Lta Hiperemesis Gravidarum Revisi Ujian

BAB I PENDAHULUAN

1.1 Latar Belakang

Menurut World Health Organization  Organization   (WHO) tahun 2012 Angka Kematian Ibu (AKI) merupakan salah satu target yang telah ditentukan dalam tujuan pembangunan  Millennium Development Goals  Goals  (MDGs) kelima yaitu meningkatkan kesehatan ibu. Di negara miskin, sekitar 25-50% kematian wanita disebabkan oleh masalah yang berkaitan dengan kehamilan dan  persalinan serta s erta nifas. nif as. WHO memperkirakan diseluruh dise luruh dunia setiap tahunnya lebih dari 585.000 Ibu meninggal saat hamil atau bersalin. AKI pada tahun 2015 menjadi 102/100.000 kelahiran hidup (Kemenkes RI, 2011). SDKI (2012) mengatakan bahwa AKI di Indonesia tahun 2012 sebesar 214 per kelahiran hidup, Akan tetapi pemerintah masih dituntut bekerja keras untuk menurunkannya hingga tercapainya target MDGs. AKI pada tahun 2015 menjadi 102/100.000 kelahiran hidup (SDKI, 2012) Profil Dinas Kesehatan Provinsi NTB menyebutkan jumlah kematian ibu pada tahun 2013 sebanyak 117 kasus, sehingga dapat disimpulkan AKI di Provinsi NTB mengalami penurunan dari tahun 2014 sebanyak 114 kasus. Tingginya AKI di NTB dipengaruhi oleh faktor kesehatan maupun diluar kesehatan yang berhubungan dengan kehamilan, persalinan, dan nifas dimana  penyebab kematian ibu adalah pendarahan (39%), infeksi (5,4%), eklampsia (17,4%), partus lama (4,3%) (Dinas Kesehatan Provinsi NTB, 2015).

1

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Angka kematian ibu di Kota Mataram ditemukan 20 kasus kematian ibu pada tahun 2013, dari 20 kasus ditemukan 10 kasus pada ibu hamil, 4 kasus pada ibu bersalin dan 5 kasus pada ibu nifas, sedangkan menurun menjadi 5 kasus pada tahun 2014 (Dinas Kesehatan Provinsi NTB,2015). Berdasarkan data dari Dinas Kesehatan Kota Mataram pada tahun 2012 terdapat 2.825 ibu hamil dan terdapat 112 (3,7%) kasus diantaranya merupakan hiperemesis gravidarum. Sedangkan pada tahun 2013, dari 3.169 ibu hamil di Kota Mataram 125 (3,94%) mengalami hiperemesis gravidarum. Sehingga dapat disimpulkan bahwa angka kejadian hiperemesis gravidarum di Kota Mataram terjadi peningkatan kasus hiperemesis gravidarum (Dinas Kesehatan Kota Mataram, 2013). Berdasarkan Jumlah data PONED Puskesmas Ampenan pada tahun 2015 terdapat 2 kasus hiperemesis gravidarum, sedangkan untuk tahun 2016  pada bulan Januari-Mei ada 4 kasus hiperemesis gravidarum, Dimana dari semua kasus hiperemesis gravidarum tersebut telah mampu ditangani langsung oleh puskesmas Ampenan (PWS KIA Puskesmas Ampenan, 2015 )  Hiperemesis gravidarum adalah mual muntah yang berlebihan pada ibu hamil, seorang ibu menderita hiperemesis gravidarum  jika seorang ibu memuntahkan segala yang dimakan dan diminumnya hingga berat badan ibu sangat turun, turgor kulit kurang dan timbul aseton dalam air kencing. Insiden dari hiperemesis gravidarum adalah 0,5-10/1.000 kehamilan. Kemungkinan terjadinya penyakit ini adalah tinggi pada orang kulit putih (16/1.000 kelahiran) dan rendah pada orang kulit hitam (17/1.000 kelahiran). Penyakit

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Penyebab hiperemesis gravidarum belum gravidarum  belum diketahui secara pasti. pasti . Tidak ada bukti bahwa penyakit ini disebabkan oleh factor toksik, juga ditemukan kelainan biokimia. Perubahan-perubahan anatomik pada otak, jantung, hati dan susunan saraf, disebabkan oleh kekurangan vitamin serta zat-zat lain akibat inanisia. Beberapa faktor predisposisi dan faktor lain yang telah ditemukan oleh beberapa penulis antara lain; 1) Faktor predisposisi yang sering dikemukakan adalah primigravida, mola hidatidosa, dan kehamilan ganda, 2) Masuknya vili khorialis dalam sirkulasi maternal dan perubahan metabolic hamil serta resistensi yang menurun, 3) Alergi, sebagai salah satu respons dari jaringan ibu terhadap anak, 4) Faktor psikologik memegang  peranan yang penting pada pada penyakit ini (Jannah 2012). Bagi ibu yang mengalami hiperemesis gravidarium beberapa langkah dibawah

ini

akan

membantu

ibu

dalam

mengatasinya

seperti:

1)

Mengkonsumsi susu dan vitamin, 2) Menu makan yang sedikit akan tetapi sering, 3) Dalam mengurangi rasa pusing ketika bangun tidur ibu dapat memiringkan badan kesebelah kanan ataupun kiri kemudian duduk secara  perlahan, setelah merasa kuat ibu dapat berdiri (Rukiyah, 2010). 2010). Dari data tersebut merupakan salah satu masalah yang cukup penting mengingat resikonya sangat tinggi dan dapat mengakibatkan kematian ibu. Sehubungan hal tersebut maka penulis tertarik untuk membahas mengenai

kasus yang berjudul “Asuhan Kebidanan   Kehamilan dengan  Hiperemesis Gravidarum Tingkat 1 Pada Ny . ”A” dan Ny . “L” dengan di Puskesmas Ampenan Kota Mataram Tahun 2016.

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1.2 Batasan Masalah

Pada studi kasus ini berfokus pada penatalaksanaan masalah Asuhan Kebidanan Kehamilan dengan  Hiperemesis Gravidarum Tingkat 1 Pada  Ny.“A” dan Ny.“L” dengan di Puskesmas Ampenan Kot a Mataram Tahun 2016.

1.3 Perumusan Masalah

Perumusan masalah dalam studi kasus ini adalah, Bagaimana Asuhan Kebidanan Kehamilan dengan  Hiperemesis Gravidarum Tingkat 1 Pada

 Ny”A” dan Ny “L” dengan di Puskesmas Ampenan Kota Mataram Tahun 2016.

1.4 Tujuan 1.4.1 Tujuan Umum

Melaksanakan asuhan kebidanan pada hiperemesis gravidarum tingkat 1 menggunakan 2 (dua) kasus dengan metode pendekatan asuhan kebidanan 7 langkah Varney di Puskesmas Ampenan. 1.4.2 Tujun Khusus

1.

Agar mahasiswi mampu mengumpulkan data subyektif dan data

obyektif pada Ny.”A” dan Ny”L” dengan hiperemesis gravidarum tingkat 1. 2.

Agar mahasiswi mampu menginterpretasikan data dasar,diagnose, atau

masalah pada Ny”A” dan Ny.”L” dengan hiperemesis gravidarum tingkat 1.

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3.

Agar mahasiswi mampu mengidentifikasi diagnose potensial pada

 Ny”A” dan Ny”L” dengan hiperemesis gravidarum tingkat 1. 4.

Agar mahasiswi mampu menetapkan kebutuhan terhadap tindakan

segera pada Ny”A” & Ny”L” dengan hiperemesis gravidarum tingkat 1. 5.

Agar mahasiswi mampu menyusun rencana asuhan menyeluruh pada

 Ny “A” dan Ny”L” dengan hiperemesis gravidarum tingkat 1. 6.

Agar

mahasiswi

mampu

memberikan

penatalaksanaan

secara

menyeluruh pada Ny.”A” dan Ny.”L” dengan hiperemesis gravidarum tingkat 1. 7.

