LAPORAN PENDAHULUAN TUMOR CEREBRI DI RUANG GARDENA RSD Dr. SOEBANDI JEMBER
OLEH: ARIS KURNIAWAN, KURNIAWAN, S. Kep K ep NIM 122311 122 311101033 101033
PROGRAM STUDI ILMU KEPERAWATAN UNIERSITAS JEMBER JEMBER 201!
LAPORAN PENDAHULUAN “TUMOR CEREBRI” Oleh Aris Kurniawan S.Ke NIM ! "##$""%"%$$ "##$""%"%$$
". Kasus T"#$r T" #$r Cere%r& #. Pr&s Pr&ses es 'er(a 'er(a)i )in* n*aa +asal +asalah ah '. Pe()er*&'( Tu+&r &'a, a'au -li&+a a)alah se,el&+&, 'u+&r *an- 'i+ul )ala+ sis'e+
sara/ sara/ usa' usa' )an )aa' )aa' )i(u+ )i(u+ai ai eera eeraaa )era(a' )era(a' )i/eren )i/erensias siasii -lia. -lia. 0Liau1 0Liau1 #%%"2 #%%"2.. Aaila sel3sel 'u+&r erasal )ari (arin-an &'a, i'u sen)iri1 )iseu' 'u+&r &'a, ri+er )an ila erasal )ari &r-an3&r-an lain1 )iseu' 'u+&r &'a, +e'as'ase. 0Hu//1 #%%42. Ne&las+a sis'e+ sara/ usa' 0SSP2 +en5a,u ne&las+a *an- erasal )ari )ala+ &'a,1 +e)ulla sinalis1 a'au +enin-en1 ser'a 'u+&r +e'as'a'i, *an- erasal )ari 'e+a' lain. Ne&las+a SSP ri+er se)i,i' ere)a )en-an ne&las+a *an'i+ul )i 'e+a' lain1 )ala+ ar'ian ahwa ah,an lesi *an- se5ara hi'&l&-is (ina,1 )aa' +en*ea,an ,e+a'ian ,arena ene,anan 'erha)a s'ru,'ur 6i'al. Selain i'u1 ere)a )en-an ne&las+a *an- 'i+ul )i luar SSP1 ah,an 'u+&r &'a, ri+er *anse5ara his'&l&-is -anas (aran- +en*ear ,ea-ian 'uuh lain 0Ku+ar et al.1 al.1 #%%72. Pa)a ,asus ,an,er1 'er)aa' se,u+ulan sel n&r+al a'au an&r+al *an- 'u+uh 'a, 'a, 'er, 'er,&n &n'r 'r&l &l +e+en +e+en'u 'u, , +assa +assa a'au a'au 'u+& 'u+&r. r. Pa)a Pa)a saa' saa' 'u+& 'u+&rr &'a, &'a, 'er(a 'er(a)i )i11 er'u+uhan sel *an- 'i)a, )ierlu,an se5ara erleihan +eni+ul,an ene,anan )an ,erusa,an a)a sel3sel lain )i &'a, )an +en--an--u /un-si &'a, a-ian 'erseu'. Tu+&r 'erseu' a,an +ene,an (arin-an &'a, se,i'ar )an +eni+ul,an 'e,anan &leh ,arena 'e,anan erlawanan &leh 'ulan- 'en-,&ra,1 )an (arin-an &'a, *an- seha'1 ser'a area se,i'ar sara/. Sea-ai hasiln*a1 'u+&r a,an +erusa, (arin-an &'a, 0C&&, 8 9ree)+an1 #%"#2.
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Seenarn*a1 en*ea 'u+&r &'a, +asih elu+ )i,e'ahui 'e'ai +asih a)a /a,'&r3 /a,'&r *an- erlu )i'in(au *ai'u! ". Here)i'er Sin)r&+ here)i'er seer'i 6&n Recklinghausen’ 6&n Recklinghausen’ss Disease1 Disease 1 tuberous sclerosis1 sclerosis1 retinoblastoma, multiple endocrine neoplasma isa neoplasma isa +enin-,a',an resi,& res i,& 'u+&r &'a,. :en *an- 'erlia' isa )iaha-i,an a)a )ua ,elas iai'u tumor –suppressor genes )an oncoge oncogens. ns. Selain i'u1 sin)r&+a seer'i Tur5&' )aa' +eni+ul,an ,e5en)erun-an -ene'i, un'u, -li&+a 'e'ai han*a #;. 0 Meh'a1 #%""2 #. Ra)iasi Ra)ias iasi (enis ioni ionizi zing ng radi radiat atio ion n isa +en*ea,an 'u+&r &'a, (enis neuroepi neuroepithelia theliall tumors, tumors, meningioma meningiomass )an nerve sheath tumors. tumors. Selain i'u1 aaran 'herha)a sinar < (u-a )aa' +enin-,a',an risi,& 'u+&r &'a,.0 Kea'in-1 #%%"2 $. Sus'ansi3sus'ansi Karsin&-eni, Pen*eli)i,an 'en'an- sus'ansi ,arsin&-en su)ah la+a )an luas )ila,u,an. Kini 'elah )ia,ui ahwa a)a sus'ansi *an- ,arsin&-eni, seer'i ni'r&sa+i)es )an ni'r&s&ureas ni'r&s&ureas *an- isa +en*ea,an +en*ea,an 'u+&r s*s'e+ sara/ usa' 0 Pe'r&6i5h1 Pe'r&6i5h1 et al .1 .1 #%%$.1 Mar)(&n&1 #%%%2 $. =irus In/e,si 6irus (u-a )ier5a*ai isa +en*ea,an 'u+&r &'a,. C&n'&hn*a1 6irus Epseien-barr. ( Kau//+an1 Kau//+an1 #%%72 >. :a*a Hi)u Pene Peneli' li'ian ian 'elah 'elah +enu +enun( n(u, u,,a ,an n ahw ahwaa +a,a +a,ana nan n see seer' r'ii +a,a +a,ana nan n *an*an)iawe',an1 )iawe',an1 )a-in- asa a'au a5ar 'a+a,n*a 'a+a,n*a er,&relasi )en-an enin-,a'an enin-,a'an risi,& 'u+&r &'a,. Di sa+in- i'u1 risi,& 'u+&r &'a, +enurun ,e'i,a in)i6i)u +a,an leih an*a, uah )an sa*uran. 0S'ar,3=an5e1 0S'ar,3=an5e1 e' al.1 #%""2 #%""2
