terapi cairan tasya

8/17/2019 TERAPI CAIRAN tasya

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TERAPI CAIRAN

Delvina Anastasya Pertiwi

1510221051


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PENDAHULUAN

• Kira-kira 55-0! "ari #erat #a"an $ran%"ewasa ter"iri atas air& "an 'a"a #ayi"an anak t$tal air t(#() le#i) tin%%i la%i

yakni *0! 'a"a #ayi #ar( la)ir+• Dala, wakt( 2 .a, .(,la) air "an

elektr$lit yan% ,as(k setara "en%an .(,la) yan% kel(ar+

• Pen%el(aran /airan "an elektr$lit "arit(#() "a'at #er('a (rin& tin.a& kerin%at"an (a' air 'a"a saat #erna'asinsensi#le water l$ss+


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• Tera'i Cairan tin"akan (nt(k,e,eli)ara& ,en%%anti& ,ile( interi$r"ala, #atas 3si$l$%is "en%an kristal$i"

ta( k$l$i" se/ara intravena+• Tera'i "inilai #er)asil a'a#ila 'a"a

'en"erita ti"ak "ite,(kan tan"a-tan"a)i'$v$le,ik "an )i'$'er4(si ata( tan"a-

tan"a kele#i)an /airan #er('a e"e,a'ar( "an %a%al na4as+


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CAIRAN TUUH

• Air ,er('akan #a%ian ter#esar 'a"at(#() ,an(sia& 'resentasenya "ata#er(#a) ter%ant(n% 'a"a (,(r& .enis

kela,in& "an "ere.at $#esitas sese$ran%+• Per(#a)an .(,la) "an k$,'$sisi /airan

t(#() "a'at ter.a"i 'a"a 'er"ara)an&l(ka #akar& "e)i"rasi& ,(nta)& "iare& "an

'(asa 're$'erati4 ,a('(n 'eri$'erati4&"a'at ,enye#a#kan %an%%(an 3si$l$%isyan% #erat


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• 6el(r() /airan t(#() "i"istri#(sikanke "ala, k$,'arte,en intrasel(lar"an k$,'arte,en ekstrasel(lar – Cairan intrasel(ler 0!

– Cairan ekstrasel(ler 20!• Cairan interstitial 15!

• Cairan intravask(lar 5!


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• 6elain air& /airan t(#() ,en%an"(n%"(a .enis 7at yait( elektr$lit "an n$nelektr$lit – Elektr$lit

• Kati$n – Natri(, Na8

– Kali(, K8

• Ani$n – Kl$ri"a Cl-

– ikar#$nat HC9:-

– ;$s4at P9-


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Distribusi Cairan dalam

Tubuh

Kation Utama Anion Utama

Cairan Intrasel(40%)

K+ PO43-

Cairan Ekstrasel (20%)

- Cairan Interstisial

(15%)

- Cairan Intravaskular

(5%)

Na+, K+, Ca2+,Mg2+

Cl, HCO3, Albumin

Distri#(si Cairan "an Elektr$lit "ala, K$,'arte,en T(#()


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– N$n elektr$lit•


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PR96E6 PER


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• Tekanan )i"r$statik a"ala) tekananyan% ,e,'en%ar()i 'er%erakan air,elal(i 'er%erakan "in"in% ka'iler

• Tekanan 9nk$tik atas tekanan$s,$tik k$l$i" a"ala) tekanan yan%,en/e%a) 'er%erakan air


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Ke#(t()an Air "an Elektr$lit

• Dewasa

• Air :0-:5 ,l>k% kenaikan 1"era.at /el/i(s "ita,#a) 10-15!

• Na8 1&5,E?>k% 100,E?>)ari ta(5&@ %

•

K8 1 ,E?>k% 0 ,E?>)ari ta( &5%


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• ayi Anak

• Air

•

0-10k% ,l>k%>.a, 100,l>k%• 10-20k% 0,l 8 2 ,l>k%>.a,

• B20k% 0,l 81,l>k%>.a,

•

Na8 2 ,E?>k%• K8 2 ,E?>k%


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A6UPAN DAN KEHILAN


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Cairan Kel(ar

• Per(#a)an $l(,e – IL 15 ,l>k% >)ari – Urine n$r,al B 0&5 F 1 ,l>k%>.a, – ;eses 1 ,l>)ari


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DA6AR TERAPI CAIRAN

• Tera'i /airan "i#a%i ,en.a"i "(a – Tera'i /airan res(sitasi

• "it(.(kan (nt(k ,en%%antikan ke)ilan%an ak(t

/airan t(#() ata( eks'ansi /e'at "ari /airanintravask(lar

• Tera'i /airan res(sitasi "a'at "ilak(kan "en%an'e,#erian N$r,al 6aline N6& Rin%er AsetatRA& ata( Rin%er Laktat RL+

