KONSEP DASAR PENYAKIT HERPES Klasifikasi Herpes I.
I.
Herpes Simpleks
II.
Herpes Genital
III.
Herpes Zoester
Herpes Simpleks a. Pengertian
Herpes simpleks adalah penyakit akut yang ditandai dengan timbulnya vesikula yang berkelompok, timbul berulang,yang mengenai permukaan mukokutaneus, yang disebabkan oleh Virus Herpes Simpleks. (Mutaqin,Arif. 2012. Sistem integumen. Jakarta : Salemba Medika) Herpes simpleks adalah infeksi virus yang paling umum. Kondisi yang muncul karena infeksi ini sangat bervariasi meliputi infeksi tanpa gejala,pilek, herpes pada genatal. Herpes simpleks mengikuti pola yang biasa pada famili virus herpes, infeksi primer,inkubasi (masa latten) dan reaktivasi (infeksi virus). ( Brunner & Sudart. 2001. Keperawatan Medical Bedah. Jakarta : EGC)
b. Etiologi
HSV ditularkan melalui kontak langsung. Infeksi HSV terjadi melalui inokulasi virus kedalam permukaan mukosa ( misalnya : orofaring, serviks, konjungtiva ) atau melalui suatu lesi dikulit. HSV -1 ditularkan terutama melalui kontak dengan air liur yang terinfeksi virus, sedangkan HSV-2 ditularkan secara seksual atau dari infeksi melalui kontak pada jalan akhir seorang ibu untuk bayinya yang lahir. (Mutaqin,Arif. 2012. Sistem integumen. Jakarta : Salemba Medika)
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c. Patofisiologi
Infeksi primer dimulai 2 – 20 hari setelah mengalami kontak. Infeksi genetalia HSVtipe 1 dan 2 secara klinis identik. Individu dengan riwayat lesi orang dan antibodi HSV tipe 1 cenderung untuk menderita infeksi HSV tipe 2 yang tidak begitu berat. Infeksi primer dapat menimbulkan lesi atau gejala yang ringan atau tidak sama sekali. Akan tetapi pada wanita, infeksi herpes genitalis primer secara khas ditunjukkan oleh adanya vesikel nultipel pada labia mayora dan minora, menyebar pada perineum dan paha, yang kemudian berlanjut menjadi tukak yang sangat nyeri. nyeri. HSV mempunyai kemampuan untuk reaktivasi melalui beberapa rangsangan (misalnya : demam, trauma, stress emosional, sinar matahari dan menstruasi). HSV tipe1 dapat aktif kembali 8-10 kali lebih sering didaerah genital daripada genitalia. Sementaraitu, HSV-1 dapat aktif kembali dan lebih sering pada bagian oral dari pada genital dari pada di daerah orolabial. Reaktivasi lebih umum dan parah terjadi pada individu dengan kondisi penurunan fungsi imun. (Mutaqin,Arif. 2012. Sistem integumen. Jakarta : Salemba Medika)
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patflow herpes simpleks
kontak virus
berkembang menjadi HSV
Infeksi akut
infeksi primer
infeksi rekuren
fase laten
setelah infeksi mukokuntaneus
simtomatik
virus tidak aktiv pada
asimtomatik
gang lion partikel virus menyerang ganglion saraf yang terhubung
timbul fase laten yang berlangsung lama
fase laten terputus oleh reaktivitas virus yang disebut fase rekuren
timbul infeksi yang asitomatik
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mk GG integritas kulit
( Mutaqin,Arif.2012. sistem Integumen. Jakarta : EGC) d. Tanda Dan Gejala
Gejala dapat dicirikan dengan lesi dimulut,faring, kelopak mata,atau genital. Suatu saat lesi pada area ini akan berkelompok. Pejamu yang terinfeksi
