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Ulfah Nurrahmani
RSUP dr Hasan Sadikin Bandung
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Post-operative nursing bleeding management in mitral valve repair-re-exploration patient during early post-operative period: A case report Ulfah Nurrahmani; Riani Siti Hafsah; Reza Widianto Sudjud
Jurnal Keperawatan Padjadjaran Vol. 12 No. 1 (2024): Jurnal Keperawatan Padjadjaran
Publisher : Faculty of Nursing Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24198/jkp.v12i1.2363

Abstract

Background: One of the first targets of post-operative care for cardiac surgery is to control bleeding. Significant bleeding can affect cardiac function as it can lead to hemorrhagic shock, severe anemia, and cardiac tamponade. Valve surgery has a mortality rate of 3.4%. Mitral valve repair surgery has a mortality rate of 1.2% compared to a valve replacement mortality rate of 4.5%. A quick and appropriate decision in the management of bleeding is one of the factors determining the patient's outcome. This study aims to report on nursing bleeding management in mitral valve repair-re-exploration patient during early postoperative period. This research is qualitative research using the case study method. Case: 59-year-old female with a medical diagnosis of mitral valve prolapse with severe mitral regurgitation of non-significant coronary artery diseases performed mitral valve repair surgery. This case has a score of 1 on the Papworth scale, which means low risk of bleeding. During treatment in the ICU, there was an increase in blood production from the chest tube of 1,670 ml within six hours post-surgery. PT APTT value was within normal range. Bleeding management during early post-operative period was carried out, namely conducting supporting laboratory tests, monitoring hypotension, monitoring urine production, performing chest tube maintenance, giving blood transfusions, fluid management and collaboration for re-exploration. Re-exploration surgery was performed at the sixth hour of post-operative care. Conclusion: The application of post-operative nursing bleeding management in mitral valve repair-re-exploration patient during the early post-operative period provides good clinical outcomes. Effective collaboration (multi-disciplinary teams) between cardiac surgeon, perfusionist, anesthetist, clinical pharmacist, and nurse is required to prevent and manage post-operative bleeding.
ORAL HYGIENE IN PREVENTION OF PNEUMONIA POST OPERATION HEART SURGERY: LITERATURE REVIEW Ulfah Nurrahmani; Noviyah Noviyah
Jurnal Penelitian Keperawatan Vol 6 No 2 (2020): Jurnal Penelitian Keperawatan
Publisher : STIKES RS Baptis Kediri

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32660/jpk.v6i2.489

Abstract

Pneumonia pasca operasi adalah komplikasi paling umum ketiga untuk semua prosedur bedah dan dikaitkan dengan peningkatan morbiditas dan mortalitas pasien. VAP terjadi pada 9-27% pasien dengan endotrakeal intubasi, menghasilkan peningkatan risiko 8 kali lipat kematian pada pasien yang menjalani operasi bedah jantung. Aspirasi bakteri dari saluran pencernaan bagian atas telah diidentifikasi sebagai mekanisme kunci dalam patogenesis VAP. Pencegahan pneumonia pasca operasi dihubungkan dengan optimalisasi kebersihan mulut mulai dari fase praoperasi hingga pascaoperasi. Tujuan mengetahui hubungan oral hygiene dengan penurunan kejadian pneumonia pasca operasi bedah jantung berdasarkan pada sumber literatur jurnal penelitian ilmiah terkait. Metode penelitian dengan melakukan pencarian terhadap hasil penelitian dari database seperti PubMed, sciencedirect, dan NCBI dengan menggunakan kata kunci oral hygiene, pneumonia, cardiac surgery. Studi yang digunakan kuantitatif dan kualitatif, serta artikel yang dipublikasikan sampai tanggal 30 Juni 2020 dengan metode penelitian menggunakan quasi experiment dan randomized control trial. Hasil penelusuran didapat 173 artikel dan dipilih 7 artikel yang memenuhi kriteria untuk dilakukan review. Berdasarkan hasil review didapatkan: Tingkat infeksi nosokomial secara keseluruhan menurun pada pasien yang mendapat intervensi oral hygiene. Pneumonia pasca operasi dapat dicegah dengan intervensi sederhana berupa oral hygiene, sikat gigi, dan kumur klorheksidine. Protokol kebersihan mulut dilaksanakan mulai 3 hari preoperasi sampai pasca operasi dengan menggunakan klorheksidine 0,12% atau 0,2% dan salep mupirocin intranasal 2% atau salep dengan kandungan klorheksidine 0,12%. Kesimpulan: Oral hygiene signifkan dalam pencegahan pneumonia pascaoperasi bedah jantung. Dengan optimalisasi kebersihan gigi, dapat meningkatkan keluaran hasil operasi bedah jantung
Co-Authors Noviyah Noviyah Reza Widianto Sudjud Riani Siti Hafsah