LAPORAN KASUS

PRAKLINIK KEPERAWATAN KOMPLEMENTER

Semester 7

Tahun Ajaran 2019/2020

Dosen Pengampu:

Mardiyanti, M.Kep., MDS

Disusun Oleh:

NAMA: Dawda Kairaba Kijera NIM: 11161040000089

PSIK A 2016

PROGRAM STUDI ILMU KEPERAWATAN

FAKULTAS ILMU KESEHATAN

UNIVERSITAS ISLAM NEGERI SYARIF HIDAYATULLAH JAKARTA

NOVEMBER / 2019
 FORMAT LAPORAN KASUS

A. RESUME PASIEN

Ny. I datang ke klinik bekam dengan penyakit lupuas dan mengalami keluhan rambut
rontok, nyeri sendi, seluruh tubuh ngilu, mata sebelah kanan seperti terhalang benda
hitam kemudian klien mengkonsumsi obat-obatan lupus dan anti nyeri sejak 4 tahun
yang lalu hingga sekarang, klien melakukan bekam pertama kali pada tanggal 22 juni
2019, kemudian setelah itu klien mendapatkan jadwal bekam 10 hari sekali. Klien sudah
melakukan bekam 5 kali, klien mengatakan setelah melakukan bekam kondisi klien
membaik. Pada tanggal 21 November 2019 klien melakukan bekam ke 6 setalah
sebelumnya tidak melakukan bekam selama 3 bulan, dilakukan pengkajian pada klien
didapatkan, klien mengeluh sesak, nyeri sendi, dan lapang pandang masih belum jelas
tapi tidak separah sebelum dilakukan bekam, TD 129/85 mmHg, N 97 x/menit RR
26x/menit S 37,5 klien tampak meringis, konsentrasi kurang, suara napas vesikuler, otot
bantu pernapasan +. Kemudian dilakukan bekam pada titik AK 1- 2, Za 5-6, 10-IL,
16-17. Un 10, Ra 6-7, Sa -2

B. PENGKAJIAN
I. DATA DEMOGRAFI
o Inisial klien : Ny. I
o Usia : 36 tahun
o Jenis kelamin : Perempuan
o Alamat : Pamulang, Tangerang Selatan
o Suku/bangsa : Jawa
o Status pernikahan : Nikah
o Agama : Islam
o Pekerjaan : Swasta
o Diagnosa Medik : Lupus, Gastritis
o Jenis terapi komplementer : Bekam
o Lama pemakaian terapi : 5 bulan
o Terapi medik lainnya : Konsumsi obat anti nyeri dan imunosupresan

II. KELUHAN UTAMA :

Klien mengeluh sesak sejak 3 hari yang lalu, sakit kepala, mudah Lelah ketika
beraktivitas, nyeri seluruh sendiri, seluruh tubuh ngilu, dan mata kanan klien seperti
tertutupi benda hitam
III. RIWAYAT KESEHATAN
A. Riwayat kesehatan sekarang :
o Waktu kejadian, kapan? Jam berapa? : klien sesak napas sejak 3 hari yang lalu,
berawal ketika sedang melakukan aktivitas, klien mengalami gangguan penglihatan
sejak 6 bulan yg lalu
o Bagaimana awal munculnya (tiba-tiba/berangsur-angsur) : tiba-tiba
o Keadaan penyakit (membaik/parah/menetap) : membaik
o Factor pencetus (trauma/infeksi) : infeksi
o Tanggal kejadian :-

B. Riwayat Kesehatan Dahulu

o Pernah dirawat: tidak/ya (kapan, dimana dan sakit apa) : Ya, di RSUD Tebet
karena penyakit lupus

C. Riwayat Operasi:
o Tidak/pernah (kapan, dimana, jenis operasi) : Tidak ada

D. Riwayat Pengobatan : Klien mengkonsumsi obat anti nyeri

selama 5 tahun

IV. RIWAYAT PSIKOSOSIAL

o Cemas/kooperatif/tidak kooperatif : Klien kooperatif

V. RIWAYAT SPIRITUAL
Klien mengatakan suka ikut pengajian di sekitar rumahnya

VI. PEMERIKSAAN FISIK

A. Keadaan umum
o Kesadaran : Composmentis
o BB/TB : 60 kg/ 152 cm
o TTV : 129/85 mmHg, RR 26 x/menit, N : 97 x.menit, S 37.5
 B. Sistem pernafasan
Suara nafas vesikuler, terdapat bantuan otot pernapasan

