Manajemen Keperawatan

Pada Kasus Covid-19

dan Efektifitas Prone Position
Oleh :
Puji Raharja Santosa

Dalam Webinar Keperawatan November 2020

Tak kenal maka tak sayang...
Puji Raharja Santosa
Yogyakarta
akbarathallah3@gmail.com

Mobile phone :
0838 1500 1102
 Outline
• Pendahuluan
• Anatomi Saluran Pernafasan
• Overview Covid-19
• Manajemen Keperawatan
• Efektivitas Prone Position
• Kesimpulan
 Tujuan
• Mampu meningkatkan pengetahuan bagi
perawat/mahasiswa perawat terutama pada
kasus covid-19 dengan tindakan prone
position.
• Mampu mencegah kegawatdaruratan
respirasi
 Pendahuluan
• 31 Desember 2019 disebutkan terdapat kasus kluster
pneumonia dengan etiologi tidak jelas di kota
Wuhan, Hubei, China.
• 30 Januari 2020, WHO menetapkan sebagai Public
Health Emergency of International Concern (PHEIC).
• 12 Pebruari 2020, WHO menetapkan sebutan
penyakit Novel Corona Virus Disease (nCOVID-19).
• 2 Maret 2020, di Indonesia dilaporkan 2 kasus
konfirmasi Covid-19.

• 11 Maret 2020, WHO menetapkan Covid-19 sebagai Pandemi.

Data Wikipedia, 27 November 2020
@pandemictalk
• Semakin tidak terkendali
“New Case Daily Record
“ 5.828 Cases.
• New Death Daily Record
169 Deaths.
• 242 Kasus baru/jam
• 7 kematian/jam
Sumber : Kemenkes, 27
November 2020.
• COVID-19, Kapan
berlalu?
Anatomi Sal. Pernafasan Bawah
Anatomi Sal. Pernafasan Bawah
 Covid-19
• Tanda dan gejala umum :
 Demam > 38 ⁰ C, batuk dan sesak nafas.
 Rata-rata inkubasi 5 – 6 hari (terpanjang 14
hari).
• Kasus berat menimbulkan pneumonia
(infiltrat luas di kedua paru), sindrom
gangguan pernafasan akut/ARDS, syok septik,
DIC, asidosis metabolik, gagal ginjal, kematian.
• Penularan melalui kontak erat dan droplet (percikan
batuk, ludah), masih dimungkinkan melalui udara/Airborn
(pada tindakan yang menimbulkan aerosol).
• Orang berisiko adalah kontak erat, salah satunya tenaga
kesehatan.
• Mencegah penyebaran infeksi :
 Cuci tangan dengan sabun, air bersih.
 etika batuk, bersin; hindari kontak langsung.
 Faskes mengikuti standar PPI.
• Pembaruan pedoman dapat diakses pada situs
www.infeksiemerging.kemkes.go.id.
Pebruari – Awal Juli 2020, Kategori Covid-19:
o Pasien dalam Pengawasan (PDP)
o Orang Dalam Pemantauan (ODP)
o Orang Tanpa Gejala (OTG)
o Kasus Konfirmasi
 Komplikasi
• Pneumonia ringan
• Pneumonia berat/ISPA berat
• ARDS
• Sepsis, Septik syock
• Kematian
Managemen Keperawatan
Masalah Keperawatan
 Masalah Keperawatan

Gangguan Pertukaran Gas

Outcome
Pertukaran gas (tidak terjadi cyanosis,
hipoxia – hipoxemia, PaO₂ > 60 mmHg atau Sat
O₂ > 90 ℅; pH 7,35 – 7,45; PaCO₂ 35 – 45
mmHg, tidak disorientasi.
 Alternatif Tindakan Keperawatan

• Positioning : “Prone Position”