Agar mahasiswi mampu mengevaluasi hasil asuhan menyeluruh pada

 Ny.”A” dan Ny.”L” dengan dengan hiperemesis gravidarum tingkat 1.

1.5 Manfaat 1.5.1 Teoritis

Hasil laporan ini diharapkan dapat menambah ilmu kebidanan dalam penatalaksanaan pada kasus ibu hamil dengan hiperemesis  gravidarum tingkat 1. 1.5.2 Praktis

1.

Bagi Puskesmas Diharapkan dapat digunakan sebagai salah satu sumber informasi di puskesmas dalam penyusunan program kesehatan khususnya kesehatan ibu dan anak.

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2.

Bagi Institusi Pendidikan Diharapkan studi kasus ini dapat bermanfaat sebagai bahan dokumentasi dan bahan perbandingan untuk studi kasus selanjutnya di STIKES YARSI Mataram Jenjang D3 Kebidanan dalam meningkatkan wawasan mahasiswa mengenai asuhan kebidanan  pada ibu hamil dengan hiperemesis gravidarum tingkat 1.

3.

Bagi Mahasiswi Dapat dijadikan sebagai bahan pembelajaran dan peningkatan  pengetahuan serta keterampilan dalam penerapan manajemen asuhan kebidanan khususnya pada kasus hiperemesis gravidarum tingkat 1.

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BAB 2 TINJAUAN TEORI

2.1 Konsep Dasar Kehamilan 2.1.1

Pengertian Kehamilan

Kehamilan adalah masa mulai dari ovulasi sampai partus kirakira 280 hari (40 minggu) dan tidak lebih dari 300 hari (43 minggu). Kehamilan 40 minggu disebut sebagai kehamilan matur (cukup  bulan), dan bila lebih dari dar i 43 minggu disebut sebagai kehamilan post matur. Kehamilan antara 28 sampai 36 minggu disebut kehamilan  premature (Prawirohardjo, 2010). Kehamilan adalah masa di mulai dari timbulnya ovulasi dimana lamanya hamil normal adalah kira-kira 280 hari (40 minggu) dan tidak lebih dari 300 hari (43 minggu) (Wiknjosastro, 2009). 2.1.2

Perubahan fisiologis pada ibu hamil

Menurut Wiknjosastro (2009), perubahan fisologi dalam kehamilan yaitu : 1. Perubahan pada organ reproduksi

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 b. Ovarium Pada permulaan kehamilan, masih terdapat korpus luteum sampai terbentuknya plasenta kira-kira kehamilan 16 minggu.  Korpus luteum  luteum  ini mengeluarkan

hormon estrogen  estrogen  dan

 progesteron yang  progesteron yang lambat laun fungsi ini akan diambil alih oleh  plasenta.  plasenta. c. Uterus Uterus  Uterus  akan membesar pada bulan-bulan pertama dibawah  pengaruh hormon estrogen  estrogen  dan  progesteron   progesteron  yang kadarnya meningkat.

Pada

minggu-minggu

pertama

istmus

uteri

mengadakan hipertropi  hipertropi  seperti korpus uteri, uteri, inilah yang membuat istmus menjadi istmus menjadi panjang dan lebih lunak (tanda Hegar  (tanda  Hegar ). ). d. Serviks Serviks uteri Serviks uteri pada kehamilan juga mengalami perubahan karena hormon estrogen. estrogen. Serviks uteri  uteri  mengandung lebih banyak  jaringan ikat yang banyak mengandung kolagen. kolagen. Akibat kadar estrogen yang estrogen yang meningkat dan dengan adanya hipervaskularisasi maka konsistensi serviks menjadi serviks menjadi lunak.

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seluruh areola mammae  mammae  karena hiperpigmentasi. Glandula montgomery  montgomery  tampak lebih jelas menonjol di permukaan areola mammae. mammae . 2. Perubahan pada sistem lain a. Sirkulasi darah Sirkulasi darah ibu dalam kehamilan dipengaruhi oleh adanya sirkulasi ke plasenta. Volume darah ibu dalam kehamilan  bertambah secara fisiologik dengan adanya pencairan darah yang disebut hidremia (hemodilusi ( hemodilusi). ). Volume darah akan  bertambah banyak.  b. Sistem respirasi Seorang wanita hamil tidak jarang mengeluh tentang rasa sesak dan pendek nafas. Hal ini ditemukan pada kehamilan 32 minggu keatas oleh karena usus-usus tertekan oleh uterus  uterus  yang membesar kearah diafragma, diafragma, sehingga diafragma kurang diafragma kurang leluasa  bergerak. c. Traktus digestivus Pada bulan-bulan pertama kehamilan terdapat perasaan enek

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salah satu keluhan utama wanita hamil. Tidak jarang dijumpai  pada bulan-bulan pertama kehamilan gejala muntah (emesis). emesis). Biasanya terjadi pada pagi hari, dikenal sebagai  Morning Sickness. Sickness. d. Traktus urinarius Pada bulan-bulan pertama kehamilan kandung kencing tertekan oleh uterus  uterus  yang mulai membesar, sehingga timbul sering kencing. Keadaan ini hilang dengan makin tuanya kehamilan  bila uterus  gravidus   gravidus  keluar dari rongga panggul. Pada akhir kehamilan, bila kepala janin mulai turun kebawah pintu atas  panggul, keluhan sering kencing akan timbul lagi karena kandung kencing mulai tertekan lagi. e. Kulit  Hiperpigmentasi   Hiperpigmentasi  pada kulit dipengarihi oleh  Melanophore  stimulating hormone (MSH) yang meningkat. Hormone ini dikeluarkan oleh lobus anterior  hipofifis, hipofifis, deposit  pigmen deposit  pigmen   pada dahi, pipi dan hidung dikenal sebagai kloasma  gravidarum,  gravidarum, areola mammae pun mammae pun menjadi lebih hitam. Tidak jarang dijumpai

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3. Gelisah menunggu proses persalinannya normal/tidak bayinya cacat/mati 4. Khawatir bisa menyusui/tidak 5. Takut kehilangan perhatian 6. Gelisah dan takut menjelanh kelahiran 7. Gangguan Bounding  Gangguan Bounding  Attachmant  Attachmant 2.1.4

Tanda dan Gejala Kehamilan

Menurut Wiknjosastro (2009), Tanda dan gejala kehamilan (diagnosa kehamilan) dibagi menjadi 2 macam, yaitu : 1. Tanda tidak pasti kehamilan a.  Amenorea,  Amenorea, gejala ini sangat penting karena umumnya wanita hamil tidak dapat haid lagi. Penting diketahui tanggal hari  pertama haid terakhir untuk menentukan tuanya kehamilan serta  perkiraan persalinan.  b.  Nausea   Nausea  (mual) dan  Emesis   Emesis  (muntah). Biasanya terjadi pada  bulan-bulan pertama kehamilan dan menghilang pada akhir triwulan pertama. Oleh karena sering terjadi pada pagi hari

disebut dengan “ morning sickness”.

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g. Tanda  piscaseck , uterus  uterus  membesar kesalah satu jurusan hingga menonjol jelas kejurusan pembasaran tersebut. h. Tanda braxton hicks, hicks, bila uterus  uterus  dirangsang maka akan mudah  berkontraksi. i. Adanya Human Adanya  Human Chorionik Gonadotropin pada Gonadotropin pada kehamilan muda di tes melalui air kencing pertama pagi hari. 2. Tanda pasti kehamilan a. Dapat diraba dan kemudian dikenal bagian-bagian janin  b. Dapat didengar denyut jantung janin c. Dapat dirasakan gerakan janin d. Dengan sinar rontgent  tampak  tampak kerangka janin e. Dengan USG dapat USG dapat diketahui adanya kantong janin.

