergens,
Ronchi, wheezing and krekers.
d) Give health education by strengthening the important things to
know ineffectiveness in the treatment of respiratory pattern.
2) Families are able to make appropriate health decisions actions
Intervention:
a) Assess the level of knowledge about important families make the
right decisions to identify ineffective breathing pattern
b) Explain about how to make the right decisions to find out the
ineffectiveness of breathing pattern

34
c) Teach how to make the right decisions in addressing the problem
is not breathing pattern efekif
d) Discuss what's become an obstacle in making decisions
3) The family is able to give care to a sick member
Intervention :
a) Give an explanation on how to give care to sick family members
b) Explain the treatment pentingnya sick family members
c) Teach a way to give treatment to the sick family members
d) Teach breathing techniques and positions in the semi-Fowler
4) The family is able to modify a healthy home
Intervention:
a) Assess the level family knowledge about how to modify healthy
home
b) Explain the importance of a healthy home
c) Teach to modify home healthy
d) Maintain adequate humidity inspiration
5) Families are able to use existing health facilities
Intervention :
a) Instruct the family utilize existing health facility / nearest
b) Assess the level of knowledge of the family in utilizing health
facilities
c) Explain about the benefits of health facilities.
b. Comfortable feeling pain disorders associated with (Doengoes, 2000:
545)
35
Pain is an unpleasant sensory and emotional experience that comes the
actual or potential tissue damage or describe the damage (pain studies
association): sudden attacks or slow the intentiasnya from mild to severe.
2) Inability of families to make decisions appropriate action
The common objective: the family is able to eliminate or control pain
1) Family able to recognize family problems
Intervention :
a) Review of knowledge about the pain the family
b) Explain the process of pain
c) Explain the causes of pain
2) Families are able to make decisions appropriate health measures
Intervention:
a) Assess the level of knowledge about the importance of families
make the right decisions to address / control pain
b) Explain about how to make the right decisions to control pain
c) Discuss what's become an obstacle in making decisions
3) The ability of families caring for sick family members
Intervention:
36
b) Explain the importance of maintenance of sick family members
c) Teach how to give treatment of sick family members
d) Teach relaxation and distraction techniques
4) Family able to modify a healthy home
Intervention:
a) Assess the level family knowledge about how to modify the
hospital
c) Teach to modify healthy home
Intervention:
facilities
c) Explain about the benefits of health facilities
c. Impaired nutritional needs less than body requirements related to (Nanda,
2007 to 2008: 315)
Impaired nutritional needs less than the body needs is not enough
nutrition for the body's metabolism.
1) Inability to recognize family of environmental health issues

37
5) Inability to utilize existing health care facilities
The common objective: the body's nutritional needs are met
Intervention:
a) Assess family knowledge about the nutritional needs of less than
body requirements
b) Explain the process of the nutritional needs of less than body
requirements
c) Give health education by strengthening the important things in the
care of nutritional needs is less than your body needs.
2) Families are able to make the right decisions in nursing actions
Intervention:
a) Assess the level family knowledge about the importance of
making good decisions to find ways to overcome the nutritional
needs of less than body requirements.
b) Explain about how to make the right decisions to find ways to
overcome the nutritional needs of less than body requirements.
3) The family is able to give care to sick family members
Intervention
38
c) Teach how to give care to sick family members, by providing
small but frequent meals
Intervention:
home
Intervention:
facilities
c) Explain the benefits of health facilities
d. Activity intolerance related to (Nanda, 2007 to 2008: 317)
Intolerant activity is insufficient physiological or psychological energy to
continue or complete the required activities and everyday activities.
2) Inability of families to make decisions appropriate nursing actions

39
General objective: patient tolerance to activity
Intervention:
a) Assess family knowledge about the intolerant activity
b) Explain the process of activity intolerance
c) Provide health education by strengthening the important things in
care to know how to deal with intolerant activity
Intervention:
a) Assess the level family knowledge about the importance of
making good decisions to find ways to overcome intolerance
activity
b) Explain about how to make the right decisions about the intolerant
activity
Intervention:
c) Teach how to give care to sick family members
d) Encourage activities to help families with sick family members

40
Intervention:
home
Intervention:
facilities
e. Impaired tissue perfusion associated with (Nanda, 2007 to 2008: 35)
Impaired tissue perfusion is the reduction of oxygen in the failure to feed
the network at the capillary level.
1) Inability to recognize family health problems
The common objective: the patient returns to normal tissue perfusion
Intervention:
a) Assess family knowledge about tissue perfusion disturbances

41
b) Explain the process by which a tissue perfusion disorder
c) Give health education on tissue perfusion disturbances
Intervention:
a) Assess the level family knowledge about tissue perfusion
disturbances
b) Explain about how to make the right decisions to address tissue
perfusion disturbances
Intervention:
Intervention:
home
c) Teach amemodifikasi healthy home
Intervention:
42
b) Assess the level of knowledge akeluarga to utilize health facilities
f. The risk of injury associated with (Nanda, 2005: 122)
Cedra risk is the risk cedra as a result of interactions with environmental
conditions of individual adaptation and defense sources.
General objective:
Intervention:
a) Assess family knowledge about the risk of injury
b) Explain the process by which the risk of injury
c) Provide health education about the importance of the risk of injury
prevention
Intervention:
a) Assess the level of knowledge about the importance of making the
right decisions to prevent risk of injury
b) Explain about how to make the right decisions to prevent the risk
of injury
43
Intervention:
a) Give an explanation on how to provide care to sick members
d) Encourage family members pay attention to sick family members
to prevent the injury occurred
Intervention:
a) Assess the level of knowledge about how to modify the family
home healthy
Intervention:
a) Instruct the family take advantage of existing health facilities or
the nearest
facilities
CHAPTER III
CASE REVIEW
44
A. ASSESSMENT
The assessment of Mr. K’s family was done on April 18th, 2010 at 01.00 A.M in
Nogosaren village, Nogosaren sub distric, Semarang regency.
1. General Identity
a. The identity of the family head
Name : Mr. K
Age : 60 years
Religion : Islam
Tribe : Java
Education : SR
Occupation : Farmer
Address : Village Nogosaren
b. Family composition
Table. 3. 1. Family Composition.
Family Imunization Status

Pair Infor
No Name Age connecti education BC Polio DPT Hepatitis
sort Campak mation
on G 1 2 3 1 2 3 1 2 3
1 Mr. K ♂ 60 year Head Society
family school
2 Mrs. T ♀ 54 year Wife Society
school
3 Mr. Ko ♂ 27 year Child Junior
high
school
4 Mrs. S ♀ 24 year Daughter Junior
high
school
5 Child. N ♀ 11 month Grend √ √ √ √ √ √ √ √ √ √ √
child
c. Genogram
44
Chart. 3. 2. Genogram.
45
Information :
: Male
: Female
: Patients
: Died
: Married
: Brother
: Living roof
d. Family types
It belonged to a family in a big family type (Extended Family),
because in a house consisted fathers, mothers, children who were married,
daughter and grandchildren.
e. Tribe
1) This family civilized tribes java.
2) Most of the society surrounding Mr. K residence was the java and
ethnic composition homogeneous character.

