MANUSCRIPT CASE STUDY NURSING CARE Of PAIN ON Mrs.J

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MANUSCRIPT CASE STUDY NURSING CARE Of PAIN ON Mrs.J WITH POST SECTIO CAESAREA WITH THE INDICATION OF THE BREECH POSITION AT THE BOUGENVILLE ROOM OF TUGUREJO PUBLIC HOSPITAL SEMARANG

By: Ni Putu Ayu Sintia Indriyani 0141881

DIPLOMA III OF NURSING FACULTY OF NURSING NGUDI WALUYO UNIVERSITY 2017

NURSING CARE Of PAIN ON Mrs.J WITH POST SECTIO CAESAREA WITH THE INDICATION OF BREECH POSITION AT THE BOUGENVILLE ROOM OF THE TUGUREJO PUBLIC HOSPITAL SEMARANG Ni Putu Ayu Sintia Indriyani*,Ns.Umi Aniroh**,Eko Mardiyaningsih The Faculty of Nursing of Ngudi Waluyo University [email protected] ABSTRACT Sectio caesarea is the Act to take out the fetus or newborn baby which is done through slices on the abdominal wall. The risk of the mother after having sectio caesarea is an increase in the incidence of infection, severe bleeding after the surgery due to incisions caused by the tearing of the tissue in the abdominal wall and the wall of the uterus that make the mother difficult to move and take care of herself and the baby. Pain is an unpleasant emotional experience as the result of actual and potential tissue damage. The objective of this study is to know the nursing care of pain on Mrs.J with post sectio caesarea with the indication of breech inverre position at the Bougenville room of the Tugurejo Public Hospital Semarang. The method used was to provide patient care to reduce pain by taking a deep breath in relaxation. The pain management was conducted for 3 days on Mrs. J. The technique of data collection was interview, physical examination, observation, and supporting examination. The result obtained was that the pain came after the surgery if the patient moved and the pain diminished when conducting the deep breath in relaxation techniques. It is suggested for nurses in hospitals in order to apply the techniques of deep breath in relaxation control against the onset of impaired sense of comfort in the pain to improve the comfort of the patient.

Keywords Bibliography

: Post Sectio Caesarea, breech position, pain : 40 (2008-2016)

INTRODUCTION

According to Indonesia Demographic and

By 2015, the WORLD HEALTH ORGANIZATION

Health

Survey

(SDKI) in

2012,

maternal

States that there are 536,000 women died due

mortality rate is about 359 / 100,000 of live

to childbirth, it is related to the level of

birth and the fetal mortality rate is 32 / 100.000

knowledge and economic community that are

of live birth. However, this number is

still low. As for the direct causes of the maternal

particularly higher among ASEAN countries

mortality are bleeding 28%, eclamsi 24%,

instead of Laos and Cambodia. The fetal

Breech position 11%, infection 11%, old partus

mortality rate in Indonesia is still the 2highest in

15%, and abortion 5% (Nakita, 2011).

comparison with ASEAN countries such as Singapore (3 per 1000), Brunei Darussalam (8

per 1000), Malaysia (10 per 1000), Vietnam (18

starts from the buttocks, shoulders, and head

per 1000) and Thailand (20 per 1000).

(Sukarni, 2013; Feryanto, 2011).

Many factors can cause breech position,

The problem that often arises on post

one of which is mother's parity. The number of

section of the caesarean due to tissue incision

Breech position occurrence rate when it is

in the abdominal wall and uterine wall is pain

associated with parity of mother, then it mostly

(Feryanto, 2011). The efforts to overcome the

happen

multigravida

discomfort of pain are by doing relaxation

comparing to primigravida. Women with high

techniques, breathing techniques, movement

parity were 10 times more likely to have labor

and change of position, massage, hydrotherapy,

with breech position (Prawirhardjo, 2014).

hot/cold therapy, music, guided imagery,

to

a

mother

with

Labor is the process of opening and thinning

acupressure, and aromatherapy as some of the

the cervix and the fetus down into the birth

techniques of influence on effective coping of

canal. Labor and normal delivery is a process of

the labor experience (Santriani, 2013; Asmadi,

fetal expulsion occurring in a month-long

2008).

pregnancy (37-42 weeks), spontaneously born with a presentation behind the head, with no complications of either mother or fetus (Sukarni, 2013).

