pemeriksaan diagnostik 2

Pemeriksaan Pemeriksaan DiagnostikDiagnostik

Muhammad Nur Hasan, S.Kep., NsMuhammad Nur Hasan, S.Kep., Ns

TIU/TIKTIU/TIK Mendefinisikan istilah yang berhubungan dengan Mendefinisikan istilah yang berhubungan dengan

prosedur diagnostikprosedur diagnostik Mendeskripsikan tujuan dan langkah-langkah Mendeskripsikan tujuan dan langkah-langkah

prosedur diagnostikprosedur diagnostik Mengidentifikasi data yang dikaji dan dibutuhkan Mengidentifikasi data yang dikaji dan dibutuhkan

untuk prosedur diagnostikuntuk prosedur diagnostik Mengidentifikasi pendidikan kesehatan yang Mengidentifikasi pendidikan kesehatan yang

dibutuhkan klien untuk melakukan pemeriksaan dibutuhkan klien untuk melakukan pemeriksaan diagnostik tertentudiagnostik tertentu

Mengidentifikasi persiapan pasien untuk Mengidentifikasi persiapan pasien untuk pemeriksaan diagnostik tertentupemeriksaan diagnostik tertentu

Mengidentifikasi peran perawat pada pemeriksaan Mengidentifikasi peran perawat pada pemeriksaan diagnostik tertentudiagnostik tertentu

Menggambarkan panduan untuk evaluasi dan Menggambarkan panduan untuk evaluasi dan mencatat tanggung jawab klien untuk prosedur mencatat tanggung jawab klien untuk prosedur diagnostik tertentudiagnostik tertentu

Pemeriksaan Diagnostik (Impuls Pemeriksaan Diagnostik (Impuls Elektrik)Elektrik)

ElektrokardiografiElektrokardiografi ElektroensephalografiElektroensephalografi ElektromiografiElektromiografi

ElektrokardiografiElektrokardiografi

Alat untuk mendeteksi impuls Alat untuk mendeteksi impuls jantungjantung

Dilakukan pada pasien dengan Dilakukan pada pasien dengan gangguan pada jantunggangguan pada jantung

Gelombang P, QRS, TGelombang P, QRS, T

ElektroensephalografiElektroensephalografi

Mencatat aktivitas listrik pada otakMencatat aktivitas listrik pada otak Persiapan PasienPersiapan Pasien

Ruangan yang gelapRuangan yang gelapPada saat klien tidur (pemeriksaan 1-2 Pada saat klien tidur (pemeriksaan 1-2 jam)jam)Klien tidak distimulan dengan kopi, Klien tidak distimulan dengan kopi, depresan, dan alkoholdepresan, dan alkoholHygiene pada daerah kepala Hygiene pada daerah kepala Dilakukan pada pasien trauma/injuri otak Dilakukan pada pasien trauma/injuri otak (ex. Cedera kepala, stroke)(ex. Cedera kepala, stroke)

Pemeriksaan Diagnostik (Inspeksi Pemeriksaan Diagnostik (Inspeksi Visual/endoskopi)Visual/endoskopi)

Thorakoskopi, pemeriksaan pleura, rongga Thorakoskopi, pemeriksaan pleura, rongga pleura, mediastinum dan perikardium pleura, mediastinum dan perikardium (bagian-bagian paru-paru dan jantung). (bagian-bagian paru-paru dan jantung).

Proktoskopi (sigmoidoskopi dan Proktoskopi (sigmoidoskopi dan proktosigmoidoskopi), untuk memeriksa proktosigmoidoskopi), untuk memeriksa rektum dan kolon sigmoid. rektum dan kolon sigmoid.

Laringoskopi, untuk memeriksa laring Laringoskopi, untuk memeriksa laring (salah satu bagian saluran napas). (salah satu bagian saluran napas).

Laparoskopi, untuk melihat lambung, hati, Laparoskopi, untuk melihat lambung, hati, dan organ-organ lain di dalam rongga dan organ-organ lain di dalam rongga perut. perut.

Gastroskopi, untuk melihat dinding Gastroskopi, untuk melihat dinding dalam esofagus, lambung, dan usus dalam esofagus, lambung, dan usus halus. halus.

