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JURUSAN FISIOTERAPI
POLITEKNIK KESEHATAN SURAKARTA
KEMENTERIAN KESEHATAN R.I.

MATERI POKOK
FISIOTERAPI NYERI
TEORI FT.4.500 / 3 SKS (7 MODUL)

MODUL 4

FISIOTERAPI PADA NYERI NOSISEPTIF

SOMATIK

Oleh :
SAIFUDIN ZUHRI, SKM, SSt FT, M.
KES

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DAFTAR ISI

Tinjauan Mata Kuliah

Modul 1 : Fisioterapi Pada Nyeri Kronis

Pendahuluan .....................................................................................................
................................................. 4
Kegiatan Belajar 1 : Nyeri
Kronis........................................................................
......................................... 6
Latihan .................................................................................
..................................... 12
Rangkuman ..........................................................................
................................... 12
Tes Formatif
1 ........................................................................................................... 13
Kegiatan Belajar 2 : Fisioterapi Pada Nyeri
Kronis ............................................................................ 13

Latihan ....................................................................................................
................. 18

Rangkuman ......................................................................................................
...... 20
Tes Formatif
2 ......................................................................................................... 23

Kunci Jawaban Tes

Formatif ............................................................................................................
............ 24
Glosarium .........................................................................................................
.................................................. 24
Daftar
Pustaka .............................................................................................................
................................... 25

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PENDAHULUAN
TINJAUAN MATA KULIAH

Fisioterapi Nyeri merupakan mata kuliah Fisioterapi yang membahas khusus

fisioterapi pada kondisi nyeri berisi tentang patofisiologi gangguan, kelainan,
problem nyeri meliputi: nyeri akut, nyeri kronis, nyeri nosiseptif (somatik &
viseral), nyeri neuropati, dan kondisi khusus nyeri myofascial.

Ruang lingkup Fisioterapi Nyeri meliputi penerapan teknologi fisioterapi

dimulai dari pemeriksaan, penentuan problematik, penentuan dan rencana
fisioterapi, pelaksanaan, evaluasi sampai prognosis fisioterapi.

Mata Kuliah ini mempunyai bobot 3 SKS yang dikemas dalam 7 modul yang
dibuat sedemikian rupa sehingga anda akan terbantu dalam memahami
penatalaksanaan fisioterapi pada kasus nyeri. Setelah menyelesaikan mata
kuliah ini, diharapkan Anda sudah mampu memahami, menjelaskan, dan
menerapkannya dalam persiapan profesi Anda sebagai Fisioterapis, yang
berperan aktif dalam ranah gerak dan fungsi tubuh manusia yang optimal.

Modul 1 menghantar Anda untuk mengenal dan memahami tentang

kelainan/gangguan (problematik) nyeri dan manajemen fisioterapi pada nyeri
secara umum.

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Modul 2 menghantar Anda untuk lebih memahami proses fisioterapi dimulai

dari pengkajian sampai dengan pendokumentasian, prognosis
penatalaksanaan fisioterapi pada nyeri akut.

Modul 3 menghantar Anda untuk lebih memahami proses fisioterapi dimulai

dari pengkajian sampai dengan pendokumentasian, prognosis
penatalaksanaan fisioterapi pada nyeri kronis.

Modul 4 menghantar Anda untuk lebih memahami proses fisioterapi dimulai

dari pengkajian sampai dengan pendokumentasian, prognosis
penatalaksanaan fisioterapi pada nyeri nosiseptik somatik

Modul 5 menghantar Anda untuk lebih memahami proses fisioterapi dimulai

dari pengkajian sampai dengan pendokumentasian, prognosis
penatalaksanaan fisioterapi pada nyeri nosiseptik viseral.

Modul 6 menghantar Anda untuk lebih memahami proses fisioterapi dimulai

dari pengkajian sampai dengan pendokumentasian, prognosis
penatalaksanaan fisioterapi pada nyeri neuropati.

Modul 7 menghantar Anda untuk lebih memahami proses fisioterapi dimulai

dari pengkajian sampai dengan pendokumentasian, prognosis
penatalaksanaan fisioterapi pada nyeri myofascial.