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Tu+&r Tu+&r &'a, in'ra,ranial in'ra,ranial )aa' )i,lasi/i,asi )i,lasi/i,asi,an ,an +en(a)i 'u+&r &'a, benigna )an maligna. maligna. Tu+&r &'a, benig enigna na u+u+n* u+u+n*aa e,'ra3a e,'ra3a,si ,sial1 al1 *ai'u *ai'u 'u+uh 'u+uh )ari )ari +enin-en1 sara/ ,ranialis1 a'au s'ru,'ur lain )an +en*ea,an ,&+resi e,s'rinsi, a)a sus'ansi &'a,. Mes,iun )in*a'a,an benigna se5ara his'&l&-is1 'u+&r ini )aa'
+en-an5a+ n*awa ,arena e/e, *an- )i'i+ul,an. Tu+&r +ali-na sen)iri u+u+n*a 'er(a)i in'ra3a,sial *ai'u erasal )ari aren,i+ &'a,. Tu+&r +ali-na )ia-i +en(a)i 'u+&r +ali-na ri+er *an- u+u+n*a erasal )ari sel -lia )an 'u+&r &'a, +ali-na se,un)er *an- +erua,an +e'as'asis )ari 'u+&r +ali-na )i a-ian 'uuh lain 0:inser-1 #%""2. Pa)a asien 'u+&r &'a, *an- erusia 'ua )en-an a'r&/i &'a,1 ,e(a)ian e)e+a &'a, (aran- +eni+ul,an enin-,a'an 'e,anan in'ra ,ranial1 +un-,in )i,arena,an ruan- in'ra,ranial *an- erleihan. Hal ini )aa' +en(elas,an 'i)a, a)an*a aile)e+a a)a asien erusia 'ua. Mun'ah leih serin'er(a)i a)a ana,3ana, )ian)in-,an )en-an )ewasa )an iasan*a erhuun-an )en-an lesi )i )aerah in/ra'en'&rial 0Kaal 8 =e5h'1 #%%>2.
Klasi/i,asi Tu+&r O'a, Pri+er Menuru' ?HO Tael ". Klasi/i,asi :ra)in- Tu+&r O'a, Menuru' ?HO 0World ealth !rganization "lassi#ication o# $umors o# the %ervous &'stem1 #%%72 I A-*r$*& *"#$rSueen)*+al -ian' 5ell as'r&5*'&+a Pil&5*'i5 as'r&5*'&+a Pil&+*@&i) as'r&5*'&+a Di//use as'r&5*'&+a Ple&+&rhi5 @an'h&as'r&5*'&+a Analas'i5 as'r&5*'&+a :li&las'&+a :ian' 5ell -li&las'&+a :li&sar5&+a O+&)$(e(r$)+&'+ *"#$rOli-&)en)r&-li&+a Analas'i5 &li-&)en)r&-li&+a O+&)$'-*r$*& *"#$rOli-&as'r&5*'&+a Analas'i5 &li-&as'r&5*'&+a Epe(#'+ *"#$rSueen)*+&+a M*@&aillar* een)*+&+a Een)*+&+a Analas'i5 een)*+&+a C$r$& p+e"- *"#$rCh&r&i) le@us aill&+a A'*i5al 5h&r&i) le@us aill&+a Ch&r&i) le@us 5ar5in&+a
II
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Menuru' Brunner )an Su))ar'h "471 -an--uan neur&l&-i a)a 'u+&r &'a, )isea,an &leh # /a,'&r *ai'u -an--uan /&,al )isea,an &leh 'u+&r )an ,enai,an
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TIK. ". :an--uan /&,al1 'er(a)i aaila 'er)aa' ene,anan a)a (arin-an &'a, )an in/il'rasi a'au in6asi lan-sun- a)a are,i+ &'a, )en-an ,erusa,an (arin-an neur&n. Ten'u sa(a )is/un-si *an- alin- esar 'er(a)i a)a 'u+&r *an- 'u+uh alin- 5ea' 0+isaln*a -li&las'a+a +ul'i/&r+e2. Peruahan sulai )arah a,ia' 'e,anan *an)i'i+ul,an 'u+&r *an- er'u+uh +en*ea,an ne,r&sis (arin-an &'a,. :an--uan sulai )arah ar'eri a)a u+u+n*a er+ani/es'asi sea-ai ,ehilan-an /un-si se5ara a,u' )an +un-,in )aa' )i,a5au,an )en-an -an--uan eruahan serer&6as,uler ri+er. Seran-an
,e(an-
sea-ai
+ani/es'asi
eruahan
,ee,aan
neur&n
)ihuun-,an )en-an ,&+resi1 in6asi )an eruahan sulai )arah ,e(arin-an &'a,. Beeraa 'u+&r +e+en'u, ,is'a *an- (u-a +ene,an aren,i+ &'a, se,i'arn*a sehin--a +e+erera' -an--uan neur&l&-is /&,al.