mungkin
mengalami
gejala
umum
seperti
demam,
sakit
tenggorokan, kelemahan dan limfadenopati. Keparahan gejala karena kekebalan yang disupresi meliputi penyebaran penyakit yang luas dengan lesi yang tampak di area yang luas antara lain membran mukosa dan kulit. Infesi primer mungkin berlangsung selama beberapa hari. Infeksi primer hampir semua orang yang terinfeksi tidak mengetahui
episode pertama dari infeksi herpes simplek. Pada gejala individu, infeksi primer adalah tahap dimana mungkin rasa nyeri muncul dan gejala memanjang tahap sesudahnya. Masa latten . Virus yang awalnya menginfeksi sel epitel membran
mukosa dan kulit akan menyerang sel saraf sensorik selama masa latten. Pada masa ini virus tidak melakukkan replikasi tetapi tetap hidup. Pada keadaan ini, adanya stressor emosi atau fisiologik dapat menyebabkan virus aktif kembali. Reaktivasi infeksi. Virus melakukan repliukasi pada reaktivasi dari
infeksi baik dengan menunjukkan gejala atau tanpa gejala. Pada kasus lain dapat terjadi penyebaran virus pada orang lain. Umumnya, reinfeksi simtomatik tidak terlalu parah dan dalam waktu yang lebih singkat dariinfeksi primer. Gejala yang muncul kembali dari infeksi mempunyai periode prodromal dan dapat diketahui dengan adanya sensasi gatal, panas atau kesemutan. ( Brunner & Sudart. 2001. Keperawatan Medical Bedah. Jakarta : EGC)
e. Komplikasi
Komplikasi yang paling signifikan dari HSV adalah ensefalitis meskipun jarang, merupakan kasus fatal sekitar 60-80%. HSV dapat muncul
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Infeksi primer atau rekuren selama hamil dapat menimbulkan infeksi kongenital janin dan bayi baru lahir. Komplikasi dapat berupa infeksi lokal sampai dengan kelainan dan kadang meninggal.( Brunner & Sudart. 2001. Keperawatan Medical Bedah. Jakarta : EGC)
f.
Pemeriksaan Diagnostik
Diagnosis tentang virus herpes simpleks dapat dibuat dengan kultur virus
atau
tes
serologik.
Seringnya
penggunaan
test
usap
Tzanck
menggunakan kikisan dari lesi dan menambhakan pewarna khusus lagsung mengobservasi sel multinukleus raksasa yang menandakan HSV atau infeksi zoster lain. ( Brunner & Sudart. 2001. Keperawatan Medical Bedah. Jakarta : EGC)
g. Penatalaksanaan Medis
Herpes simpleks ensefalitis dan infeksi neonatal umunya diatasi asiklovir. Asiklovir juga telah menunjukkan penanganan yang efektif untuk membatasi morbiditas dari episode awal pada herpes genital dan untuk munculnya kembali menifestasi herpes yang berat.( Brunner & Sudart. 2001. Keperawatan Medical Bedah. Jakarta : EGC)
II.
Herpes Genitalia a. Pengertian
Merupakan infeksi pada genital dengan gejala khas berupa vesikel yang berkelompok dengan dasar eritem bersifat rekuren. Herpes genitalis terjadi pada alat genital dan sekitarnya sekitarn ya (bokong, daerah anal dan paha). Ada dua macam tipe HSV yaitu : HSV-1 dan HSV-2 dan keduanya dapat menyebabkan herpes genital. Infeksi HSV-2 sering ditularkan melalui hubungan seks dan dapat menyebabkan rekurensi dan ulserasi genital yang yang nyeri. Tipe 1 biasanya mengenai mulut dan tipe 2 mengenai daerah genital.