46
3) There were few environment activity were still closely associated with
ethnic values, among others, worked to clean the environment,
harisan, and yasinan in RT 02 Nogosaren Village.
4) Mr. K and his wife typically used traditional dress patterns and child
along with law uses modern fashion.
5) Decision making in the family was usually agreed upon by all
members of the family.
6) According to Mr. K if there’s a sick family member brought to
primary health centers or general doctor. There isn’t problem in using
health services.
7) The language used was Java language, and sometimes used
Indonesian language, there were any barriers in communication within
family, especially the language.
f. Religion and beliefs
1) All members of the family embraced Islam and the same view in the
practice of religious beliefs.
2) All family members were still active in religious activity, such as
prayers five times and yasinan organize.
3) According to Mr. K that the disease was destiny outlined by the
Almighty and will always strived for a cure. There weren’t values
that conflict with the health beliefs.
g. Socioeconomic status
Mr. K said that family income wasn’t necessarily, his wife and his
son worked as a farmer. ± 500 000 a month income; and his law worked
47
as a seamstress, ± 500 000 a month income;. Supplies include
expenditures incurred for daily needs and the cost of electricity.
h. Family leisure activities
Mr. K said that in free time, Mr. K and his family went to Salatiga
to relatives' houses. And Mr. K usually took advantage of free time the
assemble with his family while watching TV.
2. History and Family Development Stage
a. Current stage of family development
The first and the second child were married, it means that the family was
on stage parent families with middle age.
b. Stage of development of the unmet family
Stage was the stage of the unmet family in retired age and elderly.
3. Family Health History
a. Previous family health history
1) Mr. K said that he didn’t quite understand about his mother and
father’s health history because they died caused of old age.
2) Mrs. T said that his father had died of illness, but Mrs. T didn’t know
about her father's illness. While her mother Mrs. T was still in good
health.
48
b. Healthl history of each family member currently
According to Mr. K health history of each family member was as
follows:
1) Mr. K was currently not good condition now Mr. K suffered from
liver cirrhosis.
2) Mrs. T was currently in good health and not suffered from diseases
such as Mr. K illness now. Mrs. T also didn’t have a history of
hypertension and symptoms of diabetes militus (DM).
3) Mr. Ko was currently in good health, never suffered illness like his
father now.
4) Mrs. S was currently in good health, never experienced illnesses like
his parent.
5) child. N was currently in good health, but Mrs. S said that her
daughter had fever three days ago.
c. Source of health services utilized
Mr. K said that if there’s a sick family member immediately checked
to the nearest health service.
4. Environmental Assessment
a. House Characteristics
House status was own property.

49
1) Ground Plan house
Chart 3.2. Ground Plan Houses.
1 2 8
3 4 5 6
7
Information :
1. Page 5. Bedroom
2. Terrace 6. Bedroom
3. Bedroom 7. living room
4. Bedroom. 8. Bathroom
9. Kitchen
2) House consists of living room, four bedrooms, bathroom, and kitchen.
In front of the house which was also used for drying clothes and there
was the terrace. Disordered arrangement of the furniture was pretty
neat, sufficient ventilation, adequate lighting during the day because
there were windows and doors that opened in the morning and
afternoon, tile floors, walls permanent homes, and sufficient lighting
for the bedroom.
3) The kitchen was clean, the source of water from springs, complete and
clean utensils for each meal household items were always in the wash,
there’s not safety device to fire.

50
4) a complete bathroom equipment, bathroom equipment each family
member individually, drained the tub once a week and there weren’t
mosquito larvas.
5) Mr. K slept with his wife. Privacy assured people that there’s room
because it had door and could be locked.
6) Mr. K house have pets such as cows, chickens and cats.
7) Mr. K said that he felt safe living in the house because Mr. K could
rest comfortably.
8) Houses ware relatively safe from the risk of accidents or criminal
threat, a house surrounded by permanent walls, strong doors and the
driveway was relatively devoid of large vehicles, so the risk of small
accidents.
9) Household Waste collected waste storage site
10) Mr. K was satisfied with the arrangement of the house, because he
realized the land and their houses weren’t too large.
b. Characteristics Neighbors
Mr. K neighbor rarely came to his house in the afternoon and when
there were yasinan associations. He said that if there were problems
experienced by him now, a neighbor helped the his family.
c. Geographic Mobility Family
Mr. K said that all family members resided in the Nogosaren village
they were native Nogosaren village.

51
d. Association of Family and society with Interaction
Currently Mr. K wasn’t in good condition, but he could still
assemble with other society members, such as when there were yasinan
associations.
e. Family Support System
Currently Mr. K condition wasn’t good, because he said that
breathlessness and heartburn. But his family was always trought him to
health to health service.
5. Family Structure
a. Family communication patterns
Family communication patterns conducted openly, the language
used every day was Java language and sometimes used Indonesia
language. Family didn’t have difficulty in speaking with family members
or with others.
b. Family power structure
Decisions within the family despite the small problems or large
problems, the decision had to be agreed by all members of the family.
c. Role structure
Role for a living was by Mr. K, but his condition wasn’t good at that
moment. For the time being carried by his wife and children. So far in the
his family didsn’t occur family role conflict.

52
d. Values and norms of family
Family norms related to health was when there’re sick family
immediately checked to health service. In life every day demands of
family life based on Islam.
6. Family Function
a. Effective function
Mr. K attitudes and relationships with his family well and he said
within a family hed to have mutual respect among fellow members of the
family.
b. The function of socialization
Mr. K lived at home with his family, so that the function of
socialization among the well-knit family.
c. Health care functions
1) Ability to recognize the problem: Mr. K didn’t know about the
disease he suffered and also the diet that must be obeyed by Mr. K.
2) The ability of family to make decisions: any decision taken must be
agreed upon by members of the family.
3) The ability of family in cared for sick family members: Mr. K said
that if there were one sick family member, consider each other family
and keeping a sick family member and immediately checked into the
health service that is the nearest primary health center.
4) Ability to maintain a family in the home environment: the family
knows the importance of cleanliness of the home environment, that

53
was by sweeping the floor every day and mop the floor every three
time a weeks.
5) The ability of families utilize health facility: if the sick family
member, Mr. K said that always consult the nearest health service.
d. Reproductive function
Mr. K said that having two children, Mrs. T was in the menopause
stage, before Mrs. T followed the family planning program.
e. Economic function
Primary income source was by Mr. K, but his coundition wasn’t
good. At this time was carried by his wife and children.
7. Stress and Family Coping
a. Short-term stressors
Mr. K said that in the second period this month his coundition
wasn’t good, because he felt breathlessness and heartburn.
b. Ability of families respond to situations and stressors
If there were health problems as experienced in the Mr. K’s family
currently, the family immediately checked Mr. K to the nearest health
service.
c. Coping strategies used
If there’re problems both large and small problems were always
discussed with family members who lived one house.

54
d. Dysfunctional adaptation strategies
Mr. K was usually in the face of Mr. K problem felt confused and if
the problem could be solved he was able to relax.
8. Physical examination
No Examination Mr. K Mrs. T

1 Age 60 years 55 years
2 TD 120/70 mmHg 110/60 mmHg
3 Pulse 76 X / min 70 x / min
4 RR 25 x / min 22 x / min
5 Weight 50 Kg 51 Kg
6 Height 155 cm 150 cm
7 Head Mesochepal Mesochepal
8 Hair Wavy, black, spread Straight, black, spread
evenly, there were gray evenly, not branched, and
hairs, and not dandruff. not dandruff.
9 Eye Sclera not Icteric, Sclera not Icteric,
conjunctiva not anemis, conjunctiva not anemis,
unclear vision, not clear vision, not tenderness.
tenderness.
10 Nose Symmetrical, there Symmetrical, there wasn’t
wasn’t buildup of buildup of secretions, no
secretions, not enlargement of polyps, there
enlargement of polyps, wasn’t tenderness, not pull
there wasn’t tenderness, nostrils.
11 Ear not pull nostrils. Symmetrical, clean, not
Symmetrical, clean, not buildup serumen, not
buildup serumen, not tenderness, and good
tenderness, and good hearing.
hearing.
12 Mouth Mucosa, dry lips, not Mucosa moist lips, not
stomastitis, tongue fairly stomastitis, tongue fairly
clean, there were dental clean, not caries in the teeth.
caries.
13 Neck There wasn’t There wasn’t enlargement of
enlargement of the the thyroid gland and the
thyroid gland and lymph lymph glands, there weren’t
glands, there aren’t tenderness, not swallow.
tenderness, not swallow.
Lungs
14
I
Symmetrical, there was Symmetrical, ther waren’t
interkosta attraction. interkosta attraction.
Pal There wasn’t tenderness.
There wasn’t tenderness.
55
Per Resonant Resonant

A Audible wheezing. Not audible wheezing and
Ronchi.
15 Heart
I Cardiac Ictus invisible. Cardiac Ictus invisible.
Pal There wasn’t cardiac There wasn’t cardiac
enlargement and enlargement and tenderness.
tenderness.
Per Dull. Dull.
A S1 and S2 regular S1 and S2 regular
17 Stomach Convex surface.
I Intestinal peristalsis 18 Convex surface.
A x / min Intestinal peristalsis 16 x /
There was tenderness in min
Pal quadrant one and There wasn’t tenderness, not
palpated region there palpable enlargement of the
enlargement of the liver. liver.
Hipertimpani.
Per Tympani.
18 Extremity There weren’t injuries,
a. Superior could be moved freely, There weren’t injuries, could
there was’t hematum and be moved freely, there
not congenital defects. wasn’t hematum and not
There weren’t injuries, congenital defects.
b. Inferior could be moved freely, There weren’t injuries, could
not defects, there wasn’t be moved freely, not defects,
hematum farises. there wasn’t hematum
Damp, not injuries, and farises.
19 Skin not cyanosis occurs. Damp, not injuries, and not
Net, there weren’t signs cyanosis occurs.
20 Nail of hypoxia. Net, there weren’t signs of
hypoxia.
No Examination Mr. Ko Mrs. S