#. Penin-,a'an TIK )aa' )ia,ia',an &leh eraa /a,'&r ! er'a+ahn*a +assa )ala+ 'en-,&ra,1 'eren'u,n*a &e)e+a se,i'ar 'u+&r )an eruahan sir,ulasi 5airan serer&sinal. Per'u+uhan 'u+&r +en*ea,an er'a+ahn*a +assa ,arena ia +en-a+il 'e+a' )ala+ ruan- *an- rela'i/ 'e'a )ari ruan-an 'en-,&ra, *an- ,a,u. Tu+&r -anas +en*ea,an &e)e+a )ala+ (arin-an &'a, se,i'arn*a. Me,anis+en*a elu+ seluruhn*a )iaha+i1 'e'ai )i)u-a )isea,an &leh selisih &s+&'i, *an+en*ea,an en*earan 5airan 'u+&r. Beeraa 'u+&r )aa' +en*ea,an er)arahan. Os'ru,si 6ena )an &e)e+a *an- )isea,an &leh ,erusa,an sawar )arah3&'a,1 se+uan*a +eni+ul,an ,enai,an 6&lu+e in'ra,ranial )an ,enai,an TIK. Os'ru,si sir,ulasi 5airan serer&sinal )ari 6en'ri,el la'eral ,e ruan-an su ara,n&i) +eni+ul,an hi)r&sealus. Penin-,a'an TIK a,an +e+aha*a,an (iwa ila 'er(a)i 5ea' a,ia' salah sa'u en*ea *an- a,an 'elah )ii5ara,an seelu+n*a. Me,anis+e ,&+ensasi +e+erlu,an wa,'u erhari3hari a'au erulan3ulan un'u, +en(a)i e/e,'i/ )an &leh ,arena i'u 'i)a, er-una aaila TIK 'i+ul 5ea'. Me,anis+e ,&+ensasi an'ara lain ! e,er(a +enurun,an 6&lu+e )arah in'ra,ranial1 6&lu+e 5airan serer&sinal1 ,an)un-an 5airan in'ra sel )an +en-uran-i sel3sel aren,i+. Kenai,an 'e,anan *an- 'i)a, )i&a'i +en-a,ia',an herniasi ul,us sereellu+.
Herniasi ul,us
+ene,an +ensese/al&n +en*ea,an
hilan-n*a
,esa)aran sara/ &'a, ,e'i-a. Pa)a herniasi 5ereellu+ 'er-eser ,e awah +elalui
/&ra+en +a-nu+ &leh sua'u +assa &s'eri&r. K&+resi +e)ulla &l&n-a'a )ari hen'i erna/asan 'er(a)i )en-an 5ea'. Peruahan /isi&l&-is lain 'er(a)i )en-an 5ea'. Peruahan /isi&l&-is lain 'er(a)i a,ia' enin-,a'an TIK *an- 5ea' a)alah ra)i,ar)ia r&-esi/1 hier'ensi si'e+i,1 0elearan 'e,anan na)i2 )an -an--uan erna/asan.
e. M'(&e-*'-& K+&(&-
". Sa,i' ,eala. Sa,i' ,eala +erua,an -e(ala u+u+ *an- alin- serin- )i(u+ai a)a en)eri'a 'u+&r &'a,. Rasa sa,i' )aa' )i-a+ar,an ersi/a' )ala+ )an 'erus +enerus1 'u+ul )an ,a)an-3,a)an- hea' se,ali. N*eri ini alin- hea' a)a a-i hari )an leih +en(a)i leih hea' &leh a,'i6i'as *an- iasan*a +enin-,a',an TIK seer'i +e+un-,u,1 a'u,1 +en-e(an a)a wa,'u BAB. N*eri se)i,i' er,uran (i,a )ieri asirin )an ,&+res )in-in a)a 'e+a' *an- sa,i'.
#. Nausea )an +un'ah. Ter(a)i sea-ai a,ia' ran-san-an usa' +un'ah a)a +e)ulla &l&n-a'a. Mun'ah alin- serin- 'er(a)i a)a ana,3ana, erhuun-an )en-an enin-,a'an TIK )iser'a er-eseran a'an- &'a,. Mun'ah )aa' 'er(a)&i 'ana )i)ahului nausea )an )aa' r&*e,'i/.
$. Paile)e+a Disea,an &leh s'a'is 6ena *an- +eni+ul,an e+en-,a,an ailla ner6i&'is'. Bila 'erliha' a)a e+eri,saan /un)us,&i a,an +en-in-a',an a)a ,enai,an TIK. Serin-,ali suli' un'u, +en--una,an 'an)a ini sea-ai )ia-n&sis 'u+&r &'a, &leh ,arena a)a eeraa in)i6i)u /un)us 'i)a, +e+erliha',an e)e+a +es,iun TIK 'i)a, a+a' 'in--i. Dala+ huun-ann*a )en-an aile)e+a +un-,in 'er(a)i eeraa -an--uan en-liha'an. Ini 'er+asu, e+esaran in'i, u'a )an a+aurusis /u-un 0erasaan er,uran-n*a en-liha'an2.
>. :e(ala /&,al. Tan)a3'an)a )an -e(ala3-e(ala 'u+&r &'a, an'ara lainn*a (u-a 'er(a)i1 'e'ai ini leih 5en)erun- +e+un*ai nilai +el&,alisasi ! a. Tu+&r ,&r'e,s +&'&ri,1 +e+ani/es'asi,an )iri )en-an +en*ea,an -era,an seer'i ,e(an- *an- 'erle'a, a)a sa'u sisi 'uuh *an- )iseu' Ke(ana5,s&nian. . Tu+&r l&us &,sii'al +eni+ul,an -e(ala 6isual1 he+iar&sia hu+uni+us ,&n'rala'eral 0hilan-n*a en-liha'an a)a se'en-ah laan- an)an-1 a)a sisi *an erlawanan )ari 'u+&r2 )an halusinasi en-liha'an. 5.
Tu+&r
sereelu+1
+en*ea,an
usin-1
a'a,sia
0,ehilan-an
,esei+an-an2 a'au -a*a er(alan *an- se+&*&n-an )en-an ,e5en)erun-an (a'uh ,e sisi *an- lesi1 &'&'3&'&' 'i)a, 'er,&&r)inasi )an nis'a-+us 0-era,an +a'a erira+a 'i)a, )isen-a(a2 iasan*a +enun(u,,an -era,an h&ri&n'al. ). Tu+&r l&us /r&n'al serin- +en*ea,an -an--uan ,eria)ian eruahan s'a'us e+&si&nal )an 'in-,ah la,u1 )an )isin'e-rasi erila,u +en'al. Pasien serin+en(a)i e,s're+ *an- 'i)a, 'era'ur )an ,uran- +erawa' )iri )an +en--una,an ahasa 5aul. e. Tu+&r su)u' serer&&nsin iasan*a )iawali a)a sarun- sara/ a,us'i, )an +e+er ran-,aian -e(ala *an- 'i+ul )en-an se+ua ,ara,'eria'i, -e(ala a)a 'u+&r &'a, ! "2 Per'a+a1 'inni'us )an ,eliha'an 6er'i-&1 )ii,u'i 'er(a)in*a 'uli 0sara/ 5ranial32 #2 Beri,u'n*a ,ese+u'an )an rasa -a'al a)a wa(ah )an li)ah 0sara/ 5ranial32 $2 Selan(u'n*a1 'er(a)i ,ele+ahan a'au aralisis 0sara/ 5ranial372 >2 A,hirn*a1 ,arena e+esaran 'u+&r +ene,an sereelu+1 +un-,in a)a an&r+ali'as a)a /un-si +&'&ri,. /. Tu+&r 6en'ri,el )an hi&'ala+us +en-a,ia',an s&+n&lensia1 )iae'es insii)us1 &esi'as1 )an -an--uan en-a'uran suhu. Tu+&r in'ra,ranial )aa' +en-hasil,an -an--uan ,eria)ian1 ,&n/usi1 -an--uan /un-si i5ara )an -an--uan -a*a er(alan.
