Perawatan Luka Konvensional Dan Modern

8/18/2019 Perawatan Luka Konvensional Dan Modern

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PERAWATAN LUKAKONVENSIONAL DAN MODERN

OLEH :

STELLA PUTRI WANDA

PEMBIMBING :dr. KISMAN HARAHAP, SP.B

KEPANITERAAN KLINIK SENIOR BAGIAN ILMU BEDAH


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LATAR BELAKANG

Luka : adalah suatu d!sru"s!# $k%adaa&"utus&'a k(&t!&u!tas) *ar!&+a& tuuh$!sa kul!t, -uk(sa, atau *ar!&+a& la!&)'a&+ d!s%aka& (l%h %%ra"a hal.

P%&'%a luka : Trau-a

D!s%&+a*a : ("%ras!


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P%ra& "%raata& luka sa&+at "%&t!&+ "%&'%-uha& luka %rla&+su&+ d%&+a& a!k.

K(&s%" "%&+%l(laa& luka saat !&! sdh a&'ak%ruah luka d!k%l(la %rdasarka& KONDISI LUKA.

/(kus uta-a : PREPARASI LUKA, s%%lu- d!tutu".

Wound Healing Society P%&'%-uha& lukaadalah

“suatu proses kompleks dan dinamis untukmengembalikan kontinuitas dan fungsi anatomi

jaringan”


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Pr!&s!" "%raata& luka -(d%r&Moist wound healing

L%!h %0%kt!0 u&tuk "r(s%s "%&'%-uha& luka

I&d(&%s!a -as!h -%&+a&ut -%t(d%k(&1%&s!(&al

Asia Pasic Wound !are !ongress "#$"

s%t!dak&'a aru ada 23 dar! 4555 RS d!I&d(&%s!a 'a&+ -%&+a&ut "%raata& luka-(d%r&


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TUJUAN PENELITIAN

M%-aha-! da& -a-"u -%lakuka&"%raata& luka -(d%r& s%6ara t%"at

M%&!&+katka& k%-a-"ua& "%&ul!sa&!l-!ah d! !da&+ k%d(kt%ra& khusus&'ad! Ba+!a& Il-u B%dah

M%-%&uh! salah satu s'arat u*!a&

k%"a&!t%raa& Kl!&!k d! Ba+!a& Il-uB%dah /akultas K%d(kt%ra& U&!1%rs!tasR!au RSUD Ar!7& A6h-ad Pr(1!&s! R!au.


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METODE PENULISAN

P%&ul!sa& r%0%rat !&! -%&++u&aka&-%t(d% t!&*aua& "ustaka d%&+a&-%&+a6u k%"ada %%ra"a l!t%ratur.


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TINJAUAN PUSTAKA


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Luka : adalah suatu d!sru"s!# $k%adaa&"utus&'a k(&t!&u!tas) *ar!&+a& tuuh$!sa kul!t, -uk(sa, atau *ar!&+a& la!&)'a&+ d!s%aka& (l%h %%ra"a hal.

P%&'%a luka : Trau-a

D!s%&+a*a : ("%ras!


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FASE PENYEMBUHANLUKA

Fase infamasi : %ru"a h%-(stas!s da& !&8a-as!. Fase !"#i$e!a%i$ : t%rd!r! dar! %"!t%l!sas!,

a&+!(+%&%s!s, "%-%&tuka& *ar!&+a& +ra&ulas! da&d%"(s!s! k(la+%&.

Fase ma%&!asi : k(&traks!, "%-%&tuka& *ar!&+a&


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'( FASE INFLAMASI

P%-. Darah '+"utus : k(&tr!ks!,r%traks!, d!s%rta!

r%aks! h%-(stas!s.

T%r*ad! -!+ras! s%l2 !&8a-as! $PMN da& Makr(0a+),%ksudas! "las-a '+ -%&+a&du&+ %&s!-2 "r(t%(l!t!k,a&t!(d!, 7r!& u&tuk -%-%rs!hka& luka dar! %&daas!&+# da& *ar!&+a& &%kr(t!k.