C. Sistem pencernaan : normal

D. System Saraf : Konsentrasi berkurang

E. Sistem muskuloskeletal : Seluruh persendian terasa nyeri
F. Sistem integument : kulit kemerahan di sekitar peru

G. Mata : Mata kanan mengalami kebutaan

VII. AKTIFITAS SEHARI-HARI

A. Nutrisi : Klien tidak ada pantangan makanan
B. Cairan : Klien mengkonsumsi air putih
C. Eliminasi : BAK 6-7 x/hari, BAB 3 hari sekali
D. Istirahat tidur : 8 jam
E. Personal hygiene : Bersih

VIII. PEMERIKSAAN PENUNJANG

Titik bekam AK 1, 2 Za 5-6, 10-IL, 16-17. Un 10, Ra 6-7, Sa -2

Foto Iridology
IX. ANALISA DATA

Data Subjektif Data Objektif

1. Klien mengeluh sesak sejak 3
hari yang lalu
2. Klien mengeluh cepat lelah
ketika beraktivitas sehari-hari
3. Klien mengatakan nyeri pada
sendi
4. Klien mengatakan mata kanan
seperti tertutup benda hitam
1. TD 130/80mmHg, RR : 25
x/menit, BB 60 kg TB 157 cm
2. Tampak meringis
P : kelelahan dan mempunyai
penyakit lupus
Q : seperti tertusuk
R : sendi lutut
S : 3-4
T : setiap bangun tidur dan
aktivitas

X. DIAGNOSA KEPERAWATAN

Data Masalah Etiologi

DS: Pola Nafas Tidak Penurunan Energi
1. Klien mengeluh Efektif
sesak sejak 3 hari
yang lalu
2. Klien mengeluh
cepat lelah ketika
beraktivitas sehari-
hari
DO :
RR 25 x/menit
DS: Nyeri akut Agen pencedera fisiologis
1. Klien mengatakan
nyeri pada sendi
DO :
1. Tampak meringis
P : kelelahan dan
mempunyai
penyakit lupus
Q : seperti tertusuk
R : sendi lutut
S : 3-4
T : setiap bangun
tidur dan aktivitas
 DS : Gangguan persepsi Gangguan penglihatan
1. Klien mengatakan sensori
mata kanan seperti
tertutup benda hitam
DO :
1. Penurunan lapang
pandang

XI. RENCANA DAN INTERVENSI KEPERAWATAN

Dx SLKI SIKI
1 Pola Napas Manajemen Jalan Napas
Setelah dilakukan tindakan Observasi
keperawatan selama 1x30 menit 1. Monitor pola napas
diharapkan pola napas klien normal, 2. Monitor bunri napas
dengan KH: 3. Monitor sputum
1. Dipsnea tidak ada Terapeutik
2. Penggunaan otot bantu napas 1. Pertahankan kepatenan jalan napas dg
tidak ada head-tilt chin-lift
3. Pemanjangan fase ekspirasi 2. Posisikan semi fowler atau fowler
tidak ada 3. Berikan minum hangat
4. Frekuensi nafas normal 16- Edukasi
20x/menit 1. Anjurkan asupan cairan 2000 ml/hari
jika tidak ada kontraindikasi
Kolaborasi
1. Kolaborasi pemberian bronkodilator
Manajemen Energi
Observasi
1. Identifikasi gangguan fungsi tubuh yang
menyebabkan kelelahan
2. Monitor kelelahan fisik dan emosional
3. Monitor pola dan jam tidur
Terapeutik
1. Sediakan lingkungan nyaman dan
rendah stimulus
2. Berikan aktivitas distraksi yang
menenangkan
Edukasi
1. Anjurkan tidrah baring
2. Anjurkan melakukan aktivitas secara
bertahap
Kolaborasi
1. Kolaborasi dengn ahli gizi tentang cara
meningkatkan asupan makanan
Terapi Bekam
Observasi
1. Periksa riwayat kesehatan
2. Identifikasi kontraindikasi terapi bekam
(mis konsumsi obat pengencer darah)
3. Lakukan pemeriksaan fisik
 Terapeutik
1. Tentukan titik pembekaman
2. Tentukan jenis bekam yang akan
dilakukan (bekam kering/basah)
3. Baringkan pasien senyaman mungkin
4. Buka pakaian pada area yag akan
dilakukan pembekaman
5. Pasang sarung tangan dan alat pelindung
diri lainnya
6. Desinfeksi area yang akann dibekakm
dengan kapas alcohol atau alkoh swab
7. Olesi kulit dengan minyak herbal untuk
meningkatkan peredaran darh
8. Lakukan pengekopan dengan tarikan
secukupnya
9. Lakukan penyayatan pada area yang
telah dilakukan bekam kering
10. Lakukan pengekopan kembali setelah
dilakukan penyayatan
11. Lakukan pembekaman tidak lebih dari 5
menit unutk menghindari hipoksia
jaringan
12. Buka kop dan bersihkan darah yang
tertampung
13. Bersihkan area yang telah dilakukan
pembekaaman
14. Hindari pembekaman pada area mata,
hidung, mulut, areola mamae, dekat
pembuluh darah besar, varises, dan
jaringan luka
15. Lakukan sterilisasi pada alat-alat bekam
yang telah digunakan
Edukasi
1. Jelaskan tujuan dan prosedur terapi
bekam
2. Anjurkan berpuasa sebelum
pembekaman jika perlu
3. Anjurkan tidak mandi 2-3 jam pasca
pembekaman