Se5ara u+u+ asien 'u+&r &'a, isa +e+ili,i -e(ala seer'i eruahan erila,u 5&n'&hn*a1 asien +un-,in +u)ah lelah a'au ,uran- ,&nsen'rasi. Selain i'u1 -e(ala hier'ensi in'ra5ranial seer'i sa,i' ,eala1 +ual1 6er'i-&. Seran-an eilesi (u-a serin- )i(u+ai a)a asien 'u+&r &'a,. 0R&h,a++1 #%%>2 ". L&us /r&n'al F Meni+ul,an -e(ala eruahan ,eria)ian seer'i )eresi. F Meni+ul,an +asalah ps'chiatric. F Bila (aras +&'&ri, )i'e,an &leh 'u+&r he+iarese ,&n'ra la'eral1 ,e(an- /&,al )aa' 'i+ul. :e(ala ,e(an- iasan*a )i'e+u,an a)a s'a)iu+ lan(u' F Bila +ene,an er+u,aan +e)ia )aa' +en*ea,an in,&n'inen'ia. F Pa)a l&us )&+inan +eni+ul,an -e(ala a/asia.
#. L&us 'e+&ral F Daa' +eni+ul,an -e(ala he+ian&sia. F :e(ala neurops'chiatric seer'i amnesia1 h'pergraphia dan DG( 6u (u-a )aa' 'i+ul. F Lesi a)a l&us *an- )&+inan isa +en*ea,an ahasia.
$. L&us arie'alis F A,an +eni+ul,an -an--uan sens&ri )an +&'&r *an- ,&n'rala'eral. F :e(ala homon'mous hemianopia (u-a isa 'i+ul. F Bila a)a lesi a)a l&us *an- )&+inan' -e(ala )is/asia. F Lesi *an- 'i)a, )&+inan isa +eni+ul,an geographic agnosia )an dressing apraia.
>. L&us &,sii'al F Meni+ul,an h&+&n*+&us he+ian&ia *an- ,&n'rala'eral F :an--uan en-liha'an *an- er,e+an- +en(a)i &(e5' a-n&sia. . Tu+&r )i 5ereell& &n'in an-le F Terserin- erasal )ari N =III *ai'u a5us'i5 neurin&+a. F Daa' )ie)a,an ,arena -e(ala awaln*a erua -an--uan /un-si en)en-aran.
. :li&+a a'an- &'a, F Biasan*a +eni+ul,an neur&a'i 5ranial )en-an -e(ala3-e(ala seer'i diplopia, #acial )eakness )an d'sarthria.
7. Tu+&r )i 5ereelu+ F Di)aa'i -an--uan er(alan )an -e(ala 'e,anan in'ra,ranial *an- 'in--i seer'i +ual1 +un'ah )an n*eri ,eala. Hal ini (u-a )isea,an &leh &)e+ *an- 'eren'u,. F N*eri ,eala ,has )i)aerah &,sii'al *an- +en(alar ,e leher )an sas+e )ari &'&'3 &'&' ser6i,al 0S5hi//1 #%%.1 J&u+ans1"44%2.
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Menuru' Brunner )an Su))ar'h "471 ,&+li,asi *an- )aa' 'er(a)i a)alah ! ". Penin-,a'an TIK )ari 'u+&r )ala+ ruan- ,raniu+ *an- 'era'as. Biasan*a +eni+ul,an -e(ala3-e(ala neur&l&-is seer'i er)arahan )an in/e,si. Pen--unaan s'er&i) &ral a,an +enurun,an &e)e+a sereral )an +un-,in )aa' +en-&n'r&l -e(ala 'erseu'. #. A)an*a lesi *an- +en--an--u /un-si n&r+al *an- )i,&n'r&l &leh a-ian &'a, 'erseu' $. Pen-&a'an ,e+&'erai +un-,in +e+eri,an ,&n'riusi a)a &e)e+a sereral se+en'ara *an- +un-,in +e+erlu,an enin-,a'an e+erian s'er&i) a'au &a' an'i ,&n6ulsan. :e(ala *an- )iala+i asien se5ara lan-sun- )ia,ia',an )en-an l&,asi 'u+&r &'a,.
). Pe#er&/-''( Pe("(6'()
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+en-i)en'i/i,asi a)a 'i)a,n*a ,elainan in'ra ,ranial1 a)alah )en-an! ". R&n'-en /&'& 0<3ra*2 ,eala leih an*a, sea-ai screening test 1 (i,a a)a 'an)a3 'an)a enin--ian 'e,anan in'ra ,ranial1 a,an +e+er,ua' in)i,asi erlun*a )ila,u,an e+eri,saan leih lan(u'. #. An-i&-ra/i sua'u e+eri,saan )en-an +en*un'i,,an ahan ,&n'ras ,e )ala+ e+uluh )arah leher a-ar )aa' +eliha' -a+aran ere)aran )arah 06as,ularisasi2 &'a,
$. C&+u'erie) T&+&-rah* 0CT3S5an ,eala2 )aa' +e+eri,an in/&r+asi 'en'anl&,asi 'u+&r 'e'ai MRI 'elah +en(a)i ilihan un'u, ,ean*a,an ,arena -a+aran (arin-an luna, *an- leih (elas 0S5h&er1 #%"%2 >. Ma-ne'i5 Res&nan5e I+a-in- 0MRI21 isa +e+ua' )ia-&sa *an- leih )ini )an a,ura' ser'a leih )e/i'i'i/. :a+ar &'a, 'erseu' )ihasil,an ,e'i,a +e)an +a-ne' erin'era,si )en-an (arin-an asien i'u 0 Sa'*ane-ara1 #%"%.1 9ree)+an1 #%%42.
