1.

Please, take the big 5 of the most disease that occure in your workplace and make
a resume from that situation.

The top 5 diseases in the work area, especially the children's room at RSUD Sayang
Cianjur in 2018, as follows:

No Disease Name amount

1 Diarrhea 838
2 Typhoid fever 633
3 Fever 453
4 Brochopneumonia 394
5 Febris 192
Amount 2510

BACKGROUND

Diarrhea is an abnormal, liquid discharge of stool. Acute diarrhea is defecation whos

frequency is more frequent than usual (generaly 3x or more) per day with with a liquid
consistency and lasts less than 7 days (MOH, 2009). Diarrheal diseas is still the biggest
cause of infant mortality (babies under 5 years) in the world ( Amirudin, 2007). When
viewed from the level of gravity generally assume that diarrhea is a mediocre disease, in
general our society underestimates this disease, so that it is often fatal in terms of
patient management, this is caused by lack of knowledge of the application of the
principles of rehydrations as early as possible not yet done bye the community so that
there is a delay in the action the action of rehydration which can worsen the pain, it can
even lead to death (Unik, 2005). According to date from the World Health Organization
(WHO) in 2009, globally every year there were around 2 billion case of diarrhea with a
mortality rate of 1,5 milion per year. In developing countries, xhildren under 3 years
experience an average of 3 epiaodes of diarrhea per year. Each episode of diarrhea will
cause loss of nutrients needed by children to grow, so diarrhea is major cause of
malnutrtion in children (WHO, 2009). For the national scale based on data from
Indonesia Health Profile in 2008, diarrhea sufferers in that year were 8.443 children with
diarrhea mortality was 2,5%. This figure increased from the previous year, which is 1,7%
with the number of diarrhea sufferers is 3.667 children (Perwira, 2008). Data obtained by
the Medical Record in the last three years, namely from 2012 to 2014 recorded 2710
children who were treated at Gambiran City Hospital in Kediri. In general, diarrhea can
be caused by several things, namely infection, food allergies, impaired food absorbption,
food poisoning or as one of the symptoms of a disease that causes an immune system
disorder. Retrovirus infections are the main cause of diarrhea in Indonesia, in addition,
bacteria and parasites can also be a cause , this of course closely related to poor
hygiene. Lack of handling of diarrhea disease can cause children. Thesis Article
Nusantara University PGRI Kediri MIFTAHUL JANNAH | 12.2.05.01.0026 FACULTY OF
HEALTH SCIENCE - D3 Nursing simki.unpkediri.ac.id || 3 || afected by dehydration
caused bt loss of water and electrolyte content in body (Saing, 2007). Efforts in dealing
with children who have diarrhea is done by providing oral dehydration therapy by
continuing to breasfeed from age 0 to 2 years, the use of antimicrobials only for children
with bloody diarrhea, severe cases of cholera, or serious non-intestinal infextions.
 Caregivers of young children must also be taught about clean and healthy feeding and
auccess that can reduce diarrhea morbidity. Seeing the above description, the authors
are interested in discussing and studying more deeply about the problem of nursing
disorders of fluid and electrolyte balance with medical diagnosis of diarrhea in children

METHODE

1. By conducting an interview that is, conducting an assessment of the patien and

family
2. By direct observation of general condtion of the patien and physical examination
during the assessment
3. With the study of medical record documentation in the form of examinarion
results and patient documentation during hoapitalization until the assessment is
carried out.

2. Please, make a case study from the patien that you have cared before please write

A. ASSESMENT
a. Anamnesa
Client identitiy
Name : M . Denis Alfiand
No. CM : 884994
Age : 11 month
Religion : Islam
Education : -
Job : -
Diagnosis : Acute Diarrhea Non dysentery
Person in charge name : Mr. Dede Amir

b. Reasons to the Hospital

±3 days before go the hospital, client body is hot and then arise defecate with
the consistency of liquid frequency more than 10 times

c. Current Medical History

Clients experience frequent bowel movements with frequency more than 6 times
accompanied by a body heat up and down, vomiting - coughing - fussy child,
looks thirsty.

d. Previous Medical History

According to his family, the client has been hospitalized for 4 months with the
same case of diarrhea from birth clients already have abnormalities with down
syndrome
e. Family Health History
According to the family's recognition, no family member suffered from serious
illnesses such as Diabetes Mellitus, heart disease, hypertension or kidney
disease, and Down syndrome..

f. Social Data
According to the family when the child is born crying, normal body weight is
2.7kg Every month the body weight always goes up, but for the client's
development is very slow on his stomach, sitting very slow unlike kids usually do

g. Psycological Data
The family said that they were very sad for what had happened to their children
during this time, whose growth and development were very slow and easily sick.

Activity Pattern At home At the hospital

 Eat
- Frequency 2 to 3 times every day Porridge and LLM
- Menu Side dishes & extra milk
- Amount vegetables
 Drink ½ - 1 serving
- Frequency
- Menu ± 4 to 5 glasses every
day
water, milk
 Defecation elimination Diarrhea defecation During client
 Urination elimination assessment
defecate more than 6
times
Activity Clients can only sleep Bedrest
and cry
Personal Hygiene :
- Take a bath 2 times a day Every morning
- Toothbrush 2 times a day -
- Nails cutting Once a week -

h. Primary Survey
1. Airway
Airway no problem
2. Breathing
In breathing there are no obstacles
RR: 20 times every minute, PCH (-),
Palpation: left lung expansion is the same as the right lung. Percussion:
sonor. Inspection: vascular breath sounds
3. Circulation
Acral: warm
N: 95 times every minute
CRT>3 seconds
 Blood pressure: 121/71mmHg
IV line mounted right hand liquid RL 3cc / kg
4. Disability
GCS: E4 M 6 V 5 Pupils cannot be studied, eyelids no abnormalities.
Exposure to body temperature when assessed 40° C.
5. Foley catheter
Foley catheter not installed
6. Gastrictube is not installed NGT.