2. Tingkat nyeri Manajemen Nyeri

Setelah dilakukan tindakan Observasi
keperawatan selama 1x24 jam 1. Identifikasi lokasi, karakteristik, durasi,
diharapkan tingkat nyeri klien frekuensi, kualitas, intensitas nyeri
membaik, dg KH: 2. Identifikasi skala nyeri
1. Keluhan nyeri menurun 3. Identifikais respon nyeri non verbal
2. Tidak meringis dan gelisah 4. Identifikasi factor yang memperberat
3. Frekuensii nadi normal dan memperingan nyeri
Terapeutik
1. Berikn Teknik terapi non farmakologis
 2. Control lingkungan yang memperberta
rasa nyeri
3. Fasiltasi istirahat dan tidur
Edukasi
1. Jelaskan penyebab, periode, dan pemicu
nyeri
2. Jelaskan strategi meredakan nyeri
Kolaborasi
1. Kolaborasi pe,nerian analgetik
3. Fungsi sensori Minimalisasi Rangsangan
Setelah dilakukan tindakan Observasi
keperawatan selama 1x24 jam 1. Periksa status mental, status sensori, dan
diharapkan fungsi sensori klien tingkat kenyamanan
membaik, dg KH : Terapeutik
1. Ketajaman penglihatan 1. Diskusikan tentang toleransi terhadap
membaik beban sensori
2. Batasi stimulus lingkungan
3. Jadwalkan aktivitas harian dan istirahta
Kolaborasi
1. Kolaborasi dalam meminimalkan
prosedur/tindakan

XII. IMPLEMENTASI
1. Melakukan pengkajian alasan dibekam
2. Memeriksa ttv
3. Mengkaji nyeri
4. Menjelaskan prosedur bekam
5. Menyarankan pasien membaca doa “ALLAHUA YASFI”
6. Mengobservasi tindakan bekam pada titik bekam AK 1, 2 Za 5-6, 10-IL, 16-17.
Un 10, Ra 6-7, Sa -2

XIII. EVALUASI
S : Klien mengatakan sesak berkurang, nyeri berkurang, dan lapang pandang membaik
setelah melakukan bekam
O : RR 20 x/menit, tampak tenang

A: Masalah Sesak, Nyeri dan lapang pandang teratasi sebagian

P: Melakukan bekam 10 hari kemudian

Tanggal Pengkajian : Kamis, 21 November 2019

Nama mahasiswa : Dawda Kairaba Kijera

MECHANISME BEKAM (CUPPING THERAPY) TERHADAP NYERI

Journal of Traditional and Complementary Medicine 9 (2019) 90e97

JUDUL: Journal of Traditional and Complementary Medicine (The medical perspective

of cupping therapy: Effects and mechanisms of action)

METODE PENELITIAN: This review focused on theories and hypotheses that explain
mechanisms of cupping therapy from a modern medicine perspective. Theories related to
traditional systems of medicine such as Traditional Chinese Medicine, Unani Medicine or
other traditional healing practices were excluded from this review.

JUMLAH SAMPLE: Articles retrieved were 223 which were reviewed by two independent
assessors and finally both agreed to include 64 studies in this narrative review.

HASIL PENELITIAN: Two hundred twenty three articles were identified and finally 64
studies included in this review. The revealed results signified that certain effects and
outcomes related to cupping therapy might be linked to its possible theoretical and
hypothetical mechanisms of action. Neural, hematological, and immunological effects may
be considered as mechanism of action of cupping.