Apabila Anda telah menyelesaikan Mata Kuliah ini, maka diharapkan Anda
telah mampu untuk:
 Menjelaskan tentang kelainan, gangguan dan kondisi nyeri
 Menjelaskan tentang bentuk-bentuk problematik nyeri
 Menjelaskan tentang manajemen fisioterapi pada nyeri
 Menjelaskan tentang penentuan problematic fisioterapi pada nyeri
akut, nyeri kronis, nyeri nosiseptif (somatik & viseral), nyeri neuropati
& kondisi khusus nyeri myofascial
 Menjelaskan tentang tujuan dan rencana terapi pada kasus nyeri
 Menjelaskan tentang pelaksanaan terapi pada kasus nyeri
 Menjelaskan tentang evaluasi dan dokumentasi terapi pada kasus nyeri

Perlu Anda ketahui, bahwa modul ini bukan sumber yang berisi penuh
dengan materi yang seharusnya Anda ketahui. Terkait hal itu maka
pembelajaran Anda dari materi-materi sejenis yang berasal dari sumber-
sumber lain sangat disarankan.
Selain itu, modul ini bukan model pembelajaran jarak jauh yang tidak pernah
bertatap muka dengan dosen, maka materi yang disampaikan dosen saat
tatap muka (yang mengikuti ketentuan 14 X pertemuan per semester

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ditambah 2 pertemuan untuk UTS dan UAS sangat perlu diperhitungkan,

termasuk nilai afektif.

MODUL 4
FISIOTERAPI PADA NYERI NOSISEPTIF SOMATIK
PENDAHULUAN
Modul ini membantu Anda untuk memahami lebih lanjut penatalaksanaan
Fisioterapi pada nyeri nosiseptif somatik
Setelah menyelesaikan modul ini, diharapkan Anda mampu menjelaskan:
1. Kelainan atau gangguan nosiseptif somatik
2. Bentuk-bentuk problematik atau jenis kasus- kasus nyeri nosiseptif
somatik
3. Penanganan kasus nyeri nosiseptif somatik
4. Proses pengkajian Fisioterapi pada nyeri nosiseptif somatik
5. Penentuan problematika Fisioterapi nyeri nosiseptif somatik
6. Penentuan tujuan dan rencana penatalaksanaan fisioterapi pada nyeri
nosiseptif somatik

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7. Pelaksanaan Fisioterapi pada nyeri nosiseptif somatik

8. Evaluasi, dokumentasi dan prognosis pada nyeri nosiseptif somatik

KEGIATAN BELAJAR 1
NYERI NOSISEPTIF SOMATIK

A. Types of Pain
1. Nociceptive Pain
 An appropriate
 Physiologic response to painful stimuli
2. Neuropathic Pain
 An inappropriate response caused by a dysfunction in the nervous system

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The Erlanger/Gasser classification of peripheral nerve fibres (1939)

Avg.  Avg. C.V.

Type Function
( m) (m/s)

A Primary muscle-spindle afferent, motor to

15 70-120
skeletal muscles
A Cutaneous touch and pressure afferents 8 30-70

A Motor to muscle spindles 5 15-30

A Cultaneous temperature and pain afferents <3 12-30
B Sympathetic pre-ganglionic 3 3-15

C Cutaneous pain afferents, sympathetic post- 0.5-2

1.0
ganglionic(unmyelinated)
Characteristics of pulpal sensory fibres (Trowbridge and Kim, 1991)

Location of Stimulation
Type Myelination Pain characteristics
terminal threshold

Principally in
A Yes region of pulp- Sharp, pricking Relatively low
dentine junction

Probably Burning, aching, less Relatively high,

C No distributed bearable than A fibre usually associated
throughout pulp sensations with tissue injury

B. Nociceptive first order neuron

1. Mechanothermal afferents
A delta fibers c.v. 12-18 m/s response to heat and mechanical stimuli
2. Polymodal afferents
C fiber c.v. 0.5 m/s response to mechanical, heat and chemical stimuli
3. High-threshold mechanoreceptive afferents
mostly A delta response to mechanical, noxious thermal and chemical stimuli

C. Various Descriptors of Pain

1. Somatic pain: caused by the activation of pain receptors in either the
cutaneous (the body surface) or deeper tissues (musculoskeletal tissues).