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)( FASE PROLIFERASI

Har! k% 39 4

M!+ras! da& !&7ltras! s%l2 7r(last dar! *ar!&+a&s%k!tar, '+ aka& -%-"r(duks! k(la+%&,7r!&%kt!&, 7r!&, '+ "%&t!&+ u&tuk -%&utu"luka.


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*( FASE REMODELLING

Har! k% 4 ; 2 tahu&

Luka k%-ud!a& -%&+ala-!

r%-(d%l!&+, *ar!&+a& %ks%s

aka& d!as(rs!.K%kuata& luka $t%&s!l%

str%&+th#) %rta-ah, '+

da"at -%&aha& trau-a tar!ka&.


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PENYEMBUHAN LUKA

Wound Healing Society P%&'%-uha& lukaadalah“suatu proses kompleks dan dinamis untuk

mengembalikan kontinuitas dan fungsianatomi jaringan”

Primary Wound Healing

Secondary Wound Healing%ertiary Wound Healing


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PRINSIP PERAWATANLUKA

4. D%r!d%-%&t2. M(!st W(u&d B%d>. Pr%1%&t /urth%r

I&*ur'. Nutr!t!(&al Th%ra"'3. Tr%at U&d%rl'!&+

D!s%as%?. W(rk !th La (0

Natur%


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DEBRIDEMENT

S%luruh -at%r! as!&+=&(&1!al%=*ar!&+a& &%kr(t!k -%ru"aka&d%r!s da& da"at -%&+ha-at "%&'%-uha& luka s%h!&++ad!"%rluka& t!&daka& u&tuk -%-%rs!hka& luka dar! s%-ua-at%r! as!&+ !&!.

N%kr(t(-! $"%-ua&+a& *ar!&+a& &%kr(t!k) *u+a t%r-asuk dala-d%r!d%-%& luka. D%r!d%-%& da"at d!lakuka& %rkal!9kal!$%rtaha") sa-"a! s%luruh dasar luka $wound bed) %rs!h da&1!tal.?

M%ka&!kal d%r!d%-%&t Aut(l't!6 d%r!d%-%&t B!(l(+!6al d%r!d%-%t E&@!-at!6 d%r!d%-%&t Sur+!6al d%r!d%-%&t


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MOIST WOUND BED

Dasar luka $wound bed) harus

s%lalu l%-a. L%-a uka&

%rart! asah.

Kassa 'a&+ d!r%&da- dala-

laruta& s%"%rt! Na6l

!tu asah uka& l%-a, kar%&a

kassa 'a&+ asah da"at -%&*ad!

k%r!&+ s%h!&++a t!dak "%r&ah

-%&*ad! l%-a.

L%-a 'a&+ d!-aksud adalah ada&'a %ksudat 'a&+ %rasaldar! s%l d! dasar luka 'a&+ -%&+a&du&+ s%l9s%l darah "ut!h,growth factors, da& %&@!-9%&@!- 'a&+ %r+u&a dala- "r(s%s"%&'%-uha& luka.Suasa&a l%-a !&! harus d!"%rtaha&ka& d%&+a& d!!kut!"%&6%+aha& !&0%ks! da& "%-%&tuka& "us


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PREVENT FURTHER INJURY


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NUTRISI

Nutr!s! adalah suatu t%ra"! uka&ha&'a s%a+a! su"l%-%&=ta-aha&.

T%ra"! &utr!s! sa&+at "%&t!&+ dala-

"r(s%s "%&'%-uha& luka s%ak(-"(&%& *ar!&+a& 'a&+ rusak harusd!+a&t!.

Nutr!s! 'a&+ a!k adalah -aka&a&t!&++! "r(t%!&


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TREAT UNDERLYINGDISEASE

Salah satu 0akt(r 'a&+ %r"%&+aruhdala- "r(s%s "%&'%-uha& lukaadalah "%&'ak!t 'a&+ -%&dasar! luka

t%rs%ut -!sal&'a D!a%t%s M%l!tus,S!&dr(-a Lu"us Er!-at(sus, dll.


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WORK WITH LAW OFNATURE

P%"atah -%&+ataka& t!-% h%als all(u&ds. S%su&++uh&'a "%&'%-uha&luka d!lakuka& (l%h tuuh "%&d%r!ta

s%&d!r!.