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Menuru' Brunner )an Su))ar'h "47 ! ". Pe+e)ahan Merua,an ilihan er'a+a a-i asien )en-an 'u+&r &'a,. Tu(uan )ia-n&sis )e/ini'i6e )an +e+er,e5il 'u+&r 'erseu'. Pen-an-,a'an )ari se+ua 'u+&r +eni+ul,an )e/isi' neur&l&-is *an- era'. #. Terai ra)iasi a.Ra)i&'erai1 un'u, +en-a'asi )aera, e,sisi )i+ana lesi +e'as'a'i5 'u+&r 'elah )ian-,a'. .Ke+&'erai1
un'u,
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Oa'3&a'an *an- )i-una,an ! Ni'r&seurea1 BCNU )an CCNU ,arena &a' ini +a+u +elewa'i sawar )arah &'a,. Sela+a e+erian &a'3&a'an ini asien harus +en-hin)ari +a,anan *an- 'in--i 'ira+in 0+isaln*a an--ur1 *&-ur'1 ,e(u1 ha'i a*a+1 isan-2 )an al5&h&l1 ,arena &,&raine +en-ha+a' )an +ele+ah,an a,'i6i'as inhii'&r +&n&a+ine &,si)ase 0MAO2. Pr&,aaine )i,ai',an )en-an +ual )an +un'ah *an- +un-,in hilan- a'au er,uran- saa' er'a+a ,ali a'au saa' en-&a'an se)an- )ila,u,an. $. I+un&'erai a. Den-an +en--una,an an'i&)* +&n&5l&nal *an- )i5i'a,an se5ara ,husus un'u, +en*eran- )an +en-han5ur,an sel 'u+&r &'al. . In'erleu,in3# )i-una,an un'u, +en--an'i lesi3lesi +e'as'a'i5 )ari ,an,er ri+er -in(al )an +elan&+a1 a,an 'e'ai ,e+an(urann*a +asih erlu )iu,'i,an. >. Pen-&a'an en*eli)i,an a. BCNU )i-aun-,an )ala+ en'u, 'ale' 'iis *an- +e+a'i,an se5ra i&l&-is un'u, )i'e+a',an a)a )aerah 'u+&r sela+a e+e)ahan ,rani&'&+i.
. Pene+a'an ,a'e'er ar'eri )e,a' )en-an 'u+&r. Beri in/us +ani'&l un'u, erusa,an )ari arier )arah a'au &'a,. 5. Translan'asi su+su+ 'ulan- (u-a se)an- )i-una,an )alan u(i ,linis un'u, ena'ala,sanaan as'r&sil&+a.
Pena'ala,sanaan ,eerawa'an! Serin-,ali asien 'u+&r &'a, *an- )irawa' )i ru+ah sa,i' )a'an- su)ah )ala+ ,ea)aan a*ah1 san-a' )isnea1 ernaasan 5uin- hi)un-1 sian&sis1 )an -elisah. Masalah *an- erlu )ierha'i,an ialah! a. Men(a-a ,elan5aran erna/asan. . Keu'uhan is'iraha'. 5. Keu'uhan nu'risi )an 5airan. ). Men-&n'r&l suhu 'uuh. e. Men5e-ah ,&+li,asi-an--uan rasa a+an )an n*a+an. /. Kuran-n*a en-e'ahuan &ran- 'ua +en-enai en*a,i'.
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"2 Ana+nesis Usia 0,ean*a,an 'er(a)i a)a usia lansia2. #2 Keluhan u'a+a Keluhan u'a+a *an- serin- +en(a)i alasan ,lien un'u, +e+in'a an'uan ,eseha'an a)alah ,ele+ahan an--&'a -era, 0aralisis21 enurunan en-liha'an1 'i)a, )aa' er,&+uni,asi1 )an a)an*a ,e(an-. $2 Riwa*a' en*a,i' saa' ini Tan)a )an -e(ala )ari 'u+&r &'a, serin-,ali 'i)a, sesi/i,. Biasan*a 'er(a)i n*eri ,eala1 +ual1 +un'ah1 ah,an ,e(an- sa+ai 'i)a, sa)ar selain -e(ala ,ele+ahan an--&'a -era, a'au -an--uan /un-si &'a, *an- lain. A)an*a enurunan a'au eruahan a)a 'in-,a' ,esa)aran )ala+ hal eruahan
)i)ala+ in'ra,ranial. Keluhan eruahan erila,u (u-a u+u+ 'er(a)i. Sesuai er,e+an-an en*a,i'1 )aa' 'er(a)i le'ar-i1 'i)a, res&nsi/1 )an ,&+a. >2 Riwa*a' en*a,i' )ahulu A)a riwa*a' hier'ensi1 riwa*a' s'r&,e a'au 'u+&r seelu+n*a1 )iae'es +elli'us1 en*a,i' (an'un-1 ane+ia1 riwa*a' 'rau+a ,eala1 ,&n'rasesi &ral *an- la+a1 en--unaan &a'3&a' an'i,&a-ulan1 asirin1 6as&)ila'&r1 &a'3&a' a)i,'i/1
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an'ilii)e+ia1 en-ha+a' e'a1 )an lainn*a. A)an*a riwa*a' +er&,&,1 en--unaan &a' ,&n'rasesi &ral. Pen-,a(ian riwa*a' ini )aa' +en)u,un en-,a(ian )ari riwa*a' en*a,i' se,aran- )an +erua,an )a'a )asar un'u, +en-,a(i leih lan(u' )an un'u, +e+eri,an 'in)a,an selan(u'n*a. 2 Riwa*a' en*a,i' ,eluar-a Biasan*a a)a riwa*a' ,eluar-a *an- +en)eri'a hier'ensi1 )iae'es +elli'us a'au riwa*a' s'r&,e )ari -enerasi 'er)ahulu. 2 Pe+eri,saan /isi, Se'elah +ela,u,an ana+nesis *an- +en-arah a)a ,eluhan3,eluhan ,lien1 e+eri,saan /isi, san-a' er-una un'u, +en)u,un- )a'a )ari en-,a(ian ana+nesis. Pe+eri,saan /isi, seai,n*a )ila,u,an ersis'e+ 0B"3B2 )en-an /&,us e+eri,saan B$ 0rain2 *an- 'erarah )an )ihuun-,an )en-an ,eluhan3 ,eluhan )ari ,lien. a2 Kea)aan u+u+ U+u+n*a
+en-ala+i
enurunan
,esa)aran.