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2. Visceral pain: pain that is caused by activation of pain receptors from

infiltration, compression, extension or stretching of the thoracic, abdominal or
pelvic viscera.
3. Neuropathic pain
D. Pain
1. Superficial Pain
 Sharp, pricking sensation
 brief duration(<min.)
 1st pain or initial pain
2. Deep pain
 Dull, aching, burning, diffuse,
 long duration (min., hrs., days)
 second pain
E. Sensory Receptors

F. Neural Transmission
1. Afferent nerve fibers transmit impulses from the sensory receptors toward the
brain
2. Efferent fibers such as motor neurons transmit impulses from the brain toward
the periphery

G. Neural Transmission (First Order Neurons)

First order or primary afferents transmit impulses from the sensory receptor to the
dorsal horn of the spinal cord

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1. Four different types of first order neurons

a. A
b. A
c. A
d. C
2. A and A fibers are characterized as being large diameter afferents and A and
C fibers as small diameter afferents
3. Afferent First Order Neurons

H. Neural Transmission (Second Order Neurons)

1. Second order afferent fibers carry sensory messages from the dorsal horn to the
brain

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2. Second order afferent fibers are categorized as wide dynamic range or

nociceptive specific

3. Wide dynamic range second order afferents receive input from A, A and C
fibers.
4. Second order afferents serve relatively large, overlapping receptor fields
5. Nociceptive specific second order afferents respond exclusively to noxious
stimulation
Receive input only from A and C fibers

I. Neural Transmission (Third Order Neurons)

1. All of these neurons synapse with third order neurons which carry information to
various brain centers where the input in integrated, interpreted and acted upon

J. Facilitators and Inhibitors of Synaptic Transmission

1. For information to pass between neurons, a transmitter substance must be
released from one neuron terminal-enter the synaptic cleft- and attach to a
receptor site on the next neuron
2. This was thought to occur due to chemicals called neurotransmitters
3. Several compounds which are not true neurotransmitters can facilitate or inhibit
synaptic activity.
a. Biogenic amine transmitters
i. Serotonin- active in descending pathways
ii. Norepinephrine- inhibits pain transmission between 1st
&2nd order neurons
b. Neuroactive peptides
i. Substance P- from small-diameter primary afferent neurons
ii. Enkephalins - opiod active in descending pathways

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iii. ß-endorphin- opiod endogenous to CNS

K. Nociception
1. A nociceptive neuron is one that transmits pain signals
2. Once released substance P initiates electrical impulses along afferent fiber
toward spinal cord
3. Substance P is also a transmitter substance between 1st & 2nd order afferent
fibers
4. A and C fibers transmit sensations of pain and temperature (A fibers are
larger)
5. A neurons originate from receptors located in skin and transmit “fast pain”
6. C neurons originate from both superficial tissue (skin) and deeper tissue
(ligaments and muscle) and transmit “slow pain”

L. Mechanisms of Pain Control

1. Gate Control Theory
 Information from ascending A afferents and (pain messages) carried along
A and C afferent fibers enter the dorsal horn.
 Impulses stimulate the substantia gelatinosa at dorsal horn of the spinal
cord inhibiting synaptic transmission in A & C fiber afferent pathways
Sensory information coming from A fibers is transmitted to higher centers
in brain
 “Pain message" carried along A & C fibers is not transmitted to second-
order neurons and never reaches sensory centers

2. Descending mechanisms(Central Biasing)

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 Stimulation of descending pathways in the dorsolateral tract of the spinal

cord by A and C fiber afferent input results in a “closing of the gate” to
impulses carried along the A and C afferent fibers.
 It is theorized that previous experiences, emotional influences, sensory
perception, and other factors could influence transmission of pain message
and perception of pain
 Ascending neural input from A and C fiber afferents and possibly central
biasing stimulates periaquductal grey region in midbrain which stimulates
raphe nucleus in pons and medulla thus activating descending mechanism in
dorsolateral tract
 Efferent fibers in dorso- lateral tract synapse with enkephalin interneurons
 Serotonin is a neuro-transmitter
 Interneurons release enkephalin into the dorsal horn, inhibiting the synaptic
transmission of impulses to second-order afferent neurons
 A second descending, pathway projecting from the pons to the dorsal horn
has been identified
 Thought to inhibit transmission due to release of norepinephrine

