Asuhan keperawatan kusta

Asuhan keperawatan kusta ASUHAN KEPERAWATAN I

PENGKAJIAN

Pengkajian merupakan pemikiran dasar dari proses keperawatan yang bertujuan untuk mengumpulkan informasi atau data tentang klien agar dapat mengidentifikasi mengenai masalah kebutuhan kesehatan dan keperawatan klien baik fisik, mental, sosial, dan lingkungan. (Nasrul Effendi, 1995 : 18). a. Pengumpulan Data 1. Identitas klien Meliputi : nama, umur, nomor register, jenis jenis kelamin, status, alamat, tanggal MRS, diagnosa medis. 2. Keluhan utama Pada umumnya pada pasien dengan morbus hensen ,mengeluh adanya bercak-bercak Disertai hiperanastesi dan terasa kaku diikuti dengan peningkatan suhu 3. Riwayat kesehatan a. Riwayat kesehatan sekarang Riwayat penyakit kusta biasanya adanya bercak-bercak merah disertai hiper anastesi dan odema pada ektrimitas pada bagian perifer seperti tangan,kaki serta bisa juga terjadi peningkatan suhu tubuh.  b. Riwayat kesehatan dahulu Penyakit yang diderita pasien sebelumnya seperti hepatitis,asma dan alergi,jantung koroner. c. Riwayat kesehatan keluarga Biasanya merupakan penyakit menular Maka anggota keluarga mempunyai resiko beasar tertular dengan kontak lama. 4. Pola-Pola Fungsi Kesehatan a. Pola persepsi dan tatalaksana hidup sehat Pada umumnya pada pola presepsi pada pasien kusta mengalami gangguan terutama pada  body image,penderita merasa rendah diri dan merasa terkucilkan sedangkaan pada tatalaksana hidup sehat pada umumnya klien kurang kebersihan diri dan lingkungan yang kotor dan sering kontk langsung dengan penderita kusta.Karena kurangnya pengetahuan tentang penyakitnya maka timbul masalah dalam perawatan diri.  b. Pola nutrisi dan metabolisme Meliputi makanan klien sehari-hari komposisi:sayur, lauk pauk,minum sehari berapa gelas,berat  badan naik atau turun,sebelum dan saat masuk rumah sakit turgor kulit normal atau menurundan kebiasaan maskan klien.Klien tinggal ditempat yang kotor atau bersih Adanya penurunan nafsu makan, mual, muntah, pemnurunan berat badan, gangguan pencernaan. c. Pola eliminasi Pada Pola eleminasi alvi dan uri pada pasien kusta tidak ada kelainan. d. Pola istirahat dan tidur 

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Pada klien kusta pada umumnya pola tidur tidak teerganggu tetapi bagi kusta yang belum menjalani pengubatan pasien baru biasanya terjadi gangguan kebutuhan tidur dan istirahat yang disebabkan oleh pikiran stress, odema dan peningkatan suhu tubuh yang yang diikuti rasa nyeri. e. Pola aktivitas dan latihan Biasanya pada pasien kusta dalam aktifitas ada gangguan dalam hal interaksi sosial dengan masyarakat biasanya pasien mengurung diri dan pada pergerakan ektrimitas bagian perifer didapatkan bercak-bercak merah disertai odema dan pasien dianjurkan harus bayak mobilisasi. f. Pola persepsi dan konsep diri Presepsi klien tentang penyakitnya dan bagaimana konsep dalam menghadapi penyakitnya yang diderita. g. Pola sensori dan kognitif  Pada umumnya penderita kusta mengalami gangguan disalah satu sensorinya seperti peraba . Pasien tidak merasa adanya rangsangan apabila bercak tersebut diberikan rangsangan.Pada kognitifnya pasien kusta merasa merasa tidak berguna lagi dan merasa terkucilkan serta merasa tidak tidak diterima oleh masyarakat dan keluarganya. h. Pola reproduksi seksual Pada umumnya pada pola produksi seksual klien tidak mengalami gangguan. i. Pola hubungan peran Biasanya pada pasien kusta selalu mengurung diri dan menarik diri dari masyarakat (disorentasi) Pasien merasa malu tentang keadaan dirinya.Dan masyarakat beranggapan penyakit kusta merupakan penyakit yang menjijikan.  j. Pola penanggulangan stress Bagai mana klien menghadapi masalah yang dibebani sekarang dan cara penanggulangannya. k. Pola nilai dan kepercayaan Dalam pola ini terkadang ada anggapan yang bersifat ghaib.  b. Analisa Data Data yang telah dikumpulkan selanjutnya dikelompokkan meliputi data subyektif dan data obyektif untuk menentukan masalah klien. Data yang telah dikelompokkan untuk menentukan masalah keperawatan kemudian penyebabnya dan dirumuskan dalam diagnosa keperawatan. (Lismidar, 1990 : 7-8) II

