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Lampiran 1. LEMBAR PENELITIAN Ruang perawatan Intensive Care Unit (ICU) No
Kriteria
Data
1.
No. CM RSDK
2.
No. CM penelitian
3.
Nama
5.
Tanggal Lahir
6.
Alamat
7.
Indikasi penggunaan
Gagal Napas
ventilator mekanik
Penurunan kesadaran
L/P
Frekuensi napas > 35x/menit Hipoksemia Komplikasi kardiovaskuler Komplikasi lain Telah menggunakan NIPPV lainnya 8.
Tanggal masuk ICU
/ /
Jam
9.
Mulai penggunaan Ventilator
/ /
Jam
/
jam
mekanik Berakhir penggunaan
/
Ventilator mekanik 10.
Ventilator bundle Elevasi tempat tidur
Kontraindikasi :
60
(Head Of the Bed) 30 º
frakturspinal,
sampai 45 º, kecuali
frakturpelvis,
kontraindikasi medis
Intra-Aortic Balloon Pump (IABP ulkus parah akibat tekanan pada daerah sacrum
Penghentian secara berkala agen sedasi dan penilaian
Obat sedasi : midazolam
kesiapan ekstubasi lorazepam dexmedetomidine atau propofol Lainnya profilaksis trombosis vena Obat Profilaksis TVD dalam (kecuali
Heparin
kontraindikasi medis) Enoxaparin (Lovenox) Nandroparin Fraxiparin Lainnya Profilaksis ulkus peptikum
Obat yang digunakan : PPI Sukralfat Antagonis H2 Lainnya
Oral care secara berkala
0,12%
dengan chlorhexidine
0,2%
61
Lainnya Kontraindikasi lainnya
Pasien on pressors (vasopressor) Pasien dengan ciri-ciri kematian Pasien dengan blokade neuromuscular Pasien dengan resiko perdarahan
62
Lampiran 2
63
Lampiran 4 DOKUMENTASI
Lampiran 3 Biodata Mahasiswa
64
Identitas Nama
: Dea Aulia Futaci
NIM
: 22010110120106
Tempat tanggal lahir
: Majalengka,16 Maret 1992
Jenis Kelamin
: Perempuan
Alamat
: Ds.sindang no.61 Rt/Rw 01/004 Blok.Salasa kec.Cikijing Kab.Majalengka.Jawa barat
No. HP
: 083838071100
Email
:
[email protected]
Riwayat Pendidikan Formal : 1. SD
: SDN SINDANG 1
Lulus tahun: 2004
2. SMP : SMP N 1 KUNINGAN
Lulus tahun: 2007
3. SMA : SMA N 2 KUNINGAN
Lulus tahun: 2010
4. SI
: Fakultas Kedokteran Universitas Diponegoro
Masuk : 2010