METHOD The writer uses descriptive method in the paper. Descriptive method is to analyze and

According to Monchtar (1998) in Nurjanah

present facts systematically so that it can be

(2013), the term of section caesaria comes from

easier to be understood and concluded. The

word, caedere, which means to cut. Section

conclusions given are always clear with the

caesaria is a way of giving birth to the fetus by

factual basis so that everything can always be

making an incision in the uterine wall through

returned directly to the data obtained. This

the front wall of the stomach or vagina. The

research tries to describe situation or event that

indication of the SC action may be done if the

by collecting data, analyzing data, drawing

breech position occurs

conclusion data about concept of nursing care

The breech position of the fetus is located

in patient section caesarea for indication of

elongating with the position of the head of the

breech position in RSUD Tugurejo Semarang

fetus in the fundus uteri and the position of the

(Azwar, 2016).

fetal bottom is at the bottom of the uterine

Data collecting technique was done by

cavity. In the breech position, it happens tothe

interview

technique,

increasingly enlarged part of the birth that

documentation

study

observation, at

RSUD

and

Tugurejo

Nursing Care of Pain on Mrs.J with Post Sectio Caesarea with the Indication of the Breech position at the BOUGENVILLE Room of the Public Hospital in TUGUREJO SEMARANG

1

Semarang.

Meanwhile,

the

management

nursing care for 3x24 hours, it was expected

method used in the form of pain treatment by

that the client could control the pain, with the

teaching deep breath in relaxation techniques.

result criteria: 1) pain is controlled on a scale of

The pain management in Mrs.J was performed

3 (quite satisfied) to 5 scale (Fully satisfied), 2)

for 3 days.

client can control pain with pain management from scale 3 (medium knowledge) to scale 5 (so

RESULT

much knowledge), 3) Pain is reduced from scale

Assessment

3 (medium) to scale 5 (no pain).

The assessment on Mrs.J was done on May

Interventions

obtained

from

the

14, 2017 at 07.25 Am in Bougenvile Room of

assessment was to address the pain problem

Dr.Adhyatma, MPH Hospital Semarang. The

associated with the physical injury agent that

patient

in

the author planed a nursing action include,

postoperative sectio caesarea. Pain is a

conducting a comprehensive pain assessment

sensation of discomfort manifested as suffering

that included (location, characteristics, onset /

caused by real perception of the soul, threats,

duration,

and wounded fantasies. Referring to the

severity

International Association's theory of pain which

observation of nonverbal reactions from clients'

is the understanding of pain emphasized is that

discomfort, teach about non-pharmacological

the pain is a physical event, which of course for

techniques

the management of pain is related to physical

environmental controls that might affect pain

manipulation or elimination of physical causes

such as room temperature, lighting and noise,

(Tamsuri, 2014; Potter & Perry, 2010).

support adequate sleep rest to help decrease

said

that

there

was

pain

frequency, of

pain,

(breath

quality, and

intensity

trigger

or

factors),

relaxation techniques),

pain, giving analgesics to patients by close Nursing Diagnoses

monitoring.

Diagnosis that appeared on Mrs.J based on problem priority was pain related to a physical injury agent.

Implementation To

solve

the

problems

above,

the

researcher on Thursday 14 May 2017 at 08.39 Nursing Intervention

am performed pain implementation with

Intervention prepared on Sunday, on May

subjective response of patient who felt the pain

14, 2017 at 8:10 pm was to address the nursing

in post operation wound, pain like sliced, pain

diagnosis of pain that was after the act of

felt on move and decrease at rest, scale of pain

Nursing Care of Pain on Mrs.J with Post Sectio Caesarea with the Indication of the Breech position at the BOUGENVILLE Room of the Public Hospital in TUGUREJO SEMARANG

2

7, missing and arising at ± 10 minutes, while the

of the drug without an allergic reaction, the

objective response was that the patient looked

client seemed to grimace and withhold pain.