Ca&+ da"at k!ta lakuka& adalah

-%-%r!ka& suasa&a da& k(&d!s! !d%ala+ar luka da"at s%-uh ta&"a ada&'aha-ata&=+a&++ua&.


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KLASIFIKASI LUKA

Luka akut : luka aru, -%&dadak, da&"%&'%-uha& s%sua! d%&+a& aktu'a&+ d!hara"ka&. (&t(h : luka sa'at,

luka akar, luka ("%ras!.Luka kr(&!k : luka 'a&+ %rla&+su&+

la-a atau s%r!&+ t!-ul k%-al!.

(&t(h : ulkus d%ku!tus, ulkusd!a%t!k, dll.


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L&+a A+&%

L&+a K!"nis


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Akut Kronik Luka baru

Timbul mendadak

Dapat diperkirakansembuhnya

Khas : luka sembuh primer

Contoh : Luka operasi danluka trauma

Melebihi waktu yangdiperkirakan sembuh

Penyembuhan lambat atauberhenti

Khas : luka sembuh sekunder

Contoh : Ulkus dekubitus,Ulkus diabetikum


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PERAWATAN LUKAKONVENSIONAL , MODERN

P%raata& lukak(&1%&s!(&al : T!dak -%&+%&al

"%raata& luka l%-a

Kassa l%&+k%t "ada ar%aluka

Luka dala- k(&d!s! k%r!&+

P%rtu-uha& *ar!&+a&la-at

I&0%ks! l%!h a&'ak Baluta& luka ha&'a

-%&++u&aka& kassa

Luka t%ruka=t%rtutu"

P%raata& luka -(d%r& : P%raata& luka l%-a

$-(!st (u&d 6ar%)

Kassa t!dak l%&+k%t "ada

ar%a luka Luka dala- k(&d!s! l%-a

P%rtu-uha& *ar!&+a&l%!h 6%"at

I&0%ks! s%d!k!t

Baluta& luka -(d%r& Luka t%rtutu" d%&+a&

aluta& luka


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K"n-ensi"na# -sM".e!n

Me#e+a%/men0e1a1+an+e!&sa+an .an n0e!i

M&.a2 .i#eas+an/ %i.a+men0e1a1+an+e!&sa+ana.a #&+a


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Mana3emen #&+a +"n-ensi"na#

Ti.a+ men4ena# a.an0a #in4+&n4an #&+a0an4 #em1a1

M%-%rs!hka& luka d%&+a& laruta& sal!&

&(r-al atau d!ta-ahka& d%&+a& "(1!d!&%!(d!&, atau h!dr(+%& "%r(ks!da $H2O2)

-%&+a&++u "r(s%s "%&'%-uha& luka

t!dak ha&'a -%-u&uh ku-a& ta"!

-%-u&uh l%uk(s!t 'a&+ %rtu+as

-%-u&uh ku-a& "at(+%&, k%-ud!a&

d!tutu" d%&+a& kassa k%r!&+.


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Kassa -%&%-"%l "ada luka da&

-%&'%aka& rasa sak!t "ada "as!%&,

s%l9s%l 'a&+ aru tu-uh "ada luka-%&*ad! rusak.

Luka dala- k(&d!s! k%r!&+ da"at-%-"%rla-at "r(s%s "%&'%-uha&

da& aka& -%&!-ulka& %kas luka.


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Mana3emen #&+a m".e!n

M"is% W"&n. Hea#in4Moist wound healing

-%ru"aka& suatu -%t(d%

'a&+ -%-"%rtaha&ka&l!&+ku&+a& luka t%ta"l%-a u&tuk -%-0as!l!tas!"r(s%s "%&'%-uha& luka.

L!&+ku&+a& luka 'a&+

l%-a da"at d!6!"taka&d%&+a& occlusi&e dressing $"%raata& luka t%rtutu").


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MOIST WOUND HEALING

M%&urut G!tar*a $2552), ada"u& alasa& dar! t%(r!"%raata& luka d%&+a& suasa&a l%-a !&! a&tara la!&:

Meme!5ea% 61!in"#isis(

/!r!& 'a&+ t%r%&tuk "ada luka kr(&!s da"atd!h!la&+ka& l%!h 6%"at (l%h &%tr(7l da& s%l %&d(t%ldala- suasa&a l%-a.