1 Age 27 years 24 years
2 TD 110/70 mmHg 110/60 mmHg
3 Pulse 70 x / min 68 x / min
4 RR 22 x / min 22 x / min
5 Weight 55 Kg 42 Kg
6 Height 163 cm 150 cm
7 Head Mesochepal Mesochepal
8 Hair Wavy, black, spread Straight, black, spread
evenly, not gray hairs, evenly, not branched, and
and not dandruff not dandruff.
9 Eye Sclera not icteric, Sclera not icteric,
conjunctiva not anemis, conjunctiva not anemis,
56
clear vision, not clear vision, not

Nose tenderness. tenderness.
10 Symmetrical, there Symmetrical, there wasn’t
wasn’t buildup of buildup of secretions, not
secretions, not enlargement of polyps,
enlargement of polyps, there wasn’t tenderness,
there wasn’t tenderness, not pull nostrils.
Ear not pull nostrils.
11 Symmetrical, clean, not Symmetrical, clean, not
buildup serumen, not buildup serumen, not
tenderness, and good tenderness, and good
Mouth hearing. hearing.
12 Mucosa moist lips, there Mucosa moist lips, there
wasn’t stomstitis, tongue wasn’t stomstitis, tongue
fairly clean, not dental fairly clean, not caries in
Neck caries. the teeth.
13 There wasn’t There wasn’t enlargement
enlargement of the of the thyroid gland and
thyroid gland and the the lymph glands, there
lymph glands, there wasn’t tenderness, there
wasn’not tenderness, wasn’t swallow pain.
there wasn’t swallow
Lungs pain.
I
14
Symmetrical, not pull Symmetrical, not pull
Pal interkosta. interkosta.
Per There wasn’t tenderness. There wasn’t tenderness.
A Resonant. Resonant
Not audible wheezing. Not audible wheezing and
Heart Ronchi.
I
15
Pal Cardiac Ictus invisible.
Cardiac Ictus invisible.
There wasn’t cardiac There wasn’t cardiac
enlargement and enlargement and
Per tenderness.
tenderness.
A Dull.
Dull.
Stomach S1 and S2 regular
S1 and S2 regular
I
17
A Convex surface.
Convex surface.
Intestinal peristalsis 18 Intestinal peristalsis 16 x /
Pal min
x / min
There wasn’t tenderness There wasn’t tenderness,
and there wasn’t there wasn’t palpable
Per
enlargement of the liver. enlargement of the liver
Extremity
Tympani. Tympani.
a. Superior
18
There weren’t injuries, There weren’t injuries,
could be moved freely, could be moved freely,
57
there wasn’t hematum there wassn’t hematum

b. Inferior and there weren’t and there weren’t
congenital defects. congenital defects.
There weren’t injuries, There weren’t injuries,
could be moved freely, could be moved freely,
there weren’t defects, there weren’t defects,
Skin there wasn’t hematum there wasn’t hematum
farises. farises.
19 Nail Damp, not injuries, and Damp, not injuries, and
not cyanosis occurs. not cyanosis occurs.
20 Net, there weren’t signs Net, there weren’t signs
of hypoxia. of hypoxia.
No Examination Child. N
1 Age 11 months
2 Pulse 110 x / min
3 RR 35 x / min
4 Weight 8 Kg
5 Height 69 cm
6 Arm circumference 14 cm
7 Chest circumference 57 cm
8 Head circumference 45 cm
9 Head Mesochepal
10 Hair Curly, black, spreading evenly, and there
wasn’t dandruff.
11 Eye Sclera not icteric, conjunctiva not anemis,
there wasn’t tenderness.
12 Nose Symmetrical, there wasn’t buildup of
secretions, there weren’t enlargement of
polyps, there wasn’t tenderness, not pull
nostrils.
13 Ear Symmetrical, clean, not buildup serumen,
not tenderness, and good hearing
14 Mouth Mucosa moist lips, not stomstitis, tongue
cleaner, not dental caries.
15 Neck There wasn’t enlargement of the thyroid
gland and the lymph glands, there wasn’t
swallow pain.
16 Lungs
I Symmetrical, not pull interkosta
Per Resonant.
A Not audible wheezing and Ronchi.
17 Heart
I Cardiac Ictus invisible.
Pal There wasn’t cardiac enlargement and
tenderness.
58
Per Dull.
A S1 and S2 regular
Stomach
18 I Flat surface.
A Intestinal peristalsis 18 x / min.
Per Tympani.
Extremity
19 a. Superior There weren’t injuries, could be moved
freely, there wasn’t hematum and there
weren’t congenital defects.
b. Inferior There weren’t injuries, could be moved
freely, not defects, there wasn’t hematum
farises.
Skin Damp, not injuries, and there wasn’t
20 cyanosis occurs.
Nail Net, there weren’t signs of hypoxia
21
9. Additional Data
DS : Mr. K said that pain
DO : P = Pain due to liver enlargement
Q = Pain felt by clients such as compressed
R = Pain that is felt area to the right upper abdomen
S = Scale 4 pain
0 1 2 3 4 5 6 7 8 9 10
light average heavy
T = Missing arise
59
Bathel Assessment Index
With
No Criteria Independent information
Help
1 Eat 5 10√ Frequency: 3 times a
day, the number of: 1
plate, type: rice,
vegetables, side dishes
2 Drink 5 10√ Frequency: 6-8 cups a
day, number: 1 600 cc,
type: water.
3 Moving from place to 5-10 15√
wheelchair seat
4 Personal toileting 0 5√
5 In and out of toilet 5 10√
6 Bath 5 10√ Frequency: 2 times a
0 15√ day
7 Flat surface road 5 10√
8 Up and down stairs 5 10√
9 Wearing apparel 5 10√ Frequency: 1 times a
10 Control Bouel 5 10√ day
11 Bladder Control 5 10√ Consistency: soft
5 10√ Frequency: 5-7 times a
day
12 Sports
13 Recreation
number 0 130
Assumption: the value of 130 is classified as an independent state.
Mental Status Assessment Gerontic
True wrong No Quietion

√ 01 What's the date today?
√ 02 What day is today?
√ 03 What is the name of this place?
√ 04 Where is your address?
√ 05 How old are you?
√ 06 When you were born?
√ 07 Who was president of Indonesia now?
√ 08 Who was president before Indonesis?
√ 09 Who is your mother's name?
√ 10 3 Less than 20 and remains third
reduction of any new figures, all in
declined.
60
Assessment Index KATZ
No Criteria Information
1 BATHING Mr. K shower 1times a day and can be done alone.
2 DRESSING Mr. K changing clothes 1x a day and can wear his
own clothes.
3 TOILETING Mr. K could go the toilet (bowel and bladder) own.
4 TRANSFER Mr. K can be moved from place to place without
assistance.
5 KONTINENCE Mr. K could be controlled with good impulses.
6 FEEDING eat 3 times a day without assistance.
Assumption : In this study obtained a mean value of equilibrium Mr. K in both
activity.
A Change the position or movement value
1 Waking up from a chair 1

2 Sit down into a chair 1
3 Resisting the urge of the sternum 1
4 Eyes closed 1
5 Neck rotation 1
6 The movement reached something 1
7 Bow 1
B Components of gait / movement value
8 Ask the client to walk to the place specified 1
9 Feet altitude 1
10 Continuity footsteps 1
11 symmetrical footsteps 1
12 deviation path at run-time 1
13 Turn 1
Assumption : In this assessment could be seen the value obtained by Mr. K
means the balance of Mr. K in performing its still good.