DIAGNOSA KEPERAWATAN

Diagnosa keperawatan merupakan suatu pernyataan dari masalah klien yang nyata (potensial) dan membutuhkan tindakan keperawatan sehingga masalah klien ditanggulangi / dikurangi (Lismidar, 1990 : 13). Diagnosa yang sering muncul pada klien Penyakit kusta adalah 1. Gangguan citra tubuh b/d Perasaan negatif pada dirinya sendiri 2. Kerusakan integritas kulit b/d ulkus akibat mycobacterium leprae. 3. Harga diri rendah berhubungan dengan penyakit yang dideritanya

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Diagnosa :Kerusakan integritas kulit b/d ulcus akibat mycobakterium leprae. :Menunjukkan tingkah laku atau teknik untuk mencegah kerusakan kulit atau meningkatkan  penyembuhan Kriteria Hasil : 1. Mencapai kesembuhan luka mendemontrasikan tingkah laku atau teknik untuk meningkatkan kesembuhan dan mencegah komplikasi 3. Menunjukkan kemajuan pada luka/penyembuhan pada lesi

ujuan

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Rencana Tindakan : Guanakan teknik aseptip dalam perawatan luka Kaji kulit tip hari dan warnanya turgor sirkulasi dan sensori Instruksikan untuk melaksanakan higiene kulit, misalnya membasuh kemudian mengeringkannya,dena berhati-hati dan melakukan masase dengan menggunakan losion dan krim Ingatkan pasien jangan menyentuh yang luka Tingkatkan masukan protein dan karbohidrat Pertahankan sprei bersih atau ganti spei sesuai dengan kebutuhan kering dan tidak berkerut. Kolaborasi dengan tim medis lainnya Rasional: Mencegah luka dari perlukaan mekanis dan kontaminasi Menentukan garis dasar bila ada terdapat perubahan dan dapat melakukan intervensi dengan tepat Mempertahankan kebersihan ,karena kulit yang kering bisa terjadi barrel infeksi,pembasuhan kulit kering sebagai penggaruk,menurunkan resiko trauma dermal kulit yang kering dan rapuh masase meningkatkan sirkulasi kulit dan meningkatkan kenyamanan Mencegah kontaminasi luka Mempertahankan keseimbangan nitrogen positif  Freksi kulit disebabkan oleh kain yang berkerut dan basah yang menyebabkan iritasi dan  potensial terhadap infeksi. elaksanakan fungsi interdependen

Diagnosa :Ganguan citra tubuh b/d persaan negetif tentang dirinya Tujuan :Klien dapat menerima keadaan dirinya. KH : 1. Mengungkapkan rasa percaya diri dalam kemampuan menghadapi penyakitnya,perubahan gaya hidup dan kemungkinan keterbatasan 2. Menyusun rencana untuk realitas untuk masa depan

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1. 2. 3. 4. 5. 6. 7. 1. 2. 3. 4. 5. 6. 7.