• 6e"an%kan lar(tan 'las,a eks'an"er yait(k$l$i" "a'at "i#erikan 'a"a l(ka #akar&'enin%katan sirk(lasi ka'iler& sy$k kar"i$%enik&)e,$ra%ik& ata( sy$k se'tik


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• Ke#(t()an n$r,al (nt(k r(,atan

•

C$nt$) 'a"a wanita "en%an #erat #a"anG0 k%& ,aka #esar ke#(t()an r(tin/airannya a"ala) 10 k% ,l>k%>.a,8 10 k% 2 ,l>k%>.a, 8 50 k% 1

,l>k%>.a, 110 ,l>.a,+

Berat Tubuh Kebutuhan Cairan

Unt#$ 0 $g &ertama (0-

0 $g)

4 ml/kg/jam

Unt#$ 0 $g 'eri$#tna

(-20 $g)

tambah 2 ml/kg/jam

Setiap 1 kg berikutnya (>20

kg)

tambah 1 ml/kg/jam


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• Tera'i r(,atan "a'at "i#erikan in4(s/airan elektr$lit "en%an kan"(n%ankar#$)i"rat ata( in4(s yan% )anya,en%an"(n% kar#$)i"rat sa.a

• Lar(tan elektr$lit yan% .(%a ,en%an"(n%kar#$)i"rat a"ala) lar(tan KA-EN&"etran 8 saline& D


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• Dala, tera'i r(,atan /airankesei,#an%an kali(, 'erl( "i'er)atikan

• U,(,nya in4(s k$nvensi$nal RL ata( N6ti"ak ,a,'( ,ens('lai kali(, ses(aike#(t()an )arian+ In4(s KA-EN "a'at,ens('lai kali(, ses(ai ke#(t()an)arian

• Unt(k ,en%%antinya ter%ant(n% #esar

ke/ilnya 'e,#e"a)an& yait( – -* ,l>k% (nt(k #e"a) #esar – - ,l>k% (nt(k #e"a) se"an% – 2- ,l>k% (nt(k #e"a) ke/il


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PENATALAK6ANAAN TERAPI

• Cairan 'ra #e"a) – "i#erikan "ala, #ent(k /airan

'e,eli)araan& 'a"a "ewasa 2

,l>k%>.a,+ Ata( 0 ,l "ita,#a) 1,l>k% (nt(k #erat #a"an le#i) "ari 20k%

– Pa"a anak-anak ,l>k% 'a"a 10 k% I&"ita,#a) 2 ,l>k% (nt(k 10 k% II& "an"ita,#a) 1 ,l>k% (nt(k #erat #a"ansisanya


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• Cairan sela,a 'e,#e"a)an – tra(,a rin%an "i#erikan /airan 2 ,l>k%

>.a, (nt(k ke#(t()an "asar "ita,#a)

,l>k% >.a, se#a%ai 'en%%anti aki#attra(,a 'e,#e"a)an – tra(,a 'e,#e"a)an se"an% ,l>k%

>.a, –

tra(,a 'e,#e"a)an #erat * ,l>k% >.a, – Cairan 'en%%anti aki#at tra(,a

'e,#e"a)an 'a"a anak& (nt(k tra(,a'e,#e"a)an rin%an 2 ,l>k% >.a,&

se"an% ,l>k%>.a, "an #erat ,l>k%>.a,


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• Cairan 'as/a #e"a) – T(.(an

• =e,en()i ke#(t()an air& elektr$lit "an

n(trisi+• =en%%anti ke)ilan%an /airan 'a"a ,asa

'aska #e"a) /airan la,#(n%& 4e#ris+• =elan.(tkan 'en%%antian "e3sit 'ra#e"a) "an

sela,a 'e,#e"a)an+• K$reksi %an%%(an kesei,#an%an karena

tera'i /airan+ – + Pe,#erian kal$ri sa,'ai 0 F 50 K/al>k% "en%an

'r$tein 0&2 F 0&2 N>k%+ N(trisi 'arenteral ini'entin%& karena 'a"a 'en"erita 'aska #e"a) yan%

ti"ak ,en"a'at n(trisi sa,a sekali akan ke)ilan%an'r$tein G5 F 125 %r>)ari


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Jenis Cairan

• Cairan Kristal$i"

• Cairan yan% ,en%an"(n% = ren"a) *000"alt$n "en%an ata( tan'a %l(k$sa

•

Tek+ $nk$tik ren"a)& s)% /e'at ter"istri#(si ker(an% ekstrasel(ler

• Cairan K$l$i"