61
B. DATA ANALYSIS
Name of client : Mr. K Dx. Medical : liver cirrhosis
Date / Nursing
No Data Focus Possible cause Sgn
Jam Hour problems
1 Sunday DS: inability of the Ineffective
18-04-10 Mr. K said that shortness family in caring breathing
16:00 of breath. for sick family pattern
P.M DO: members
- RR 25 x / min
- Mr. K appeared holding
his chest
- There were pull
interkosta
- There were pull nostrils
- When Mr. K breath.
middle look out of breath
2 Sunday DS: The inability of Impaired
18-04-10 Mr. K said that pain in the family to cope sense of
16:00 upper right abdomen. with a sick family comfort pain
P.M DO: member illness.
- P = pain
because there
Was liver damage
- Q = pain as pressed
- R = abdominal pain side
Right on
- S=4
- T = loss arising
- Mr. K looks grimace
Withstand pain
- Mr. K looks pale Mr. K
holds regional pain
3 Sunday DS: Inability of family Anxiety
18-04-10 Mr. K said that to feel to know the
16:00 anxious with the disease health problems
P.M
DO:
- Mr. K was restless
- Mr. K looked confused
Cold acral
4 Sunday - DS: Inability of family Lack of
18-04-10 Patients told not know about to know the knowledge
16:00 her illness and her diet. health problems. about
P.M DS: disease and
- Mr. K to wonder about diet.
the disease and diit.
62
- Mr. K silent when asked

about his illness
C. THEOLOGICAL PROBLEMS
Name of client: Mr. K Dx. Medical: liver cirrhosis
1. Ineffective breathing pattern related to the inability of the family in caring for
sick family members.
2. Pain related to the inability of family to cope with a sick family member
illness.
3. Anxiety related to the inability of family to know the health problems.
4. Lack of knowledge about disease and diet related to the inability of family to
know the health problems.
D. SCORING
Criteria Score Justification

3
a. The nature of the problem /3 x 1 = 1 If things wren’t going to
Scale: less healthy jeopardize Mr. K addressed
urgently. because Mr. K was
shortness of breath, so family
need to pay attention and bring
Mr. K to health service.
b. Possible problems that could be ½x2=1 Health care facility far enough
changed 2
/3 x 1 = 2/3 away from his house, but Mr. K
Scale: some 2
/2 x 1 = 1 still has the desire to seek
treatment.
c. Potential problems to be Family have their own activity,
prevented but the family took the time to
Scale: enough Mr. K.
d. Prominence of the issue Mr. K and the family feel this
Scale: the problem must be was a problem that must be
addressed addressed.
32/3
3
a. The nature of the problem /3 x 1 = 1 If things weren’t going to
Scale: less healthy jeopardize Mr. K overcome.
63
because at this time Mr. K felt

pain upper right abdomen that
needs to be taken family health
service.
b. Possible problems which could ½ x 2 = 1 Not only environmental issues
be changed 2
/3 x 1 = 2/3 but also the physical condition of
Scale: some 2
/2 x 1 = 1 Mr. K so that also requires
regular medication and diet.
c. Potential problems to be Family have their own busy but
prevented take the time to Mr. K’s family.
Scale: enough
32/3
2
a. The nature of the problem /3 x 1 = 2/3 If things weren’t resolved will
Scale: health threats appear belarut anxiety, so Mr. K
to stress and new problems arise.
b. Possible problems that could be ½ x 2 = 1 Health-care facilities far enough
changed 2
/3 x 1 = 2/3 away from home Mr. K, but Mr.
Scale: some 2
/2 x 1 = 1 K still has the desire to seek
treatment.
c. Potential problems to be Family have their own activity,
prevented but the family took the time to
Scale: enough Mr. K.
31/3
2
a. The nature of the problem /3 x 1 = 2/3 if the situation wasn’t resolved
Scale: health threats then the Mr. K’s family and Mr.
K in particular didn’t know
about the disease and diet.
b. Possible problems that could be ½ x 2 = 1 Mr. K education was SR
changed 2
/3 x 1 = 2/3 (Society school) and still able to
Scale: some 0
/2 x 1 = 0 read, because the age factor so
that his memory started to
c. Potential problems to be decrease.
prevented Mr. K education SR (Society
Scale: enough school) and could read as well
as existing television and radio
d. Prominence of the issue media.
Scale: the problem wasn’t felt Fill the family issues are not too
problematic, the critical illness
suffered by Mr. K can be
recovered.
21/3
64
E. DIAGNOSIS PRIORITIES
Name of client: Mr. K Dx. Medical: liver cirrhosis
1. Ineffective breathing pattern related to the inability of the family in caring for
illness.
3. Anxiety related to the inability of family to know the health problems.
4. Lack of knowledge about disease and diit related to the inability of family to
know the health problems.
F. NURSING ACTION PLAN
Name of client : Mr. K Dx. Medical: liver cirrhosis
No. Sfecifiic
General purpose Criteria Intervention
Dx purpose
I Having provided 1. Mr. K’s family Knowledge 1. Dig family knowledge
nursing care during could recognize to know the cause of
the four days the the impact of shortness of breath
family is expected Mr. K disease. Mr. K.
Mr. K capable of 2. Explain the process of
Mr. K treating. occurrence of
shortness of breath on
the Mr. K’s family
and Mr. K.
3. Invite family and Mr.
K to explain the return
process shortness of
breath occur.
65
2. Mr.K’s family Affective 1. Explain to the Mr.

could decide the K’s family and Mr. K
appropriate regarding measures
health measures to reduce the problem
in striked of ineffective
ineffective breathing pattern
breathing 2. Involve family
pattern members in making
problems. decisions.
Provide suggestions
for action that can be
done at house.
3. Mr. K’s family Psychomotor 1. Adjust the Mr. K
could treat Mr. position.
K. 2. Advise Mr. K to
practice breathing
deeply.
3. Instruct Mr. K’s
family to note the
Mr. K condition.
II Having provided 1. Mr. family. K Knowledge 1. Dig knowledge about
nursing care during could recognize the cause of pain Mr.
the four days the the impact of K’s family.
family is expected Mr. K disease. 2. Explain about the
Mr. K capable of process of pain on
Mr. K treating. the Mr. K’s family
and Mr. K.
3. Mr. K’s family
guided and Mr. K to
explain the return of
pain
2. Mr. K’s family Afektive 1. Explain to the
could decide family and Mr. K
appropriate regarding measures
health measures to reduce the
in striked pain problem of pain
problems 2. Involve the
whole family in
making decisions.
Give advice abstain
appropriate action
done at house.
66
3. Mr. K’s family. Psychomotor 1. Teach relaxation

could treat Mr. and distraction
K. techniques.
2. Advise Mr. K
adequate rest.
Advise Mr. K to not
move the weight.
III Having provided 1. Mr. K’s family Knowledge 1. Assess family
nursing care during could recognize knowledge about
the four days the health problems anxiety felt by Mr..
family was K.
expected Mr. K 2. Explain to the
capable of Mr.K family about how to
treating. overcome anxiety
Tn.K.
3. Mr. K’s family and
Mr. K guides to
explain again about
the way overcome
anxiety.
2. Mr.K’s family Afektive 1. Motivation Mr. K for
health can positive action to
decided an anxiety
appropriate decrease.
acton of dealing 2. Give advice to
with anxiety family to keep
problems. control to health
service.
3. Mr. K’s family Psychomotor 1. Teach the technique
could treat Mr. of distraction.
K. 2. Advise Mr. K so as
not to stress.
IV After given health Mr. K’s Family Knowledge 1. Dig family
education during may be familiar knowledge about the
expected Mr. 1x30 with Mr. K disease liver
minutes. K bias to health problems. cirrhosis.
explain again about 2. Tell than about the
the disease and diet. disease including
liver cirrhosis:
a. Definition
b. Cause
b. Signs and
symptoms
c. Handling
d. Complication
e. Diet
3. Invite family to
explain the return of
67
liver cirrhosis
disease.
G. NOTE NURSING
Name of client : Mr. K Dx. Medical: liver cirrhosis
Day / No. Dx.