Intervensi: Dorong pengungkapan mengenai masalah tentang proses penyakit,harapan masa depan Diskusikan arti dari perubahan pada pasien terhadap penampilannya Perhatikan prilaku menarik diri atau terllu memperhatikan tubuh atau perubahan Susun batas pada prilaku maladaptif Bantuklien untuk mengidentifikasi prilaku positif yang dapat membantu koping Ikut sertakan pasien dalam merencanakan perwatan dan membuat jadwal aktivitas Berikan harapan dalam situasi individu jangan berikan keyakinan yang salah Berikan kesempatan untuk berbagi rasa dengan individu yang mengalami yang sama Rasional : Memberikan kesempatan untuk mengidentifikasi rasa takut atau kesalahan konsep dan meng hadpi secara langsung Mengidentifikasi bagaimana penyakit menpengaruhi persepsi diri dan interksi diri dengan orang lain akan menentukan kebuuhan terhadap intervensi Dapat menunjukkan emosional ataupun metode koping maladaptif, Membutuhkan intervensi lebih lanjut atau dukungan pskologis mempertahankan kontrol diri yang dapat meningkatka harga diri Meningkatkan perasan kompetensi atau harga diri mendorong kemandirian atau mendorong  partisipasi dalam terapi Kata-kata penguat dapat mendukung terjadinya koping positif  Memberikan motivasi dan rasa percaya diri.

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BAB III  ASUHAN KEPERAWATAN PADA PASIEN LEPRA/KUSTA  A. PENGKAJIAN Yang haruss di kaji dengan pasien lepra adalah sebagai berikut : 1. Identitas pasien 2. Pemeriksaan tanda-tanda vital 3. Keluhan utama, pada pasien lepra pada umumnya mengeluh adanya bercak-bercak di kulit,gatal,kaku dan panas serta mengalamai demam yang tinggi. 4. Riwayat kesehatan sekarang,riwayat penyakit kusta umumnya adanya bercak-bercak merah disertai hiperanestesi dan oedema pada ekstremitas pada bagian perifer seperti tangan, kaki dan terjadi peningkatan suhu. 5. Riwayat penyakit dahulu, penyakit yang di derita pasien sebelumnya seperti hepatitis,terpajan oleh bakteri M. leprae sebelumnya namun dengan kondisi imun yang baik, asma ,alergi dan jantung koroner. 6. Riwayat kesehatan keluarga, pada umumnya anggota keluarga ada yang pernah mengalamai penyakit leprae dan resiko keluarga terkena penyakit yang sama akan tinggu. Pada pembahasan tentang asuhan keperawatan pada pasien leprae pengkajian berdasarkan Nanda internasional adalah sebagai berikut : 1. Domain 1. promosi kesehatan : Data subyek: • Tanyakan kesehatan masa lalu pasien : pasien pada umumnya pernah mengalami alergi, penyakit kulit sebelumnya. • Tanyakan keluhan utama pasien. • Tanyakan riwayat kesehatan sekarang pasien. • Tanyakan riwayat alergi a lergi makanan/obat :pada pasien dengan leprae umunya mengalami alergi makanan/obat sehingga timbul penyakit leprae. • Tanyakan riwayat imuniasasi. Data subyek : • Observasi perilaku kepatuhan terhadap program terapi : pasien leprae harus di pantau terapinya terapiny a dan kepatuhanya sehingga dapat sembuh dan tidak bertambah parah khususnya kondisi kukit. • Pengobatan saat ini : observasi pemberian obat,frekuensi ,dosis. 2. Domain 2. nutrisi. Data subyek : • Riwayat berat badan :tanyakan perubahan berat badan pada psi en pada umunya pasien mengalamai penurunan berat badan. • Kebiasaan makan dan minum : tanyakan kebiasaan makan meliputi makanan klien sehari hari,sayur,lauk,minuman sehari-hari minuman sehari berapa gelas. Umumnya pasien dengan penyakit lepra alergi makanan sehingga mengobservasi kebiasaan makan sangat penting. • Perubahan nafsu makan :umumnya pada pasien lepra mengalamai penurunan nafsu makan. • Pada umumnya pasien lepra megalamai kesulitan mencerna makanan. • Riwayat alergi makanan : tanyakan tentang aler gi aler gi makanan pada pasien karena pada penderita leprae akan mengalamai alergi terhadap makanan sebagai penyebab dari penyakitnya.

