PATIENT CARE WOMEN POST KEPEREAWATAN board the Kalabia SECTIO

PROBLEMS WITH ACUTE PAIN IN HOSPITAL OF ELDERLY POOR Waluya

Sawahan
Wiwin Krisjayanti, Maria Magdalena Setyaningsih, Sr.Felisitas
Prodi D-III Nursing, Nursing STIKes Waluya Malang
Email: krisjayanti1@gmail.com

ABSTRACT
Sectio caesarea merupakan persalinan melalui pembedahan abdomen dan. Pasca pembedahan, klien
akan merasakan nyeri pada daerah luka. Penelitian ini bertujuan untuk melaksanakan asuhan
keperawatan pada klien post sectio caesarea dengan masalah nyeri akut. Desain penelitian ini
menggunakan metode penelitian studi kasus pada dua responden pada bulan Februari 2019. Hasil
pengkajian didapatkan kedua klien mengeluh nyeri pada daerah luka operasi, klien mengatakan nyeri
dengan skala nyeri klien 1 yaitu 6 (skala 0-10), sedangakan skala nyeri klien 2 yaitu 5 (skala 0-10).
Pada kedua klien direncanakan dan dilakukan tindakan keperawatan sesuai dengan masalah
keperawatan yang muncul dengan tindakan farmakologi dan non-farmakologi. Hasil yang didapatkan
kedua klien merasakan nyeri berkurang, terbukti kedua klien menunjukkan skala nyeri 2. Masalah
kedua klien tersebut dapat teratasi setelah dilakukan asuhan keperawatan dan penerapan metode non
farmakologi yaitu manajemen nyeri berupa teknik relaksasi nafas dalam dan distraksi. Relaksasi nafas
dalam dan distraksi dapat membantu pasien mengalihkan nyeri yang dialaminya. Maka dari itu teknik
management nyeri merupakan hal yang penting salah satu diantaranya adalah teknik nafas dalam dan
distraksi karena dengan melakukan teknik tersebut, otot serta pembeluh darah akan vasodilatasi
sehingga nyeri yang terjadi dapat berkurang.
Keywords: Post Sectio caesarea, Acute Pain

ABSTRACT
Sectio caesarea is a way of giving birth by penetrating abdominal surgery and uterus to remove the
baby. Surgery sectio caesarea Generally the use of spinal anesthesia. Post-anesthesia is missing, then
the client will feel pain in the incision area. This study Aimed to carry out nursing care to clients post
sectio caesarea with acute pain problems. Design of this study using a case study in two clients as
respondents in February 2019 run for three days. The assessment results Obtained both the client
complains of pain in the Injured area of operation, the client says pain with pain scale client 1 as 6
(scale 0-10), while the pain scale of the clients 2 5 (scale of 0 -10). On both client nursing actions
planned and Carried out in accordance with the nursing problems that Arise, both the client has
made implementation of nursing pharmacological and non-pharmacological Teaches deep breathing
relaxation techniques and relaxation distraction. The results Obtained both the client feel pain is
reduced, both the client indicates a pain scale of the clients 2. The second problem can be resolved
after the nursing care and the implementation of non-pharmacological methods of pain management
items, namely in the form of deep breathing relaxation techniques and distractions. It can Overcome
the problem of pain in post sectio caecarea clients so as to provide comfort to the client. The results
Obtained both the client feel pain is reduced, both the client indicates a pain scale of the clients 2.
The second problem can be resolved after the nursing care and the implementation of non-
pharmacological methods of pain management, namely in the form of deep breathing relaxation
techniques and distractions. It can Overcome the problem of pain in post sectio caecarea clients so
as to provide comfort to the client. The results Obtained both the client feel pain is reduced, both the
1
client indicates a pain scale of the clients 2. The second problem can be resolved after the nursing
care and the implementation of non-pharmacological methods of pain management items, namely in
the form of deep breathing relaxation techniques and distractions. It can Overcome the problem of
pain in post sectio caecarea clients so as to provide comfort to the client. both the client indicates a
pain scale of the clients 2. The second problem can be resolved after the nursing care and the
implementation of non-pharmacological methods of pain management items, namely in the form of
deep breathing relaxation techniques and distractions. It can Overcome the problem of pain in post
sectio caecarea clients so as to provide comfort to the client. both the client indicates a pain scale of
the clients 2. The second problem can be resolved after the nursing care and the implementation of
non-pharmacological methods of pain management items, namely in the form of deep breathing
relaxation techniques and distractions. It can Overcome the problem of pain in post sectio caecarea
clients so as to provide comfort to the client.

