Penerapan Asuhan Keperawatan pada Pasien Langerhans Cell Histiocytosis dengan Pneumonia di Bangsal Onkologi Anak: Studi Kasus

Infrastuti, Lathifah
Sandhi, Ayyu
PujiLestari, Rahayu

Jurnal Keperawatan Klinis dan Komunitas (Clinical and Community Nursing Journal)
Vol 8, No 2 (2024)

Background: Langerhans Cell Histiocytosis (LCH) is a condition when the body produces many immature Langerhans cells which attack the host’s organs such as the lungs. This can result in the deterioration of patient's condition. LCH among pediatric patients are rare. But among those rare cases, lung involvement cases are widely reported. Unfortunately, nursing care on pneumonia children with LHC study case is scarcely applied.Objective: To identify the implementation of nursing care in pediatric LCH patient with pneumonia in the pediatric oncology ward of RSUP Dr. Sardjito Yogyakarta.Case report: A 1-year-5-month-old boy with LCH in the 13th week of the chemotherapy protocol came into the Pediatric Hemato-Oncology Clinic with rapid breathing and underwent oxygen desaturation up to 75% with nasal flare. The patient was treated in the pediatric oncology ward based on the main medical diagnosis of pneumonia with the differential diagnosis (dd) was lung involvement of LCH. Patient was provided nursing care based on main complaints with ineffective breathing pattern and hyperthermia as the main nursing diagnoses.Outcome: The interventions included non-pharmacological techniques such as adjusting the semi-fowler position to 30o-45°, administering chest physiotherapy, regulating environment, and monitoring fluid balance. The non-pharmacological techniques were collaborating with pharmacological therapies, such as antibiotic, antipyretic, and oxygen therapy. On the sixth day of nursing care implementation, hyperthermia was fully resolved and ineffective breathing pattern was partially resolved.Conclusion: Nurses play important roles in dealing with hyperthermia and ineffective breathing pattern in patients with pneumonia and lung involvement of LCH.INTISARILatar belakang: Langerhans cell histiocytosis (LCH) merupakan kondisi ketika tubuh seseorang memproduksi banyak sel Langerhans yang belum matang dan dapat menyerang organ tubuh seperti paru-paru sehingga dapat memperparah kondisi pasien. Kejadian LCH pada anak merupakan kasus langka. Namun, dari kasus LCH pada anak yang berhasil diidentifikasi, keterlibatan organ paru termasuk yang paling sering dilaporkan. Studi kasus terkait asuhan keperawatan pneumonia pada anak dengan LCH belum banyak dilakukan.Tujuan: Mengidentifikasi penerapan asuhan keperawatan pneumonia pada anak dengan LCH di bangsal onkologi anak RSUP Dr. Sardjito Yogyakarta.Laporan kasus: Pasien anak laki-laki berusia 1 tahun 5 bulan dengan LCH dalam protokol kemoterapi minggu ke-13 datang ke Poli Hemato-Onkologi dengan napas cepat, sesak, dan desaturasi oksigen hingga 75% disertai nasal flare. Pasien mendapatkan perawatan di bangsal onkologi anak berdasarkan diagnosis medis utama pneumonia ditandai dengan lung involvement of LCH. Pasien diberikan asuhan keperawatan sesuai keluhan utama dengan diagnosis keperawatan utama, yaitu ketidakefektifan pola napas dan hipertermia.Hasil: Intervensi yang diberikan mencakup teknik nonfarmakologi seperti pengaturan posisi semi fowler 30°-45°, fisioterapi dada, pengaturan lingkungan, dan pemantauan keseimbangan cairan. Tindakan non-farmakologi dikolaborasikan bersama terapi farmakologi, seperti terapi antibiotik, antipiretik, dan oksigen. Pada evaluasi keperawatan di hari ke-6, hipertermia teratasi dan ketidakefektifan pola napas teratasi sebagian.Simpulan: Perawat berperan penting dalam menangani masalah keperawatan hipertermia dan ketidakefektifan pola napas pada kondisi pasien dengan pneumonia ditandai dengan lung involvement of LCH.