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• kondisi mulut akan memerah,mengalamai stomatitis. • Kondisi bekas luka akan memerah dan d an lengket. • Intake oral dan intravena : kaji intake oral pasien melalui minuman dan intravena : jenis cairan,berapa kali permenit tetesan infuse. • Kaji program diit saat ini. • Hasil lab : 3. Domain 4. aktivitas istirahat Data subyek : • Tanyakan kemampuan kemam puan makan,mandi,toileting, mobilitas di tempat tidur. Pada pasien dengan penyakit leprae akan mengalami hambatan mobilitias atau dapat disebabkan karena kondisi luka yang lengket dan kulit kaku serta klien akan menyatakan lemah pada ekstremitas dan mati rasa. • Tanyakan periode istirahat pasien :jam tidur,frekuensi tidur dan istirahat serta kegiatan rekreasional. Data obyek : • Observasi tingkat ketergantungan pasien : level 0 pasien dapat mandiri, level 1membutuhkan penggunaan alat bantu, level 2 membutuhkan pengawasan orang lain, level 3 membutuhkan bantuan orang lain masih berpatisipasi, dan level 4 ketergantungan tanpa partisipasi. Pada pasien dengan lepra dan kondisi tubuh untuk bermobilisasi kurang baik umunya kan berada pada level 3 atau 4 yang tergantung dengan orang lain. • Tes sendi/ROM , masa otot: pasien akan mengalami kelemahan otot sampai lumpuh dan mati rasa. • Kaji status vaskuler : pada pasien dengan lepra akan mengalami perandangan kronis pada saraf perifer akibat dari luka yang kemerahan dan lesi akan keputih-putihan/hipopigmentasi kulit kaku dan kering. • Hasil pemeriksaan lab :pemeriksaan bakterioskopik digunakan untuk menegakan diagnosis dan pengamatan pengobatan. Bakterioskopik negative pada seorang penderita bukan berarti orang tersebut tidak mengandung M. leprae. Pemeriksaan darah lengkap atau HMT sangat penting untuk mengetahui sel darah putih untuk indikasi adanya infeksi.Pemeriksaan histopatologik ,makrofag dalam jaringan yang berasal dari monosit di dalam darah ada yang mempunyai nama khusus antara lain sel kuffer dari hati,sel alveolar dari paru ,sel glia dari otak dan dari kulit yaitu stiotit. Pada lepramatosa terdapat kalim sunyi subepidermal(subepidermal clear zone, ialah suatu daerah langsung di bawah epidermis yang jaringan tidak patologik,ada sel vircho dengan banyak khas). 4. Domain 6. persepsi diri Data subyek : • Tanyakan perasaan pasien : pada pasien dengan lepra biasnya akan mengalami putus asa,merasa tidak berguna dan rendah diri atas penyakit yang di deritanya. • Tanyakan Tanyak an pengaruh penyakit terhadap kehidupan : pasien akan menyatakan diasingkan dari lingkungan,di hina karena kelaianan kulit yang di alamainya. • Penilaian pasien terhadap diri sendiri : pasien merasa di asingkan ,tidak di hargai di lingkunganya,merasa jelek karena keadaan kulit tubuhnya. Data obyek : • Amati respon pasien saat berinteraksi. Pasien akan mengalihkan perhatian saat bicara,terlihat malu dan suara rendah. • Ukur skala kecemasan : skala 1 antisipasi/relaksi, skala 2 cemas ringan,skala 3 cemas seda ng , skala 4 cemas berat dan skala 5 panik. Pada pasien dengan lepra akan menagalami kecemasan pada skala 4