weak and in pain. At 08.40 am the researcher observed a nonverbal reaction from client discomfort with clients' subjective reactions

Discussion In this discussion the researcher

will

who felt pain when sitting, while the client's

describe the gap that occurs between the

objective response seemed to grimace in pain

theory and the case reviews in managing

as she got up to sit down. At 08.43 am, the

nursing care "Pain on Mrs.J with Post Sectio

researcher taught techniques to reduce pain

Caesarea with the Indication Breech Position in

with deep breathing relaxation techniques with

the room of Bougenville at Tugurejo Public

subjective response patient said that less pain

Hospital Semarang". The assessment results

when

relaxation

obtained on Mrs.J, the patient said the pain in

techniques, while client's objective response

the postoperative wound where client felt the

looked relaxed.

pain when moving and decreased during rest;

taking

deep

breath

in

At 08:45 am, it started with controlling the

the pain felt like slashed with the pain scale of

environment that could affect pain such as

7, the pain disappeared ± 10 minutes, while the

room temperature, lighting and noise with

objective data of the client seemed to hold the

subjective response of clients who said that a

pain, the patient seemed not relaxed, There

cool temperature and not too crowded room

were wound sutures of abdominal surgery,

made patients feel comfortable, then the

stitch length of 10 cm horizontal.

client's objective response looked comfortable

The

emergence

of

pain

in

patients

if the room temperature was cool and not

postoperative SC caused by the incision of skin

crowded. At 08.50 am it supported adequate

tissue due to incisions on the action of sectio

restful sleep to help decrease pain with

caesarea that resulted in injury to the abdomen.

subjective response clients said to have hard

The wound on the abdomen will lead to tissue

rest during the day. The client's objective

discontinuity so that it stimulates histamine and

response looked weak and less rested. At 08.55

prostaglandin exposure resulting in pain (Potter

am,

& Perry, 2010 & Rasjidi, 2009).

it

continued

by

ensuring

analgesic

treatment for the patient which was conducted

This diagnosis was raised as the top priority

by rigorous monitoring (giving ketorolac 30 mg

based on the main complaints felt by clients

injections therapy) with an objective response

that clients said pain in postoperative wounds of sectio caesarea, the pain arised when moving

Nursing Care of Pain on Mrs.J with Post Sectio Caesarea with the Indication of the Breech position at the BOUGENVILLE Room of the Public Hospital in TUGUREJO SEMARANG

3

and decreased when resting, the pain felt as

peace and calm. (Rahmayati, 2010; Patasik,

severed with the scale of pain 7, then

2013; Utami, 2014; Muttaqin, 2008).

disappeared ± 10 minutes and in accordance

In overcoming the problem of nursingpain

with the limitations of characteristics possessed

on Mrs.S, the implementation conducted by the

by patients in which the patient expressed

researcher from Sunday, May 14, 2017 to

restless behavior, crying, sadness, changes in

Tuesday, May 16, 2017 was in accordance with

position to avoid pain, and changes in appetite.

the planned intervention and all the actions

So, if the problem was not addressed, then it

planned could be implemented to the patients.

might have an impact on the need for a sense of

During the problem handle on Mrs. J, the

security and comfort of client. The need for a

researcher found no difficulty because the

sense of security and comfort is a physiological

patient responded well when invited to interact

need that must be met because if it isfulfilled,

and was willing to be given a planned nursing

then it can affect other needs. The physiological

action.

need that must be prioritized is the handling of

assistedthe patient to perform actions that

pain because the pain can interfere with daily

were taught independently.

The

family

also

supported

and

activities or psychic (Asmadi, 2008). Therefore, the researcher planed some

CONCLUSION

actions of nursing to overcome the problem of

Based on the acts that have been

pain on patient and teach deep breath in

conducted to the patient for 3 days, the

relaxation techniques. Relaxation is a state in

researcher want to make a final evaluation with

which a person is free from the pressure and

the results of pain nursing problems related to

anxiety or the return of equilibrium after the

the physical injury agent on Mrs. J that has been

disturbance. The goal of relaxation techniques

resolved. It can be seen from the achievement

is to achieve a state of complete relaxation,

of objectives and predetermined results criteria

including the physiological relaxation state,

in which the pain was controlled from the scale

cognitively, and behaviorally. This technique

of 3 (quite satisfied) to scale of 5 (fully

begins with a process of relaxation in general

satisfied). The client or patient could control the

that asks the client to slowly close her or his

pain with pain management from scale of 3

eyes and focus on their breath, then the client is

(medium knowledge) to scale of 5 (very much

encouraged for relaxation to empty his or her

knowledge), then the pain decreased from 3

mind and fill the mind with a shadow to create

(medium scale) to scale of 5 (no pain).

