ENGLISH PROGRESS PROGRAMME

“NURSING IN PATIENTS POST OP APPENDECTOMY

IN FULFILLMENT COMFORTABLE
IN THE CITY OF JASMINE Hospital KENDARI
YEAR 2018”

ARRANGED BY:

ICHA :21117066
PRODI :PSIK 3 B
DEPARTEMEN :KMB

MENTOR :

1. Romiko, S.Kep.Ns,M.Kep

SEKOLAH TINGGI ILMU KESEHATAN MUHAMMADIYAH

PALEMBANG
PROGRAM STUDI S1 ILMU KEPERAWATAN
TAHUN 2019
 “NURSING IN PATIENTS POST OP APPENDECTOMY
IN FULFILLMENT COMFORTABLE
IN THE CITY OF JASMINE Hospital KENDARI
YEAR 2018”

A. Main Idea.

The Role of the Nurse In Giving Patients Comfort After Surgery.

B. Summary.

Surgery is an invasive treatment action through an incision to open or display parts

of the body that will be handled and ended with wound closure and suturing
(Sjamsuhidajat, 2010).
In general patients after surgery will feel pain, pain is an uncomfortable feeling,
whether mild or severe. Pain is defined as a condition that affects a person and the
extension is known if someone has experienced it. Symptoms are sudden, and usually
the cause and location of pain are known.
The role of nurses in meeting the needs of a sense of comfort as in patients after
appendectomy is to overcome the patient’s pain by one of them breathing techniques,
and nursing actions before and after surgery.

C. Literature Review.

Theory Overview:

A. Definition Apendiktomi.
Apendiktomi vermiformis is an inflammation of the appendix, appendicitis
Acute usually caused by a blockage of the appendix lumen caused by fekalit /
apendikdolit, lymphoid hyperplasia, foreign objects, parasites, neoplasms, or
stricture due to fibrosis as a result of a previous trade. The appendix has a variable
length of about 6 to 9 cm. luminal obstruction which happens to support the
development of bacteria and mucus secretion so causing distention of the lumen
and the pressure lumen wall. Increased pressure will impede the flow of lymph so
cause edema, diapedesis bacteria and mucosal ulceration. When the focal acute
appendicitis occurs which is characterized by pain periumbilikal. (Wibosono.EW
Saditya W., 2014).

B. Clinical Manifestations.

Complaints apendiktomi starting from pain diperiumbilikus and munta and

stimulation of visceral peritoneum. Within 2-12 hours in line with the irritations
peritoneal, abdominal pain will move the bottom right kekuadran settled and
aggravated by coughing and running. the pain will be more progeresif and the
examination will show one point with maximal pain. Other symptoms that can be
found are anorexia, malaise fever tek too high constipation diarrhea, nausea, and
vomiting.
C. Pathophysiology Apendiktomi.

Apendiktomi usually caused by a blockage of the appendix lumen which can

be caused by fekalit / or apendikolit, lymphoid hyperplasia, foreign bodies,
parasites, mioplasma or strictures because fibrosir result previous inflammation.
Lumen obstruction that occurs supports the development of bacteria and mucous
secretion, causing distention of the lumen and increase pressure lumen wall.
Increased pressure will impede the flow sehinngga cause lymph edema, diapedesis
bacteria and pulserasi mucosa. At that time, there was acute appendicitis focal
characterized by periumbilikal pain. Mucous secretion continuing and increasing
pressure cause obsruksi vein, increased edema, and bacterial growth that cause
inflammation. Inflammation arising widespread and about pritoneum causing pain
under the right area. (Saditya 2014).

D. Anatomy of the Digestive System.

a. Mouth
Is an open cavity where the entry of food and water mouth also is the
entrance to the inside of the digestive system 8 from mouth covered by mucous
membrane. The tasting is perceived by sensory organs contained by Lida surface.

b. Larynx (pharynx)
Is a link between the oral cavity and esophagus, in There pharyngeal arch
tonsils (tonsillitis) which lymph nodes are much gland containing lymphocytes and
is a defense against infection, Here lies intersects between the airway and the
makanna, located behind the mouth and nasal cavity, in front of the vertebrae back.

c. Esophagus
The esophagus is the tube (tb) muscle in vertebrates passed when food flows
from the mouth into the stomach.

d. Side Gastric
a large hollow muscular organ and resembles sac in the peritoneal cavity
located between the esophagus and intestines smooth. empty, stomach resembles a
tube and when full giant pear-shaped. Hull serves as a warehouse contracting food
systemically to mix food by enzyme - enzymes.

e. Small intestine.
Small intestine or the small intestine is the part of the gastrointestinal tract
which is located between the stomach and large intestine. The small intestine
consists of three9 namely section 12 fingers intestine (duodenum), jejunum
(jejunumo) and colon absorption (ileum).

f. The large intestine (colon).