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dan putus asa. 5. Domain 11. keamanan dan proteksi. Data subyek : • Tanyakan keluhan nyeri dengan PQRST: Pada pasien dengan lepra akan mengeluh nyeri di seluruh tubuh terutama ekstrimitas dan muncul tiba-tiba ,berkurang saat di kompres,lebih nyeri saat gatal timul dan nyeri karena lukanya. • Riwayat penggunaan pengguna an obat-obatan. Pada pasien dengan lepra umumnya akan karena laergi obatobatan. • Tanyakan riwayat penyakit imun yang sebelumnya. Data obyek : • keadaan umum : observasi keletihan ,kegelisahan klien dan kondisi kesadaran pasien. • Observasi tanda-tanda tanda-tanda vital. • kaji tanda-tanda tanda-tanda infeksi : saat di raba luka akan terasa kering,kaku, pasien akan merasa panas,luka akan berbau,kemerahan, ekstremitas kaku. • hasil lab : pemeriksaan bakterioskopik digunakan untuk menegakan diagnosis dan pengamatan pengobatan. Bakterioskopik negative pada seorang penderita bukan berarti orang tersebut tidak mengandung M. leprae. Pemeriksaan darah lengkap atau HMT sangat penting untuk mengetahui sel darah putih untuk indikasi adanya infeksi.Pemeriksaan histopatologik ,makrofag dalam jaringan yang berasal dari monosit di dalam darah ada yang mempunyai nama khusus antara lain sel kuffer dari hati,sel alveolar dari paru ,sel glia dari otak dan dari kulit yaitu stiotit. Pada lepramatosa terdapat kalim sunyi subepidermal(subepidermal clear zone, ialah suatu daerah langsung di bawah epidermis yang jaringan tidak patologik,ada sel vircho dengan banyak khas). 6. Domain 12. kenymanan Data subyek : • Tanyakan keadaan pasien saat ini. Pasien akan menyatakan cemas dan takut karena penyakit yang di deritanya. • Tanyakan penyebab ketidaknyamanan yang di deritanya. Pasien akan megalamai ketidaknyamanan karena luka pada kulitnya yang yang kaku,panasmberbau dan gatal serta tidak dapat berinteraksi dengan lingkungan sekitarnya. • Tanyakan apakah klien merasa mual. merasa  mual. Pasien akan merasa mual dan muntah serta penurunan berat badan karena bau pada lukanya dan makanan tidak enak saat dimakan. • Kaji nyeri dengan PQRST :Pada pasien dengan lepra akan mengeluh nyeri di seluruh tubuh terutama ekstrimitas dan muncul tiba-tiba ,berkurang saat di kompres,lebih nyeri saat gatal timul dan nyeri karena

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• ketidakefektifan menejemen kesehatan diri berhubungan dengan kurang pengetahuan. • Gangguan citra tubuh berhubungan dengan perubahan pada tubuh. • Resiko infeksi berhubungan dengan p engetahuan yang tidak cukup untuk menghindari pemajanan pathogen. • Kerusakan integritas kulit berhubungan dengan penurunan imun. • Mual berhubungan dengan situasional (bau luka di kulit yang tidak menyenangkan,nyeri, faktor psikologis dan rasa makanan atau minuman tidak enak di lidah. • Nyeri akut berhubungan dengan agen cidera. • Hipertermi berhubungan dengan penyakit. C. RENCANA KEPERAWATAN NO DIAGNOSA KEPERAWATAN TUJUAN(NOC) INTERVENSI(NIC) 1. Kerusakan integritas kulit Setelah dilakukan tindakan selama….x24 selam a….x24 jam pasien dapat Respon alergi : lokasi dengan kriteria hasil : 1. Nyeri sinus 2. sakit kepala 3. konjungtivitis 4. lakrimasi 5. sekresi mukosa 6. lokasi gatal 7. lokasi luka 8. lokasi eritem 9. temperature lokasi kulit 10. lokasi udem 11. lokasi nyeri skala: 1. besar 2. subtansi 3. sedang 4. ringan 5. tidak ada Integritas jaringan dengan kriteria hasil : 1. temperature kulit

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16. nekrosis jaringan skala: 1. sangat dikompromikan 2. substansial dikompromikan 3. moderat 4. ringan 5. tidak ada MERAWAT KULIT : GRAFT SITE 1. memeriksa secara komplit riwayat mendapat dan uji fisik dan memprioritaskan pembedahan skin graft graft 2. menyediakan control nyeri adekuat 3. mengevaluasi penanaman kulit sampai sirkulasi sekitar pencangkokan (seminggu sekali) . 4. menginstruksikan pasien untuk tidak bergerak/imobilisasi selama penyembuhan 5. menginspeksi area skin graf 6. memonitor warna, suhu ,capillary revil dan turgor skin graft 7. memonitor tanda infeksi 8. mendorong/memberi semangat pasien , pemahaman, kepada pasien dan keluarga tentang skin graft 9. menginstruksikan pasien untuk untuk menggunakan metode proteksi dari area pencangkokan kulit misal perlindungan dari matahari dan suhu. 10. menginstruksikan pasien untuk melaporkan setiap perubahan pada area skin graft PERAWATAN LUKA 1. Melepaskan dressing sebelumnya 2. mencukur rambut yang mengelilingi area luka 3. memonitor karakteristik dari luka,drainage,warna,ukuran dan bau 4. ukuran dari area luka 5. membersihkan dengan normal saline atau non-toksik cleanser 6. memasangkan dressing 7. menjaga sterilitas luka 8. menginspeksi luka 9. memberi intake cairan 10. menginstruksikan pasien untuk megenali tanda dan gejala infeksi dan segera melaporkan kepada petugas kesehatan 11. mendokumentasikan lokasi luka,ukuran dan penampilan luka.