Hour Implementation Respon Sgn
Date Nursing
Friday 11.00 IV 1. Digging family knowledge DS : Mr. K’s
23-04-10 A.M about the liver cirrhosis Family and
disease. Mr. K said
that didn’t
know about
illness.
DO:
- Mr. K and
family couldn’t
answer when
asked about
illness.
2. Explaining to the family and DS : Mr. K’s
Mr. K of liver cirrhosis Family and
disease, including: Mr. K said
a. Definition that obvious
b. Cause about liver
c. Signs and symptoms cirrhosis
d. Handling disease.
e. Complication DO:
f. Diet - Mr. K and
Family
Capable
Answer
Question
About liver
chirrosis
disease and
68
diit..
3. Guiding the Mr. K’s family DS : Mr. K and
and Mr. K to repeat the Mr. K’s
explanation of liver cirrhosis family said
and diet. that could
repeated
explanations
of liver
cirrhosis and
diit.
DO:
- Mr. K and Mr.
K’s family
could explain
about liver
cirrhosis and
his diet.
4. Giving a compliment to the DS : Mr. K’s
family and Mr. K because the family and
cooperative to listen and Mr. K said
answer about liver cirrhosis that happy
and diet were given
health
education
DO : - Mr. K
seemed
pleased
- Mr. K and
the family
seemed to
laugh
- Mr. K
doesn’t
appear
confused
Saturday 11.00 II 1. Adjust the position of DS : Mr. K said
24-04-10 A.M Mr. K with semi-Fowler that more
position. cozy with
semi-Fowler
position.
DO :
- Mr. K appear
happy
- Mr. K not
Fidget.
DS : Mr. K said
2. Mr. K teaches deep that after do
breathing techniques. breathing
69
techniques
Inside, Mr. K
felt more
relief.
DO :
- Mr. K
could do
breathing
techniques
deep.
H. NOTES DEVELOPMENT
Name of client : Mr. K Dx. Medical : liver chirrosis
Day / Date
No. Dx.
/ Jam Evaluation Sgn
nurse
Hour
Friday IV S : Mr. K ‘s family and Mr. K said that glad to know
23-04-10 about the liver cirrhosis disease.
11.30 O : Mr. K’s family and Mr. K was able to answer
A.M questions that include:
a. Definition
b. Cause
c. Signs and symptoms
d. Handlers
e. Complication
f. Diet
A : Problem solved
P : Preserve intervention
Saturday I S : Mr. K said that after the technique of breathing in,
24-04-10 Mr. K was more relieved and less crowded
11.25 already.
A.M O :
- Mr. K can perform independently in a breath
technique.
- Mr. K seemed calm.
- Mr. K didn’t seem agitated
- RR 24 x / min
A : Problem solved
P : Keep intervention
70
CHAPTER IV
DISCUSSION
In this chapter the author would discuss about nursing care of Mr. K’s family
especially Mr. K with liver cirrhosis, in the Nogosaren Village, Getasan sub district,
Semarang regency. On April 18 until 27 April 2010, which started from the stage of
assessment, planning, implementation to evaluation stages. On the implementation of
family nursing care was a real case which of course there was a gap between the
problems that arise with existing nursing theory.
A. Discussion
After assessment process of the data collecting and analyzing data finally the
author got the data of four issues on Mr. K’s family, well maked priority used the
scoring. The problems that were based on the priority issues were:
1. Ineffective breathing pattern on Mr. K’s family especially Mr. K associated
with the inability of family caring for sick family members by scoring 3 2/ 3.
The data that appeared on Mr. K said that shortness of breath,
cough, the pull of interkosta, audible wheezing. While for the signs that lead
71
to ineffective breathing pattern is the change in the depth, speed breathing,
development of the chest disturbance, cough with or without sputum
production, abnormal breath sounds such as krikels, wheezing (Doenges,
2000: 156).
Ineffective breathing pattern was inspired ventilation or air
exchange and / or inadequate expiratory (Nanda, 2005: 27). The process of
occurrence
of shortness of breath or Ineffective breathing pattern on Mr. K because there

70
was ascites of the abdomen that could cause a pressure on the diaphragm so
the lungs become narrowed and the space there was shortness of breath
(Smeltzer, 2002: 1178).
Factors related to ineffective breathing pattern with family in caring
for family inability sick family member. According to Suprajitno (2004: 18)
has family taked appropriate and right action, but the family has a known
limitation of his own family. There were certain factors that will create
barriers or obstacles to healthy development, and cause to environmental
factors that bad.
Limitation of the major characteristics (one must exist) at diagnosis
are the changes in frequency or pattern of breathing, changes in pulse
(frequency, duration, quality), the age limit criteria were orthopnea,
tachycardia, hipercapnea, hyperventilation, respiratory diritmic, difficult
breathing, or be careful (Carpenito, 2001: 326).
Limitation of ineffective breathing pattern characteristics such as
decrease of expiration or inspiration, the decline in ventilation per minute, the

72
use of additional respiratory muscles for breathing, nasal pharynx breathing,
dyspnea, chest irregularities, shortness of breath, pursed-lip breathing (by
mouth), expiratory elongate, breath frequency (infants <25 or> 60, 1-4 years
<20 or> 30, 5-14 years <14 or> 25, more than 14 years <11 or> 24), decrease
the vital capacity (Nanda, 2005: 27).
Inability of family caring for sick family members is the inability of
family to know the disease, knowing about the nature and development of
treatments required, to know the existing resources within the family (a
family member who was responsible, finance physical facilities,
psychosocial), knowing the existence of the necessary facility to care and
family attitudes toward the sick (Mubarak, 2006: 289).
The reason of author to prioritize this diagnosis became the first
diagnosis of respiratory problems because according to author was the most
actual problems that must be addressed, if the need for oxygen (O2) in the
body weren’t met could be life threatening with a short time. Moreover, I also
saw the results of the scoring ability that could be changed with the scale part,
was a potential problem to be prevented simply because it was affected by
many factors, among others: environmental factors and intrinsic material, and
the prominence of issues that must be addressed. Besides, according to Perry
& Potter (2005: 1569-1570), describes the O2 (oxygen) is the most basic
physiological needs and if needs are not met would threaten the life that
previously showed signs of tissue hypoxia were inadequate oxygenation at
the tissue level this network if not addressed will lead to cardiac dysrhythmic
increased pulse rate and breathing and could cause death.

73
Intervention that had been prepared, among others, assessed
knowledge of Mr. K’s family especially Mr. K about the cause of shortness of
breath and a process of shortness of breath, set the positions and breathing
techniques taught in order to stimulate awareness and acceptance of family
related to problems and health needs and provide confidence for caring for
Author solved the above problems by doing that carried out the
implementation date of 24 April 2010 at 11:00 hours which assessment
knowledge of Mr. K’s family especially Mr. K about the causes and
processes of the occurrence of shortness of breath. Rational was to recognize
how much knowledge his family especially about the causes and occurrence
of shortness of breath, whose purpose was Mr. K’s family and especially Mr.
K could be explained again about the causes and processes of the occurrence
of shortness of breath. Adjust the position of Mr. K with semi-Fowler's
position or half-sitting position. Rational was to stimulate breathing function
or lung expansion, effective in the prevention and improvement of pulmonary
congestion with the aim to facilitate of respiratory or lung expansion
(Doenges, 2000: 123).
Teached relaxation techniques or breathing in to the Mr. K’s family especially
Mr. K Rational was to help breathing reekspansi or maintain airway potency
which aims to reduce shortness of breath and can demonstrate how relaxation
techniques or breathing in (Doenges, 2000: 123). Motivated family to
communicate with other family members about how the management of the
74
right decisions in caring for sick family, because the motivation of the family
will be able to changed the attitude of these family (Suprajitno, 2004: 50).
After the implementation of the evaluation was obtained as follows:
Mr. K’s family and Mr. K said that his shortness of breath was decreased
compared to before, and was able to overcome said that in shortness of
breath, respiratory frequency was reduced to 24 x / min. Mr. K’s family and
Mr. K knows the cause and process of occurrence of shortness of breath. And
able to demonstrate how to perform semifowler and engineering positions in
a breath. From the analysis of problems found in nursing diagnose the issue is
resolved so that the action plan is maintained.
Breathing techniques was a process of fulfilling the needs of O2
(oxygen) was adequate in the body, adequate oxygen in the body causing
oxygenation process is the process of ventilation, diffusion and perfusion can
be working perfectly so in the process of ventilation or gas exchange during
inspiration and expiratory path not experiencing respiratory obstruction or
narrowing. so that the author teaches breathing techniques to reduce his
shortness of breath.
Author determined factor endowments that support the family of
nursing problem solving in the Mr. K’s family, among others, the ability of
his family to understand the material that has been submitted, the desire of the
family members to achieve better health standards, while the inhibiting factor
was a bit of time to meet with his family members of the sidelines
preoccupations.
2. Pain related to the inability of family to recognize health issues with scoring
75
3 2/3.
The formulation of nursing diagnoses in line with the needs of clients,
supported by restriction characteristics, which shows the basic data of clients,
aetiological conditions (Potter, Perry, 2006: 169-170).
The data that appeared on Mr. K said that pain in area at the upper
right abdomen and pain when performing activities increases, the pain
disappeared arise, activity limitations, there was hepatomegaly palpable,
pale, grimaced pain, and his holds regional pain (Doenges, 2000: 156). While
for the signs that lead to a sense of comfort and pain disorders was
found on Mr. K complaint, pain, discomfort, fatigue
Leisure is a situation that has been the fulfillment of basic human needs,
which include the need for tranquility (a satisfaction that enhance the
appearance of everyday), relief (needs have been met), and transcendent (a
state of something that exceeds any problems or pain) (Perry-Potter , 2006:
1502)
Pain was a sensory and emotional experience unpleasant damages
arising from actual or potential tissue or show damage. (Nanda, 2005:146).
While acute pain is pain that lasts from several seconds up to 6 months,
whereas chronic pain is constant or intermittent pain settled over a period of
time or held for six months or more (Smeltzer, 2002:213).
Pain receptors are free nerve endings in the skin that respond only to
strong stimuli, which are potentially damaging. Chemical mediators of pain is
the number of substances that affect the sensitivity of nerve endings or pain
receptors to tissue released extracellularly as a result or the perception of pain