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perhatian dari beberapa ahli, seperti : ahli penyakit kulit dan kelamin, ahli kandungan, ahli mikrobiologi dan lain sebagainya. Infeksi primer oleh HSV lebih berat dan mempunyai riwayat yang berbeda dengan infeksi rekuren Setelah terjadinya infeksi primer virus mengalami masa laten atau stadium dorman, dan infeksi rekuren disebabkan oleh reaktivasi virus dorman ini yang kemudian menimbulkan kelainan pada kulit. Infeksi herpes simpleks fasial-oral rekuren atau herpes labialis dikenali sebagai fever blister atau cold sore dan ditemukan pada 25-40% dari penderita Amerika yang telah terinfeksi. Herpes simpleks fasial-oral biasanya sembuh sendiri. Tetapi pada
penderita dengan imunitas yang rendah, dapat ditemukan lesi berat dan luas berupa ulkus yang nyeri pada mulut dan esofagus. Virus herpes merupakan sekelompok virus yang termasuk dalam
famili herpesviridae yang mempunyai morfologi yang identik dan mempunyai kemampuan untuk berada dalam keadaan laten dalam sel hospes setelah infeksi primer. Virus yang berada dalam keadaan laten dapat bertahan untuk periode yang lama bahkan seumur hidup penderita. Virus tersebut tetap mempunyai kemampuan untuk mengadakan reaktivasi kembali sehingga dapat terjadi infeksi yang rekuren.
b. Etiologi
Herpes genitalis disebabkan oleh HSV atau herpes virus hominis (HVH), yang merupakan anggota dari famili herpesviridae. Adapun tipe-tipe dari HSV : 1) Herpes simplex virus tipe I : pada umunya menyebabkan lesi atau luka pada sekitar wajah, bibir, mukosa mulut, dan leher. 2) Herpes simplex virus tipe II : umumnya menyebabkan lesi pada genital dan sekitarnya (bokong, daerah anal dan paha). Herpes simplex virus tergolong dalam famili herpes virus, selain HSV yang juga termasuk dalam golongan ini adalah Epstein Barr (mono) dan varisela zoster yang menyebabkan herpes zoster dan varicella. Sebagian besar kasus herpes genitalis disebabkan oleh HSV-2, namun tidak menutup
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sering juga menyebabkan herpes genital. HSV-1 genital menyebar lewat oral seks yang memiliki cold sore pada mulut atau bibir, tetapi beberapa kasus dihasilkan dari vaginal atau anal seks.
c. Patofisiologi
HSV-1 dan HSV-2 adalah termasuk dalam famili herphesviridae, sebuah grup virus DNA rantai ganda lipid-enveloped yang berperanan secara luas pada infeksi manusia. Kedua serotipe HSV dan virus varicella zoster mempunyai hubungan dekat sebagai subfamili virus alpha-herpesviridae. Alfa herpes virus menginfeksi tipe sel multiple, bertumbuh cepat dan secara efisien menghancurkan sel host dan infeksi pada sel host. Infeksi pada natural host ditandai oleh lesi epidermis, seringkali melibatkan permukaan mukosa dengan penyebaran virus pada sistem saraf dan menetap sebagai infeksi laten pada neuron, dimana dapat aktif kembali secara periodik. Transmisi infeksi HSV seringkali berlangsung lewat kontak erat dengan pasien yang dapat menularkan virus virus lewat permukaan mukosa. Infeksi HSV-1 biasanya terbatas pada orofaring, virus menyebar melalui droplet pernapasan, atau melalui kontak langsung dengan saliva yang terinfeksi. HSV-2 biasanya ditularkan secara seksual. Setelah virus masuk ke dalam tubuh hospes, terjadi penggabungan dengan DNA hospes dan mengadakan multiplikasi serta menimbulkan kelainan pada kulit.