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9) melaporkan control nyeri skala : 1. tidak demonstrasikan 2. jarang demonstrasikan 3. kadang-kadang demostrasikan 4. sering demonstrasikan 5. konsisten Level nyeri dengan kriteria hasil : 1. melaporkan nyeri 2. panjangnya episode nyeri 3. mengerang dan menangis 4. ekspresi wajah saat nyeri 5. istirahat 6. iritasi 7. mengigil 8. menangis 9. mengeluarkan keringat 10. tensi otot 11. muntah skala : 6. besar 7. subtansi 8. sedang 9. ringan 10. tidak ada ADMINISTRATION ANALGESIC 1. Menentukan lokasi,karakteristik dan kualitas nyeri sebelum memberikan obat. 2. Cek medical order obat ,dosis dan frekuensi dari pemberian resep analgetik. 3. Mengecek riwayat dari alergi obat. 4. Mengevaluasi kemmapuan pasien untuk untuk berpartisipasi dari seleksi analgetik ,rute dan dosis dosis dan melibatkan pasien,yangbsesuai. 5. Memilih analgetik yang sesuai atau kombinasi dari analgetik ketika mendapatkan rekomendasi lebih dari satu resep. 6. Memilih cara pemberian lewat intravena,intramuscular untuk frekuensi nyeri medikasi injeksi.

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3. Gunakan strategi komunikasi terapeutik . 4. eksplore pengetahuan dan kepercayaan pasien tentang nyeri. 5. Memberi semangat pasien untuk medikasi nyeri secara adekuat. 6. Mengajarkan metode non farmakologi kepada pasien. 7. Mengajarkan prinsip menejemen nyeri. 8. Menginstruksikan pasien untuk melaporkan nyeri kepada petugas kesehatan. 3. Resiko infeksi Setelah dilakukan tindakan selama….x24 jam pasien dapat mencapai Pengetahuan : menejemen infeksi dengan indicator :  Modeof transmisi  Faktor-faktor yang transmisi  Praktek yang mengurangi transmisi  Tanda dan gejala infeksi  Pemantauan prosedur untuk infeksi  Pentingnya sanitasi tangan  Kegiatan untuk meningkatkan ketahanan terhadap infeksi  Pengobatan untuk infeksi didiagnosis  Tindak lanjut untuk infeksi didiagnosis  Tanda dan gejala eksaserbasi infeksi  Identifikasi nama yang benar dari obat  Efek samping obat. Skala: 11. besar 12. subtansi 13. sedang 14. ringan 15. tidak ada Integritas jaringan:kulit dan membrane mukosa dengan indicator :  Suhu kulit  Elastisitas kulit  Hidrasi  keringat  tekstur kulit  ketebalan kulit

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Skala : 1. besar 2. subtansi 3. sedang 4. ringan 5. tidak ada PERLINDUNGAN INFEKSI KEGIATAN : 1) Pantau tanda-tanda sistemik dan lokal dan gejala infeksi. 2) Memantau mutlak granulosit menghitung, WBC count dan hasil diferensial. 3) Ikuti tindakan pencegahan neutropenia, yang sesuai. 4) Batasi jumlah pengunjung, yang sesuai. 5) Menyaring semua pengunjung untuk penyakit menular. 6) Menjaga asepsis untuk pasien beresiko. 7) Pertahankan teknik isolasi, yang sesuai. 8) Berikan perawatan kulit yang sesuai untuk daerah pembengkakan. 9) Periksa kulit dan selaput lendir untuk kemerahan, kehangatan ekstrim atau drainase. 10) Periksa kondisi dari setiap luka. 11) Promosikan asupan gizi yang cukup. 12) Mendorong asupan cairan, yang sesuai. 13) Mendorong istirahat. 14) Anjurkan pasien untuk mengambil antibiotik yang diresepkan. 15) Ajarkan pasien dan keluarga tentang tanda dan gejala infeksi dan kapan harus melaporkannya ke

