ASUHAN KEPERAWATAN

PADA ANAK DENGAN KASUS

CAMPAK

Ns. Rosani Naim, S.Kep.,M.Kep

Kelompok 2
Homairannisa : (222431213)
Eva tri yulianti :(222431222)
Nesa indira pratiwi : (222431219)
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Husnul khatima : (222431228)
Fitriani : (222431228)
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 01.
Definisi Campak
 Definisi Campak
Campak Adalah Penyakit menular melalui sistem
pernapasan, percikan ludah atau cairan yang keluar
dari sistem pernapasan, seperti bersin, batuk,
berbicara. Campak merupakan penyakit menular
dan dapat menyebabkan komplikasi serius,
terutama pada bayi dan anak-anak. Campak atau
tampek umumnya menginfeksi saluran pernapasan
lalu menyebar ke seluruh tubuh. Penderita bisa
menularkan infeksi ini dalam waktu 2-4 hari
sebelum timbulnya ruam kulit dan selama ruam
kulit ada
 02.
Etiologi
Penyebab campak ialah infeksi virus
campak yang merupakan virus RNA
berkapsul yang termasuk dalam genus
morbilivirus dan famili paramyxoviridae.
Masa inkubasi antara 7-18 hari. stadium
prodormal yaitu demam 3-5 hari, suhu
tubuh ≥ 38 disertai gejala lainnya, seperti
batuk, pilek, dan gejala konjungtivitis.
(Kemenkes RI, 2013). Pasien dapat
menularkan campak 1-2 hari sebelum
muncul gejala klinis sampai 4 hari setelah
munculnya lesi eritem pada kulit
 03.
Patofisiologi
Penyakit campak memiliki sifat virulensi yang tinggi. Penularan tersebut
dimediasi lewat droplet aerosol dari saluran pernapasan. Virus awalnya
masuk lewat saluran napas, kemudian menginfeksi sel dendritik di alveoli.
Sel-sel tersebut akan masuk ke kelenjar getah bening sekitar dan virus mulai
bereplikasi. Sel-sel yang terinfeksi bersirkulasi di dalam darah dan menyebar
ke seluruh tubuh, menyebabkan distribusi virus ke organ-organ seperti kulit,
paru-paru, hati, limpa dan otak. Setelah masa inkubasi 6-19 hari, gejala
prodromal muncul, termasuk peningkatan suhu secara bertahap hingga
sekitar 39°C atau lebih tinggi, batuk, pilek, konjungtivitis dan muncul lesi
putih pada mukosa bukal yang dikenal sebagai Koplik spot yang
patognomonik. Dua sampai empat hari setelah prodromal, reaksi yang
diperantarai sel yang melibatkan sel T-helper melepaskan interferon dan
interleukin-2 yang menyebabkan munculnya ruam morbiliform yang khas
dimulai pada wajah dan kepala dan menyebar ke seluruh tubuh. Ruam
menetap selama 5-6 hari dan kemudian memudar sesuai urutan munculnya
 04.
Manifestasi Klinis
Gejala awalnya adalah demam ringan. Lalu, diikuti
oleh ruam- ruam berwarna merah terutama di
bagian wajah dan leher dan menyebar ke bagian
tubuh lainnya. Gejala campak terjadi bertahap
sesuai fasenya, yaitu sebagai berikut:
a. Masa Inkubasi
b. Fase Prodermal
c. Fase Makulopapuler
d. Fase Penyembuhan
 05.
Pemeriksaan penunjang
01 Deteksi antigen
Antigen campak dapat dideteksi pada sel epitel dalam
secret respirasi dan urine. Antibody terhadap nucleoprotein
bermanfaat karena merupakan protein virus yang paling
banyak ditemukan pada sel yang terinfeksi

02 Isolasi dan identifikasi virus

Apusan nasofaring dan konjungtiva, sampel darah, secret pernafasan,
serta urine yang diambil dari pasien pada saat demam