2.2 Konsep Dasar Hiperemesis Gravidarum

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 Hiperemesis Gravidarum adalah muntah yang terjadi pada awal kehamilan sampai umur kehamilan 20 minggu. Keluhan muntah kadang- kadang begitu hebat dimana segala apa yang dimakan dan diminum dimuntahkan sehingga dapat mempengaruhi keadaan umum dan mengganggu pekerjaan sehari-hari, berat badan menurun, dehidrasi, dan terdapat aseton dalam urin seperti gejala penyakit apendisitis,  pielititis, dan sebagainya (Sidik, 2010).  Hiperemesis

Gravidarum

adalah

mual

dan

muntah

yang

 berlebihan pada wanita hamil sehingga mengganggu pekerjaan seharihari dan kedaan umumnya menjadi buruk, karena terjadi dehidrasi,  biasanya terjadi pada usia kehamilan trimester I. Gejala tersebut te rsebut kurang lebih terjadi 6 minggu setelah hari pertama haid terakhir dan  berlangsung selama kurang lebih 10 minggu (Marmi 2011). 2.2.2 Etiologi Hiperemesis Gravidarum

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Sebagian kecil primigravida belum mampu beradaptasi terhadap hormon estrogen dan HCG, sedangkan pada hamil ganda dan mola hidatidosa, jumlah hormon yang dikeluarkan terlalu tinggi dan menyebabkan terjadi hiperemesis itu. 2. Faktor Psikologis Hubungan faktor psikologis dengan kejadian  Hiperemesis Gravidarum  belum jelas. Besar kemungkinan bahwa wanita yang menolak hamil, takut kehilangan pekerjaan, keretakan hubungan suami dan sebagainya, diduga dapat menjadi faktor kejadian hiperemesis gravidarum. 3. Faktor alergi Pada kehamilan, dimana diduga terjadi invasi jaringan villi chorealis yang masuk kedalam peredaran darah ibu, maka faktor alergi

dianggap

dapat

menyebabkan

kejadian

hiperemesis

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2. Faktor organik a. Masuknya vili khorialis dalam sirkulasi maternal.  b. Perubahan metabolik akibat hamil. c. Resistensi yang menurun dari pihak ibu. d. Alergi. 3. Faktor psikologis a. Rumah tangga yang retak.  b. Hamil yang tidak di inginkan. c. Takut terhadap kehamilan dan persalinan. d. Takut terhadap tanggung jawab sebagai ibu. e. Kehilangan pekerjaan. Mual dan muntah terjadi pada 60-80% primigravida dan 40-60% multigravida. Satu diantara seribu kehamilan, gejala-gejala ini menjadi lebih berat. Perasaan ini disebabkan oleh karena meningkatnya kadar

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ditemukan kelainan biokimia, perubahan-perubahan anatomik yang terjadi pada otak, jantung, hati dan susunan syaraf, disebabkan oleh kekurangan vitamin serta zat-zat lain akibat kelemahan tubuh karena tidak makan dan minum. Beberapa faktor predisposisi dan faktor lain yang telah ditemukan adalah sering terjadi pada primigravida, masuknya vili khorialis dalam sirkulasi maternal dan perubahan metabolisme akibat hamil serta resistensi yang menurun dan pihak ibu terhadap perubahan ini merupakan faktor organik alergi, faktor  psikologik,

molahidatidosa,

faktor

adaptasi

dan

hormonal

(Prawirohardjo, 2010). 2.2.3 Patofisiologi Hiperemesis Gravidarum

Patofisiologi hiperemesis gravidarum diawali dengan mual dan muntah yang berlebihan sehingga dapat menimbulkan dehidrasi, tekanan darah turun dan diuresis menurun. diuresis menurun. Hal ini menimbulkan perfusi

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 baik akan menyebabkan komplikasi bahkan kematian ibu dan janin. Prevalensi hiperemesis gravidarum antara 1-3 % atau 5-20 kasus per 1000 kehamilan (Winkjosastro, 2009). 2.2.4 Gejala Klinik Hiperemesis Gravidarum

Berdasarkan batas antara muntah yang yang fisiologis dan patologis tidak jelas, tetapi muntah yang menimbulkan gangguan kehidupan sehari-hari dan dehidrasi memberikan petunjuk bahwa wanita hamil telah memerlukan perawatan yang intensif (Sulistyawati, 2012). Gambaran gejala  Hiperemesis Gravidarum secara klinis dapat

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Gejala  Hiperemesis Gravidarum tingkat satu adalah muntah t,erus menerus yang mempengaruhi keadaan umum penderita, ibu merasa lemah, nafsu makan tidak ada, berat badan menurun, dan nyeri epigastrium, nadi meningkat sekitar 100 permenit, tekanan darah sistolik menurun, turgor kulit mengurang, lidah mengering dan mata cekung. 2.  Hiperemesis Gravidarum tingkat kedua a. Penderita tampak lebih lemah  b. Gejala dehidrasi makin tampak, mata cekung, turgor kulit makin

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3.  Hiperemesis Gravidarum tingkat ketiga a. Muntah berkurang  b. Keadaan umum wanita hamil makin menurun, tekanan darah turun, nadi meningkat, dan suhu naik, keadaan dehidrasi makin  jelas c. Gangguan faal hati terjadi dengan manifestasi ikterus d. Gangguan kesadaran dalam bentuk: samnolen sampai koma, komplikasi

susunan

saraf

pusat

(ensefalopati

Wernicke),

nistagmus-perubahan arah bola mata, diplopia-gambar tampak ganda, perubahan mental.

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2.2.3 Komplikasi Hiperemesis Gravidarum

Menurut Manuaba (2010) Komplikasi pada ibu Hipermisis Gravidarum di bagi menjadi: 1. Komplikasi Ringan: Kehilangan berat badan, dehidrasi, asidosis dari kekurangan gizi, alkalosis alkalosis hipokalemia, kelemahan otot, kelainan elektrokardiografik, tetani dan gangguan psikologi. 2. Komplikasi yang mengancam kehidupan,

Ruptur oesophageal

 berkaitan dengan muntah yang berat,encephalophaty berat,encephalophaty wernicke’s, mielinolisis pusat pontine, retinal haemorage, kerusakan ginjal,

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2.2.4

Pencegahan Pencegahan Hiperemesis gravidarum

Menurut

Manuaba

(2010),

pencegahan

 Hiperemesis

Gravidarum dapat dilakukan dengan: 1. Pencegahan terhadap  Hiperemesis gravidarum  gravidarum  diperlukan dengan  jalan memberikan penerapan tentang kehamilan dan persalinan sebagai suatu proses yang fisiologis. Dengan memberikan informasi dan edukasi tentang kehamilan pada ibu-ibu dengan maksud menghilangkan faktor psikis rasa takut. Juga tentang diet ibu hamil, makan dalam porsi kecil /sedikit namun sering. Jangan tiba-tiba

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2.2.5 Penatalaksanaan Penatalaksanaan Hiperemesis Gravidarum

Adapun penatalaksanaan yang dapat diberikan pada pasien dengan Hiperemesis dengan Hiperemesis gravidarum menurut Runiari (2010) yaitu : 1. Penatalaksanaan Umum a. Memberikan penjelasan tentang kehamilan dan persalinan sebagai

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 berat diberikan antiemetic seperti disiklomin hidrokhonae atau khlorpromasin. Penanganan hiperemesis gravidarum yang berat  perlu dikelola dirumah sakit. i. Isolasi Penderita disendirikan dalam kamar yang tenang tetapi cerah dan

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sehingga diperlukan pertimbangan untuk melakukan gugur kandung. Keadaan yang memerlukan pertimbangan gugur kandung diantaranya: 1) Gangguan kejiwaan (delirium, (delirium, apatis, somnolen sampai somnolen  sampai koma, terjadi gangguan jiwa ensefalopati wernicke). wernicke).