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4. Catat secara teliti setiap tindakan yang dilakukan. E. EVALUASI Evaluasi merupakan langkah terakhir dalam proses keperawatan. Evaluasi adalah kegiatan yang disengaja dan terus menerus dengan melibatkan klien,perawat dan anggota tim kesehatan lainya(Lismidar,1990:68). Evaluasi dalam proses keperawatan memiliki aspek yang harus di pahami : 1. S/subyek : yaitu respon pasien secara subyek (metode wawancara langsung/bertanya kepada pasien) terhadap implementasi yang sudah dilakukan selama target yang sudah ditetapkan/direncanakan perawat.Pada pasien lepra tanyakan tentang kondisi saat melakukan evaluasi. 2. O/obyek: respon pasien non verbal (diobservasi setiap melakukan pengkajian) terhadap implementasi yang dilakukan. Pada pasien lepra observasi utamanya pada kondisi luka,kondisi fisik klien. 3. Analisa: adalah hasil dari implementasi yang sudah dilakukan yaitu diantaranya :masalah teratasi sebagian,masalah teratasi dan masalah tidak teratasi. Masalah teratasi pada pasien lepra bila kondisi pasien sudah pulih dan lebih baik dari sebelumnya,masalah tidak teratasi bila kondisi lebih buruk atau tetap dan masalah teratasi sebagian bila respon pasien sudah lebih baik dari sebelumnya namun belum semua masalah terselesaikan. 4. Perencanaan, perencanaan dalam evaluasi proses keperawatan adalah perencanaan ulang yang hasilnya masalah tidak teratasi dan masalah teratasi sebagian. Perencanaan dapat melanjutkan perencanaan sebelumnya atau menambah perncanaan tindakan lain yang tetap berkolaborasi dengan tenaga kesehatan lainya.

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BAB I PENDAHULUAN

1.1 LATAR BELAKANG

Penyakit kusta tersebar diseluruh dunia dengan endemisitas yang berbeda-beda. Diantara 122 negara yang endemis pada tahun 1985, 98 negara telah mencapai eliminasi kusta yaitu  prevalensi rate < 1/10.000 penduduk. Padatahun 1991 World Health Assembly telah mengeluarkan suatu resolusi yaitu eliminasi kusta tahun 2000. Pada 1999, insidensi penyakit kusta di dunia diperkirakan 640.000 dan 108 kasus terjadi di Amerika Serikat. Pada 2000,Word