patoflow herpes genitalis
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timbul vesikel multipel pada labiya mayora dan minora menyebar ke perineum dan paha berlanjut menjadi tukak yang sangat nyeri
setelah itu infeksi mukokutaneus primer
partikel virus menyerang ganglion yang berhubungan
timbul vase laten yang belangsung lama
factor pencetus muncul yaitu demam, trauma, stres emosional dan menstruasi
HSV mengalami resktivitas dan multiplirasi kembali
sehingga HSV 2 aktiv kembali 8 – 10 X
fase rekrum
MK: menyerang ke genital dan paha -
Nyeri GG integritas kulit
( Brunner & Sudart. 2001. Keperawatan Medical Bedah. Jakarta : EGC)
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Tanda utama dari genital herpes adalah luka di sekitar vagina, penis, atau di daerah anus. Kadang-kadang luka dari herpes genital muncul di skrotum, bokong atau paha. Luka dapat muncul sekitar 4-7 hari setelah infeksi. Gejala dari herpes disebut juga outbreaks, muncul dalam dua
minggu setelah orang terinfeksi dan dapat saja berlangsung untuk beberapa minggu. Adapun gejalanya sebagai berikut : 1) Nyeri dan disuria 2) Uretral dan vaginal discharge 3) Gejala sistemik (malaise, demam, mialgia, sakit kepala) 4) Limfadenopati yang nyeri pada daerah inguinal 5) Nyeri pada rektum, tenesmus Tanda (si (si gn) :
1) Eritem, vesikel, pustul, ulserasi multipel, erosi, lesi dengan krusta tergantung pada tingkat infeksi. 2) Limfadenopati inguinal 3) Faringitis 4) Cervisitis a) Herpes genital primer Infeksi primer biasanya terjadi seminggu setelah hubungan seksual (termasuk hubungan oral atau anal). Tetapi lebih banyak terjadi setelah interval yang lama dan biasanya setengah dari kasus tidak menampakkan gejala. Erupsi dapat didahului dengan gejala prodormal, yang menyebabkan salah diagnosis sebagai influenza. Lesi berupa papul kecil dengan dasar eritem dan berkembang menjadi vesikel dan cepat
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di dalam hospes sudah ada antibodi spesifik sehingga kelainan yang timbul dan gejala tidak seberat infeksi primer. Faktor pencetus antara lain: trauma, koitus yang berlebihan, demam, gangguan pencernaan, kelelahan, makanan yang merangsang, alkohol, dan beberapa kasus sukar diketahui penyebabnya. Pada sebagian besar orang, virus dapat menjadi aktif dan menyebabkan outbreaks beberapa kali dalam setahun. HSV berdiam dalam sel saraf di tubuh kita, ketika virus terpicu untuk aktif, maka akan bergerak dari saraf ke kulit kita. Lalu memperbanyak diri dan dapat timbul luka di tempat terjadinya outbreaks. Mengenai gambaran klinis dari herpes progenitalis : gejaia klinis herpes progenital dapat ringan sampai berat tergantung dari stadium penyakit dan imunitas dari pejamu. Stadium penyakit meliputi : Infeksi primer — - stadium laten — - replikasi virus — - stadium rekuren Manifestasi klinik dari infeksi HSV tergantung pada tempat
infeksi, dan status imunitas host. Infeksi primer dengan HSV berkembang pada orang yang belum punya kekebalan sebelumnya terhadap HSV-1 atau HSV -2, yang biasanya menjadi lebih berat, dengan gejala dan tanda sistemik dan sering menyebabkan komplikasi.
e. Pemeriksaan Laboratorium
Pemeriksaan laboratorium yang paling sederhana adalah Tes Tzank diwarnai dengan pengecatan giemsa atau wright, akan terlihat sel raksasa berinti banyak. Sensitifitas dan spesifitas pemeriksaan ini umumnya rendah.
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b)
Tes POCK untuk HSV-2 yang sekarang mempunyai sensitivitas yang tinggi.
3) Kultur virus
Kultur virus yang diperoleh dari spesimen pada lesi yang dicurigai masih merupakan prosedur pilihan yang merupakan gold standard pada stadium awal infeksi. Bahan pemeriksaan diambil dari lesi mukokutaneus pada stadium awal (vesikel atau pustul), hasilnya lebih baik dari pada bila diambil dari lesi ulkus atau krusta. Pada herpes genitalis rekuren hasil kultur cepat menjadi negatif, biasanya hari keempat timbulnya lesi, ini terjadi karena kurangnya pelepasan pel epasan virus, perubahan imun virus yang cepat, teknik yang kurang tepat atau keterlambatan memproses sampel. Jika titer dalam spesimen cukup tinggi, maka hasil positif dapat terlihat dalam waktu 24-48 jam.
f.