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g. Bila makan pagi dan siang sulit diterima, pemberian dioptimalkan  pada makan malam dan selingan pada malam hari. h. Pemberian makanan ditingkatkan secara bertahap dalam porsi dan nilai gizi sesuai dengan keadaan dan kebutuhan gizi klien. Terdapat tiga macam diet bagi pasien hiperemesis, yaitu :

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2.2.6 Pengobatan Pengobatan Hiperemesis Gravidarum

Pengobatan yang baik pada emesis gravidarum sehingga dapat mencegah hiperemesis gravidarum. Dalam keadaan muntah berlebihan dan dehidrasi ringan, penderita emesis gravidarum sebaiknya dirawat sehingga dapat mencegah hiperemesis gravidarum. Konsep pengobatan

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Observasi

Kasus 1

Kasus 2

Pemeriksaan Fisik Kepala

Kulit kepala bersih, rambut tidak rontok, distribusi rambut merata, tidak ada nyeri tekan

Kulit kepala bersih, rambut tidak rontok, distribusi rambut merata, tidak ada nyeri tekan

Wajah

Tidak pucat, tidak ada cloasma gravidarum, tidak oedem, tidak ada nyeri tekan

Tidak Pucat, tidak ada cloasma gravidarum, tidak oedem, tidak ada nyeri tekan

Mata

Simetris, konjungtiva tidak anemis, sklera tidak ikterus, mata cekung

Simetris, konjungtiva tidak anemis, sklera tidak ikterus, mata cekung

Hidung

Simetris, tidak ada polip, tidak ada kelainan

Simetris, tidak ada polip, tidak ada kelainan

Telinga

Simetris, tidak ada sekret, tidak ada kelainan, letak sejajar dengan mata

Simetris, tidak ada sekret, tidak ada kelainan, letak sejajar dengan mata

Mulut

Bibir kering, tidak ada karies gigi, gigi tidak berlubang, lidah  bersih, tidak ada kelainan, lidah pasien kering dan kotor

Bibir kering, tidak ada karies gigi, gigi tidak berlubang, lidah  bersih, tidak ada kelainan, lidah pasien kering dan kotor kotor

Leher

Tidak ada pembesaran kelenjar tiroid maupun limfe dan tidak ada bendungan vena jugularis

Tidak ada pembesaran kelenjar tiroid maupun limfe dan tidak ada  bendungan vena jugularis

Payudara

Simetris, terdapat pembesaran mamae, puting menonjol, susu  bersih, tidak ada nyeri tekan, tidak ada benjolan.

Simetris, terdapat pembesaran mamae, puting menonjol, susu  bersih, tidak ada nyeri tekan, tidak ada benjolan.

Abdomen

Simetris, pembesaran abdomen sesuai dengan usia kehamilan, Simetris, pembesaran abdomen sesuai dengan usia kehamilan, terdapat linea nigra, striae gravidarum (-), nyeri epigastrium (+), terdapat linea nigra, striae gravidarum (-), nyeri epigastrium turgor kulit (-) (+),turgor kulit (-) Leopold I : TFU belum belum teraba Leopold I : TFU belum teraba Leopold II : Tidak dilakukan dilakukan Leopold II : Tidak dilakukan Leopold III : Tidak dilakukan Leopold III : Tidak dilakukan Leopold IV : Tidak dilakukan Leopold IV : Tidak dilakukan dilakukan DJJ : DJJ : Bersih, tidak ada kelainan, tidak ada pengeluaran cairan Bersih, tidak ada kelainan, tidak ada pengeluaran cairan  pervaginam, tidak varises, tidak ada condiloma, tidak ada luka  pervaginam, tidak varises, tidak ada condiloma, tidak ada luka  parut pada perineum, tidak ada hemoroid pada anus  parut pada perineum, tidak ada hemoroid pada anus anus

Genetalia

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Observasi

Kasus 1

Kasus 2

Ekstremitas atas

Simetris, tidak ada kelainan, jari-jari lengkap, kuku tidak pucat, tidak ada nyeri tekan.

Simetris, tidak ada kelainan, jari-jari lengkap, kuku tidak pucat, tidak ada nyeri tekan, turgor kulit berkurang

Ekstremitas bawah

Simetris, tidak ada kelainan, tidak ada varises pada tungkai, jari - Simetris, tidak ada kelainan, tidak ada varises pada tungkai, jari jari lengkap, tidak ada nyeri tekan, refleks patella (+/+)  jari lengkap, tidak ada nyeri tekan, refleks patella patella (+/+)

3. Hasil Pemeriksaan Diagnostik Pemeriksaan

Lab

Kasus 1 Hb : 13 gr% tanggal 11 -4-2016 Gol. Darah : B

Kasus 2 Hb : 12,1 gr% tanggal 26- 3-2016 Gol. Darah : O

4.1.2 Interpretasi Data Dasar Diagnosa/ Masalah Analisis Data Kasus 1 Data Subyektif: - Ibu mengatakan ini kehamilan yang keempat. - Ibu mengatakan tidak pernah mengalami keguguran. - Ibu mengatakan hamil 1,5 bulan. - Ibu mengatakan muntah setiap masuk makanan dan minuman disertai mual , lemas, nyeri ulu hati dan nafsu makannya berkurang - Ibu mengatakan menstruasi terakhir pada tanggal 26-02-2016

Data Obyektif : Keadaan umum ibu lemah TD : 100/70 mmHg S : 36,9 36,9C  N : 96x/menit R : 21 x/menit Lila : 24 cm cm

Penyebab

Masalah

 Hormon estrogen & HCG

-

↓

-

Asam Lambung Meningkat

↓ Perut kosong

↓  Hiperemesis Gravidarum

-

 Hiperemesis gravidarum tingkat 1 G4P3A0H2 UK 6 minggu dengan hiperemesis gravidarum tingkat 1 Penurunan berat badan

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Analisis Data BB sebelum hamil : 51 kg BB : 50 Kg TB : 154 cm Palpasi : Leopold I : TFU belum teraba Leopold II : Tidak dilakukan Leopold III : Tidak dilakukan Leopold IV : Tidak dilakukan DJJ : -

Kasus 2 Data Subyektif: - Ibu mengatakan ini kehamilan yang pertama dan tidak pernah mengalami mengalami keguguran - Ibu mengatakan mual muntah berlebih, pusing dan nyeri ulu hati serta nafsu makannya berkurang. - Ibu mengatakan mengatakan usia kehamilannya kehamilannya 8 -9 minggu. minggu. - Ibu mengatakan menstruasi terakhir terakhir pada tanggal 09-02-2016 Data Obyektif : Keadaan umum ibu lemah TD : 90/60 mmHg S : 36,8 36,8C  N : 98x/menit R : 24 x/menit Lila : 24 cm cm BB sebelum hamil : 47,5 kg BB : 46 Kg TB : 153 cm Palpasi : Leopold I : TFU belum teraba Leopold II : tidak dilakukan Leopold III : Tidak dilakukan Leopold IV : Tidak dilakukan

Penyebab

Masalah

Faktor psikologis

-

↓

-

 Hormon estrogen & HCG

↓ Gastritis

↓ Asam Lambung Meningkat

↓  Hiperemesis Gravidarum

-

 Hiperemesis gravidarum tingkat 1 G1P0A0H0 UK 8 minggu dengan hiperemesis gravidarum Penurunan berat badan Kecemasan ibu karena kehamilannya