Keywords: Post Sectio cecarea, Acute Pain

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preliminary
sectio caesareais a way of giving birth by
performing a surgical incision that penetrates
the abdomen and uterus to remove the baby
(Wiknjosastro, 2010). Sectio Caesaria generally
done to mothers who have a narrow pelvis,
tumors in the birth canal that cause obstruction,
uterine rupture that threatens, placenta previa,
ever do sectio caesarea earlier, while a relative
indication of prolonged labor, obstructed labor
does not progress, preeclampsia, hypertension
and twins , (Wiknjosastro, 2010).
Sectio caesarea surgery begins with general
anesthesia using spinal anesthesia in the area
near the spinal cord. After the anesthetic begins
to react will be made an incision in the lower
segment of the abdomen, which would cause
trauma wounds (Keat, 2013). Trauma wounds in
surgery sectio caesarea will release chemical
substances pain as bradykinin, serotonin, and
the enzyme periotik. Implus-implus pain
channeled into the spinal cord by the A and C
fibers of afferent nerves to the spinal. Substance
will be merasang and damage the nerve endings
of pain receptors and delivered to the
hypothalamus through the ascending nerve so
that people will menggalami pain (Chayatin,
2011). Once the anesthesia has completely
reacted client will feel pain in the incision area
so that clients are comfortable. Client feelings of
discomfort after surgery can lead to the risk of
complications in the mother and baby. The
impact of pain on the mother are: limited activity
daily living (ADL), the mobilization of the
capital due to an increase in pain intensity when
mother move. An increase in pain in the mother
can affect the stress hormones that impact on the
delay in breast milk as baby food expenditure
(Indiarti, 2011).
Word Health Organization (WHO) set in 2016,
it was reported that the incidence of post sectio
Caesaria 51.59%. The number of maternal
surgery caesarea number of 60.22%, in 2013
amounted to 65.19%, in 2014 amounted to
69.22%. National Survey in 2015, 951 000
Operating caesarea labor with delivery of 4.039
million or 23.8% of all deliveries (MoH,
2015).Based on the results of medical records at
the hospital Panti Waluya Malang noted the
incidence of sectio caecarea since January 2018
till December 2018 are calculated amounted to
146.7% overall, consisted of 170 cases of sectio
caesarea and maternal normal 116 (RM RSPW,
2018).
The phenomenon I have found when clinical
practice in the Delivery Room Panti Sawahan
Waluya Malang in July 2017 that there were
three mothers had undergone surgery caecaria
sectio. Ny.Y to the age of 26 years, Ny.S by age
29 years, and Ny.D the age of 30 years who
complained of pain after childbirth sectio
caecaria. When researchers in assessing the data
obtained pain pain in the incision. When asked,
the mother said the pain felt like a stomach
slashed the bottom, when measured with a pain
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scale Ny.Y & Ny.S shows the number 4 on the
pain scale of 0-10 pain scale. It was felt post-op
care clients on the first day, while Ny.D indicate
a pain scale of 0-10 figure 5 as shown at the time
post-op day care clients second. The three
mothers said reduced pain when resting.
Generally pain is described as a state of being
uncomfortable, due to the contraction of the
uterine lining that stimulate pain in the area of
injury.
As a nurse, providing health assistance such as
providing nursing care to clients with the
approach of preventive, curative, rehabilitative
and collaborative. One independent
interventions that can be given is to conduct a
comprehensive assessment of pain, discomfort
observing non-verbal reactions, environmental
controls that may affect pain, breathing
relaxation technique teaches distraction
techniques and provide a comfortable position.
Collaborative interventions to do a collaboration
with doctors in analgesic (Pratiwi 2010).
Research methods
Research design which is a case study. Nursing
care on the mother post sectio Caesarea with
acute pain problems in Panti Waluya Sawahan
Malang, then translated by the author:
1) Clients with a diagnosis of post sectio sectio
Caesaria regardless indication Caesaria
with acute pain problems in Panti Waluya
Sawahan Malang.
2) Clients experiencing pain 2-3 hours after
post sectio caesarea, client verbally
reported pain, pain in the injured area of
operation and shows criteria's pain scale is
above 4
In this research the client 1 Ny.N participant is
29 years old perform operations on 15 February
2019 and client 2 Ny. The 27-year-old B
perform operations on February 18, 2019 were
treated in Agnes Pavilion at Panti Waluya
Sawahan Malang.
The study was conducted during three days of
each client using data collection techniques such
as interviews, observation, physical
examination, and document research. The
underlying ethics included the preparation of
scientific papers, consisting of:
1) informed Consent (Approval as a client)
2) anonimity (without a name)
3) confidentiality (Confidentiality)
result
In this case study obtained the following results:
1. assessment
On February 15, 2019 at 5:20 pm client
admission, the same day the client is done sectio
caesare with an indication of the location of
breech babies, as do penggkajian 17:00 pm (± 3
hours after surgery) client complains of pain in
the abdomen scar. We conducted a physical
assessment, especially in the abdominal area:
there are scars of post sectio caecarea, the client
says as mutilated pain, stomach pain felt in the
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Lukan scar and pain pain scale 6 intermittent.On
February 18, 2019 at 12:05 pm, client
admission. The next day on February 19 2019
clients sectio caesarea surgery performed by
post date + indication of fetal distress. When the
assessment is done at 16:00(± 3 hours after
surgery) clients complain of abdominal surgery
scar. We conducted a physical assessment,
especially in the abdominal area: there are scars