Komplikasi
Infeksi herpes genital biasanya tidak menyebabkan masalah kesehatan yang serius pada orang dewasa. Pada sejumlah orang dengan sistem imunitasnya tidak bekerja baik, bisa terjadi outbreaks herpes genital yang bisa saja berlangsung parah dalam waktu yang lama. Orang dengan sistem imun yang normal bisa terjadi infeksi herpes pada mata yang disebut herpes okuler. Herpes okuler biasanya disebabkan oleh HSV-1 namun terkadang dapat juga disebabkan HSV-2. Herpes dapat menyebabkan penyakit mata yang serius termasuk kebutaan. Wanita hamil yang menderita herpes dapat menginfeksi bayinya. Bayi yang lahir dengan herpes dapat meninggal atau mengalami gangguan pada
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1) menjaga kebersihan lokal 2) menghindari trauma atau faktor pencetus Penggunaan idoxuridine mengobati lesi herpes simpleks secara lokal sebesar 5% sampai 40% dalam dimethyl sulphoxide sangat bermanfaat. Namun, pengobatan ini memiliki beberapa efek samping, di antaranya pasien akan mengalami rasa nyeri hebat, maserasi kulit dapat juga terjadi. Meskipun tidak ada obat herpes genital, penyediaan layanan kesehatan anda akan meresepkan obat anti viral untuk menangani gejala dan membantu mencegah terjadinya outbreaks. Hal ini akan mengurangi resiko menularnya herpes pada partner seksual. Obat-obatan untuk menangani herpes genital adalah : 1) Asiklovir (Zovirus) 2) Famsiklovir 3) Valasiklovir (Valtres) Asiklovir
Pada infeksi HVS genitalis primer, asiklovir intravena (5 mg/kg BB/8 jam selama 5 hari), asiklovir oral 200 mg (5 kali/hari saelama 10-14 hari) dan asiklovir topikal (5% dalam salf propilen glikol) dsapat mengurangi lamanya gejala dan ekskresi virus serta mempercepat penyembuhan.
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dimetabolisme dengan cepat menjadi pensiklovir. Obat ini di metabolisme dengan baik.
h. Pencegahan
Hingga saat ini tidak ada satupun bahan yang efektif mencegah HSV. Kondom dapat menurunkan transmisi penyakit, tetapi penularan masih dapat terjadi pada daerah yang tidak tertutup kondom ketika terjadi ekskresi virus. Spermatisida yang berisi surfaktan nonoxynol-9 menyebabkan HSV menjadi inaktif secara invitro. Di samping itu yang terbaik, jangan melakukan kontak oral genital pada keadaan dimana ada gejala atau ditemukan herpes oral. Secara ringkas ada 5 langkah utama untuk pencegahan herpes genital yaitu: 1) Mendidik seseorang yang berisiko tinggi untuk mendapatkan herpes genitalis dan PMS lainnya untuk mengurangi transmisi penularan. 2) Mendeteksi kasus yang tidak diterapi, baik simtomatik atau asimptomatik. 3) Mendiagnosis, konsul dan mengobati individu yang terinfeksi dan follow up dengan tepat. 4) Evaluasi, konsul dan mengobati pasangan seksual dari individu yang
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subfamili alfa herpes viridae. VVZ dalam subfamili alfa mempunyai sifat khas menyebabkan infeksi primer pada sel epitel yang menyebabkan lesi vaskular.