Sistoskopi, untuk melihat saluran Sistoskopi, untuk melihat saluran kencing, kandung kencing dan kencing, kandung kencing dan prostat. prostat.

Kolposkopi, untuk memeriksa vagina Kolposkopi, untuk memeriksa vagina dan mulut rahim. dan mulut rahim.

Kolonoskopi, untuk memeriksa usus Kolonoskopi, untuk memeriksa usus besar. besar.

Bronkhoskopi, untuk melihat trachea Bronkhoskopi, untuk melihat trachea dan cabang-cabang bronkhus dan cabang-cabang bronkhus (bagian dari saluran napas) (bagian dari saluran napas)

Laryngoscopy or bronchoscopyLaryngoscopy or bronchoscopy

ProsedurProsedur• Jelaskan prosedur tindakanJelaskan prosedur tindakan• Jelaskan bahwa akan dilakukan anestesi lokal Jelaskan bahwa akan dilakukan anestesi lokal

(injeksi akan menimbulkan nyeri)(injeksi akan menimbulkan nyeri)• Jelaskan tes akan dilakukan selama 30-60 Jelaskan tes akan dilakukan selama 30-60

menitmenit• Kaji TTV, sputum, dan karakter repirasiKaji TTV, sputum, dan karakter repirasi• Anjurkan klien tidak memakai gigi palsu, Anjurkan klien tidak memakai gigi palsu,

kalung, anting, dan pinkalung, anting, dan pin• Lakukan oral hygieneLakukan oral hygiene• Cek ulang klien tidak alergi terhadap Cek ulang klien tidak alergi terhadap

medikasimedikasi• Atur analgesik, sedativa, dan antianxiety, Atur analgesik, sedativa, dan antianxiety,

medikasi untuk dry secretionmedikasi untuk dry secretion

LanjutanLanjutan

o Selama prosedurSelama prosedurAsistensi dokterAsistensi dokterMonitor nadi dan respirasiMonitor nadi dan respirasiBeri support pada klienBeri support pada klien

Post PresedurPost Presedur

Monitor TTV setiap 30 menitMonitor TTV setiap 30 menit Monitor cairan sampai terdapat tanda gag Monitor cairan sampai terdapat tanda gag

reflexreflex Posisikan lateralPosisikan lateral Inspeksi sputum Inspeksi sputum Observasi klien terhadap tanda adanya Observasi klien terhadap tanda adanya

dyspnea, stridor, nafas pendekdyspnea, stridor, nafas pendek Administrasikan anestesi jika dibutuhkanAdministrasikan anestesi jika dibutuhkan Menghubungi petugas kesehatan jika ada Menghubungi petugas kesehatan jika ada

kesulitan bernafas dan darah pada sputumkesulitan bernafas dan darah pada sputum

Esophagoscopy, gastroscopy, Esophagoscopy, gastroscopy, duodenoscopyduodenoscopy

Jelaskan pada klien perasaan tidak Jelaskan pada klien perasaan tidak nyaman pada lambungnyaman pada lambung

Administrasikan oral simethicone Administrasikan oral simethicone sebelum tes (mengurangi udara pada sebelum tes (mengurangi udara pada daerah lambung)daerah lambung)

Jika atropine diberikan maka lakukan Jika atropine diberikan maka lakukan monitor pada Heart ratemonitor pada Heart rate

Post ProsedurPost Prosedur

Inspeksi emesis Inspeksi emesis Jika kesulitan menelan persistent, Jika kesulitan menelan persistent,

nyeri, demam, vomitus, dan black nyeri, demam, vomitus, dan black stool untuk menghubungi dokter/ stool untuk menghubungi dokter/ perawatperawat

CystoscopyCystoscopy

Kaji TTV, frekuensi urunaria, disuria, Kaji TTV, frekuensi urunaria, disuria, jumlah, dan konsistensinyajumlah, dan konsistensinya

Administrasikan enema jika diorderkanAdministrasikan enema jika diorderkan Puasa selama 6-8 jam atau hanya cairan Puasa selama 6-8 jam atau hanya cairan

IV IV

ProsedurProsedur

Monitor VS, urinaria, bandingkan dengan Monitor VS, urinaria, bandingkan dengan data dasardata dasar