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4.1.3 Diagnosa/ Masalah Potensial Data Fokus Kasus 1 Data Subyektif: - Ibu mengatakan ini kehamilan yang keempat. - Ibu mengatakan tidak pernah mengalami keguguran. - Ibu mengatakan hamil 6 minggu. - Ibu mengatakan lemas, mual muntah, nyeri ulu hati serta nafsu makannya berkurang - Ibu mengatakan menstruasi terakhir pada tangga 26-02-2016 - Ibu mengatakan porsi makan selama hamil + 2 sendok dengan komposisi nasi, tempe Data Obyektif : K/u ibu lemah TD : 100/70 mmHg S : 36,9 36,9C  N : 80 x/menit R : 21 x/menit Lila : 24 cm cm BB : 50 Kg TB : 154 cm Palpasi : Leopold I : TFU belum teraba Leopold II : Tidak dilakukan Leopold III : Tidak dilakukan Leopold IV : Tidak dilakukan DJJ : Kasus 2 Data Subyektif: - Ibu mengatakan ini kehamilan yang pertama dan tidak pernah mengalami keguguran. keguguran. - Ibu mengatakan mual muntah berlebih, pusing dan nyeri ulu hati serta nafsu makannya berkurang. - Ibu mengatakan usia kehamilannya 2 bulan. bulan. - Ibu mengatakan menstruasi terakhir terakhir pada tanggal 09-02-2016. - Ibu mengatakan masih merasa cemas dengan kehamilannya karena merasa kehamilannya terlalu cepat dan ini kehamilannya yang pertama,tetapi keluarga merasa senang dengan kehamilannya Ibu mengatakan porsi makan selama hamil + 2 sendok dengan komposisi nasi, Ikan

Penyebab

 Hormon estrogen & HCG

↓ Asam Lambung Meningkat

↓

Masalah Potensial

1. 2. 3. 4. 5.

Penurunan berat badan KEK Persalinan prematurus Anemia BBLR

1. 2. 3. 4. 5.

Penurunan berat badan KEK Persalinan prematurus Anemia BBLR

Perut kosong

↓  Hiperemesis Gravidarum

Faktor psikologis

↓  Hormon estrogen & HCG

↓ Gastritis

↓ Asam Lambung Meningkat

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↓

Data Obyektif : TD : 90/60 mmHg S : 36,8 36,8C  N : 82 x/menit R : 24 x/menit Lila : 24 cm cm BB : 46 Kg TB : 153 cm Palpasi : Leopold I : TFU belum teraba Leopold II : Tidak dilakukan Leopold III : Tidak dilakukan Leopold IV : Tidak dilakukan

 Hiperemesis Gravidarum

4.1.4 Tindakan Segera Kasus 1

Kasus 2

Tanggal

: 11 April 2016

Tanggal : 21 April 2016

Jam

: 12.15 Wita

Jam

: 19.15 Wita

Tempat

: Ruang nifas Puskesmas Ampenan

Tempat

: Ruang nifas Puskesmas Ampenan

Tindakan

Kasus 1

Kasus 1

Mandiri

-

Melakukan pemasangan infus RL 28 tpm

-

Melakukan pemasangan infus RL 28 tp m

Kolaborasi

-

Memberikan ibu obat oral B6, antacid 3x1

-

Memberikan injeksi Ranitidine/iv Memberikan ibu obat oral B6, antacid 3x1

Rujukan

-

Tidak ada

-

Tidak ada

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4.1.5 Perencanaan Diagnosis Kasus 1 G4P3A0H2 UK 6 minggu dengan hiperemesis gravidarum tingkat 1

Kriteria Hasil

Mual muntah berkurang

Perencanaan

-

Informed consent

-

-

Jelaskan pada ibu dan keluarga hasil  pemeriksaan Konseling tentang nutrisi ibu hamil. Kolaborasi dengan dokter untuk pemberian terapi (pemasangan infus RL 28 tpm dan  pemberian obat oral) Anjurkan ibu untuk makan sedikit tapi sering dan banyak minum air putih

-

-

Informed consent

-

-

Jelaskan pada ibu dan keluarga hasil  pemeriksaan Konseling tentang nutrisi ibu hamil. Kolaborasi dengan dokter untuk pemberian terapi (pemasangan infus RL 28 tpm dan injeksi ranitidin serta pemberian obat oral) Anjurkan ibu untuk makan sedikit tapi sering dan minum air putih minimal 8 gelas  per hari. Menjelaskan pada ibu bahwa mual muntah  pada kehamilan pertama merupakan hal yang normal dan biasa terjadi pada semua ibu hamil.

-

-

-

Kasus 2 G1P0A0H0 UK 8 minggu dengan hiperemesis gravidarum

Mual muntah berkurang

Rasional

-

-

-

-

-

-

Karena semua tindakan harus ada  persetujuan Supaya ibu dan keluarga mengetahui keadaan ibu Agar nutrisi ibu hamil terpenuhi Untuk pemberian terapi yang tepat dengan kondisi pasien agar tidak banyak cairan tubuh dan tenaga ibu yang hilang Untuk membantu meningkatkan metabolisme dan akhirnya membakar lebih  banyak kalori serta menjaga ketahanan tubuh

Karena semua tindakan harus ada  persetujuan Supaya ibu dan keluarga mengetahui keadaan ibu Agar nutrisi ibu hamil terpenuhi Untuk mengurangi sakit maag yang diderita

-

Agar tidak banyak cairan tubuh dan tenaga ibu yang hilang

-

Supaya ibu tidak cemas sehingga tidak memperberat kondisi penyakit yang dialami ibu saat ini.

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4.1.6 Pelaksanaan Kasus Kasus 1

 Ny. “A”

Hari 1 Tanggal 11 April 2016 pukul 12.30 wita - Memberitahu ibu hasil pemeriksaan k/u ibu lemah. - Memasang infus RL 28 tpm, - Memberikan obat antacid 3x1dan B6. Ibu sudah minum obat - Menjelaskan pada ibu bahwa yang dialami ibu  biasa terjadi pada ibu hamil dan bisa diperbaiki. - Memberikan konseling tentang nutrisi ibu hamil yaitu makan makanan yang cukup energi seperti roti panggang, biskuit, dan  buah, makan sedikit tapi sering menghindari makanan yang merangsang mual seperti  berlemak dan berbau khas, biasakan makan dan minum yang hangat- hangat. - Menjelaskan dampak pada ibu dan kehamilannya apabila nutrisi tidak terpenuhi yaitu; ibu bisa mengalami KEK, penurunan  berat badan dan anemia. Sedangkan pada bayi  bisa terjadi BBLR dan terhambatnya  pertumbuhan janin.

Hari 2 Tanggal 12 April 2016 pukul pukul 16.00 wita - Melakukan pemeriksaan TTV - Menganjurkan ibu untuk tetap istirahat yang cukup dan teratur, tidur siang 1  –  2  2  jam/hari, tidur malam 8 jam/hari - Memberikan konseling tentang nutrisi ibu hamil yaitu makan makanan yang cukup energi seperti roti panggang,  biskuit, dan buah, makan sedikit tapi sering menghindari makanan yang merangsang mual seperti berlemak dan  berbau khas. - Menganjurkan ibu untuk meminum obat yang diberikan bidan.

Hari 3 Tanggal 1 3 April 2016 pukul 10.00 wita wita - Menganjurkan ibu untuk tetap istirahat yang cukup dan teratur, tidur siang 1  –  2 jam/hari, tidur malam 8 jam/hari. - Menganjurkan kepada ibu untuk makan sedikit tapi sering dan ibu melakukannya - Menganjurkan ibu untuk membaca  buku KIA tentang tanda bahaya kehamilan. - Menganjurkan ibu untuk meminum obat yang di berikan bidan. - Menganjurkan ibu untuk melakukan  pemeriksaan USG - Kolaborasi dengan dokter : Aff infus - Pasien pulang pukul 11.00 wita

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Kasus Kasus 2

 Ny. “L”

Hari 1 Tanggal 21 April 2016 pukul pukul 08.00 wita - Memberitahu ibu hasil pemeriksaan k/u ibu lemah. - Memasang infus RL 28 tpm. - Memberikan obat antacid 3x1dan B6. Ibu sudah minum obat - Menjelaskan pada ibu bahwa yang dialami ibu  biasa terjadi pada ibu hamil dan bisa diperbaiki. - Memberikan konseling tentang nutrisi ibu hamil yaitu makan makanan yang cukup energi seperti roti panggang, biskuit, dan  buah, makan sedikit tapi sering menghindari makanan yang merangsang mual seperti  berlemak dan berbau khas, biasakan makan dan minum yang hangat- hangat Ibu mengerti - Menjelaskan pada ibu bahwa mual muntah  pada kehamilan pertama merupakan hal yang normal dan biasa terjadi pada semua ibu hamil.