Pasien
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in,&&r)inasi1 hilan- ,esei+an-an. Suara i5ara ,a)an- +en-ala+i -an--uan1 *ai'u su,ar )i+en-er'i1 ,a)an- 'i)a, isa i5ara1 )an 'an)a3'an)a 6i'al! 'e,anan )arah +enin-,a'1 )en*u' na)i er6ariasi. 2 B" 0rea'hin-2 Inse,si )i)aa',an ,lien a'u,1 enin-,a'an r&)u,si su'u+1 sesa, naas1 en--unaan &'&' an'u naas1 )an enin-,a'an /re,uensi ernaasan. Aus,ul'asi )i)aa',an un*i naas 'a+ahan seer'i r&n,hi a)a ,lien )en-an enin-,a'an r&)u,si se5re' )an ,e+a+uan a'u,
*an- +enurun *an- serin- )i)aa',an a)a ,lien s 'r&,e )en-an enurunan 'in-,a' ,esa)aran ,&+a. Pa)a ,lien )en-an 'in-,a' ,esa)aran 5&+&s +en'is a)a en-,a(ian inse,si ernaasan 'i)a, a)a ,elainan. Palasi 'h&ra,s )i)aa',an 'a,'il re+i'us sei+an- ,iri )an ,anan. Aus,ul'asi 'i)a, )i)aa',a un*i naas 'a+ahan. 52 B# 0l&&)2 Pen-,a(ian a)a s*s'e+ ,ar)i&6as,uler )i)aa',an a)an*a enin-,a'an 'e,anan )arah )an eruahan /re,uensi (an'un-. TD iasan*a 'er(a)i enin-,a'an )an isa 'er)aa' a)an*a hier'ensi +asi/ TD #%% ++H-. )2 B$ 0Brain2 Tu+&r &'a, +en*ea,an era-ai )e/isi' neur&l&-is er-an'un- a)a l&,asi lesi 0e+uluh )arah +ana *an- 'ersu+a'21 u,uran area *an er/usin*a 'i)a, a)e,ua'1 )an aliran )arah ,&la'eral 0se,un)er a'au a,ses&ri2. Lesi &'a, *an- rusa, 'i)a, )aa' +e+ai, seenuhn*a. Pen-,a(ian B$ +erua,an e+eri,asaan 'er/&,us )an leih len-,a )ian)in-,an en-,a(ian a)a sis'e+ lainn*a.
e2 B> 0la))er2 Klien +un-,in +en-ala+i in,&n'enensia urine se+en'ara ,erena ,&n/usi1 ,e'i)a,+a+uan +en-,&+uni,asi,an ,eu'uhan1 )an ,e'i)a,+a+uan un'u, +en--una,an urinal ,arena ,erusa,an ,&n'r&l +&'&ri, )an &s'ural. /2 B 0B&wel2 Di)aa',an a)an*a ,eluhan ,esuli'an +enelan1 na/su +a,an +enurun1 +ual1 )an +un'ah a)a /ase a,u'. Mual sa+ai +un'ah )ihuun-,an )en-an enin-,a'an r&)u,si asa+ la+un- sehin--a +eni+ul,an +asalah e+enuhan ,eu'uhan nu'risi. P&la )e/e,asi iasan*a 'er(a)i ,&ns'iasi a,ia' enurunan eris'al'i5 usus. A)an*a in,&n'inensia al6i *an- erlan(u' +enun(u,,an ,erusa,an neur&l&-is luas. -2 B 0B&ne2 A)an*a in,&&r)inasi )an ,ehilan-an ,esei+an-an.
Tu+&r &'a,
+en-a,ia',an ,ehilan-an ,&n'r&l 6&lun'eer 'erha)a -era,an +&'&ri,. Karena neur&n +&'&r a'as +elin'as1 -an--uan 5&n'r&l +&'&r 6&lun'eer
a)a salah sa'u sisi 'uuh )aa' +enun(u,,an ,erusa,an a)a neur&n +&'&r a'as a)a sisi *an- erlawananar& &'a, 72 Pe+eri,saan sis'e+ neur&l&-is a
Tin-,a' Kesa)aran 0"2 Kuali'a'i/ a)alah /un-si +en'al ,eseluruhan )an )era(a' ,ewasaa)aan. 3 CM sa)ar a,an )iri )an un*a &rien'asi enuh 3 APATIS 'in-,a' ,esa)aran *an- 'a+a, lesu )an +en-an'u, 3 LATAR:IE 'in-,a' ,esa)aran *an- 'a+a, lesu )an +en-an'u, 3 DELIRIUM enurunan ,esa)aran )iser'ai e an&r+al 3
a,'i/i'as si,&+&'&r -a)uh -elisah SAMNOLEN ,ea)aan asien *an- selalu +au 'i)ur
3
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0#2 Kuan'i'a'i/ *ai'u )en-an +en--una,an :las-&w C&+a S5ale 0:CS2 3 Res&n +e+u,a +a'a 0 E E*e 2 a S&n'an 0>2 Den-an erin'ah 0$2 5 Den-an n*eri 0#2 ) Ti)a, eres&n 0"2 3 Res&n =eral 0 = =eral 2 a Ber&rien'asi 02 Bi5ara +e+in-un-,an 0>2 5 Ka'a3,a'a 'i)a, 'ea' 0$2 ) Suara 'i)a, )aa' )i+en-er'i 0#2 e Ti)a, a)a res&ns 0"2 3 Res&n M&'&ri, 0M M&'&ri, 2 a Den-an erin'ah 02 Mel&,alisasi n*eri 02 5 Menari, area *an- n*eri 0>2 ) 9le,si an&r+al&s'ur )e,&r'i,asi 0$2 e E,s'ensi an&r+al&s'ur )esererasi 0#2 / Ti)a, eres&n 0"2 2 Pe+eri,saan sara/ ,ranial a2 Sara/ I. Biasan*a a)a ,lien )en-an 'u+&r &'a, 'i)a, a)a ,elainan a)a /un-si en5iu+an. 2 Sara/ II. Dis/un-si ersesi 6isual ,arena -an--uan (aras sens&ri, ri+er )ian'ara
+a'a )an ,&r'e,s 6isual. :an--uan huun-an 6isual3sasial
0+en)aa',an huun-an )ua a'au leih &(e, )ala+ area sasial2 serin-