The large intestine or colon is a colon between the appendix and rectum. The
main function of this organ is to absorb water from the stool, the colon is composed
of the ascending colon, transversun colon, descending colon, and colon sigmoid.
The number of bacteria present in the large intestine function digesting some
material and help the absorption - of nutrients.
 g. Appendix.
Appendix or in terms of the cecum is a pouch anatomy connected on
intestinal absorption and colon uphill section of colon. Appendix (appendix).
Appendix or appendix is an auxiliary organ of the appendix. Orga padea infection is
called appendicitis or umai worms. appendicitis which can cause severe appendix
rupture and form nana within the abdominal cavity or peritonitis (infection of the
abdominal cavity).

h. The rectum
is a room that starts from the end of the large intestine (After column
sigmoid) and ends at the anus. This organ serves as a a temporary storage area
faeces. Normally the rectum is usually empty because the stool kept higher, ie in
the colon densendens. If the full descending colon and feces into the rectum,10 then
the desire to defecate. (Elita wibisono wifanto saditya: 2014)

E. Complication.

It usually occurs distal of fekalit. A flegmon of the bowel loop grooved - dent
and omentum and inflamed, it can be cured or spread or forming an abscess
periappendiceal or cause intestinal obstruction. The spread of peritonitis allow
contamination in a bag pelvic or right through the gut cavity subhepatik right.
Pileplebitis signage with high fever, chills, hepatic pain, and jaundice. (Schwartz
shires, Spencer 2000).

F. Basic Concepts Disorders Pain Comfortable.

Definition

Kocaba (1992, in the potter and perry, 2006) revealed convenience / comfort
is a condition has been fulfilled basic human needs: the need for peace of (a
satisfaction which improves the appearance of the day - day), relief (Needs
have been met) and transcendent (state about a who exceed problems and
pain). Comfort should be viewed holistically which includes four aspects:

1) Physical, bodily sensations associated with.

2) Social, associated with internal vigilance in oneself which include self-

esteem, sexuality, and the meaning of life 11.

3) Psychospiritual, dealing with internal vigilance in the background yourself

which include self-esteem, sexuality, and the meaning of life.

4) Environment, dealing with external experience background humans such as

light, sound, temperature, color and natural elements more.

Increasing the need for a sense of comfort interpreted nurse already give
strength, hope, consolation, support, encouragement and help. In general in its
application fulfillment of taste Comfortable is the need for a sense of comfort
free from pain. This matter pain caused by the condition and hypo
 hyperthermia is a condition discomfort affecting the patient indicated by mark
the onset of symptoms in patients.

G. As a result of Pain Disorders Pain Comfortable.

a) Understanding Pain.

Painful is a sensory and emotional experience that is not pleasant result of

tissue damage actual and potential (Smatzler and Bare, 2002). Pain is a
subjective sensory and unpleasant emotional experience of relating to actual
tissue damage and potential perceived in events - events in which there is
damage to the IASP (the potter and perry, 2006).

b) Classification of Pain.

Pain can be classified into acute and chronic pain. acute pain is pain that
occurs after an acute injury, illness or intervention surgery and has a rapid
onset and intensity varies (Mild to severe) and short duration (less than six
months) and disappear with or without treatment after a state recovered in
damaged area. Chronic pain is constant or intermittent pain settled over a
period of time the pain caused by their causes cancer malignancy such as
uncontrolled or non malignancy. Chronic pain lasts longer (more than six
months) and will continue even if the patient is given medication or illness
without cured. Characteristics of chronic pain is a painful area is not easy
identified, the intensity of pain is difficult to be lowered, the pain is usually
lowered, the pain usually increases, the nature of pain is less clear, and small
chance to recover or missing. Malignant chronic pain usually associated with
pain caused by tissue damage non progressive or more experience healing.

c) Physiology of Pain.

According to Potter and Perry (2006) there are three components fisiologois
in pain that is the reception, and the reaction transmit pain stimuli pengahasil
implus through peripheral nerve fibers. Pain fibers enter the cord spinal and
undergo one of several routes of nerve and finally until in colored mass - gray
in the spinal cord are the pain message can interact with cell - inhibutor nerve
cells, preventing 13 a painful stimulus that does not reach the brain or
transmitted without obstacles to the cerebral cortex, the brain interpret pain
kualiatas and Processing asset information about the experience and knowledge
owned and cultural associations in an effort to prepare for pain.

d) Response to Pain.

1) Physiological.

Responses At the time of pain impulses to the spinal medule leading to the
brain stem thalamus, the autonomic nervous system becomes stimulated as part
of the stress response. Pain with mild to moderate intensity and pain the
superficial cause a reaction flight or fight, which is general adaptation
syndrome. Stimulation of the sympathetic branch of the system The autonomic
nervous produce physiological responses.