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1.2 RUMUSAN MASALAH

Bagaimana asuhan keperawatan klien dengan kusta? 1.3 TUJUAN

1.3.1 Tujuan Umum  Untuk

mengetahui asuhan keperawatan pada pasien kusta

1.3.2 Tujuan Khusus 

Untuk mengetahui definisi penyakit Kusta



Untuk mengetahui bagaimana etiologi dari penyakit Kusta



Untuk mengetahui bagaimana manifestasi klinis dari penyakit Kusta



Untuk menegetahui klasifikasi dari penyakit Kusta



Untuk mengetahui patofisiologi dari penyakit Kusta



Untuk mengetahui patoflow dari penyakit Kusta



Untuk mengetahui apa saja pemeriksaan diagnostik dia gnostik dari penyakit Kusta



Untuk mengetahui bagaimana penatalaksanaan dari penyakit Kusta

BAB II TINJAUAN PUSTAKA

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Penyakit kusta disebabkan oleh bakteri Myobacterium leprae yang ditemukan pada tahun 1874, oleh GA Hansen . Kuman ini berbentuk batang,gram positip, berukuran 0.34 x 2 mikron dan berkelompok membentuk globus. Kuman Myohacterium leprae hidup pada sel Schwann dan sistim retikuloendotelial, dengan masa generasi 12-24 hari, dan termasuk kuman yang tidak ganas serta lambat berkembangnya. Kuman-kuman kusta berbentuk batang, biasanya berkelompok dan ada yang tersebar satu-satu dengan ukuran panjang 1-8 mic, lebar 0,2-0,5 mic yang bersifat tahan asam. Sampai saat ini kuman tersebut belum dapat dibiakkan dalam medium buatan, dan manusia merupakan satu-satunya sumber penularan. Berbagai usaha telah dilakukan untuk membiakkan kuman tersebut yaitu melalui: telapak kaki tikus, tikus yang diradiasi,armadillo, kultur jaringan syaraf manusia dan pada media buatan.

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3)

Adanya bakteri tahan asam (BTA) didalam kerokan jaringan kulit (BTA+) Seseorang dinyatakan sebagai penderita kusta apabila di temukan satu atau lebih dari tanda-tanda utama diatas. Pada dasarnya sebagian besar penderita dapat didiagnosis dengan pemeriksaan klinis.  Namun demikian pada penderita yang meragukan dapat dilakukan pemeriksaan kerokan kulit. Apabila hanya ditemukan cardinal sign kedua perlu dirujuk kepada wasor atau ahli kusta, jika masih ragu orang tersebut dianggap sebagai penderita p enderita yang dicurigai. 2.4 KLASIFIKASI

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 pada bercak 

 berkeringat, bulu tidak rontok 

Infiltrat a.Kulit 2

 b.Membranamukosa tersumbat perdarahan

a.Ada, kadang-kadang a.Tidak ada

tidak ada

 b.Tidak pernah ada

 b.Ada, kadang-kadang tidak ada

dihidung

a.Punched out lessi 3

Ciri hidung

”central healing”  penyembuhan ditengah

 b.Medarosis c.Ginecomastia d.Hidung pelana

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orang yang terinfeksi oleh kuman M. leprae menderita kusta, dan diduga faktor genetika juga ikut berperan, setelah melalui penelitian dan pengamatan pada kelompok penyakit kusta di keluarga tertentu. Belum diketahui pula mengapa dapat terjadi tipe kusta yang berbeda pada setiap individu.. individu

[14]

Faktor ketidakcukupan gizi juga diduga merupakan faktor penyebab.

Penyakit ini sering dipercaya bahwa penularannya disebabkan oleh kontak antara orang yang [15]

terinfeksi dan orang yang sehat. sehat .

Dalam penelitian terhadap insidensi, tingkat infeksi untuk kontak [16]

lepra lepromatosa beragam dari 6,2 per 1000 per tahun di Cebu Cebu,, Philipina per tahun di India Selatan Selatan..

hingga 55,8 per 1000

[17]

Dua pintu keluar dari M. leprae dari tubuh manusia diperkirakan adalah kulit dan mukosa hidung. Telah dibuktikan bahwa kasus lepromatosa menunjukkan adanya sejumlah organisme di dermis kulit. Bagaimanapun masih belum dapat dibuktikan bahwa organisme tersebut dapat

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2.6 PATOFLOW

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 

Semua pasien baru yang didiagnosis secara klinis k linis sebagai pasien kusta Semua pasien kusta yang diduga kambuh (relaps) atau karena tersangka kuman resisten terhadap obat



Semua pasien MB setiap 1 tahun sekali

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B. DDS tablet 100 mg/hari diminum di rumah Pengobatan 6 dosis diselesaikan dalam 6-9 bulan dan setelah selesai minum 6 dosis dinyatakan RFT meskipun secara klinis lesinya masih aktif. Menurut WHO (1995) tidak lagi dinyatakan RFT tetapi menggunakan istilah Completion Of Treatment Cure dan pasien tidak lagi dalam pengawasan.

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

Tangan mati rasa dilindungi dari panas, benda tajam, luka

C. Perawatan kaki yang mati rasa

 

Penderita memeriksa kaki tiap hari Kaki direndam dalam air dingin lebih kurang ½ jam

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e.

Riwayat Psikososial

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