76
include histamine, bradykinin, acetylcholine, and substance prostaglandin
(Smeltzer, 2002: 215). Changes in circumstances where the individual's
comfort is experienced or reported a great sense of discomfort or unpleasant
sensations (Carpenito, 2001: 42).
Processes and causes of pain in diseases suffered by Mr. K . liver
cirrhosis was caused by liver cells were destroyed resulting in inflammation
of the liver after liver inflammation pad liver parenchymal necrosis will occur
after that there was increased formation of scar tissue that causes the
connective tissue, causing the failure of the liver parenchyma. From the
failure of the liver parenchyma was then emerge the pain response (Smeltzer,
2002: 1178).
Limitation of the major characteristics (one must exist) on individual
diagnoses are reported to feel pain. While the characteristics of minor
limitations (not necessarily exist) was a disorder of social and family
relationships, sensitive stimulation, depression, holds part of the pain, anxiety,
grimacing appearance, fatigue, and anxiety.
Inability of family caring for sick family members is the inability of
family to know the disease, knowing about the nature and development of
needed care, knowing that there are resources within the family (a family
member who was responsible, finance physical facilities, psychosocial),
knowing the existence of the necessary facilities to care and family attitudes
toward the sick (Mubarak, 2006: 289).
The reason the writer to prioritize this diagnosis as a second diagnosis
because emergencies terms of the pain was at the second position which
77
should be treated after breathing problems. According Bailon and Maglaya in
Setyowati and Murwani (2008) mentioned that the diagnosis should consider
the prioritization criteria, the nature of the problem, possible problem was
changed, the potential problems to be prevented and the prominence of the
issue. From the assessment scoring, the authors get the same scoring value in
the case of Mr. K, but the authors continue to take pain as a priority both
because of the pain although it also could be life threatening but requires a
longer period than the breathing problems.
Mr. K’s family and Mr. K not know clearly about the process of pain
and prominence occurrence problem that must be addressed as his family
assume that health was very important, for the determination of priorities
should consider the criteria of the nature of the problem it was unhealthy or
because it has happened, possible problems could be handled in part because
of low education and low socio-economic.
Intervention on April 25, 2010 which dig knowledge of Mr. K’s
family and Mr. K about causes and processes aimed at the pain that the his
family and Mr. K know about the pain. Explain the causes and processes of
the occurrence of pain, to illustrate the existence of the causes and processes
given the occurrence of pain the his family is expected and Mr. K was able to
understand and apply the science that has been obtained. For how to
overcome the pain felt by Mr. K. Author teach relaxation techniques to the
Mr. K’s family and Mr. K. To achieve these objectives, the author conduct
health education and to demonstrate the way of relaxation and distraction
techniques.
78
Authors in troubleshooting and implemented by the above conduct on
April 25, 2010, provides health education about the causes and processes of
the occurrence of pain. Rational was to provide basic knowledge to the family
and Mr. K in order to understand the causes and the process of pain, objective
that Mr. K’s family and Mr. K knows and could explain the causes and
processes of re-occurrence of pain. Teaches about how relaxation techniques
with a deep breath and imagine the fun things. Rational relaxation technique
that was by doing so could cause vasodilatation muscles become lax and
assist in reducing the decreased in pain perception or response, provides
control situations, and increase positive behaviors, which aims to enhance
relaxation and reduce pain.
Relaxation technique was a process of fulfilling the O2 (oxygen) in the
body including organs in the body by a deep breath. With fulfilled oxygen on
the internal organs of the body like the muscles in the body become loose
or relax so it could reduce the occurrence of pain response.
After doing these implementation in the evaluation obtained as
follows: Mr. K’s family and Mr. K said that could explain the causes and
processes of pain and Mr. K said the pain was reduced from the previous after
doing relaxation techniques and was able to overcome the pain when his
illness relapsed, three pain scale. his family and his could demonstrate how
the relaxation technique, the analysis found problems in nursing diagnose the
issue was resolved so that the action plan was maintained.
The author found a supporting factor in the management of his family is a
family capable of understanding the material presented and could

79
demonstration of relaxation techniques. While the inhibiting factors to lack of
time given to managing the his family.
3. Anxiety related to inability of Mr. K’s family and Mr. K know the health
problem by scoring 2 1 / 3.
The data that appeared on Mr. K said that anxiously, Mr. K looked
confused or restless, acral cold and dry lip mucosa. According to Carpenito
(2001: 90-10) for signs and symptoms that lead to anxiety could be
determined by three categories namely physiological, emotional, and
cognitive. Physiological include an increase in blood pressure, increased
cardiac frequency, respiratory frequency increased, pale, dry mouth, and
weakness. Emotional includes clients feel fear, helplessness, nervousness,
lack confidence, can not be relaxed, sensitive to stemuli, excessive anger, and
poor eye contact. Cognitive include client can not concentrate, lack of
awareness of surroundings, and decreased ability to learn.
Anxiety was a condition in which individual or groups experiencing feelings
of anxiety (assessment or opinion) and nervous system activity in autonum
respon to threats that were unclear, nonspecific (Carpenito, 2001: 9).
Anxiety was feeling uncomfortable or fear that weren’t clear and anxiety
accompanied by autonomic responses (sometimes non-specific sources or not
known by the individual), feelings of anxiety not to overcome the danger
(Nanda, 2005: 9).
Factors related to anxiety by the inability of Mr. K’s family to know
health problems. According Suprajitno (2004: 18), the family has the right
and correct action, but the family has limitations that have been known to the
80
family. There were certain factors that will create barriers or obstacles to
healthy development.
Limitation of anxiety characteristics according to Nanda (2005: 9-11),
in terms of behavioral, affective, physiological and cognitive. Behaviours
include decreased productivity, alertness and staring, restless glance, poor eye
contact, and restless. Includes affective feeling regret, iritabel, anguish, fear,
nervousness, feelings of inadequacy and easily offended. Physiological
tremble include voice, hand tremors, shaky, increased respiration, increased
urination and increased pulse. While cognitive include blocking,confused,
reflective, damage to attention, and a decrease in the field of perception.
Inability to recognize family health problems is the inability of family
to know the facts of health problems including the definition, causes, signs
and symptoms of, and that affects family, and the perception of problem
(Mubarak, 2006: 288-289).
The reason the author to prioritize this diagnosis became the third
diagnosis Because worry was a problem which should also be handled but the
result of third-ranked scoring worried that views of the nature of the problem,
scale health threats, possible problems that could be modified in part and
potential problems to be prevented simply because it was affected by various
One factor was the source environment. And the prominence of the issue
must be addressed so as not to cause new problems.
Interventions that had been prepared, among others, digging
knowledge of Mr. K’s family and Mr. K about anxiety and how to overcome
anxiety, teach or distracting distraction techniques with the aim to stimulate