Meme!5ea% an4i"4enesis(

Dala- k%adaa& h!"(ks!a "ada "%raata& lukat%rtutu" aka& -%ra&+sa&+ l%!h "%-%&tuka&"%-uluh darah d%&+a& l%!h 6%"at.

Men&!&n+an !esi+" in$e+si


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Ke3a.ian in$e+si t%r&'ata r%lat!0 l%!h r%&dah *!ka

d!a&d!&+ka& d%&+a& "%raata& k%r!&+.

Meme!5ea% em1en%&+an G!"7%2 $a5%"!( Gr(th 0a6t(r -%-%&tuk stratu- 6(r&%u- da&a&+!(+%&%s!s"r(duks! k(-"(&%& t%rs%ut l%!h 6%"at t%r%&tukdala- l!&+ku&+a& 'a&+ l%-a.

Meme!5ea% %e!3a.in0a em1en%&+an se#

a+%i$( Pada k%adaa& l%-a, !&1as! &%tr(7l 'a&+ d!!kut! (l%h-akr(0a+, -(&(s!t da& l!-0(s!t k% da%rah luka%r0u&+s! l%!h d!&!.


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MOIST WOUND HEALING


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Dr' H%al!&+ M(!st H%al!&+


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Suatu "r(s%s "%-ua&+a& arr!%r 'a&+t%rda"at d! luka u&tuk -%-"%rs!a"ka&luka su"a'a da"at -%lalu! "r(s%s

"%&'%-uha& luka d%&+a& a!k.D!lakuka& d%&+a& : D%r!d%-%&t

K(&tr(l akt%r!

P%&+%l(laa& %ksudat

PREPARASI BED LUKA


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D%r!d%-%&t : "r(s%s usaha-%-%rs!hka& luka da&-%&+h!la&+ka& *ar!&+a& &%kr(t!k.

D!lakuka& "ada luka akut -au"u&kr(&!s.

Tu*ua& : -%&+ura&+! k(&ta-!&as! "ada

luka u&tuk -%&+(&tr(l da& -%&6%+ah!&0%ks!.

DEBRIDEMENT


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Pemasan4an D!essin4

M%&6%+ah t!-ul trau-aaru "ada luka

M%&duku&+ "%&'%-uha&

lukaM%&*a+a l!&+ku&+a& lukat%ta" l%-a Pr!-ar' dr%ss!&+ : 'a&+ k(&tak

d+& *ar. '+ luka S%6(&dar' dr%ss!&+ : "%-alut

d! atas aluta& "r!-%r


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JENIS PERAWATAN

LUKA MODERN

PERAWATAN LUKA


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PERAWATAN LUKAMODERN

'( Pe!a7a%an .en4an ma.&)( Ma44"% De1!i.emen% T2e!a0*( Fi#m .!essin48( H0.!"5"##"i.9( A#4ina%e( F"am .!essin4


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H"ne0 W"&n. Hea#in4

•Madu -%&+a&du&+ h!dr(+%& "%r(ks!da dala-%&@!- +luk(sa (ks!das% 'a&+ %rasal dar!l%ah !tu s%&d!r!-adu %rs!0at a&t!-!kr(!al•E0%k (s-(t!k 'a&+ d!has!lka& (l%h -adu aka&

-%&6!"taka& l!&+ku&+a& l%-a Eksudat d!tar!k k% "%r-ukaa& luka•Madu 'a&+ a!k utk d!+u&aka& adalah MaduMa&uka• Madu %rs!0at sa&+at asa- d%&+a& "Ha&tara > da& Bakt%r! aka& t%ru&uh dala- l!&+ku&+a&asa-•Madu da"at -%&st!-ulas! "r(s%s"%&'%-uha& luka, -%&6%+ah !&0%ks!,-%&st!-ulas! "%rtu-uha& *ar!&+a&


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Ma44"% De1!i.emen% T2e!a0

GGO


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MAGGOT DEBRIDEMENTTHERAPY

B%latu&+ -%&*!*!kka& s%a s%r!&+ d!s%rta!d%&+a& au 'a&+ t!dak s%da"

P%rta-a kal! 433 A-r(!s% Par%$d(kt%r %dah) -%&+a-at! %0%k %latu&+ "adat%&tara 'a&+ t%rluka

K%-ud!a& ahl! %dah -!l!t%r Na"(l%&, dr. Bar(&D.