c. Patofisiologi
Sesudah seseorang menderita cacar air, virus varisela zoater yang diyakini sebagai penyebab terjadinya penyakit ini hidup secara inaktif (dormant) didalam sel – sel sel saraf didekat otak dan medula spinalis. Kemudian hari ketika virus yang laten ini mengalami reaktivitasi, virus berjalan lewat saraf perifer ke kulit. Virus varisela dormant diaktifkan dan timbul vesikel – vesikel meradang unilateral di sepanjang satu dermatom. Kulit disekitarnya mengalami edema dan perdarahan. Kedaan ini biasanya didahului atau disertai nyeri hebat dan atau rasa terbakar. Meskipun setiap saraf dapat terkena tetapi saraf terakal, lumbal, atau kranial agaknya paling sering terserang. Herpes zoster dapat berlangsung, kurang lebih 3 minggu. Adanya keterlibatan saraf perifer secara lokal memberikan respon nyeri, kerusakan integritas jaringan terjadi akibat vesikula. Respon sistematik memberikan manifestasi peningkatan suhu tubuh, perasaan tidak enak badan, dan gangguan gastrointestinal. Respon psikologis pada kondisi adanya lesi
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kemudian virus masuk ke retikulud endoth endotheli elia a s stem stem
mengandalkan replikasi kedua bersifat viremia lebih luas dan simtomik
virus menyebar ke kulit
anti body menurun dibawah titik kritis
anti body dalam darah masih tinggi
terjadi reaktivitas pada virus
sehingga resktivitas dan virus yang laten laten da at di netral netralisi isirr
vesikula yang terbesar
respon inflamasi lokal
respon inflamasi sistemik
respon psikologis
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2) Herpes zhoster servikalis menyerang pundak dan lengan. 3) Herpes zhoster torakalis menyerang dada dan perut. 4) Herpes zhoster lumbalis menyerang me nyerang bokongdan paha. 5) Herpes zhoster sakralis menyerang sekitar anus dan genital. 6) Herpes zhoster otikum menyerang telinga.
e. Komplikasi
Herpes zoster tidak menimbulkan komplikasi pada kebanyakan orang. Bila timbul komplikasi, hal-hal berikut dapat terjadi: 1. Neuralgia pasca herpes. Ini adalah komplikasi yang paling umum. Nyeri saraf (neuralgia) akibat herpes zoster ini tetap bertahan setelah lepuhan kulit menghilang. Masalah ini jarang terjadi pada orang yang berusia di bawah 50. Rasa nyeri biasanya secara bertahap menghilang dalam satu bulan tetapi pada beberapa orang dapat berlangsung berbulan-bulan bila tanpa pengobatan. 2. Infeksi kulit. Kadang-kadang lepuhan terinfeksi oleh bakteri sehingga kulit sekitarnya menjadi merah meradang. Jika hal ini terjadi maka Anda mungkin perlu antibiotik. 3. Masalah mata. Herpes zoster pada mata dapat menyebabkan peradangan
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g. Penatalaksanaan
Asiklovir telah menujukan keefektifan dalam menurunkan keperahan dari infeksi varisela (baik cacar air atau herpes zoster ) pada pasien dengan makalah imunosupresi. Obat ini juga dianjurkan pada pejamu dengan imun yang kompeten dengan varisela penomonia yang terlihat pada cacar air. Saat ini, imun anak dan orang dewasa dengan bentuk cacar air lebih ringan telah diatasi dengan asiklovir oral denagan penurunan gejala. Dalam hal ini, keuntungan asiklovir untuk pengobatan manifestasi herpes zoster pada pasien dengan imun kompoten masih dalam penelitian. ASUHAN KEPERAWATAN
1. Asuhan Keperawatan Menurut Teori
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jaringan
penatalaksanaan keperawatan yang penting
Kompres lesi dengan cairan NaCl di Kompresi dengan cairan nrman saline dan lakukan pada seluruh lesi dan harus di
mempercepat proses penyembuhan luka dan
laksanakan dengan hati-hati sekali pda
ulkus mole. Pada setiap pergantian kasa ,
daerah yang erosif
perawat
melakukan
pengguyuran pda
kasa
sampai basah agar lebih mudah dalam melepas kasa yang menempel kuat pada sisi lesi mulai mongering Tingkat asupan nutrisi
Diet TKTP di perlukan untuk meningkatkan asupan dari kebutuhan pertumbuhan jaringan
Evaluasi
kerusakan
jaringan
dan
Apabila masih belum mencapai dari kriteria
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keperawatan Jelaskan dan bantu pasien dengan
Pendekatan