Posisi lateralPosisi lateral Inspeksi adanya darah dalam urinInspeksi adanya darah dalam urin Laporkan keadekuatan urin selama 8 jamLaporkan keadekuatan urin selama 8 jam Peningkatan cairan untuk mengurangi Peningkatan cairan untuk mengurangi

iritasi pada jaringan uriniritasi pada jaringan urin Administrasikan analgesikAdministrasikan analgesik Laporkan jika ada kesulitan BAK persisten, Laporkan jika ada kesulitan BAK persisten,

darah segar, nyeri, dan panasdarah segar, nyeri, dan panas

Anoscopy, proctoscopy, Anoscopy, proctoscopy, sigmoidoscopy, colonoscopysigmoidoscopy, colonoscopy

Kaji TTV dan konsistensi fecesKaji TTV dan konsistensi feces Yakinkan preexamination diet yang tepat dan Yakinkan preexamination diet yang tepat dan

intake cairanintake cairan Administrasikan laxativeAdministrasikan laxative Administrasikan enemaAdministrasikan enema Ensure the voids before the examinationEnsure the voids before the examination Administer sedativaAdminister sedativa ExplainExplain That the client will experience the sensation of That the client will experience the sensation of

having to move bowels due to the pressure of having to move bowels due to the pressure of instrumentinstrument

That the client may experience some abdominal That the client may experience some abdominal cramping when air is introduced to distend the cramping when air is introduced to distend the bowelbowel

Post ProsedurePost Prosedure

Support knee-chest positionSupport knee-chest position Monitor pulse and respirationMonitor pulse and respiration Label spesimenLabel spesimen Support klien emotionallySupport klien emotionally Inspect the stool for bloodInspect the stool for blood Allow the client to restAllow the client to rest Provide fluids and foodProvide fluids and food

Examinations Involving Removal of Examinations Involving Removal of Body Fluids and TissueBody Fluids and Tissue

Lumbal PunctureLumbal Puncture Abdominal paracentesisAbdominal paracentesis ThoracocentesisThoracocentesis Pericardial aspirationPericardial aspiration Bone Morrow BiopsyBone Morrow Biopsy Liver BiopsyLiver Biopsy

Lumbal Puncture (LP, Spinal Tap)Lumbal Puncture (LP, Spinal Tap)

Insertion of a needle into the Insertion of a needle into the subarachnoid of spinal canal subarachnoid of spinal canal withdraw cerebrospinal fluid (CSF)withdraw cerebrospinal fluid (CSF)

For diagnostic or therapeutic reasonsFor diagnostic or therapeutic reasons The site is ussually between the third The site is ussually between the third

and fourth lumbar vertebraeand fourth lumbar vertebrae For the infant or small child is For the infant or small child is

ussually lower ussually lower

Nursing InterventionNursing Intervention Vital’s signVital’s sign Pertinent health status (e.g. level of consciousness Pertinent health status (e.g. level of consciousness

and neurologic status)and neurologic status) Determine drug allergies, particularly to local Determine drug allergies, particularly to local

anesthetics and skin antisepticsanesthetics and skin antiseptics Explain: prosedure, when, where, who, and how Explain: prosedure, when, where, who, and how

longlong Have the client empty the bladder and bowel to Have the client empty the bladder and bowel to

prevent unnecessary discomfortprevent unnecessary discomfort Position the client laterally with the head bent Position the client laterally with the head bent

toward the chest, the knees flexed onto abdoment, toward the chest, the knees flexed onto abdoment, and the back at edge of the bed or examining and the back at edge of the bed or examining table.table.

LanjutanLanjutan

Support the positionSupport the position Encourage the client to breathe Encourage the client to breathe

normally and relax, excessive muscle normally and relax, excessive muscle tension, coughing, or change in tension, coughing, or change in breathing can increase CSF pressurebreathing can increase CSF pressure


Assist the client to a dorsal recumbent Assist the client to a dorsal recumbent positionposition

Assist VSAssist VS Ensure that CSF spesiments are Ensure that CSF spesiments are

corectly labeledcorectly labeled Record the prosedure include the date Record the prosedure include the date

and time, the name of the physician, and time, the name of the physician, the color, character, and amount of the color, character, and amount of CSFCSF