2) Behavioral Response.

The sensation that occurs when pain is the body movement that typical and
facial expressions that indicate pain can be shown by patients as behavioral
responses to pain. the response like mengkerutkan forehead, restless, looking
away when invited talk.

e) Factors That Affect Pain.

1. Age.
2. Gender.
3. Culture.
4. The meaning of pain.
5. Attention.
6. Anxiety.
7. Fatigue.
8. Previous experience.
9. Coping styles.
10.Family and social support.

f) The effects of pain.

1. Signs and symptoms.

Physiological signs can indicate pain in clients who seek to not to
complain or admit the inconvenience is very important to assess signs - vital
signs and physical examination including observing the autonomic nerve
involvement. When the acute pain of the oil, heart rate, blood pressure, and
respiratory rate increases.

2. behavioral.
Effects Patients who are experiencing pain of facial expressions and
movements Typical body and respond vocally.

3. Influence on daily activities – day.

Patients who experience pain every day less able to participate in routine
activities, such as having difficulty in doing Normal hygiene measures and can
interfere with social activities and sexual intercourse.

g) Needs Pain Comfortable On Appendicitis.

1. Definition
Pain is an unpleasant feeling such conditions are feeling pain is very
subjective because different for each person terms of scale or level, and the
only person who can tersebutlah 33 explain or evaluate the pain he endured.
 2. Appendicitis Pain Comfortable disturbance.
On In patients with severely impaired appendicitis needs flavor comfort
for the patient looked in pain and lay with fever is not too high. On abdominal
examination can be found decreased bowel sounds / disappear, tenderness and
rebound tenderness (signs Blumberg) apendiksyang focal area called
McBurney's point (Distal third of the line between the umbilicus and the
anterior superior iliac spine 34 (SIAS) right. Characterized by the presence of
peritoneal irritation defans muscular, percussion, or rebound tenderness.

Distinctive sign which can be found Acute appendicitis:

1) Signs Rosving: right lower quadrant abdominal pain on palpation the

lower left quadrant.
2) Psoas sign: abdominal pain in the right lower quadrant when an extension
right hip (show retrosekal appendix).
3) Obturator sign: the lower right abdominal pain during internal rotation
right hip (appendix shows the pelvis).
4) Dunphy sign: increase in perceived pain when coughing.
5) If there are any perforation, abdominal pain getting stronger and diffuse
defans cause increased muscular and rigidity (sign peritonitis). So in the
appendix patients here are very annoyed or feel uncomfortable because of
pain that caused.

3. Settings Pain Comfortable On Appendicitis.

In patients with appendicitis governance arrangements which are:

a. Pre-operative.
Strict observation, bedrest, and fasting. Examination of the abdomen and
rectal and blood tests may be repeated periodically. Photo abdomen and
thorax can be done to look for other complications. Broad-spectrum
intravenous antibiotics and analgesics can be given. 35 In appendicular
perforation should be given fluid resuscitation before operation.

b. Operative.
1) Apendiktomi open: performed with transverse incision at right lower
quadrant (Davis-Rockey) or oblique incision (McArthur-McBurney). In
yet clear diagnosis can subumbilikal incision in the midline.
2) Laparoscopy apendiktomi: surgical technique with injuries and the smaller
the chance of infection.

c. Post-operative.
Observation needs to be done to anticipate their vital signs bleeding, shock,
hyperthermia, or respiratory disorders. In this case the patient was placed in
the semi-Fowler's position reduce the pain. (Elita Wibosono, Wifanto Saditya
Jeo, 2014).
D. Research Methodology.

I. Research design.

The design used in this study with the case study method descriptive of a method
that is done on purpose to expose or make an overview of the study and analyze the
situation objectively more deeply about nursing care in patients with appendicitis In
fulfillment sense of comfort in Kendari City Hospital in 2018.

2. Time and Plece of Research.

1) Time.
The syudy was conducted in june until august 2018.

2) Place.
The study was conducted in the jasmine room of the general hospital area of
kendari city.

3. Population.

Population is an object of research that meets the criteria established by

researchers (Nursalam, 2016). The population in this study were individuals who
experienced problems meeting the needs of a sense of comfort.

4. Sample.

Collecting data in this data collection is done by anamnesis, physical

examination, direct observation, interviews and studies documentation. The steps of
data collection by researchers are:

a. Researchers ask for a letter of introduction from the initial data collection home
institution Health Polytechnic researchers Kendari.
b. Researchers took the data in Kendari City Hospital researcher asked for letters
research permit from the agency LITBANG Southeast Sulawesi.
c. Researchers ask for a letter of recommendation from Kendari City Hospital
Researcher asked permission from the head of the room Bed researchers came to
the subject case studies and explained the purpose of research.
d. Informat consent given to the subject of case studies and family