Hari 2 Tanggal 22 April 2016 pukul 10.00 wita - Melakukan pemeriksaan Melakukan pemeriksaan TTV - Kolaborasi dengan dokter untuk diberikan injeksi ranitidine - Menganjurkan ibu untuk istirahat yang cukup dan teratur, tidur siang 1  –  2  jam/hari, tidur malam 8 jam/hari - Menganjurkan kepada ibu untuk makan sedikit tapi sering - Menganjurkan ibu untuk meminum obat yang di berikan bidan.

Hari 3 Tanggal 23 23 April 2016 pukul 16.00 wita - Menganjurkan ibu untuk istirahat yang cukup dan teratur, tidur siang 1  –  2  jam/hari, tidur malam 8 jam/hari - Menganjurkan kepada ibu untuk makan sedikit tapi sering - Menganjurkan ibu untuk membaca  buku KIA tentang tanda bahaya kehamilan - Menganjurkan ibu untuk meminum obat yang diberikan bidan - Menganjurkan ibu untuk melakukan  pemeriksaan USG - Kolaborasi dengan dokter : Aff infus - Pasien pulang pukul 17.00 wita

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4.1.7 Evaluasi Kasus Kasus 1

 Ny. “A”

Hari 1 Tanggal 11 April 2016 S: - Ibu mengatakan pusing, mual muntahnya sudah  berkurang, nafsu makan masih kurang. kurang.

Hari 2 Tanggal 12April 2016 S: - Ibu mengatakan pusing dan mual muntahnya sudah berkurang, nafsu makan sudah ada.

O: - K/u lemah, TD: 100/70 mmHg, N: 83 x/menit, S: 36,6˚C, R: 19 x/menit, LILA 24 cm, BB 50Kg. - Pemeriksaan fisik: Mata: Konjungtiva merah muda (tidak anemis), sklera putih (tidak ikterus). Abdomen : Leopold I : TFU belum teraba Leopold II : tidak dilakukan Leopold III : tidak dilakukan dilakukan Leopold IV : tidak dilakukan

O: - k/u ibu sedikit lemah. TD 100/70 mmHg, Nadi 82 x/ menit, Respirasi 20 x/mnt, Suhu 36,7 0C, LILA 24 cm.

O: - k/u ibu baik. TD: 120/80 mmhg,  Nadi 82 x/mnt, Respirasi 20 x/mnt, Suhu 37,0 0C, LILA 24 cm

A: - G4P3A0H2, UK 6 minggu hiperemesis gravidarum

A: - G4P3A0H2, UK 6 minggu

A: - G4P3A0H2, UK gravidarum

6

minggu

dengan

hiperemesis

P: - Menginformasikan pada ibu tentang hasil  pemeriksaan yang didapatkan dan asuhan yang akan diberikan. Ibu mampu memahami tentang informasi yang telah diberikan. - Menganjurkan kepada ibu untuk tetap minum obat

dengan

P: - Menginformasikan ibu hasil  pemeriksaan, TD 100/70 mmHg, Nadi 82 x/mnt, Respirasi 20 x/mnt, suhu 36,7 0 C, Ibu memahami hasil pemeriksaannya - Menganjurkan kepada ibu untuk makan sedikit tapi sering. Ibu bersedia melakukan anjuran yang diberikan. - Menganjurkan ibu untuk teratur minum obat yang diberikan oleh bidan (B6, antasid dan paracetamol). Ibu bersedia melakukan anjuran yang diberikan.

Hari 3 Tanggal 13 April 2016 S:

-

Ibu mengatakan sudah tidak ada keluhan lagi.

P:. - Menginformasikan hasil  pemeriksaan bahwa keadaan umum ibu baik, kesadaran composmentis, emosi stabil, TD 120/80 mmhg,  Nadi 82 x/ mnt , Suhu 37,0 0C Respirasi 20 x/mnt - Menganjurkan kepada ibu untuk makan makanan yang bergizi. - Memberikan ibu obat dan menganjurkan minum sesuai aturan yaitu B6 dan Fe 1x 1 - Ibu menyepakati untuk kunjungan ulang 3 hari lagi yaitu tanggal 1604-2016

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Kasus Kasus 2

 Ny. “L”

Hari 1 Tanggal 21 april 2016 S: - Ibu mengatakan mengatakan pusing dan dan mual muntah sudah sudah  berkurang, tetapi belum ada nafsu makan. makan. O: - K/u lemah, TD: 100/60 mmHg, N: 86 x/menit, S: 36,7˚C, R: 21 x/menit, LILA 2 4cm, BB 46 Kg. - Pemeriksaan fisik: Mata: Konjungtiva merah muda (tidak anemis), sklera  putih (tidak ikterus). Abdomen : Leopold I : TFU belum teraba Leopold II : Tidak dilakukan pemeriksaan Leopold III : Tidak dilakukan pemeriksaan Leopold IV : Tidak dilakukan pemeriksaan A: - G1P0A0H0, UK 8 minggu dengan hiperemesis gravidarum P: - Menginformasikan pada ibu tentang hasil  pemeriksaan yang didapatkan keadaan umum ibu  baik TD: 100/60 mmHg, N: 86 x/menit, S: 36,7oC, R: 21 x/menit. Ibu mampu memahami tentang informasi yang telah diberikan. - Menganjurkan ibu untuk tetap mempertahankan nutrisi yang baik pada saat hamil yaitu dengan mengkonsumsi makanan yang mengandung karbohidrat (nasi, jagung, tepung, umbi-umbian),  protein hewani dan nabati (telur, ikan, daging, hati, tempe, tahu, kacang-kacangan), vitamin dan mineral (sayur dan buah-buahan), dan susu, untuk menambah asupan nutrisi ibu dan janin. - Menganjurkan ibu untuk tetap minum obat yang diberikan oleh bidan yaitu B6, antasid. Ibu akan teratur minum obat.

Hari 2 Tanggal 22 april 2016 S: - Ibu mengatakan pusing dan mual muntah berkurang, nafsu makan sudah ada.

Hari 3 Tanggal 23 Mei 2016 S: - Ibu Mengatakan Sudah Tidak Ada Keluhan

O: O: - k/u Baik. TD 110/70 Mmhg, Nadi - k/u lemah. TD 110/70 mmHg, Nadi 84 84 X/Mnt, RR 20 X/Mnt, Suhu 36,5 0 x/mnt, RR 20 x/mnt, suhu 36,5 0C, C , LILA 24 Cm LILA 24 cm A: A: - G1P0A0H0, UK 8 minggu dengan - G1P0A0H0, UK 8 Minggu hiperemesis gravidarum P: P: - Menginformasikan Hasil - Menginformasikan ibu hasil Pemeriksaan. TD 110/70 Mmhg,  pemeriksaannya, TD 110/70 mmhg,  Nadi 84 X/Mnt, RR 20 X/Mnt, Suhu  Nadi 84 x/mnt, RR 19 x/mnt, suhu 36,5 36,5 0C, Ibu Memahami Hasil 0 C, LILA 24 cm, ibu memahami hasil Pemeriksaan  pemeriksaan. - Menganjurkan Kepada Ibu Untuk - Menganjurkan ibu untuk makan sedikit Makan Makanan Yang Bergizi tapi sering - Menganjurkan Kepada Ibu Untuk - Menganjurkan ibu untuk teratur minum Menjaga Kehamilannya. obat yang diberikan oleh bidan (B6, - Menganjurkan Kepada Ibu Untuk antasid) dan ibu bersedia Tetap Minum Obat Secara Teratur - Menjelaskan pada ibu bahwa mual Yang Diberikan Oleh Bidan muntah pada kehamilan pertama (Solvitral 1x1) Vit B6. merupakan hal yang normal dan biasa - Ibu Menyepakati Untuk Kunjungan terjadi pada semua ibu hamil dan ibu Ulang 3 hari lagi yaitu tanggal 24 bisa memhami apa yang di jelaskan dan 04-2016 sudah tidak cemas lagi.