tindakan
relaksasi dan nonfarmakologi lainnya
pereda
nyeri
nonfarmakologi dan noninfasif
dengan
menggunakan
telah menunjukan keektefin dalam mengurangu nyeri
Lakukan
mennejemen
nnyeri
keperawatan :
Atur posisi fisiologis
Posisi
fisiologi
akan
meningkatkan asupan 0 2 ke jaringan
yang
mebgalami
peradangan. Pengaturan posisi idealnya adalah pada arah yang
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yang berada di ruangan
Ajarkan
teknik
relaksasi
pernapasan dalam
Ajarkan teknik distraksi pada
Meningkatkan
asupan
O2
sehingga
akan
menurunkan
nyeri
sekunder
dari
peradangan
saat nyeri
Distraksi (penglihan perhatian) dapat internal
menurunkan dengan
stimulus
mekanisme
peningkatan produksi endofren
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tetanus Beri kompres dingin di kepala dan
Memberikjan respons dingin pada
aksila
pusat
pegatur
panas
dan
pada
pembuluh darah besar Pertahankan asupan cairan minimal Selain sebagai pemenuhan hidrasi 2.500 ml sehari
tubuh,
juga
pengeluaran
akan panas
meningkatkan tubuh
melalui
system perkemihan , sehingga panas tubuh tubuh juga dapat keluar melalui urine Kolaborasi
pemberian analgetik – Anlgetik di perlukan untuk penurunan
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karena mereka sangat menular dan dapat
menyebabkan
wabah
masyarakat Jelaskan
tentang
pengobatan antivirus
pentingnya
Pemberian antivirus di rumah di butuhkan untuk mengurangi invasi virus pada kulit
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Bina hubungan terapeutik
Hubungan
terapeutik
antara
professional pelayanan kesehatan dan oenderita
ulkus
mole
merupakan
hubungan yang mencakup pendidikan serta dukungan. Pasien harus lebih memiliki
keyakinan
pemberdayaan dalam
diri
dan
melaksankan
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2. Asuhan Keperawatan Menurut Kasus Skenario
Seorang wanita umur 25 tahun datang kerumah sakit dengan keluhan adanya rasa nyeri (seperti terbakar atau tertusuk) dan gatal – gatal gatal dan adanya lepuhan yang dikelilingi oleh daerah kemerahan membentuk sebuah gelembung cair pada daerah leher dan genetalia. Sebelumnya hasil dari pemeriksaan fisik pada daerah kemaluan
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makan sering tidak habis karena tidak nafsu makan.
Analisa Data
No 1.
Data fokus
Masalah
DS :
Gangguan
Etiologi Nutrisi Intake
yang
tidak
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hilang tibul d. Klien mengtakan tersa gatalgatal dan adanya lepuhan pada daerah leher. e. Klien
mengtakan
kemerahan
adanya
membentuk
sebuah gelembung cair pada
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kemerahan
membentuk
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b. K/u : lemah
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diare.
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2. Nyeri b.d kerusakan jaringan respon sekunder ditandai adanya eritema, dan bula.
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Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
The world's largest digital library
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
The world's largest digital library
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
The world's largest digital library
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
The world's largest digital library
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
The world's largest digital library
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
The world's largest digital library
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
The world's largest digital library
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
The world's largest digital library
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
The world's largest digital library
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
The world's largest digital library
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The world's largest digital library
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The world's largest digital library
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.