3. Release of endogenous opioids (ß-endorphin)

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 Stimulation of A and C afferents can stimulate release of endogenous opioid

ß-endorphin from hypothalamus
 Dynorphin released from periaqueductal grey

4. Pain relief may result from combination of these 3 mechanisms

M. Mechanisms of Pain Control

1. The theories presented are only models
2. Pain control is the result of overlapping mechanisms
3. Useful in conceptualizing the perception of pain and pain relief

LATIHAN

Pilihlah satu jawaban yang Anda anggap paling tepat dengan cara melingkari salah
satu jawaban (A, B, C, D atau E) yang tersedia.

1. Nyeri nosiseptif dengan anti-nociceptive modulation yang timbul adalah….

a. analgesia
b. disestesia
c. hiperestesia
d. hiperalgesia
e. allodynia

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2. Berikut merupakan nyeri nosiseptif, kecuali :

a. nyeri yang di sebabkan oleh adanya stimuli noksius.
b. nyeri diklasifikasikan menjadi nyeri viseral, nyeri somatik
c. pada nyeri nosiseptik system saraf nyeri berfungsi secara normal
d. tidak ada hubungan yang jelas antara persepsi dan intensitas stimuli
e. nyeri terjadi adalah fisiologis

3. Jenis rasa sakit yang dirasakan ketika terbakar, terkilir pergelangan kaki, atau kaki.
Berupa nyeri tumpul atau tajam, dapat ringan sampai berat, merupakan nyeri...
a. Visceral
b. kronis
c. akut
d. neuropathic
e. nociceptive

Petunjuk untuk menjawab Latihan

Sebelum Anda menjawab soal-soal latihan, terlebih dahulu pelajarilah dengan seksama
dan secara urut Kegiatan Belajar 1 dari awal sampai dengan akhir. Dengan cara seperti
itu Anda dapat menjawab soal-soal pada bagian latihan ini. Untuk memastikan apakah
jawaban Anda benar, cocokkan jawaban Anda dengan Kunci Jawaban Latihan di bawah
ini.

Kunci Jawaban Latihan:

1. A
2. D
3. E
RANGKUMAN

a. nyeri nosiseptif adalah nyeri yang disebabkan karena suatu respon inflamasi
atau non inflamasi akibat adanya stimulus noxious.
b. Nyeri superfisial memiliki jenis nyeri tajam dan sensasi tertusuk, durasinya
singkat, rasa nyeri yang pertama dirasakan.
c. Nyeri dalam terasa tumpul, terbakar, menyebar, durasinya panjang, terasa
setelah nyeri pertama.
d. First order neurons adalah saraf yang mengirim implus dari reseptor sensoris ke
dorsal horn pada spinal cord.
e. Second order neurons adalah serabut aferent yang membawa pesan sensoris
dari dorsal horn ke otak.
f. Semua sinaps neuron dengan third order neurons membawa informasi ke pusat
otak lalu ditafsirkan dan ditindak lanjuti.

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TES FORMATIF I

Pilihlah satu jawaban yang Anda anggap paling tepat dengan cara melingkari salah
satu jawaban (A, B, C, D atau E) yang tersedia.