'erliha' a)a ,lien )en-an he+ile-ia ,iri. Klien +un-,in 'i)a, )aa' +e+a,ai a,aian ,ea-ian 'uuh. 52 Sara/ III1 I=1 )an =I. A)an*a ,ele+ahan &'&'3&'&' &,ularis1 )i)aa',an enurunan ,e+a+uan -era,an ,&n(u-a' unila'eral. )2 Sara/ =. Pa)a eeraa ,ea)aan 'u+&r &'a, 1 )i)aa',an enurunan ,e+a+uan ,&&r)inasi -era,an +en-un*ah. Pen*i+an-an rahan- awah ,e sisi isila'eral )an ,elu+uhan sesisi &'&'3&'&' 'eri-&i)eus in'ernus )ane,s'ernus. e2 Sara/ =II. Persesi en-e5aan )ala+ a'as n&r+al. /2 Sara/ =III. Ti)a, )i'e+u,an a)an*a 'uli ,&n)u,'i/ )an 'uli erse si. -2 Sara/ I< )an <. ,e+a+uan +enelan ,uran- ai,1 ,esu,aran +e+u,a +ulu'. h2 Sara/ isa er-era, +elawan 'ahanan e+eri,sa 'e'ai ,e,ua'ann*a er,uran )aa' +elawan 'ahanan e+eri,sa )en-an ,e,ua'an +a,si+al )2 9esi,ulasi )i)aa',an a)a &'&'3&'&' e,'re+i'as. e2 T&nus &'&' )i)aa',an +enin-,a'. /2 Ke,ua'an &'&'1 a)a enilaian )en-an +en--una,an nilai ,e,ua'an &'&' a)a sisi *an- sa,i' )i)aa',an nilai %. -2 Kesei+an-an )an ,&&r)inasi1 'er)aa' in,&&r)inasi
"%2 Pe+eri,saan re/le,s a2 Pe+eri,saan re/le,s iasan*a )ila,u,an alin- a,hir. Klien iasan*a )ala+ &sisi )u)u, a'au 'i)ur (i,a ,&n)isi ,lien 'i)a, +e+un-,in,an. E6aluasi res&n ,lien )en-an +en--una,an s,ala % > % 'i)a, a)a res&n " Ber,uran- 0Q2 # N&r+al 0QQ2 $ Leih )ari n&r+al 0QQQ2 > Hiera,'i/ 0QQQQ2 2 Re/le, 9isi&l&-is 0"2 Re/le, Ten)&n 0a2 Re/le, a'ella Pasien earin- 'erlen'an- lu'u' )ian-,a' ,ea'as /le,si ,uran- leih )ari $%%. Ten)&n a'ella 0)i'en-ah3'en-ah a'ela )an Tuer&si'as 'iiae2 )iu,ul )en-an re/le, ha+er. Res&n erua ,&n'ra,si &'&' -uar)rise /e+&ris *ai'u e,s'ensi )ari lu'u'. 02 Re/le, Bise Len-an )i/le,si,an 'erha)a si,u )en-an su)u' 4% % suinasi )an len-an awah )i'&an- a)a a'as 0+e(a eri,sa2 (ari eri,sa )i'e+a' ,an a)a 'en)&n +.ise 0)ia'as lia'an si,u2 ,e+u)ian )iu,ul )en-an re/le, ha+er.n&r+al (i,a a)a ,&n'ra,si &'&' i5es1 se)i,i' +enin-,a' ila a)a /le,si sea-ian a)a r&nasi1 hiera,'i/ +a,a a,an 'e(a)i en*earan -era,an3-era,an a)a (ari a'au sen)i. 052 Re/le, 'rise Len-an awah )ise+i/le,si,an1 'en)&n ise )iu,ul )en-an )en-an re/le, ha+er 0'en)&n ise era)a a)a (ara, "3# 5+ )ia'as &le,r&n&n2 res&n *an- n&r+al a)alah ,&n'ra,si &'&' 'rise1 se)i,i' +enin-,a' ila a)a e,s'ensi rin-an )an hiera,'i/ ila e,s'ensi ila e,s'ensi si,u 'erseu' +en*ear ,ea'as sa+ai ,e &'&' &'&' ahu. 0)2 Re/le, A5hiles P&sisi ,a,i a)alah )&rs& /le,si un'u, +e+u)ah ,an e+eri,saan re/le, ini ,a,i *an- )ieri,sa )ile'a,an)isilan-,an )ia'as 'un-,ai awah ,&n'ral la'eral.'en)&n a5hiles )iu,ul )en-an re/le, ha+er1 res&n n&r+al erua -era,an lan'ar /le,si ,a,i. 0e2 Re/le, Suer/isial 3 Re/le, ,uli' eru'
3 Re/le, ,re+eas'er 3 Re/le, ,&rnea 3 Re/le, ul&,a6ern&sus 3 Re/le, lan'ar 52 Re/le, Pa'&l&-is 0"2 Bains,i Merua,an re/le, *an- alin- en'in- ia han*a )i(u+ai a)a en*a,i' 'ra,'us ,&r'i,&si'al.un'u, +ela,u,an 'es ini1 -&reslah ,ua'3 ,ua' a-ian la'eral 'elaa, ,a,i )ari 'u+i' ,e arah (ari ,elin-,in- )an ,e+u)ian +elin'asi a-ian (an'un- ,a,i. Res&n ains,i 'i+ul (i,a iu (ari ,a,i +ela,u,an )&rs&/le,si )an (ari3(ari lain +en*ear1 ,alau n&r+aln*a a)alah /le,si lan'ar a)a se+ua (ari ,a,i. 0#2 Cara 5ha))&5, Ran-san- )ieri,an )en-an (alan +en--&res a-ian la'eral +ale&lus hasil &si'i/ ila -era,an )&rs&e,s'ensi )ari iu (ari )an -era,an a)u,si )ari (ari (ari lainn*a. 0$2 Cara :&r)&n Me+en5e' 0+en5ui'2 &'&' e'is 0>2 Cara Oenhei+ Men-uru' )en-an ,ua' 'iia )an &'&' 'iialis an'eri&r arah +en-uru' ,eawah 0)is'al2 02 Cara :&n)a Me+en5e' 0+ene,an2 sa'u (ari ,a,i )an ,e+u)ian +eleas,ann*a se,&n*&n- ,&*&n-. )2 Ran-san-an Menin-eal Un'u, +en-e'ahui ran-san-an selau' &'a, 0+isaln*a a)a +enin-i'is2 )ila,u,an e+eri,saan ! 0"2 Ka,u ,u)u, Bila leher )i 'e,u, se5ara asi/ 'er)aa' 'ahanan1 sehin--a )a-u 'i)a, )aa' +ene+el a)a )a)a 333 Ka,u ,u)u, &si'i/ 0Q2 0#2 Tan)a Bru)uns,* I Le'a,,an sa'u 'an-an e+eri,sa )i awah ,eala ,lien )an 'an-an lain )i )a)a ,lien un'u, +en5e-ah a)an 'i)a, 'eran-,a'.Ke+u)ian ,eala ,lien )i/le,si,an ,e)a)a se5ara asi/.Bru)ins,* I &si'i/ 0Q2 0$2 Tan)a Bru)ins,* II Tan)a ru)ins,* II &si'i/ 0Q2 ila /le,si ,lien a)a sen)i an--ul se5ara asi/ a,an )ii,u'i &leh /le,si 'un-,ai lainn*a a)a sen)i an--ul )an lu'u'.