Abdominal ParacentesisAbdominal Paracentesis

Abdominal paracentesis is the Abdominal paracentesis is the removal of fluid from the peritonela removal of fluid from the peritonela cavitycavity

In some disease; cirrhosis of the liverIn some disease; cirrhosis of the liver Normally the fluid about 1500 mlNormally the fluid about 1500 ml

Merupakan pemeriksaan tambahan Merupakan pemeriksaan tambahan yang sangat berguna untuk menentukan yang sangat berguna untuk menentukan adanya perdarahan dalam rongga adanya perdarahan dalam rongga peritoneum. Lebih dari 100.000 peritoneum. Lebih dari 100.000 eritrosit/mm dalam larutan NaCl eritrosit/mm dalam larutan NaCl yangkeluar dari rongga peritoneum yangkeluar dari rongga peritoneum setelah dimasukkan 100--200 ml larutan setelah dimasukkan 100--200 ml larutan NaCl 0.9% selama 5 menit, merupakan NaCl 0.9% selama 5 menit, merupakan indikasi untuk laparatomiindikasi untuk laparatomi

Abdominal paracentesisAbdominal paracentesis

Nursing InterventionNursing Intervention

VSVS Expain the procedure to client Expain the procedure to client Support the sitting positionSupport the sitting position Support clint verballySupport clint verbally A major concern is hypovolemic A major concern is hypovolemic

shockshock


Asses the pulse rate, skin color, and Asses the pulse rate, skin color, and blood presureblood presure

Observe hypovolemic shock (pallor, Observe hypovolemic shock (pallor, dyspnea, diaphoresis, and a drop in dyspnea, diaphoresis, and a drop in blood pressureblood pressure

DocumentationDocumentation

ThoracocentesisThoracocentesis

Thoracocentesis is the withdrawal of Thoracocentesis is the withdrawal of fluid or air from the pleural cavityfluid or air from the pleural cavity

For diagnostic and therapeutic For diagnostic and therapeutic purposepurpose

In injury of thoraxIn injury of thorax


Asses vital sign, respiratory depth, Asses vital sign, respiratory depth, complaints of chest pain, breath sounds, complaints of chest pain, breath sounds, dyspnea, type and frequency of cough, dyspnea, type and frequency of cough, character and amount of sputumcharacter and amount of sputum

Support sitting position with arms above Support sitting position with arms above the headthe head

VSVS The client’s cough, sputum, respiration The client’s cough, sputum, respiration

depth, breath sounds, and chest paindepth, breath sounds, and chest pain

Bone Marrow BiopsiBone Marrow Biopsi

A bone marrow biopsy is the removal A bone marrow biopsy is the removal of a spesimen of bone marraw for of a spesimen of bone marraw for study in a laboratorystudy in a laboratory

For abnormal blood cell development For abnormal blood cell development and detect anemia, leukemia, and and detect anemia, leukemia, and other disease of the bloodother disease of the blood

The sites are sternum, the posterior The sites are sternum, the posterior superior iliac crestsuperior iliac crest


Observe the VS, Observe the VS, bleeding from the site (hematoma)bleeding from the site (hematoma)

Liver BiopsyLiver Biopsy

A liver biopsy is a short prosedure, A liver biopsy is a short prosedure, generally performed at client’s generally performed at client’s bedsidebedside

The site of insertion is either The site of insertion is either between two of the right lower ribsbetween two of the right lower ribs

Facilitate diagnosis of liver disease Facilitate diagnosis of liver disease and to gain information about and to gain information about changes in liver tissuechanges in liver tissue

Nursing ProsedureNursing Prosedure

Asses vital signAsses vital sign Determine any drug allergiesDetermine any drug allergies Determine prothrombine time and platelet Determine prothrombine time and platelet

count (administered vit K, IM)count (administered vit K, IM) Administer sedativaAdminister sedativa Support a supine positionSupport a supine position Post prosedurePost prosedure Assist the client to a rihgt side-lying Assist the client to a rihgt side-lying

position for several hoursposition for several hours

High-Tech StudiesHigh-Tech Studies

RoentgenographyRoentgenography Nuclear Medicine (Radioisotop)Nuclear Medicine (Radioisotop) Computed Tomography (CT Scan)Computed Tomography (CT Scan) Ultrasonography (Ultrasound)Ultrasonography (Ultrasound)

