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ASUHAN KEPERAWATAN

PRE-OPERATIF
Oleh:

Yohanes Wahyu Nugroho


Sub Bag KDM
Giri Satria Husada

SKENARIO I
Ny Harti , 30 th , penjual bensin eceran ,
mengalami luka bakar derajat II 20% di bagian
tangan dan wajah, derajat III 12% pada dada,
akibat depot bensinnya terbakar , dokter
merencanakan untuk melakukan operasi skin
graft pada klien dan telah ditentukan operasi
akan dilakukan 2 hari lagi. Ny. Harti dirawat di
ruang klas 3 yang berisi 4 pasien. Sehari
sebelum operasi , suaminya menolak
menandatangani surat persetujuan operasi
dan mengatakan pada perawat bahwa istrinya
mau dirawat dirumah saja.

Pertanyaan :
Menurut anda apa penyebab penolakan
keluarga klien untuk dilakukannya operasi?

Peri-operative

Pre-operative:

Intra-operative:

care that occurs before surgery


care that occurs during surgery

Post-operative:

care that occurs after surgery

Classifications of Surgery

Emergency

Urgent

hemorrhage
within 24-30 hours
ruptured appendix, ovarian cyst

Required

need surgery within next weeks or


months
cataracts

Classifications of Surgery Cont

Elective

should have done


hernia repair

Optional

not necessary
cosmetic

Classifications of Surgery Cont

Elective

should have done


hernia repair

Optional

not necessary
cosmetic

Classifications based on the aim


Diagnostic

(untuk mengetahui
penyebab dan menentukan
tindakan selanjutnya)
Kuratif (menghilangkan
penyebab)
Paliatif (daily activity, dan
memperpanjang harapan hidup)

Suffixes common to surgical


procedures

Ectomy: remove

Otomy: open

appendectomy
laparotomy

Oscopy: via scope

arthroscopy

Tiga hal penting yang terkait dengan


pembedahan:
1. PASIEN
2. Penyakit
3. Pembedahan
Pasien merupakan unsur yang paling
penting
Manusia mahluk yang unik
Manusia berakal budi
Mahluk bio-psiko-sosio-spiritual

Tindakan pembedahan menimbulkan


trauma:
Fisik dan Psikis

Membutuhkan persiapan yang baik

Peran dan fungsi perawat

Your role as a nurse

Be cautious
Be careful in
preparing patient for
theatre
Reflect, think
Check
Double check
Double Double check
ASK if in doubt
Protect your patient

Pre Operative Nursing Care

During the pre-operative period, a


number of assessment documents
must be completed. We will review
these in the lab. These
documents/records are common to
all facilities, but are personalize to
each

PERAWATAN PREOPERATIF
Persiapan Pre-operasi:

Fisik
Mental
Penunjang
Persiapan yang baik akan
mempengaruhi tingkat keberhasilan
operasi di samping faktor-faktor lain,
seperti: usia, status nutrisi, penyakit
kronis, dsb.

Pre operative nursing care

Pre op care begins when the decision is


taken for surgery
Preoperative care by the nurse involves:
Psychological care
Physical Care
Emotional care
Patient teaching
Identifying fears and concerns
Answering questions
Providing information

Pre operative nursing care

Assessing patient understanding of


operation and pre & post op events
Informing patient
Assessing perceptions
Allaying misinformation % misconceptions
Emotional
Individual stress & stressors
FEAR :
Unknown / pain / loss of control / change in
body image / incapacity / disfigurement /
absence from work / death

Persiapan Fisik
Status

kesehatan fisik umum


Status nutrisi
Keseimbangan cairan dan elektrolit
Personal hygiene
Pencukuran daerah operasi - dualisme
Pengosongan kandung kemih

Kondisi fisiologis mempengaruhi


proses pembedahan

Immediate pre op preparation

Fasting / dependent on anaesthetic


How long for
Nasogastric tube
Enema / suppositories; Urethral catheter
Skin preparation / ward / theatre
Bath / shower / gown / pants
Teeth / dentures / crowns / loose teeth /
focal infection
Hair / cap
Jewellery / nail polish / make up / prostheses
/ ID band

Rationale for pre op care

Prepare and have patient in


best physical / pschological
state for surgery
Predict and prevent post op
complications
Patient safety during
surgery
Team effort: nurses in and
ward theatre & Medical
staff
Can we ever make
mistakes?

Persiapan Mental

Tindakan pembedahan merupakan ancaman


potensial maupun aktual pada integritas
seseorang yang dapat membangkitkan
reaksi stres fisiologis maupun psikologis
(Long, 1989)
Penyebab kecemasan pasien menghadapi
pembedahan, yaitu:
takut terhadap nyeri yang akan dialami
takut akan keganasan
takut menghadapi ruang operasi dan
alat bedah
takut operasi gagal - cacat
takut meninggal di meja operasi

Pre operative nursing care

Allowing time for patient to express


anxiety
Ignorance causes more fear than the
facts
Many units : theatre nurse visit
fear of unknown
Where to return: ICU / Ward?

Hal-hal yang perlu digali untuk mengantisipasi


masalah kecemasan pasien antara lain:
pengalaman operasi pasien
pengertian pasien tentang tujuan
operasi
pengetahuan pasien tentang persiapan
operasi
pengetahuan pasien tentang kondisi
kamar operasi
pengetahuan pasien tentang prosedur
peri-operatif
pengertian yang salah/keliru tentang
pembedahan
faktor pendukung/support system

Persiapan Penunjang
1. * Radiologi: foto thorax, abdomen dll
* USG
* CT. Scan
* MRI
* BNO - IVP
* Colon in Loop
* EKG
* ECHO
* Pemeriksaan Laboratorium:
Dr. Kd; Faal Hati, Ginjal,elektrolit,
Fgs
Perdrhan,kadar Gula

2. Inform Consent
Penjelasan operasi dokter
persetujuan tindakan medis
persetujuan tindakan anestesi

Diagnosa keperawatan pre-operatif


yang mungkin terjadi:

Knowledge deficit related to the


perioperatif experience
anxiety and fear related to the
perioperatif experience
sleep pattern disturbance related to fear
of impending surgery
ineffective individual coping related to
stress of impending surgery
anticipatory grieving related to effect of
surgery
body image disturbance related to
anticipated changes in body appearance
or function

Patient Education

Assessing learning needs


Discussing diagnostic tests
Calming fears about anesthesia
Discussing diet and family visits
Reviewing operating room procedure
Explaining I.V tubes and drains
Preparing the patient for recovery
Controlling pain
Performing post-operative exercises

Transportasi klien

Bertujuan untuk mentransfer


klien dari ruang rawat ke
kamar bedah scr aman

Thank you
Terima Kasih

Quiz.
1.
2.
3.
4.
5.
6.

Klasifikasi pembedahan,jelaskan
Alasan persiapan pre-operasi
Persiapan fisik
Persiapan mental
Persiapan penunjang
Persiapan intermediate