1. Karakteristik nyeri somatik dalam adalah…

a. tumpul, kurun waktu panjang dan second pain
b. tumpul, kurun waktu pendek dan initial pain
c. tumpul, kurun waktu pendek dan second pain
d. tajam, kurun waktu pendek dan initial pain
e. tajam, kurun waktu panjang dan initial pain

2. Berikut adalah gambaran dari deep pain, kecuali…

a. sensasi tumpul
b. seperti rasa terbakar
c. difus
d. durasi lama
e. sensasi tertusuk

3. Berikut ini adalah algogenic agent pada fase inflamasi kecuali

a. Proton
b. Prostaglandin
c. Serotonin
d. Bradikinin
e. Histamin

4. Berikut ini adalah jenis serabut tipe polymodal.........

a. Serabut saraf C
b. Serabut saraf A delta
c. Serabut saraf A beta
d. Semua diatas benar
e. Semua diatas salah

Cocokkanlah jawaban Anda dengan Kunci Jwaban Tes Formatif (Kegiatan Belajar I –
Modul 1) yang terdapat pada bagian akhir Modul 1 ini, Hitunglah jumlah jawaban Anda
yang benar, kemudian gunakanlah rumus di bawah ini untuk mengetahui tingkat
penguasaan Anda terhadap materi Kegiatan Belajar 1 – Modul 1 ini.

Rumus:
Jumlah jawaban Anda yang benar
Tingkat penguasaan = -------------------------------------------- X 100 %
Jumlah soal pada Tes Formatif

Arti penguasaan yang Anda capai:

90 % - 100 % = Baik Sekali
80 % - 89 % = Baik

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70 % - 79 % = Cukup
< 70 % = Kurang

Kalau Anda mencapai tingkat penguasaan 80 % ke atas, bagus! Anda dapat

melanjutkan ke Kegiatan Belajar 2. Tetapi apabila tingkat penguasaan Anda masih di
bawah 80 %, Anda masih harus mengulang Kegiatan Belajar 1, terutama pada bagian
yang belum Anda kuasai.

KEGIATAN BELAJAR 2
FISIOTERAPI PADA NYERI NOSISEPTIF SOMATIS

A. Pain assessment
 Self report is the best reflection of pain.
 Pain is a complex phenomenon which is difficult to evaluate and quantify
because it is subjective
 Thus obtaining an accurate and standardized assessment of pain is problematic

1. ANAMNESIS : Intensity, Identify type of pain, Location, Onset, Duration,

Radiation, Exacerbatio, Alleviation.
2. Inspection : any scar, pulsation, swelling, redness, discharge, asymmetry, hair
distribution, ulcers, wound, etc.
3. Palpation : superficial palpation for masses, tenderness & deep palpation for
deep masses.
4. Percution : to differentiate between air & solid surfaces.
5. Auscultation : by use stethoscope to hear normal & abnormal sounds.
6. Intervention:
a. Pain Management, therapeutic modalities can be used to
 Stimulate large-diameter afferent fibers( TENS, massage, analgesic
balms)
 Decrease pain fiber transmission velocity (cold, ultrasound)
 Stimulate small-diameter afferent fibers and descending pain control
mechanisms (accupressure, deep massage, TENS)
 Stimulate release of endogenous opioids through prolonged small
diameter fiber stimulation with TENS

b. Goals In Managing Pain

 To control acute pain and protect patient from further injury while
encouraging progressive exercise in a supervised environment.
 Reducing pain is an essential part of treatment
 Encourage body to heal through exercise designed to progressively
increase functional capacity and to return the patient to work, recreational
and other activities as swiftly and safely as possible

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7. Evaluasi
8. Dokumentasi
Alat ukur nyeri

Gambar Asesmen kondisi nyeri

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Cotoh kasus nyeri nosiseptif somatis pada bahu

 Shoulder pain is an extremely common complaint, and there are many common
causes of this problem.
 It is important to make an accurate diagnosis of the cause of your symptoms so
that appropriate treatment can be directed at the cause.
 The main joint in the shoulder is formed by the arm bone and the shoulder blade.
 The joint socket is shallow, allowing a wide range of motion in the arm.
 The rotator cuff is made up of 4 muscles that surround the arm bone.
 This cuff keeps the shoulder steady as the arm moves.
 The rotator cuff comprise (supraspinatus, infraspinatus, teres minor,
subscapularis).
 A common cause of shoulder pain is soreness of the tendon of the rotator cuff.
 Another common cause is soreness of the subacromial bursa (a sac of fluid
under the highest part of the shoulder).