Nursing Care of Pain on Mrs.J with Post Sectio Caesarea with the Indication of the Breech position at the BOUGENVILLE Room of the Public Hospital in TUGUREJO SEMARANG

4

Bibliography

Pasien Post Operasi Sectio Caesarea Di Irina

Azwar, S. (2016). Metode Penelitian.Yogjakarta :

BLU RSUP Prof.Dr.R.D. Kandou Manado. http://ejournal.unsrat.ac.id/index.php/jkp/

Pustaka Belajar. Asmadi.

(2008).

Keperawatan:

Teknik Konsep

Prosedural dan

Aplikasi

Kebutuhan Dasar Klien. Salemba Medika:

June 8, 2017 at 3.45 Pm. Prawirohardjo.

(2014).

Ilmu

Kebidanan

Maternal dan Neonatal. Jakarta: PT Nina

Jakarta Mutaqin. (2008). Efektifitas relaksasi napas dalam dan distraksi dengan Latihan 5 jari terhadap

article/view/2169. Retrieved on Thursday,

nyeri

post

laparatomi.

http://www.google.co.id/webhp?ie=utf8&oe=utf-8&client=firefox b&gws_rd=cr&ei=yZFDWZiUB8Kp0ATXm6D gDA#q=jurnal+tentang+intervensi pemberian+relaksasi+nafas+dalam+pada+p asien+post+sc. Retrieved on Thursday june 15, 2017 at 3.49 Pm.

Pustaka. Rasjidi, I. (2009). Manual Sektio Sesarea & Laparatomi Kelainan Adneksa. Jakarta: Sagung Seto Sukarni, K. I.,& Margareth Z.H.(2013). Buku Ajar Keperawatan Maternitas. Yogjakarta: Nuha Medika Tamsuri,

Anas

.(2014).

Konsep

Dan

Penatalaksanaan Nyeri. Jakarta: EGC

Potter, P.A., & Perry, A.G (2010). Buku Ajar

Utami, sri. (2014). Pemberian teknik relaksasi

Fundamental Keperawatan: Konsep,Proses,

nafas dalam terhadap penurunan tingkat

dan Praktik (Edisi 4).(Renata komalasari,

nyeri pada asuhan keperawatan Ny.S

Dian evriyani, Enie Novieastari, Alfrina Hany

dengan post op apendiktomidi ruang kanthil

dan Sri Kurnianingsih, Translation). Jakarta:

rsud

EGC

karanganya.http://www.stikeskusumahusa

Patasik, K.C.,& Tangka, J. (2013). Efektifitas Tehnik Relaksasi Nafas Dalam Dan Guide Imagery Terhadap Penurunan Nyeri Pada

da.ac.id/digilib/download.php?id=637. Retrieved on Thuesday, May 30, 2017 at 9.55 Am.

Nursing Care of Pain on Mrs.J with Post Sectio Caesarea with the Indication of the Breech position at the BOUGENVILLE Room of the Public Hospital in TUGUREJO SEMARANG

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Nursing Care of Pain on Mrs.J with Post Sectio Caesarea with the Indication of the Breech position at the BOUGENVILLE Room of the Public Hospital in TUGUREJO SEMARANG

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MANUSCRIPT CASE STUDY NURSING CARE Of PAIN ON Mrs.J

MANUSCRIPT CASE STUDY NURSING CARE Of PAIN ON Mrs.J WITH POST SECTIO CAESAREA WITH THE INDICATION OF THE BREECH POSITION AT THE BOUGENVILLE ROOM OF TU...

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