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CATATAN PERKEMBANGAN Kasus Kasus 1

 Ny.“A”

Kunjungan 1 Tanggal 16 April 2016 S: - Ibu mengatakan sudah tidak ada keluhan.

O: - K/u baik, kesadaran composmentis, TD:

120/80 mmHg, N: 80 x/menit, S: 36,7˚C, R: 23 x/menit, LILA 24 cm, BB 50 Kg. Leopold I : TFU belum teraba Leopold II : tidak dilakukan pemeriksaan Leopold III : tidak dilakukan pemeriksaan Leopold IV : tidak dilakukan pemeriksaan A: - G4P3A0H2, UK 6 minggu P: - Anjurkan ibu untuk makan lebih sering - Minum air putih 8 gelas perhari - Memberikan konseling tentang pola hubungan seksual - Anjurkan ibu untuk minum obat yang diberikan bidan seperti solvitral 1x1 - Anjurkan ibu untuk menjaga personal hygiene - Menyepakati untuk kunjungan ulang 3 hari lagi yaitu tanggal 19-04-2016

Kunjungan 2 Tanggal 19 April 2016 S: - Ibu mengatakan sudah tidak mempunyai keluhan apapun

O: - K/u baik, kesadaran composmentis, TD: 120/80 mmHg, N: 80 x/menit, S: 36,7˚C, R: 23 x/menit, LILA 24 cm, BB 50 Kg. Leopold I : TFU belum teraba Leopold II : Tidak dilakukan  pemeriksaan Leopold III : tidak dilakukan dilakukan  pemeriksaan Leopold IV : tidak dilakukan  pemeriksaan

Kunjungan 3 Tanggal 22 April 2016 S:

-

Ibu mengatakan sudah tidak mempunyai keluhan dan dapat beraktivitas seperti  biasanya

O: - K/u baik, kesadaran composmentis, TD:

110/80 mmHg, N: 82 x/menit, S: 36,7˚C, R: 23 x/menit, LILA 24 cm, BB 50 Kg. Leopold I : TFU belum teraba Leopold II : Tidak dilakukan  pemeriksaan Leopold III : tidak dilakukan dilakukan  pemeriksaan Leopold IV : tidak dilakukan  pemeriksaan

A: - G4P3A0H2, UK 6 minggu

A: - G4P3A0H2UK 6 minggu

P: - Beritahu ibu untuk menambah porsi makan dari biasanya dengan mengkonsumsi jagung, buah, sayur, tahu dan tempe - Anjurkan ibu untuk tetap rutin minum obat yang diberikan bidan yaitu solvitral 1x1 - Menyepakati untuk kunjungan ulang 3 hari lagi yaitu tanggal 22-04-2016

P: - Beritahu ibu untuk membaca buku KIA lebih sering untuk mengenali tanda  bahaya kehamilan - Anjurkan ibu untuk tetap rutin minum obat yang diberikan bidan yaitu solvitral 1x1 - Menganjurkan ibu untuk rutin datang ke Posyandu atau Puskesmas untuk memantau perkembangan janin dan kondisi ibu

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Kasus Kasus 2

 Ny. “L”

Kunjungan 1 Tanggal 24 april 2016 S: - Ibu mengatakan sudah tidak mual muntah,  pusing berkurang, ada nafsu makan dan tidak nyeri ulu hati. O: K/u baik, kesadaran composmentis, TD:

110/70 mmHg, N: 82 x/menit, S: 36,7˚C, R: 21 x/menit, LILA 24 cm, BB 46 Kg. Leopold I : TFU belum teraba Leopold II : Tidak dilakukan pemeriksaan Leopold III : Tidak dilakukan pemeriksaan Leopold IV : Tidak dilakukan pemeriksaan A: G1P0A0H0, UK 8 minggu P: - Anjurkan ibu untuk makan lebih sering - Minum air putih 8 gelas perhari - Memberikan konseling tentang pola hubungan seksual - Anjurkan ibu untuk minum obat yang diberikan bidan seperti solvitral 1x1 - Anjurkan ibu untuk menjaga personal hygiene - Menyepakati untuk kunjungan ulang 3 hari lagi yaitu tanggal 27-04-2016 - Menjelaskan pada ibu tanda bahaya TM 1 yaitu: Perdarahan yaitu: Perdarahan pervaginam, mual pervaginam, mual muntah  berlebihan, sakit kepala yang hebat,  penglihatan kabur, nyeri  perut yang hebat, gerakan  janin  berkurang,  bengkak  pada wajah, kaki dan tangan, selaput kelopak mata pucat, demam pucat, demam tinggi.

Kunjungan 2 Tanggal 27 april 2016 S: - Ibu mengatakan sudah tidak mempunyai keluhan apapun

Kunjungan 3 Tanggal 30 April 2016 S: - Ibu mengatakan sudah tidak ada keluhan

O: - K/u baik, kesadaran composmentis, TD 110/70 mmHg, Nadi 81 x/mnt, RR 20 x/mnt, suhu 36,5 0C, LILA 24 cm Leopold I : TFU belum teraba Leopold II : Tidak dilakukan  pemeriksaan Leopold III : Tidak dilakukan dilakukan  pemeriksaan Leopold IV : Tidak dilakukan  pemeriksaan A: - G1P0A0H0, UK 8 minggu P: - Beritahu ibu untuk menambah porsi makan dari biasanya dengan mengkonsumsi jagung, buah, sayur, tahu dan tempe - Anjurkan ibu untuk tetap rutin minum obat yang diberikan bidan yaitu solvitral 1x1 - Menyepakati untuk kunjungan ulang 3 hari lagi yaitu tanggal 30-04-2016

O: - K/u baik, kesadaran composmentis, TD 120/80 mmhg, Nadi 80 x/mnt, RR 20 x/mnt, Suhu 36,5 0C, LILA 24 cm Leopold I : TFU belum teraba Leopold II : Tidak dilakukan  pemeriksaan Leopold III : Tidak dilakukan dilakukan  pemeriksaan Leopold IV : Tidak dilakukan  pemeriksaan A: - G1P0A0H0, UK 8 minggu P: - Beritahu ibu untuk membaca buku KIA lebih sering untuk mengenali tanda  bahaya kehamilan - Anjurkan ibu untuk tetap rutin minum obat yang diberikan bidan yaitu solvitral 1x1 - Menganjurkan ibu untuk rutin datang ke Posyandu atau puskesmas untuk memantau perkembangan janin dan kondisi ibu

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4.2 Pembahasan 4.2.1 Pengumpulan Data

Asuhan kebidanan telah dilakukan terhadap Ny “A” umur 45 tahun usia kehamilan 6 minggu G 4P3A0H2 dan Ny “L”  umur 23 tahun usia kehamilan 8 minggu G 1P0A0H0 dengan  Hiperemesis gravidarum tingkat I. Pengkajian dilakukan untuk mengumpulkan data dasar tentang pasien. A. Data Subjektif Setelah dilakukan anamnesa tanggal 11 April 2016  pada Ny.“A” diketahui usia ibu hamil 45 tahun dan mengeluh mual muntah lebih dari 6 kali dalam sehari disertai mual, lemas, nyeri ulu hati dan tidak ada nafsu makan. Serta pengkajian data tanggal 21 April 2016  pada Ny.“ L” diketahui usia ibu hamil 23 tahun dan mengeluh mual muntah lebih dari 10 kali dalam sehari disertai mual, pusing, nyeri ulu hati dan tidak ada nafsu makan. Dari anamnesa tersebut dapat dikatakan bahwa Ny.”A”

dan Ny.”L” mengalami hiperemesis gravidarum tingkat I (ringan).