03 Serologi
Pemastian infeksi campak secara serologis bergantung pada peningkatan titer
antibody 4x lipat antara serum fase akut dan fase konvalensi atau terlihatnya
antibody IgM spesifik campak didalam specimen serum tunggal yang
diambil antara 1-2 minggu setelah awitan ruam
 06.
Penatalaksanaan
 Menurut Rampengan (2008) dan Suriadi (2010), penatalaksanaan medis
yang dapat dilakukan pada klien dengan morbili adalah, sebagai berikut:

Memperbaiki 1. Pemberian vitamin A Istirahat baring selama suhu

keadaan umum tubuh meningkat dan
pemberian antipiretik

1. Pemberian antibiotik pada anak- 1. Kortikosteroid

1. Pemberian
anak yang berisiko tinggi atau 1. Pemberian obat
sedativum dosis tinggi
terdapat infeksi sekunder batuk
 ASUHAN
KEPERAWATAN
 ● Pengkajian

-Pada klien dengan campak, meliputi :

a. Identitas pasien
● Nama, tempat tanggal lahir, umur nama ibu kandung, jenis kelamin beratbadan lahir, Panjang
badan lahir, apakah cukup bulan atau tidak, jumlah saudara.
● Orang tua: Nama, alamat, pendidikan
● Saudara kandung: urutan anak dalam keluarga
a. Riwayat keperawatan
1. Riwayat kesehatan masa lalu
● Bayi dan anak-anak yang terkena morbili biasanya yang belum mendapatkan imunisasi atau
telah mendapatkan imunisasi campak tapi kemungkinan besar vaksinnya tidak tersimpan
dengan baik sehingga mengakibatkan kualitas vaksin menurun atau pemberian dosis yang
tidak tepat dan pernah kontak dengan penderita morbilli
2. Riwayat kesehatan sekarang
a. Awal Serangan
● Keluhan awal yang muncul pada anak campak yaitu:
1) Suhu tubuh meningkat
2) Malaise, batuk, fotopobia, konjungtivitas, coryza
3) Eritma muncul dari belakang telinga ke sepanjang rambut dan bagian belakang bawah
b. Faktor Pencetus
● Virus morbili yang berasal dari sekret saluran pernafasan, darah dan urin dari orang yang terinfeksi.
Penyebaran infeksi melalui kontak langsung dengan droplet dan orang terinfeksi
c. Riwayat kesehatan keluarga

● Riwayat penyakit keluarga mungkin didapati salah satu anggota keluarga ada yang menderita
morbili yang dapat ditularkan melalui sekret saluran pernafasan.
d. Riwayat imunisasi

● Kelengkapan imunisasi anak terhadap penyakit yang disebabkan oleh imunisasi yang belum
diberikan seperti BCG, DPT I, II, III, hepatitis, polio dan campak.

e. Pemeriksaan fisik
1) Inspeksi
a. Keadaan umum lemah
b. Kesadaran komposmentis
c. Adanya ruam kemerahan diseluruh tubuh seperti wajah, telinga, leher dan pada badan.
d. Konjungtiva anemis
e. Fotopobia
f. Turgor kulit tidak elastis
g. Mukosa bibir kering
h. Peningkatan produksi sekret
2) Palpasi

● Teraba pembesaran kelenjar getah bening pada sudut mandibula dan daerah leher belakang

3) Perkusi
● Kadang terdapat distensi abdomen
● Peristaltik usus meningkat
4) Auskultasi

● Pada anak dengan campak biasanya mengalami komplikasi broncopneumonia, sehingga hasil auskultasi
didapatkan suara ronchi.
 ● Diagnosa

1. Hipertermi berhubungan dengan proses penyakit (infeksi)

2. Bersihan jalan napas tidak efektif berhubungan dengan hipersekresi jalan napas
3. Gangguan integritas kulit/jaringan berhubungan dengan kurang terpapar informasi
tentang upaya mempertahankan/melindungi integritas jaringan
THANK
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