• Cairn "en%an = tin%%i B*000 "alt$n ,is

'r$tein• Tek+ $nk$tik tin%%i& s)% se#a%ian #esar akan

teta' tin%%al "i r(an% intravask(ler

• Cairan K)(s(s

• "i)(nakan (te k$reksi ata( in"ikasi k)(s(s&


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=ACA= CAIRAN UNTUK TERAPICAIRAN

• Cairan Kristal$i" – ,e,'(nyai k$,'$sisi ,iri' /airan

ekstrasel(ler

–

)ar%a ,(ra)& terse"ia "en%an ,("a) "isetia' '(sat kese)atan& ti"ak 'erl( "ilak(kan/r$ss ,at/)& ti"ak ,eni,#(lkan aler%i ata(sy$k ana3laktik& 'enyi,'anan se"er)ana "an"a'at "isi,'an la,a

– akt( 'ar() "i r(an% intravask(ler 20-:0,enit

– le#i) #anyak ,enye#ar ke r(an% interstitiel"i#an"in%kan "en%an k$l$i" ,aka kristal$i"

se#aiknya "i'ili) (nt(k res(sitasi "e3sit/airan "i r(an% interstitiel


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• Rin%er Laktat

• /airan 'alin% 3si$l$%is

• #anyak "i%(nakan (tk re'la/e,entt)era'y

• ,is sy$k )i'$v$le,ik& "iare& tra(,a&l(ka #akar

• laktat yan% terkan"(n% "ala, RL "i

,eta#$lis,e "i )ati ,." #ikar#$nat (tk,e,'er#aiki kea"aan s'rt asi"$sis,eta#$lik

• kan"(n%an kali(,nya ren"a)

• ti"al ,en%an"(n%


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• NaCL 0&@! N$r,al 6aline

• "i%(nakan sa% /airn res(sitasi& ter(ta,akas(s

• Ra"ar Na8 ren"er

• "i%(nakan "ala, kas(s alkal$sis& retensiKali(,

• /airn 'ili)an (te kas(s tra(,a ke'ala

• "i%(nakan Ute ,en%en/erkan sel "ara),era) se#el(, trans4(si+

• Kek(ran%an

• ti"ak ,en%an"(n% HC9:-& K8

• ra"ar NA8& Cl- relati4 tin%%i s)% "a'at


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Detr$se 5! 10!• "i%(nakan (tk ,aintenan/e

• Pen%%(naan 'eri$'erati4 (nt(k

• #erlan%s(n%nya ,eta#$lis,e

• ,enye"iakan ke#(t()an air

• ,en/e%a) )i'$%like,ia• ,e,'erta)ankan 'r$tein y% a"a

• ,en/e%a) ket$sis "i#(t()kan ,ini,al 200%KH

• ,en(r(nkan level asa, leak #e#as "an ket$n

• Cairan in4(s yan% ,en%an"(n% "etr$se

k)(s(snya "etr$se 5! ti"al #le) "i#erikan


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Cairn K$l$i"

– /airan 'en%%anti 'las,a ata( #iasa "ise#(t'las,a s(#stit(te ata( 'las,a e'an"er

– Di "ala, /airan k$l$i" ter"a'at 7at>#a)an yan%

,e,'(nyai #erat ,$lek(l tin%%i "en%an aktivitas$s,$tik yan% ,enye#a#kan /airan ini /en"er(n%#erta)an a%ak la,a wakt( 'ar() :- .a, "ala,r(an% intravask(ler

– (nt(k res(sitasi /airan se/ara /e'at ter(ta,a'a"a sy$k )i'$v$le,ik>)er,$r)a%ik ata( 'a"a

'en"erita "en%an )i'$al#(,ine,ia #erat "anke)ilan%an 'r$tein yan% #anyak ,isal l(ka#akar

– ,a)al "an "a'at ,eni,#(lkan reaksi ana3laktikwala( .aran%


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• er"asarkan 'e,#(atannya& ter"a'at2 .enis lar(tan k$l$i" – K$l$i" Ala,i yait( 4raksi 'r$tein 'las,a

5! "an al#(,in ,an(sia 5 "an 2&5!• ,e,anaskan 'las,a ata( 'lasenta 0MC

sela,a 10 .a, (nt(k ,e,#(n() vir(s)e'atitis "an vir(s lainnya

–

K$l$i" 6intesis• Detran• Hy"r$ylet)yl 6tar/) Heta star/)•


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KRI6TAL9ID

Res(sitasi "en%an kristal$i"akan ,enye#a#kan eks'ansi ke

r(an% interstisial

6e/ara 3si$l$%a kri$stal$i"akan le#i) ,enye#a#kan

e"e,a

K9L9ID

Res(sitasi "en%an k$l$i" y%)i'er$nk$tik akan ren"erin%,enye#a#kan eks'ansi ke

intravask(lar


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TERI=AKA6IH

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