81
awareness and acceptance of family related to problems and health needs and
provide confidence for caring for sick family members. Author to tackle the
problem of implementing the above authors carried out on 26 April 2010
10.05 hours digging knowledge Mr. K’s family and Mr. K how to overcome
anxiety. Rational was to know how far knowledge of the family and Mr. K to
overcome anxiety, objective oder his family and Mr. K knows how to identify
anxiety. Teaching the technique of distraction or divert attention. Rational was
to give meaning anxiety removal response, lowering of attention, enhancing
relaxation, improving coping skills, an objective that his family and Mr. K
was able to explain again and to demonstrate the technique of distraction for
overcome his anxiety.
Anxiety is a mixture of physical, emotional, and behavioral disorders
are divided into three components, namely the reception, perception, and
reaction. To overcome this author taught distraction techniques or in any way
distract the client so that client's perception of the mind wasn’t focused on
anxiety.
After the implementation of the evaluation is obtained as follows: Mr.
K’s family and Mr. K said that anxiety was felt already reduced after taught
distraction techniques (distraction) and his family and his was also able to
demonstrate how the distraction technique. From the analysis of problems
found in nursing diagnose the problem resolved, so the plan of action was
maintained.
Authors determining factor endowments that support the settlement of
his family in family nursing problem, among others, the ability of Mr. K’s
82
family was able to explain again about how to overcome anxiety, the desire of
the family members to achieve health standards more where the inhibiting
factor was a bit of time to meet with Mr. K’s family members on the sidelines
of preoccupation.
4. Lack of knowledge on Mr. K’s family and Mr. K’s illness related to the
inability to recognize family health issues with scoring 21/3
The data that appeared on Mr. K said that it didn’t know about his
illness, Mr. K silent when asked about his illness, Mr. K to wonder about the
disease and the cause of her illness. According to Nanda (2007: 324), a sign
that leads about the lack of knowledge was the cognitive limitation, the
interpretation of the information was wrong or lack of desire to seek
information, and didn’t know the sources of information.
Notoatmodjo (2005: 3), describes the idea of knowledge was the
result of human beings, who merely answered the question "what" such as
what human beings, nature and so forth. According to Carpenito (2001: 223)
lack of knowledge was a state where an individual or group cognitive
deficiency of knowledge or psychomotor skills related to the condition with
treatment plan.
According to Potter-Perry (2005: 336) education for an important
client because the client has the right to know and get information about
doagnosis, prognosis, treatment and risks. The purpose of health education on
the client is to maintain good health, disease prevention, and improved health.
Limitation of the major characteristics which reveal the knowledge
and skills of information request. Minor characteristics that is less integration

83
of the treatment plan into daily activities, show changes in psychological
(anxiety, depression) lead to less information.
Inability to recognize family health problems is the inability of family
to know the facts of health problems including the understanding, causes,
signs and symptoms, and that affects family, and the perception of problem
(Mubarak, 2006: 288-289).
The reason the writer has taken this knowledge to prioritize diagnoses
become less diagnostic because it views the results of the fourth scoring
threat of the nature of health problem, possible problem that could be
modified in part and enough potential problem to be prevented while the
prominence of issues that weren’t perceived by Mr. K’s family especially
Mr. K.
Author to overcome the above problems have been planning the
nursing care that was given health education about the disease and liver
cirrhosis diet. The objective was that Mr. K’s family and his know and could
descrebs return of liver cirrhosis disease, (explain liver cirrhosis signs and
symptoms, treatment, complications, and diet to liver cirrhosis disease). Give
family the opportunity to express things that weren’t clear and give positive
praise for correct answers to the family, citing the family how much attention
to things that were discussed and motivate family to respect the family for it
was ability to answer questions.
The author in overcoming the above problem have been
implementation on 23 April 2010 at 11.30 which was provided health
education about the disease and liver cirrhosis diet. Rational was to provide
84
basic knowledge on Mr. K’s family and Mr. K so that it could make
information to overcome the illness, which aims to explore how far the
knowledge of his family and Mr. K, with the Mr. K’s family of response
criteria and Mr. K able to repeat the material presented was about the disease
liver cirrhosis, and explained again about liver cirrhosis diet. Giving family
the opportunity to ask about the things that have not been clear and positive
praise for correct answers to the family, with a reason to measure how much
attention the family against the things that have been discussed and
modification family to family appreciate the ability to answer question.
Results of evaluation of these nursing problems, the subjective data is
the family said that could explain the return of liver cirrhosis disease, signs
and symptoms, causes, treatment, complication and liver cirrhosis diet. From
the analysis of problems found in nursing diagnose the issue was resolved so
that the action plan was maintained.
The author found a supporting factor for solving the problem on Mr.
K’s family of nursing among others: the ability of family in understanding the
material, the desire of the family member to reach a better life. While the
inhibiting factors were: the limited time given to care for Mr. K’s family.
Implementation has been done on the authors to conclude that Mr. K’s
family and Mr. K was able to understand the extension has been granted.
B. Justification
Author in determining the priority of nursing diagnosis that was based on
the results of the assessment scoring, but the results of the assessment in the case
85
of Mr. K’s family especially Mr. K, the author found the same scoring value on
nursing diagnosis ineffective breathing pattern and pain, so that authors must
choose one of these diagnoses as a diagnostic priority. Finally, the author take the
diagnosis ineffective breathing pattern as the main priority of nursing diagnosis.
Because according to the author most current respiratory problems that must be
addressed, if the need for oxygen (O2) in the body weren’t met could be life
threatening with a short time. While Perry and Potter (2005: 1569-1570) also
explains the oxygen (O2) is the most basic physiological needs and if needs
weren’t met will threaten the life that previously showed signs of tissue hypoxia
was inadequate tissue oxygenation at the level of this network If not treated will
lead to cardiac dysrhythmic, increased pulse rate and respiration and could cause
death. Supported from Perry and Potter's explanation above, the writer set the
pattern of breathing wasn’t effective as a diagnostic priority. The author didn’t lift
all the diagnoses that appeared on the basic concepts of disease because of the
results of the assessment date of May 18th, 2010 in Mr. K there wasn’t data
showing that the diagnosis had to be appointed to cases review.

86
CHAPTER V
CLOSING
A. Conclusion
Liver cirrhosis was a chronic liver disease characterized by diffuse
inflammation and scarring in the liver are accompanied by noduls causing
confusion or damage in the composition of the liver parenchyma. The underlying
factors that often lead to the occurrence of disease was alcoholic liver cirrhosis,
viral hepatitis, and malnutrition. From those etiology of could be classified the
liver cirrhosis as the fowllowings:
1. Laennec portal cirrhosis (alcoholic, nutritional), in which scar tissue typically
surrounding the portal areas. Cirrhosis is most commonly caused by chronic
alcoholism and is the type most commonly found in western countries.
2. Pascanekrotik cirrhosis, where there was a wide band of scar tissue as a
result-up of acute hepatitis viral that occurred previously.
3. Biliary cirrhosis, where the formation of scar tissue occurs around the bile
ducts within the liver.
Liver cirrhosis could also cause a complication or negative impacts if not
addressed promptly could lead to failures such as the liver, hepatomegaly

87
(enlarged liver), hypertension, portal, ascites, hepatic encephalopathy
(neurological death), Transformation towards primary liver cancer (hepatoma),
and final cause death.
In the case of Mr. K’s family and Mr. K, the authors provided health
education about liver cirrhosis disease, breathing techniques taught in the weeks
to reduce his shortness of breath teaches relaxation techniques and distraction to
reduce pain and anxiety. Problem that86arise in Mr. K’s family especially Mr. K,
namely:
1. Ineffective breathing pattern on Mr. K related the inability of family caring
for sick family members. On the first diagnosis of this author has taught
technique and breath in an effective manner that was positioned with
semifowler position which aims to reduce his shortness of breath. This
diagnosis was resolved, with the family of Mr. K response and Mr. K said that
shortness of breath was reduced, Mr. K’s family and Mr. K could be
explained again and to demonstrate the technique of breathing in a way.
illness. In this second diagnosis author have taught relaxation techniques and
encourage remain relaxed in order to reduce the pain felt by Mr. K. This
diagnosis was resolved with Mr. K’s family and Mr. K response his said that
pain had subsided, his family and Mr. K could be explained again and to
demonstrate how relaxation technique.
3. Anxiety related to the inability of family to know the health problem. In this
third diagnostic technique the author has taught Mr. K distraction or divert
attention, which aims to reduce the anxiety experienced by Mr. K. This