• adalah posisi tengkurap yang bertujuan untuk

memperbaiki ventilasi pernapasan supaya
oksigen yang masuk dalam tubuh lebih
banyak.
Aplikasi Di Klinik
 Efektifitas Prone Position
• Reece-Anthony, R., Lao, G., Carter, C., &
Notter, J. (2020). COVID-19 disease: Acute
respiratory distress syndrome and prone
position. Clinics in Integrated Care, 3, 100024.
https://doi.org/10.1016/j.intcar.2020.100024
• Absolute contraindications include respiratory
distress (RR ≥ 35, PaCO2 ≥ 6.5, and/or accessory
muscle use), the immediate need for intubation,
haemodynamic instability (systolic blood
pressure < 90 mmHg) or arrhythmia, agitation or
altered mental status, unstable spine/thoracic
injury/recent abdominal surgery. Relative
contraindications include facial injuries,
neurological issues, morbid obesity, pregnancy
(2nd/3rd trimesters) and pressure sores/ulcers
• To turn a conscious patient into the prone position, it is
important to explain the importance of the procedure to
the patient, to provide reassurance, to improve
oxygenation and reduce their chance of requiring invasive
ventilation. Patients should be encouraged to remain in the
prone position for as long as possible, ideally up to 18 h
per 24 h. Patients must be assisted into and out of the
prone position, and patients should not do this without
assistance in case their oxygen levels drop during the turn.
There are two ways the patient can position themselves in
the prone position either from a sitting or lying position.
 Conclusion
Nurses need understanding of the complex pathophysiological processes that
arise from COVID-19 infection. However, as this article has indicated, the
pathophysiology associated with the development COVID-19 related ARDS is
still being investigated. Nevertheless, the high incidence of ARDS in COVID-19
patients has resulted in recognition that use of the prone position
undertaken early, for both conscious and unconscious patients, can improve
oxygenation. It has been identified as an intervention that for some patients
may reduce or avoid the need for invasive ventilation. Nevertheless, it has to
be accepted that it poses potential risks and complications. Protocols,
guidelines and training are essential to minimize the risk of adverse events
during or after prone positioning. The COVID-19 pandemic is relatively new
therefore further research is needed before definitive guidelines and
recommendations can be made.
Ghelichkhani, P., & Esmaeili, M. (2020). Prone Position in
Management of COVID-19 Patients; a Commentary. Archives
of academic emergency medicine, 8(1), e48.

• SARS-CoV-2 virus causes a pneumonia that was identified through fever,

dyspnea, and acute respiratory symptoms and named COVID-19. This
disease exacerbates in a number of patients and causes pulmonary
edema, multi-organ failure, and acute respiratory distress syndrome
(ARDS). Prevalence of ARDS among COVID-19 patients has been
reported to be up to 17%. Among the introduced treatment methods
for management of ARDS patients, prone position can be used as an
adjuvant therapy for improving ventilation in these patients. Here we
reviewed the literature regarding the role of prone position in
management of COVID-19 patients.
Pedoman Tatalaksana Covid-19, Kemenkes 2020

• Kombinasi Awake Prone Position

 Kesimpulan
• Covid-19 Belum berlalu, perlu komitment
bersama mencegah ketidakmampuan dan
ketidakberdayaan menghadapi covid-19.
• Tenakes (perawat) perlu dibekali pengetahuan
yang cukup seperti teknik prone position (PP),
kontra indikasi, komposisi tim.
• EBN telah membuktikan bahwa PP mampu
memperbaiki oksigenasi pasien sekalipun masih
perlu dilakukan penelitian lanjutan.
 Adaptasi Kebiasaan Baru
Perilaku Hidup Bersih Sehat
 Daftar Pustaka
Black. 2009. Medical Surgical Nursing. Saunders Elsevier
Brown, KM; Keats JJ, Sekulic A et al. (2010). "Chapter 8". Holland-Frei Cancer
Medicine (8th ed.). People's Medical Publishing House USA.
Brunner & Suddarth. 2002. Buku Ajar Keperawatan Medical Bedah. Jakarta.
EGC.
Burhan E, dkk. 2020. Pneumonia Covid-19. PDPI.
Djojodibroto. (2009). Respirologi. Jakarta. EGC
Ghelichkhani, P., & Esmaeili, M. (2020). Prone Position in Management of
COVID-19 Patients; a Commentary. Archives of academic emergency
medicine, 8(1), e48
Nanda.2015.
Pedoman Tatalaksana Covid-19, Kemenkes 2020
Reece-Anthony, R., Lao, G., Carter, C., & Notter, J. (2020). COVID-19 disease:
Acute respiratory distress syndrome and prone position. Clinics in Integrated
Care, 3, 100024
Tim Pokja. 2017. Standar Diagnosis Keperawatan Indonesia. DPP PPNI.