Roentgen ray (x rays)Roentgen ray (x rays) X rays are part of the spectrum of X rays are part of the spectrum of

electromagnetic radiationelectromagnetic radiation Contracst materials are introduced into Contracst materials are introduced into

the body in four way to view spesific the body in four way to view spesific organsorgans

• OrralyOrraly• IntravenouslyIntravenously• Subarachnoid space for the spine and the Subarachnoid space for the spine and the

ventricles of the brainventricles of the brain• Through a nasotracheal tube or Through a nasotracheal tube or

bronchoscope for the bronchial treebronchoscope for the bronchial tree

LanjutanLanjutan

Gastrointestinal tract: pharynx and Gastrointestinal tract: pharynx and esophagus, upper gastrointestinal tract esophagus, upper gastrointestinal tract (barium swallow), and lower (barium swallow), and lower gastrointestinal tract (barium enema)gastrointestinal tract (barium enema)

Gallbladder (cholecystography) and bile Gallbladder (cholecystography) and bile ducts (cholangiography)ducts (cholangiography)

Urynary tract (IVP or IVU)Urynary tract (IVP or IVU) Musculoskeletal systemMusculoskeletal system Central nervous system (myelography)Central nervous system (myelography) Vascular System (angiography)Vascular System (angiography) Mammograpphy/xerographyMammograpphy/xerography

Nuclear Medicine (Radioisotop)Nuclear Medicine (Radioisotop)

A basic principle is the body constituents A basic principle is the body constituents are dynamic, not staticare dynamic, not static

Isotopes enter into the same chemical Isotopes enter into the same chemical reactions and metabolic prossess reactions and metabolic prossess

Radioactive substances for spesific body Radioactive substances for spesific body tissue are introduced orally or tissue are introduced orally or intravenouslyintravenously

Example, radioactive iodine given to Example, radioactive iodine given to measure the function of the thyroid glandmeasure the function of the thyroid gland

LanjutanLanjutan

Orally or intravenousOrally or intravenous 1-48 hours, isotope is assimilated by the 1-48 hours, isotope is assimilated by the

organ organ The scanning prosedure, during which the The scanning prosedure, during which the

client must remain stillclient must remain still Scintillation scanning assess the function Scintillation scanning assess the function

of organ or detect a tumorof organ or detect a tumor Include thyroid, heart, brain, lung, liver, Include thyroid, heart, brain, lung, liver,

spleen, bone marrow, bones, and kidneyspleen, bone marrow, bones, and kidney

Computed Tomography (CT Scan)Computed Tomography (CT Scan)

Painless, non invasive x-ray Painless, non invasive x-ray prosedureprosedure

Pasien diberi kontras iodine IV, Pasien diberi kontras iodine IV, proses scanning 1 jamproses scanning 1 jam

Observasi raksi alergi terhadap Observasi raksi alergi terhadap kontraskontras

Post tindakan: puasa 4-6 jam agar Post tindakan: puasa 4-6 jam agar tidak muntahtidak muntah

UltrasonographyUltrasonography

Acoustic densities or tissueAcoustic densities or tissue Mengetahui ukuran, konsistensi Mengetahui ukuran, konsistensi

struktur internalstruktur internal Menunjukkan massa, cairan Menunjukkan massa, cairan

inflamasi, stonesinflamasi, stones Membedakan massa cystic atau Membedakan massa cystic atau

padatpadat Membedakan batas lesi atau tempatMembedakan batas lesi atau tempat Mendeteksi gerakanMendeteksi gerakan

GuidelinesGuidelines

Restless clientsRestless clients The nurse assures the client that there is The nurse assures the client that there is

no need to fear exposure to radiationno need to fear exposure to radiation Check for allergiesCheck for allergies The nurse explainsThe nurse explains There is no discomfortThere is no discomfort The client will be asked to assume various The client will be asked to assume various

positions and must remain still while the positions and must remain still while the scans are takenscans are taken

MRIMRI

AngiografiAngiografi

SelesaiSelesai

Trima KasihTrima Kasih

pemeriksaan diagnostik 2

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