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De1!i.emen%-%-aka& *ar!&+a& -at! $&%kr(t!k) ta&"a

-%&++a&++u *ar!&+a& s%hat

M%&+%luarka& %&@!- "r(t%(l!t!k 'a&+ -a-"u -%lu&akka& *ar!&+a& &%kr(t!k s%h!&++a d%&+a& -udah d!-aka&

Ha&'a -%&6%r&a *ar!&+a& &%kr(t!k ta&"a -%&++a&++u *ar!&+a& s%hat

Desin$e+%an k%-a-"ua&&'a -%&s%kr%s! %&@!- -%ruah"H luka t!dak k(&dus!0 la+! u&tuk "%rtu-uha&da& "%rk%-a&+a& akt%r!

Ma-"u -%&d%+radas! !(7l- "ada luka da& -%&6%r&aM%th!6!ll!& R%s!sta&t Sta"h'l(6(66us Aur%us $MRSA)

Hal !&!lah -%&*ad! k%l%!ha& %latu&+ s%!r!&+ d%&+a&s%-ak!& r%s!st%&&'a "%&++u&aa& a&t!!(t!6


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Memi5& 4!anasi #&+a Aks! %latu&+ dala- -%&6%r&a *ar!&+a&

&%kr(t!k luka d!"%r6a'a da"at -%&st!-ulas!

"%rtu-uha& *ar!&+a& +ra&ulas! "ada luka$Pr%t%, 4).

P%rtu-uha& *ar!&+a& +ra&uals! 0as%t%r"%&t!&+ dar! "r(s%s "%&utu"a& luka.


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INDIKASI MDT

M%&urut ha& D(-!&!6 W$255) utk luka kr(&!s Luka d!a%t%s

1%&(us ul6%r

&%ur("ath!6 ul6%r !s6h%-!6 ul6%r

D%6u!tus

Luka "(st trau-a

N%6r(t!@!&+ 0as6!!t!s

P'(d%r-a +a&+r%&(su-

Luka t%r!&0%ks! MRSA

%&(us ul6%r

Mast(!d!ts su akut

Eks!s! as%s "ada-%ll%(lus

S!&us "!l(&!d!al

Gr(ssl' !&0%6t%d t(%

Ost%(-'%l!t!s Luka !&0%ks! s%t%lah

r%"la&tas! l%&+a& aah

Luka t%ruka s%t%lah"r(t%sa lutut

Luka !&0%ks! s%t%lah("%ras! "a'udara

Luka t%-ak t%r!&0%ks!

Luka Bakar


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KONTRAINDIKASI

t!dak d!lakuka& "ada luka'a&+ sa&+at -udah %rdarah$luka ka&k%r)

t!dak ada&'a "%rs%tu*ua&

dar! "as!%&=k%luar+a&'a

T!dak -%&++u&aka& %latu&+

'+ st%r!l

luka 'a&+ %rhuu&+a&la&+su&+ d%&+a& SSP,"%-uluh darah %sar,r(&++a atau (r+a&9(r+a& 1!tal

Luka k%r!&+

Al%r+! t%rhada" %&@!-

'a&+ d!has!lka&

Pas!%& d%&+a& +a+alhat!"(t%&s!al k(-"l!kas!:

t(ks!s!tas a--(&!ada"at -%&+!&duks!%&s%0al("at!


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Fi#m .!essin4


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H0.!"5"##"i. D!essin4

Baluta& !&! %r0u&+s! -%-"%rtaha&ka&luka dala- suasa&a l%-a", -%l!&du&+!luka dar! trau-a da& -%&+h!&darka&luka dar! r!s!k( !&0%ks!, -a-"u-%&'%ra" %ksudat t%ta"! -!&!-al

S%a+a! dressing primer atau s%ku&d%r,support autolysis untuk -%&+a&+kat *ar!&+a& &%kr(t!k atau slough) T%ruat dar! "%kt!&, +%lat!&,

carbo'ymethylcellulose( da&%last(-%rs.