of post sectio caecarea, clients say pain such as
tingling and burning, stomach pain felt in the
former Lukan 5 operasiskala pain
intermittent pain
2. Nursing diagnoses
Based on the results of the assessment on the
client 1 and 2 can be enforced the same nursing
diagnosis is acute pain
3. Nursing interventions
On the client 1 and 2 have been established in
accordance with the care plan, namely literature
reviewObservation of pain comprehensively
including location, characteristics, duration,
frequency, quality and precipitation
factors,TTV observation client, a quiet
environment controls, limit visitors and relax the
client, the client expression observation, teaches
deep breathing relaxation techniques, teach or
suggest distraction techniques when the pain by
taking care of and feeding the baby, pAntau
patient acceptance of pain management that has
been done, set a comfortable position, and
olaborasi analgesic with the medical team if
there are complaints or actions unsuccessful
pain
4. implementation of Nursing
On the client 1 and 2 have been carried out in
accordance with the implementation of nursing
nursing interventions that have been developed,
but there is one intervention that is not
performed on the client 1 that distraction
techniques.
5. evaluation of Nursing
and
Client 1 to 3 days of treatment in the data get
control of pain is significantly reduced by using
relaxation techniques, pain scale 2, the client has
been mobilized to the bathroom, the client was
able to bathe themselves, clients move with
caution. On the client 2 on day care to 3 to get
the data has been reduced by controlling pain
using relaxation and distraction techniques, pain
scale 2, the client has been mobilized to the
bathroom, the client was able to bathe
themselves, clients move with caution.
Discussion
1. assessment
Based on the facts of the data that has been set,
children 1 and 2 had Post Sectio board the
Kalabia with problems acute pain shown by an
indication of the location of breech babies,
complaining of pain in wound sectio board the
Kalabia, pain scale 6, painful as mutilated at the
client 1 and indication post date + fetal distress,5
pain scale, the pain felt like distusuk tingling and
burning in the client 2. This is in accordance
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with tthrough Home Visits by Sarwono, (2013)
which says that the mother went into labor
postoperative caecaria sectio due to indications
such as severe preeclampsia, premature rupture
of membranes and complications baby across
the birth canal, breech so that clients do surgery,
and Apriansah theory (2014) which says that
pain is a condition that is not a feeling
menyenangakan, is highly subjective. Persaan
pain on each person is different in terms of scale.
2. Nursing diagnoses
On the client 1 and 2 are set the same diagnosis
is acute pain with the same etiology is trauma,
supported by the data there are stitches in the
abdomen client says pain in postoperative
wound pain scale showed sectio caesarea 6, 2
client on the pain scale 5. This is consistent with
the theory suwarno (2013) who said after the
post Sectio Caesarea no abdominal incision. As
a result of the incision cause tissue damage and
severed nerve endings.The cortex of the pain
will be prepared so that individuals experiencing
pain,
3. Intervention
In patients 1 and 2 8 interventions have been
assigned the same, because in both the client has
determined nursing objectives and expected
outcomes are the same.This is in accordance
with according Andarmayo theory (2013).
4. Implementation
On the client 1 consisting of 9 the action plan
was not carried out one intervention that
distraction techniques. On the client 2 do 9
interventions that have been planned. This
above is consistent with the theoryMitayani,
(2012) This stage appears if the plans made are
applied to the patient. Actions taken may be the
same, or may also be different from the order
that has been made in the planning. Applications
are planned in different patients, tailored to the
patient konsisi that time.
5. Evaluation
On the client 1 and 2 after the evaluation during
the 3-day problems of acute pain is resolved, it
is evident because of the effect of interventions
that teach or encourage mothers to use the
technique of non-pharmacological which is a
technique of breath in and distraction diversion
pain by taking care of the baby and breastfeed
her baby and collaboration for drug delivery, as
well as clients can melaporakan pain scale can
be reduced, the client looks relaxed, clients are
able to apply the techniques of relaxation and
distraction. This is consistent with the
theoryMitayani, (2012) which states that the
criteria resulted in the show did not happen
improvement of vital signs during activities
such as blood pressure, pulse, temperature and
respiratory within normal limits, the client is
able to control the pain, the client is able to say
that the pain is significantly reduced by use of
pain management that has been done, clients can
recognize the pain scale in a way addressing
pain scale of change value, and the last one
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client can memperlihatakan facial expressions
and posture seemed relaxed.
Conclusion
Nursing In Clients Post Sectio caesarea with
Acute Pain Problems in Hospital Nursing
Waluya Sawahan Malang was held on the Client
1 and Client 2 can be successful. This is evident
from the second response clients who are able to
control the pain, express pain decreased after the
management of pain, facial and body position
relax clients as well as clients can care for and
breastfeed her baby.
Sarwono. 2013. Science obstetrics. Jakarta: PT.
Bina Library Prawirohardjo Sarwono.
Wiknojosastro S. 2010: Obstetrics. Third
Edition. Yayasan Bina Library
Prawirohardjo Sarwono. Jakarta.
WHO. 2013. The Global Numbers and Cost of
Unnecessary Caearean Additionally
Needed and Sections Performed per Year:
Overuse as a Barrier to Univeral
Covereage. Health Systems Financing.
WHO.
,

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