88
diagnosis was resolved with Mr. K’s family and Mr. K response his said that
anxiety had subsided, his family and Mr. K could be explained again and to
demonstrate how the distraction technique.
4. Lack of knowledge about disease and diet related to liver cirrhosis recognize
the inability of family health problems. In this fourth diagnosis authors
provide health education about the disease and liver cirrhosis diet aimed at
Mr. K’s family and Mr. K could be explained again about the disease and diet.
This diagnosis could be resolved with his family and Mr. K response his said
that it know about the disease and liver cirrhosis diet.
To the above four diagnoses found in the case of Mr. K has been
overcome all. But Mr. K conditions wasn’t stable, so that Mr. K everyday
activities. should be assisted family. While Mr. K family has the busyness of
each so that Mr. K activity performed his own house. Author to overcome this
problem the author has not been able to overcome because of the limited time and
Mr. K’s family member was busy.
B. Suggestion
1. For clients
It was expected to Mr. K didn’t do light an activity , avoid eating food
that should not be taken for patients with liver cirrhosis disease, and applyed
what had been obtained while following the health education provided.
2. For Families
It was expected Mr. K to participate in the process of healing the
patient, and could modify the environment for family who suffered from liver
89
cirrhosis and providing support to a sick family member illness that could be
handled.
3. For a nurse or health institutions.
Expected to increase his work in dealing with a health problem and
could provide optimal service and give priority to what the basic needs of the
client.
90
REFERENCES
Achjar, Komang Ayu Henny. 2010. Asuhan Keperawatan Keluarga; Bagi

Mahasiswa Keperawatan dan Praktisi Perkesmas. Jakarta: Sagung Seto
Bandiyah, Siti. 2009. Lanjut Usia dan Keperawatan Gerontik. Yogyakarta: Nuha
Medika
Carpenito, Lynda Juall. 2001. Buku Saku Diagnosa Keperawatan. Edisi 8. Jakarta :
EGC
Corwin, Elizabeth. 2009. Buku Saku Patofisiologi. (Terj. Nike Budhi Subekti)
Jakarta: EGC
Darmojo. 2009. Geriatri; Ilmu Kesehatan Usia Lanjut. Jakarta: Balai Penerbit FKUI
Doenges, Marilynn E, dkk. 2000. Rencana Asuhan Keperawatan; Pedoman untuk

Perencanaan dan Pendokumentasian Perawatan Pasien. Edisi 3. Jakarta: EGC
Mansjoer, Arief, dkk. 2005. Kapita Selekta Kedokteran. Jakarta: Balai Penerbit FKUI
Maryam, Siti, dkk. 2008. Mengenal Usia Lanjut dan Perawatannya. Jakarta:
Salemba Medika
Mubarak, Wahit Iqbal, dkk. 2006. Ilmu Keperawatan Komunitas 2. Jakarta: Sagung
Seto
Nanda (Budi Santosa: editor). 2005. Panduan Diagnosa Keperawatan NANDA 2005-
2006; Definisi dan Klasifikasi. Jakarta: Prima Medika
Noer, Sjifoellah, dkk. 2004. Buku Ajar Ilmu Penyakit Dalam. Edisi III. Jakarta: Balai
Penerbit FKUI
Notoatmodjo, Soekidjo. 2005. Metodologi Penelitian Kesehatan. Edisi Revisi.

Jakarta : Rineka Cipta
Perry & Potter. 2006. Buku Ajar Fundamental Keperawatan; Konsep, Proses dan
Praktik. Edisi 4. Jakarta : EGC
91
Price Sylvia A. dan Lorraine M. Wilson. 2006. Patofisiologi; Konsep Klinis Proses-
proses Penyakit. (Terj. Peter Anugerah). Edisi 6. Jakarta: EGC
Setiadi. 2008. Konsep dan Proses Keperawatan Keluarga. Yogyakarta: Graha Ilmu
Setyowati, Sri dan Arita Murwani. 2008. Asuhan Keperawatan Keluarga; Konsep
dan Aplikasi Kasus. Yogyakarta: Mitra Cendikia Press
Smeltzer, Suzanne C dan Bare Brenda G. 2002. Keperawatan Medikal Bedah

Brunner & Suddarth. (Terj. Agung Waluyo) Vol 1. Edisi 8. Jakarta: EGC
Sudoyo, Aru W., dkk. 2007. Buku Ajar Ilmu Penyakit Dalam. Edisi IV. Jilid 1.
Jakarta: Pusat Penerbitan Departemen Ilmu Penyakit Dalam FKUI
Suprajitno. 2004. Asuhan Keperawatan Keluarga; Aplikasi dalam Prakktik. Jakarta:

EGC
Sutadi. 2003. Privalensi Serosis Hepatis di Dunia. http://www.wordpress.com

(diakses tanggal 2 Mei 2010 pukul 12.30 WIB)
Tamher dan Noorkasiani. 2009. Kesehatan Usia Lanjut dengan Pendekatan Asuhan
Keperawatan. Jakarta: Salemba Medika

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CHAPTER I

disease prevalence rate in Indonesia, definitely have not known a disease

prevalence of liver cirrhosis in 2003 in Indonesia ranges from 1 to 2.4%. Than

average prevalence (1.7%), estimated at more than 7 million population of

cirrhosis or liver cancer, about 20 million Indonesian population have chronic

liver disease. This figure is a calculation of the prevalence of patients with

hepatitis B infection in Indonesia, which ranges from 40-50% and hepatitis C,

Alcohol as a cause cirrhosis in Indonesia may be small because the frequency

of all patients in Section disease. In the phatofisiology of the disease, 20-40% of

liver structure to regenerative nodules surrounded by fibrotic tissue. These cases

(Noer, 2004: 271).

be viewed on the diagram below :

in Getasaan Primary Health Center, Getasan sub district, Semarang Regency in

as 11 cases, and in April declined experience as many as 10 cases. Based on the

sub district, Semarang regency.

Knowing about the care of a family with liver cirrhosis disease at

Nogosaren Village, Getasan sub district, Semarang regency.

liver cirrhosis that suffered by Mr. K.

about liver cirrhosis that suffered by Mr. K.

1) The family was able to know family health problems.

2) The family was able to take decisions related to liver cirrhosis.

5) Families were able to use health care facilities.

family about liver cirrhosis that suffered by Mr. K.

Mr. K’s family about liver cirrhosis that suffered by Mr. K.

Could increase knowledge and experience of health education about the

As consideration for the increase of health education about health

problems that exist in society, especially liver cirrhosis and community

participation in providing support.

Particularly for nursing community as an input in improving the

provision of health services associated with information providing about

health education especially liver cirrhosis.

4. Development of Science and Technology (Science and Technology)

Expected to contribute the development of science and technology

family members that suffered liver cirrhosis.

Could add knowledge and experience in assessing, liver cirrhosis

A. Basic Concept of Family

Family according to WHO (1969) in Mubarak, (2006: 255), the family

is a members of the household who are related by consanguinity, adoption or

marriage. Family according to the Ministry of Health (1998) in Mubarak

somewhere in a state of dependency.

Bailon and Maglaya (1978) in Murwani Setyowati and (2008: 24),

describes a family is two or more individual living in one household because

to blood relationship, marriage or adoption. Sayekti (1994) in Setiadi (2008:

3), family is a bond, or the fellowship of life based on marriage between

adults of different species living together or a person male or female person

Family According to Friedman (1998) in Achjar (2010: 1), family is a

social development of individuals in it seen from the pattern of

interdependence interaction to achieve common goals.

has the blood relationship, marriage or adoption and interdependence to

achieve common goals .

According to Setyowati and Muwani (2008: 25-26), family

characteristics are as follows:

a. Consist of two or more individuals who are bound by relationships.

b. The family members usually live together or if they remain separate

notice to each other.

husband, wife, children, brothers, sisters.

physical, psychological, and social members.

Family types according to Setiadi (2008: 4-6) depends on the context of

scientific and people who are classified as follows:

1) Nuclear family is a family that consists only of father, mother and

child received from his descendants or adoption, or both.

2) Large family (Extended Family) is a nuclear family add to other

family members who still have blood relationship (grandparents,