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Muntah yang terus-menerus disertai dengan kurang minum yang  berkepanjangan dapat menyebabkan dehidrasi. Jika terus berlanjut,  pasien dapat mengalami syok. Dehidrasi yang berkepanjangan juga menghambat tumbuh kembang janin. Oleh karena itu, pada pemeriksaan fisik harus dicari apakah terdapat abnormalitas tanda-tanda vital, seperti  peningkatan frekuensi nadi (>100 kali per menit), penurunan tekanan darah, kondisi subfebris, dan penurunan kesadaran. Selanjutnya dalam  pemeriksaan fisis lengkap dapat dicari tanda-tanda dehidrasi, kulit tampak pucat dan sianosis, serta penurunan berat badan (Gunawan, 2011). B. Data Objektif

Setelah dilakukan pengkajian data objektif pada Ny.“ A” didapatkan hasil keadaan umum ibu lemah, Tekanan Darah: 100/80 mmHg, Suhu: 36,7°C, Nadi: 96 x/menit, Respirasi: 20 x/menit, Berat

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 baik akan menyebabkan komplikasi bahkan kematian ibu dan janin. Prevalensi hiperemesis gravidarum antara 1-3 % atau 5-20 kasus per 1000 kehamilan (Winkjosastro, 2009). Mual dan muntah yang berkaitan dengan kehamilan biasanya dimulai pada usia kehamilan 9- 10 minggu, puncaknya pada usia kehamilan 11-13 minggu, dan sembuh pada kebanyakan kasus pada umur kehamilan 12-14 minggu. Dalam 1-10% dari kehamilan, gejalagejala dapat berlanjut melampaui 20-22 minggu. Kejadian hiperemesis dapat berulang pada wanita hamil. J. Fitzgerald (1938-1953) melakukan studi terhadap 159 wanita hamil di Aberdeen, Skotlandia, menemukan  bahwa hiperemesis pada kehamilan pertama merupakan faktor risiko untuk terjadinya hiperemesis pada kehamilan berikutnya. Berdasarkan  penelitian, dari 56 wanita yang kembali hamil, 27 diantaranya mengalami hiperemesis pada kehamilan kedua dan 7 dari 19 wanita

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 Nadi: 96x/menit, Respirasi: 21 x/menit. Sedangkan  Ny.”L” mengatakan ini i ni kehamilan yang pertama tidak pernah mengalami keguguran, hamil 8 minggu, mengeluh mual muntah dan pusing serta nafsu makannya  berkurang, menstruasi terakhir pada tanggal 09-02-2016. Keadaan umum ibu lemas, tekanan darah 90/60 mmHg, Suhu: 36,8°C, Nadi: 98 x/menit, Respirasi: 24 x/menit. Dari hasil pengkajian data ditemukan data fokus : Ny. “A” dan  Ny.“L”, ibu mengatakan saat ini mengeluh mual muntah lebih dari 10 x dalam 24 jam, hingga mengganggu aktivitas sehari-hari ibu, tubuh terasa

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muntah terus berlanjut. Frekuensi nadi meningkat sampai 100 kali per menit dan tekanan darah sistolik menurun. Pada pemeriksaan fisis ditemukan mata cekung, lidah kering, penurunan turgor kulit dan penurunan jumlah urin (Gunawan, 2011).

Berdasarkan data di atas maka penulis menegakkan diagnosa Ny “ A” dan Ny “ L” adalah hiperemesis Gravidarum tingkat I. Diagnosis tersebut secara prinsip tidak bertentangan dengan teori, dan tidak ada kesenjangan. 4.2.3 Diagnosa/ Masalah potensial

Masalah potensial yang mungkin terjadi pada Ny.”A” dan Ny.”L”

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Hiperemesis gravidarum dapat menyebabkan cadangan karbohidrat dan lemak habis terpakai untuk keperluan energi. Karena oksidasi lemak yang tidak sempurna, maka terjadilah ketosis dengan tertimbunya asam aseton asetik, asam hidroksi butirik, dan aseton dalam darah. Kekurangan cairan yang diminum dan kehilangan cairan akibat muntah akan menyababkan dehidrasi, sehingga cairan ekstra vaskuler dan plasma akan  berkurang (Gunawan, 2011). Dalam kasus di atas tidak terdapat kesenjangan antara tinjauan teori

dengan tinjauan kasus karena Ny “ A” dan Ny “ L” terdapat tanda-tanda

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Maka tindakan yang dilakukan adalah rehidrasi yaitu mengganti cairan tubuh yang hilang ke volume normal, osmolaritas yang efektif dan komposisi cairan yang tepat untuk keseimbangan asam basa. Pemberian cairan untuk dehidrasi harus memperhitungkan secara cermat berdasarkan:  berapa jumlah cairan yang diperlukan, defisit natrium, defisit kalium dan ada tidaknya asidosis (Gunawan, 2011). 4.2.5 Perencanaan

 Ny.”A” didiagnosis G4P3A0H2 UK 6 minggu dengan hiperemesis  gravidarum sedangkan Ny.” L” G1P0A0H0 UK 8 minggu dengan

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menggunakan anti emesis  emesis  , anjurkan ibu untuk makan sedikit tapi sering, terapi psikologis dan penambahan cairan (Manuaba, 2010). Pada emesis gravidarum, obat-obatan diberikan apabila perubahan  pola makan tidak mengurangi gejala, sedangkan pada hiperemesis gravidarum,

obat-obatan

diberikan

setelah

rehidrasi

dan

kondisi

hemodinamik stabil.3 Pemberian obat secara intravena dipertimbangkan jika toleransi oral pasien buruk.7Obat-obatan yang digunakan antara lain adalah vitamin B6 (piridoksin), antihistamin dan agen-agen prokinetik. American College of Obstetricians and Gynecologists (ACOG) merekomendasikan 10

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4.2.6 Pelaksanaan

Pada tanggal 11 dan 21 april 2016 dilakukan pelaksanaan pada

 Ny.”A” dan Ny.”L” yaitu menganjurkan ibu untuk istirahat is tirahat yang cukup dan teratur, tidur siang 1  –   2 jam/hari, tidur malam 8 jam/hari, memberikan konseling tentang pola hubungan seksual; memberikan konseling tentang

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merupakan gejala yang fisiologis pada kehamilan muda. Menganjurkan ibu untuk mengubah pola makan sehari-hari dengan makanan dalam jumlah sedikit tetapi sering. Menganjurkan pada waktu bangun pagi jangan segera turun dari tempat tidur, makan roti kering atau biskuit dengan teh hangat. Menghindari kekurangan karbohidrat merupakan faktor yang penting

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mmHg, Nadi 80 x/mnt, respirasi 20 x/mnt dan suhu 37,0

0

C. Dengan

diberikannya asuhan secara menyeluruh, permasalahan pada Ny “A’’ dapat teratasi, keadaan Ny “A’’  baik, dan Ny “A”  pun dapat menjalani kehamilannya. Ny “A” dianjurkan untuk selalu menjaga kehamilannya dengan memperhatikan pola makan, istirahat, aktivitas yang tidak terlalu

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Tujuan terapi emesis atau hiperemesis gravidarum adalah untuk mencegah komplikasi seperti ketonuria, dehidrasi, hipokalemia dan  penurunan berat badan lebih dari 3 kg atau 5% berat badan.1 Jika sudah terjadi komplikasi, perlu dilakukan tata laksana terhadap komplikasi tersebut. Penilaian keberhasilan terapi dilakukan secara klinis dan

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BAB V PENUTUP

Dari hasil yang penulis uraikan dalam laporan tugas akhir kebidanan terhadap Ny ”A” dan Ny “ L’’ dengan hiperemesis gravida rum tingkat I di

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