i. Physical Examination
1. General Conditions
The client looks weak, GCS E4 M6 V 5 pupils cannot be studied, the eyelids
are not abnormal
2. Vital signs
RR : 20 times every minute, S: 40° C, HR : 95 times every minute, TD:
121/71mmHg, Weight: 8 kg.
3. Respiratory System
RR : 20 times every minute, O² saturation 99%,
4. Cardiovascular System
CRT>3 seconds, conjunctiva there are no abnormalities: seklera not
anemic.
5. Digestive System
Abdomen flat and soft, bowel noise ± slightly increased, retention (-)
6. Urinary system is good 70 cc, mother says 3 times
7. Endocrine System
KGB is not palpable
8. Mukuloskeletal System
Mounted IV line on the right arm, motor (+), the client can move his limbs
without orders
9. Integumentary System
Skin turgor looks dehydrated, pinching back rather slowly
10. Nervous System
 Nervus I : cannot be assessed
 Nervus II : cannot be assessed
 Nervus III : eyelids no abnormalities
 Nervus IV : cannot be assessed
 Nervus V : reflexes to chew and swallow within normal limits.
 Nervus VI : cannot be assessed
 Nervus VII and Nervus VIII : cannot be assessed
 Nervus IX : client installed NGT (gag reflex & swallowing cannot be
assessed) assessed
 Nervus X : cannot be assessed
 Nervus XI : cannot be assessed
 Nervus XII : cannot be assessed
SUPPORTING INVESTIGATION

LAB Examination: 9-29-2019

TANGGAL PEMERIKSAAN HASIL RUJUKAN SATUAN

29-9-2019 HB 11,5 12-15 Gram/dl

HCT 37,7 36 -44 %

ERITROCIT 4,34 5 -6 Juta/ul

LEOKOSIT 4000 4500-10,000 10³/uL

Trombosit 376.000 140- 10³/uL

450,000

Lymfosite 50,9 20,0 -40,0 %

Therapy:

- RL 3cc infusion fluid therapy every / kg body weight

- Ranitidine injection 2 x 4 mg
- ODR 1 ampoule iv
- Oral medication zinc 1x½ tsp

B. DATA ANALYSIS

NO DATA ETIOLOGY PROBLEM

1 OD: Client Defecated
more than 6 times a day
I look weak, thirsty
- Turgor the skin when it
is pinched back rather
slowlyHR : 95x/menit
- RR : 20x/menit
- Infused RL fluid infusion
- Hb 11,5
- HCT 37,7
- PLT 376
- Lymphocytes 50,9
- Morphology 43,1
Infection (viruses, bacteria, parasites)
Lack of fluid volume
Invlamation reaction
Increased fluid and electrolyte
secretion
Fill the intestinal cavity
Diarrhea
Dehydration occurs

The body loses fluids and electrolytes

Decreased volume of extra cell fluid

Decreased skin tugor

 Lack of fluid volume
NO DATA ETIOLOGY MASALAH
2 OD: the skin on the Diarrhea Risk of damage to
anus surface appears skin integrity
red (blister)
Frequent defecation

Skin irritation

Risk of damage to skin integrity

3 OD: the client doesn't Diarrhea Changes in nutrition

want to eat, the portion
of the meal doesn't run
out Output >
Observation <

Changes in nutrition

4 OD: hot body Diarrhea

temperature, Hyperthermia
temperature 40° C

Lack of fluid volume

(dehydration)

Thermoregulation

Increase in body temperature

C. NURSING DIAGNOSES
1. Impaired cerebral perfusion associated with increased TTIK
2. Ineffective airway clearance is associated with increased mucus
production (this diagnosis was obtained on January 13 after the patient
moved to RC II and then to NNCU)
3. Disorders of meeting the needs of ADL associated with decreased
awareness
4. Risk of infection associated with the entry of microorganisms due to
tissue continuity disconnection
D. INTERVENTION
1. Diarrhea is related to physiology: the disease process
Purpose : After nursing actions are carried out during the nursing process it
is hoped that diarrhea can be overcome
NOC : Bowel elimination
NIC : Bowel elimination

2. Less fluid volume is associated with loss of fluid and electrolytes in the body
Purpose : after nursing actions during the nursing process expected liquid
and electrolyte requirements are met
NOC : Fluid balance
NIC : Fluid managent

3. Nutritional imbalances less than the body's needs associated with absorption
disorders
Purpose : after action during the nursing process is expected to be
nutritional the patient is fulfilled
NOC : Nutritional status food and fluid intake
NIC : Nutritional management

4. Hypertherm is associated with dehydration

Purpose : after taking account of nursing actions during the nursing
process expected body temperature in the normal range (36.5° C)
NOC : Thermoregulation
NIC : Fever treatmen

3. Please used at least 3 source in your report

Suntosa, Budi. 2005. Panduan Diagnosa Keperawatan Nanda. 2005-2006.

Definisi dan Klasifikasi. Yogyakarta: Prima Medika
Amirudin, H. 2008. Ilmu Kesehatan Pada Anak. Jakarta: Salemba Medika.
Ngastiyah. 2002. Perawatan Anak Sakit. Edisi 2. Jakarta: Djambatan.
 TUGAS
BAHASA INGGRIS

TITIN RUSTINI