ARTICLE HISTORY:

Received 25 July 2017

Accepted 12 March 2018

Available online 30 April 2018

CUPPING THERAPY (BEKAM)

Cupping therapy is an ancient method of treatment that has been used in the treatment of a
broad range of conditions. There are many types of cupping therapy; however, dry and wet
cupping are the two main types. Dry cupping pulls the skin into the cup without
scarifications, while in wet cupping the skin is lacerated so that blood is drawn into the cup.

Cupping is a simple application of quick, vigorous, rhythmical strokes to stimulate muscles

and is particularly helpful in the treatment of aches and pains associated with various
diseases.

There is converging evidence that cupping can induce comfort and relaxation on a systemic
level and the resulting increase in endogenous opioid production in the brain leads to
improved pain control. Other researchers proposed that the main action of cupping therapy is
to enhance the circulation of blood and to remove toxins and waste from the body. That could
be achieved through improving microcirculation, promoting capillary endo- thelial cell repair,
accelerating granulation and angiogenesis in the regional tissues, thus helping normalize the
patient's functional state and progressive muscle relaxation.
Many theories have been suggested to explain numerous effects of cupping therapy and its
mechanisms of action. Several re- searchers proposed biological and mechanical processes
associated with the cupping session. For instance, reduction of pain may result from changes
in biomechanical properties of the skin as explained by the “Pain-Gate Theory” (PGT),54
“Diffuse Noxious Inhibitory Controls” (DNICs), and “Reflex Zone Theory” (ZRT).56 Muscle
relaxation, specific changes in local tissue structures and increase in blood circulation could
be explained by the “Nitric Oxide Theory”.

Pain-Gate Theory (PGT)

This theory comprehensively explains how the pain is trans- mitted from the point of its
inception to the brain, and how it is processed in the brain which sends back the efferent,
protective signal to the stimulated or injured area. It is reported that local damage of the skin
and capillary vessels acts as a nociceptive stimulus. This is explanation based on a neuronal
hypothesis whereby cupping influences chronic pain by altering the signal processing at the
level of the nociceptors both of the spinal cord and brain. In support of this clinical effect of
cupping, a systematic review of randomized controlled trials (RCTs) reported that cupping
could be a promising therapy for pain treatment. The “Pain Gate Theory” is one of the most
influential theories of pain reduction. Melzack and Wall (1965)proposed that both thin and
large (touch, pressure, vibration) nerve fibers carry the pain signal from the site of injury to
two destinations in the dorsal horn of the spinal cord however, transmission cells carry the
pain signal to the brain while the inhibitory interneurons impede transmission cell activity.
The activity in both thin and large diameter fibers excites transmission cells. Thin fiber
activity impedes the inhibitory cells (tending to allow the transmission cell) and large
diameter fiber activity excites the inhibitory cells (tending to inhibit transmission cell
activity). So, the more large fiber (touch, pressure, vibration) activity, the less pain is felt. It is
expected that the activation of nociceptors by cupping and other reflex therapies can stimulate
“A” and “C” fibers with involvement of the spino-thalamo-cortical pain pathway. It is noted
that the peripheral nociceptor is sensitized by metabolic factors like lactate, adenosine
triphosphate, and cyto- kines. When a stimulus is applied to the skin, it produces an in- crease
in the number of active receptor-fiber units as information about the stimulus is transmitted to
the brain. Since many larger fibers are inactive in the absence of stimulus change, stimulation
tends to produce a disproportionate relative increase in large fiber over small fiber activity.
Thus, if a gentle pressure stimulus is applied suddenly to the skin, the afferent volley contains
large-fiber impulses which not only fire the “T” cells but also partially close the presynaptic
gate. And if the stimulus intensity is increased, more receptor-fiber units are recruited and the
firing frequency of active units is increased. The resultant positive and negative effects of the
large fiber and small-fiber inputs tend to counteract each other, and therefore the output of the
“T” cells rises slowly. If stimulation is prolonged, the large fibers begin to adapt, producing a
relative increase in small-fiber activity. As a result, the gate is opened further, and the output
of the “T” cells rises more steeply. If the large-fiber steady background activity is artificially
raised at this time by vibration or scratching (a maneuver that overcomes the tendency of the
large fibers to adapt), the output of the cells de- creases. Cupping therapy may alleviate pain
by means of anti- nociceptive effects and by counter irritation. However, at present, it is
unclear to what extent cupping induces such mechanisms. But it is believed that cupping
stimulate pain receptors which lead to increase the frequency of impulses, therefore
ultimately leading to closure of the pain gates and hence pain reduction. So, validation of
such theory by a scientific clinical studies is highly needed.