I&d!kas!: luka %rar&a k%-%raha&

d%&+a& %"!t%l!sas!, %ksudat -!&!-al.K(&tra!&d!kas!: luka t%r!&0%ks! atau luka

grade III9I.


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A#4ina%e

D!+u&aka& u&tuk dressing primer dan masih-%-%rluka& aluta& s%ku&d%r. M%-%&tuk geldi atas permukaan luka* berfungsi -%&'%ra"6a!ra& luka 'a&+ %rl%!ha& da& -%&st!-ulas!"r(s%s "%-%kua& darah.

T%ruat dar! ru-"ut laut 'a&+ %ruah -%&*ad!gel jika bercampur dengan cairan luka.

I&d!kas!: luka d%&+a& %ksudat s%da&+ sa-"a!%rat.K(&tra!&d!kas!: luka d%&+a& *ar!&+a& &%kr(t!kda& k%r!&+.

T%rs%d!a dala- %&tuk l%-ara& da& "!ta,-udah d!a&+kat da& d!%rs!hka&.


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F"am .!essin4

Baluta& !&! %r0u&+s! u&tuk-%&'%ra" 6a!ra& luka 'a&+ *u-lah&'a sa&+at a&'ak+absorbant dressing,

sebagai dressing primer ataus%ku&d%r.

T%ruat dar! polyurethane* non-adherent wound contact layer(highly absorpti&e)

I&d!kas!: %ksudat s%da&+ sa-"a!%rat.

K(&tra!&d!kas!: luka d%&+a& %ksudat-!&!-al, *ar!&+a& &%kr(t!k h!ta-.


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KESIMPULAN

P%&++u&aa& !l-u da& t%k&(l(+! s%rta !&(1as!"r(duk "%raata& luka da"at -%-%r!ka& &!la!("t!-al *!ka d!+u&aka& s%6ara t%"at.

Pr!&s!" uta-a dala- -a&a*%-%& "%raata& luka-(d%r& adalah -%&6!"taka& suasa&a l%-a u&tuk-%&u&*a&+ "r(s%s "%&'%-uha& luka

M%-aha-! k(&s%" "%&'%-uha& luka l%-a,"%-!l!ha& aha& aluta&, da& "r!&s!"9"r!&s!"!&t%r1%&s! luka 'a&+ ("t!-al -%ru"aka& k(&s%"ku&6! u&tuk -%&duku&+ "r(s%s "%&'%-uha& luka.


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KESIMPULAN

Pr!&s!" la-a 'a&+ -%&'%utka& "%&a&+a&a&luka harus dala- k%adaa& k%r!&+, t%r&'atada"at -%&+ha-at "%&'%-uha& luka, kar%&a-%&+ha-at "r(l!0%ras! s%l da& k(la+%&, t%ta"!luka 'a&+ t%rlalu asah *u+a aka& -%&'%aka&-as%ras! kul!t s%k!tar luka.

P%raata& luka -%&++u&aka& "r!&s!"

k%l%-a"a& s%!-a&+ $-(!stur% ala&6%)d!k%&al s%a+a! -%t(d% -(d%r& dr%ss!&+ da&-%-aka! alat +a&t! alut 'a&+ l%!h -(d%r&.


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KESIMPULAN

355 *%&!s -(d%r& (u&d dr%ss!&+ d!la"(rka&t%rs%d!a u&tuk -%&a&+a&! "as!%& d%&+a& lukakr(&!s a&tara la!& %ru"a -adu, lar1a Ma++(t,h!dr(+%l, 7l- dr%ss!&+, h'dr(6(ll(!d, 6al6!u-

al+!&at%, 0(a- = as(ra&t dr%ss!&+, dr%ss!&+a&t!-!kr(!al, h'dr("h(!6 a&t!-!kr(!al.

K%%rhas!la& "r(s%s "%&'%-uha& luka t%r+a&tu&+

"ada u"a'a -%-"%rtaha&ka& l!&+ku&+a& l%-a"'a&+ s%!-a&+, kar%&a aka& -%-0as!l!tas!"%rtu-uha& s%l da& "r(l!0%ras! k(la+%&.


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THANK YOU

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