0>2 Tan)a ,erni 9le,si 'un-,ai a'as 'e-a, lurus1lalu )i5&a +elurus,an 'un-,ai awah a)a sen)i lu'u' n&r+al31ila 'un-,ai +e+en'u, su)u' "$% 'erha)a 'un-,ai a'as. Kerni Q ila e,s'ensi lu'u' asi/ a,an +en*ea,an rasa sa,i' 'eila e,s'ensi lu'u' asi/ a,an +en*ea,an rasa sa,i' 'erha)a ha+a'an. 02 Tes' lase-ue 9le,si sen)i aha )en-an sen)i lu'u' *an- lurus a,an +eni+ul,an n*eri sean(an- Mis5hia)i5us.
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resirasi /. M&ni'&r s'a'us resirasi! le6el A:D1 &,si+e'ri na)i1 ,e)ala+an1 &la1 la(u1 )an usaha naas -. M&ni'&r ntra "ranial *ressure 0ICP2 )an "erebral
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P&la Na/as 'i)a, e/e,'i/ .) +e)ula &l&n-a'a 'er'e,an Ba'asan ,ara,'eris'i,! a. Peruahan ,e)ala+an erna/asan . Peruahan e,s,ursi )a)a 5. Men-a+il &sisi 'i-a 'i'i, ). Bra)ineu e. Penurunan 'e,anan e,sirasi /. Penurunan 6en'ilasi se+eni'
ICP NOC: NIC: a. Respirator' status+ entilation a. P&sisi,an asien un'u, +e+a,si+al,an 6en'ilasi b. Respirator' status+ ir)a' patenc' . Pasan- +a*& ila erlu c. ital sign &tatus 5. La,u,an /isi&'erai )a)a (i,a erlu Se'elah )ila,u,an 'in)a,an ). Keluar,an se,re' )en-an a'u, a'au su5'i&n ,eerawa'an sela+a ..asien e. Aus,u l'asi suara n a/as1 5a'a' a)an*a su ara +enun(u,,an ,ee/e,'i/an &la na/as1 'a+ahan )iu,'i,an )en-an ,ri'eria hasil! /. Beri,an r&n,& )ila'&r a. Men)e+&ns'rasi,an a'u, e/e,'i/ -. Beri,an ele+ a u)ara Kassa asah NaCl )an suara na/as *an- ersih1 'i)a, Le+a a)a sian&sis )an )*sneu 0+a+u h. A'ur in'a,e un'u, 5airan +en-& 'i+al,an +en-eluar,an su'u+1 +a+u ,esei+an-an. erna/as )- +u)ah1 'i)a,a)a i. M&ni'&r resirasi )an s'a'us O# urse) lis2 (. Bersih,an +ulu'1 hi)un- )an se5re' 'ra,ea . Menun(u,,an (alan na/as *an,. Per'ahan,an (alan na/as *an- a'en a'en 0,lien 'i)a, +erasa 'er5e,i,1
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'e,anan in'ra5ranial
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hasil!
n*eri1
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NIC !
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DODS !
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Ke'i)a,sei+an-an
NOC!
nu'risi
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,uran- )ari ,eu'uhan
nu'rien'
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Berhuun-an )en-an !
In'a,e
un'u, +en5e-ah ,&ns'iasi
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Se'elah )ila,u,an 'in)a,an
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Ka(i a)an*a aler-i +a,anan K&la&rasi )en-an ahli -ii un'u, +enen'u,an (u+lah
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Per'ahan,an 'erai I= line
Ca'a' a)an*a e)e+a1 hiere+i,1 hier'&ni, aila
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Ka(i ,e+a+uan ,lien un'u,
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5.
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).
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e.
K&+uni,asi,an )en-an ,lien 'en'an- eren5anaan ulan-
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D&,u+en'asi,an eren5anaan ulan-
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An(ur,an ,lien un'u, +ela,u,an en-&n'r&lan ,eseha'an se5ara ru'in