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 might have soreness after activities such as painting, lifting or playing a

sport, which require someone to lift his arms.
 may not remember any specific injury.

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some common causes

 Bursitis / Rotator Cuff Tendoniti
 Rotator Cuff Tear
 shoulder bursitis/impingement syndrome
 Frozen Shoulder(periarthritis or adhesive capsulitis)
Calcific Tendonitis
 Shoulder Instability
 Shoulder Dislocation
 Biceps Tendon Rupture
 Arthritis
 Others
Rotator Cuff Tears
 Rotator cuff tear is a common cause of pain and disability in the adult population.
 Rotator cuff tear is most common in people who are over the age of 40.
 It may occur in younger patients following acute trauma or repetitive overhead
work or sports activity.
 A cuff tear may also happen with another injury to the shoulder, such as a
fracture or dislocation
 The rotator cuff helps to lift and rotate the arm and to stabilize the ball of the
shoulder within the joint.
 Most tears occur in the supraspinatus but other parts of the tendon may be
involved

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Symptoms
 Symptoms of a rotator cuff tear may develop acutely or have a more gradual
onset.
 commonly, the onset is gradual and may be caused by repetitive overhead
activity or by wear and degeneration of the tendon.
 You may feel pain in the front of your shoulder that radiates down the side of your
arm.
 At first the pain may be mild and only present with overhead activities such as
reaching or lifting.
 It may be relieved by medication such as aspirin or ibuprofen.
 Over time the pain may become noticeable at rest or with no activity at all.
 There may be pain when you lie on the affected side and at night.
 Other symptoms may include stiffness and loss of motion.
 may have difficulty using arm to reach overhead to comb hair or difficulty placing
behind your back to fasten a button.
 When the tear occurs with an injury, there may be sudden acute pain, a snapping
sensation and an immediate weakness of the arm.
Common examples
 Workers who do overhead activities such as painting, stocking shelves or
construction
 Athletes such as swimmers, pitchers and tennis players

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Diagnosis
 Diagnosis of a rotator cuff tear is based on symptoms, examination, X-rays, and
imaging studies such as MRI (magnetic resonance imaging).
 examine shoulder to see if it is tender in any area or if there is a deformity.
 measure the range of motion of shoulder in several different directions and test
the strength of arm.
 The doctor will also check for instability and problems with the (acromioclavicular)
joint.
Rule out
 also examine neck to make sure that ones pain is not coming from a "pinched
nerve" in cervical spine
 to rule out other conditions such as osteoarthritis or rheumatoid arthritis.
Some of the signs of a rotator cuff tear
 Atrophy or thinning of the muscles about the shoulder
 Pain when someone lift his arm
 Pain when someone lower his arm from a fully raised position
 Weakness when someone lift or rotate his arm
 crackling sensation when someone move his shoulder in certain positions
 Plain X-rays of a shoulder with a rotator cuff tear are usually normal or show a
small spur.
 ultrasound or MRI.
 An MRI can sometimes distinguish between a full thickness (complete) tear of the
tendon and a partial tear.
 It can show the doctor if the tear is within the tendon itself, or if the tendon is
detached from bone.
 In some circumstances, an Arthrogram, in which local anaesthetic and dye is
injected into the joint, may also be helpful.
Treatment Options
 pain relief
 improve the function of shoulder.
 It may take several weeks or months to restore the strength and mobility to ones
shoulder.
 Rest and limited overhead activity
 Use of a sling
 Anti-inflammatory medication
 Steroid injection
 Strengthening exercise and physical therapy
Teknologi Fisioterapi
 After surgery, the arm is immobilized to allow the tear to heal.
 The length of immobilization depends upon the severity of the tear.
 You will be given an exercise program to help regain motion and strength in the
shoulder.
 This begins with passive motion.
 It advances to active and resistive exercises.

