ACUTE

ABDOMEN
KGD 1
NS. SISKA NATALIA, MSN – PALLIATIVE CARE
 Objectives
Asuhan keperawatan pasien dengan trauma
abdomen
1.Pengertian trauma abdomen
2.Penyebab trauma
3.Tanda & gejala trauma abdomen
4.Askep kegawatan trauma abdomen
Anda merawat seorang pasien yang terpukul berkali-kali di perutnya
oleh raket badminton. Dia dicurigai cedera hepar, dokter
menyarankan ditangani secara non-operatif. Manakah temuan
pengkajian di bawah ini yang mendukung penanganan tersebut?

a.Bertambahnya bengkak di abdomen

b.Pada pemeriksaan berkala tanda vital stabil
c.Menurunnya hasil pemeriksaan hematokrit berkala
d.Denyut jantung meningkat sampai 120 x/mnt
Abdominal Hemorrhage
GI Internal Bleeding
GI Trauma
Concept Map (Urden, 2014)
 GI Internal Bleeding
Upper
Esofagus : Varices – NSAIDS, Corticostreroids, Jamu
Peptic Ulcer
SRMD: Stress Related Mucosal Disease
AVM
Mallory Weiss tear
Lower
Pancreatitis
Liver Failure
Hemoroid
 Sign and Symptoms
Helena
1.Hematemesis
2.Hematochezia
3.Melena
 Nursing Problem
1. Deficient Fluid Volume, related to absolute loss
2. Decreased Cardiac Output, related to alterations in preload
3. Risk for Aspiration
4. Imbalanced Nutrition: Less Than Body Requirements, related to lack of
exogenous nutrients and increased metabolic demand,
5. Risk for Infection,
6. Powerlessness, related to health care environment or illness-related
regimen,
7. Compromised Family Coping, related to critically ill family member,
8. Deficient Knowledge, related to lack of previous exposure to
information
 Treatment Management
Medical management focuses on restoration of
hemodynamic stability and control of bleeding.
Surgery! Laparoscopy vs Laparotomy

Nursing actions:
◦ administering volume replacement,
◦ controlling the bleeding,
◦ maintaining surveillance for complications,
◦ Educating patient and family.
Interventions
Past
Sengstaken Blakemore tube (SB Tube)
Gastric Lavage: ice water NO!
fluids shift the oxyhemoglobin dissociation,
decrease oxygen delivery to vital organs, and
prolong bleeding time and prothrombin time
 Nursing Interventions
Gastric Lavage: suhu normal
Nasogastric suction tubes and long intestinal tubes.
PEG Tube
Endoskopi
Kolaborasi Farmakoterapi:
◦ Antacids: Magnesium Hidroksida (MgOH2)
◦ H2 Blocker: Ranitidine
◦ Proton Pump inhibitor: (PPIs) Pantoprazole
◦ Gastric mucosal Agents: sucralfat
GI Trauma
https://www.youtube.com/watch?v=Dv3uyBWl5lU
Anatomy GI
GI Trauma
Blunt : tumpul
Penetration: Tembus

What should we do?

Fluid and Blood administration: 2 large bore IV
Stabilization
Cover open wounds
Assessment
IAPP
Diagnostic: rontgen abdomen, USG

On Going Evaluation
LOC/Level of consciousness atau tingkat kesadaran
Respiratory Support
Serial Vital signs, Abdominal Exam, Blood test
Emotional Support
Nursing Interventions
Abdominal EMT
https://www.youtube.com/watch?v=SGQlcH-QhX4&feature=youtu.be
 References
◦ American College of Surgeon. (2012). Advance Trauma Life Support
9th ed.
◦ Urden, L.D., & Stacy, K.M., & Lough, M.E. (2014) Critical Care
Nursing:Diagnosis and Management. Elsevier, e-book