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 Complete recovery may take several

LATIHAN

Pilihlah satu jawaban yang Anda anggap paling tepat dengan cara melingkari salah
satu jawaban (A, B, atau C) yang tersedia.
1. Pada mekanisme pengurangan nyeri melalui descending pathway, dynorphin
release di....
a. PHC
b. eticular formation
c. periaquaductal grey
d. hypothalamus
e. talamus

2. Neurotransmiter yang mempengaruhi jalur nyeri

a. serotonin
b. GABA
c. glutamate
d. substance P
e. benar semua

3. Mediator kimia yang hanya berperan pada nyeri dengan kerusakan jaringan atau
inflamasi yang menyebabkan sensitisasi reseptor nyeri terhadap stimulasi mekanik
dan kimiawi adalah…
a. bradikinin
b. leukotrien
c. histamine
d. prostaglandin
e. 5-HT

Petunjuk untuk menjawab Latihan

Sebelum Anda menjawab soal-soal latihan, terlebih dahulu pelajarilah dengan seksama
dan secara urut Kegiatan Belajar 1 dari awal sampai dengan akhir. Dengan cara seperti
itu Anda dapat menjawab soal-soal pada bagian latihan ini. Untuk memastikan apakah
jawaban Anda benar, cocokkan jawaban Anda dengan Kunci Jawaban Latihan di bawah
ini.
Kunci Jawaban Latihan:
1. C
2. D
3. D

RANGKUMAN

TES FORMATIF 2

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Pilihlah satu jawaban yang Anda anggap paling tepat dengan cara melingkari salah
satu jawaban (A, B, C, D atau E) yang tersedia.

1. Seorang pasien datang dengan raut wajah menahan sakit , kedua alis mendekat
dan meneteskan air mata, jika diukur dengan skala wong baker termasuk
kategori...............
a. hurt little bit
b. hurt little more
c. hurt even more
d. hurt whole lot
e. hurt worst

2. Berikut ini adalah hal yang perlu ditanyakan pada pasien kaitnya dengan kasus
nyeri.....
A. Tipe nyeri
B. Location
C. Intensitas nyeri
D. Onset nyeri
E. Semua benar

Cocokkanlah jawaban Anda dengan Kunci Jwaban Tes Formatif (Kegiatan Belajar I –
Modul 1) yang terdapat pada bagian akhir Modul 1 ini, Hitunglah jumlah jawaban Anda
yang benar, kemudian gunakanlah rumus di bawah ini untuk mengetahui tingkat
penguasaan Anda terhadap materi Kegiatan Belajar 1 – Modul 1 ini.

Rumus:
Jumlah jawaban Anda yang benar
Tingkat penguasaan = -------------------------------------------- X 100 %
Jumlah soal pada Tes Formatif

Arti penguasaan yang Anda capai:

90 % - 100 % = Baik Sekali
80 % - 89 % = Baik
70 % - 79 % = Cukup
< 70 % = Kurang

Kalau Anda mencapai tingkat penguasaan 80 % ke atas, bagus! Anda dapat

melanjutkan ke Kegiatan Belajar 2. Tetapi apabila tingkat penguasaan Anda masih di
bawah 80 %, Anda masih harus mengulang Kegiatan Belajar 1, terutama pada bagian
yang belum Anda kuasai.

KUNCI JAWABAN TES FORMATIF

Tes Formatif pada Kegiatan Belajar 1 – Jawaban yang benar:

1. A jelas

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2. E jelas
3. C jelas
4. A jelas

Tes Formatif pada Kegiatan Belajar 2 – Jawaban yang benar:

1. E jelas
2. E jelas

GLOSARIUM
Serotonin adalah neurotransmiter otak yang dapat membantu memperbaiki
suasanan hati dan mengurangi kesedihan atau depresi
GABAadalah asam amino yang memiliki fungsi utama sebagi neurotransmiter
disistem saraf pusat. Asam gamma amino butirat menghambat transmisi saraf
diotak dan menenangkan ativitas saraf.
Glutamate adalah neurotransmiter yang paling umum di sistem saraf pusat yang
jumlahnya kira-kira separuh dari semua neuron di otak berfusi dalam hal memori.
Polymodal afferents adalah nosiseptor yang berespon terhadap semua jenis
rangsangan yang merusak termasuk iritasi zat kimia yang dikeluarkn dari jaringan yang
cedera.
DAFTAR PUSTAKA

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