Tugas Artikel MN

Disusun untuk memenuhi tugas mata kuliah Maternity Nursing 2

Disusun oleh: Perdana R. Purnomo 0710720017

JURUSAN ILMU KEPERAWATAN FAKULTAS KEDOKTERAN UNIVERSITAS BRAWIJAYA 2010

Fisiologi Jantung Jantung merupakan suatu organ otot berongga yang di dalam rongga mediastinum dari ronga dada (toraks) di antara kedua paru. Bagian kanan dan kiri jantung memiliki ruang sebelah atas (atrium) dan ruang sebelah bawah (ven trikel). Atrium Atrium kanan ( Right Atrium ) Berfungsi sebagai penampungan darah yang
Anatomi jantung

rendah oksigen dari seluruh tubuh. Darah tersebut mengalir melalui vena kava superior, vena kava inferior, serta sinus koronarius yang berasal dari jantung sendiri. Dari atrium kanan kemudian darah di pompakan ke ventrikel kanan. Atrium kiri ( Left Atrium ) Berfungsi menerima darah yang kaya akan oksigen dari paru melalui 4 buah vena pulmonalis. Kemudian darah dialirkan ke ventrikel kiri. Antara kedua atrium dipisahkan oleh sekat yang disebut septum atrium. Ventrikel Ventrikel kanan ( Right Ventricle ) Berfungsi menerima darah dari atrium kanan yang kemudian dipompakan ke paru melalui arteri pulmonalis. Ventrikel kiri ( Left Ventricle ) Berfungsi menerima darah dari atrium kiri kemudian memompakannya ke seluruh tubuh melalui aorta. Antara kedua ventrikel dipisahkan oleh sekat yang disebut septum ventrikel ( Joe, 2009 ). Fungsi Jantung Dalam Dedy, 2009 menyebutkan pada saat berdenyut, setiap ruang jantung mengendur dan terisi darah (disebut diastol). Selanjutnya jantung

berkontraksi dan memompa darah keluar dari ruang jantung (disebut sistol). Kedua atrium mengendur dan berkontraksi secara bersamaan, dan kedua ventrikel juga mengendur dan berkontraksi secara bersamaan. Darah yang kehabisan oksigen dan mengandung banyak karbondioksida dari seluruh tubuh mengalir melalui 2 vena terbesar (vena kava) menuju ke dalam atrium kanan. Setelah atrium kanan terisi darah, dia akan mendorong darah ke dalam ventrikel kanan. Darah dari ventrikel kanan akan dipompa melalui katup pulmoner ke
Sirkulasi jantung

dalam arteri pulmonalis, menuju ke

paru-paru. Darah akan mengalir melalui pembuluh yang sangat kecil (kapiler) yang mengelilingi kantong udara di paru-paru, menyerap oksigen dan melepaskan karbondioksida yang selanjutnya dihembuskan. Darah yang kaya akan oksigen mengalir di dalam vena pulmonalis menuju ke atrium kiri. Peredaran darah diantara bagian kanan jantung, paru-paru dan atrium kiri disebut sirkulasi pulmoner. Darah dalam atrium kiri akan didorong ke dalam ventrikel kiri, yang selanjutnya akan memompa darah yang kaya akan oksigen ini melewati katup aorta masuk ke dalam aorta (arteri terbesar dalam tubuh). Darah kaya oksigen ini disediakan untuk seluruh tubuh, kecuali paru-paru. Dalam Bobak,2005 pada wanita yang mencapai kehamilan aterm, tidak dianjurkan untuk berbaring telentang karena uterus yang membesar akan semakin menekan vena kava. Jika aliran vena kava terhambat, maka aliran balik darah ke atrium kanan akan berkurang sehingga dorongan darah ke dalam ventrikel kanan juga menurun. Selanjutnya pasokan darah ke paru sampai dengan ventrikel kiri juga akan berkurang.

Akibatnya terjadi penurunan curah jantung. Bila curah jantung turun, aliran darah ke otak dan jantung akan tetap dipertahankan sehingga aliran darah ke organ lain, seperti uterus akan diturunkan. Hal ini mengakibatkan aliran darah uteroplasentalmengalami hambatan yang dapat membahayakan janin.

Sirkulasi darah janin-ibu

Daftar Pustaka Bobak,I. 2005. Buku Ajar Keperawatan Maternitas Edisi 4. Jakarta : EGC Dedy.2009. Fisiologi Jantung & Pembuluh Darah. http://www.sidenreng.com/ 2009/08/endokarditis-non-infektif/. Diakses tanggal 21 Maret 2009 Joe.2009. Struktur dan Fungsi Kardiovaskuler.http://perawattegal.wordpress.com/ 2009/09/12/struktur-fungsi-sistem-kardiovaskuler/. Diakses tanggal 21 Maret 2010

Proses melahirkan merupakan proses yang sangat tidak nyaman bagi ibu. Rasa nyeri yang dirasakan ibu merupakan penyebab yang sering muncul pada proses persalinan. Terdapat beberapa metode untuk mengurangi nyeri yang dirasakan oleh ibu saat persalinan. Metode-metode tersebut juga sudah mulai digunakan di kalangan masyarakat. Salah satunya adalah metode injeksi steril water block. Dengan menginjeksikan steril water pada titik tertentu yang disebut Michaelis' rhomboid area, maka akan timbul nyeri akibat injeksi. Nyeri pada area tersebut dapat menimbulkan kondisi 'hypestimulation' atau 'counterirritation'. Sehingga nyeri akibat kontraksi uterus akan terganti oleh nyeri injeksi. Keuntungan metode steril water block : Dapat dijangkau, kemudahan penyediaan sterile water, tidak terdapat efek obat-obatan yang berbahaya dan dapat menimbulkan masalah pada janin atau bayi. Terdapat beberapa metode dalam injeksi steril water block itu sendiri, antara lain adalah injeksi steril water block pada daerah intracutan dan injeksi steril water block pada subcutan. Pada artikel berjudul Managing Labor Pain Safely, disebutkan bahwa meskipun metode subcutan lebih nyaman karena rasa sakitnya tidak sebesar pada metode intracutan, tetapi kelemahan metode ini adalah efeknya yang tidak bertahan lama. Padahal efek/sensasi tersengat atau panas yang besar inilah yang dapat mengalihkan nyeri persalinan pada ibu. Pada studi yang dilakukan Martensson and Wallin yang membandingkan rasa sakit dan efektifitas yang didapat dalam meredakan nyeri persalinan, menyebutkan bahwa metode intracutan/intradermal water block memang lebih efektif dalam meredakan nyeri, tapi metode tersebut memiliki efek rasa sakit yang lebih besar dibandingkan subcutan, sehingga memungkinkan metode injeksi steril water subcutan lebih diminati dan dapat dijadikan pilihan daripada metode intradermal. Diperkirakan penggunaan injeksi subcutan water block akan lebih sering dipilih oleh wanita-wanita yang akan melahirkan karena mayoritas wanita di era serba nyaman ini lebih sulit mentolerir ketidaknyamanan. Dan bahkan bukan tidak mungkin mereka akan memilih metode lain yang memberikan ketidaknyamanan

secara minimal. Sehingga para ahli dituntut untuk menemukan metode baru yang lebih nyaman tetapi tidak mempunyai pengaruh negatif pada janin maupun ibu.

Daftar Pustaka Peart,K.2007.Managing Labour Pain Safely. Australian Journal of Advanced Nursing 25 (3): 43-48 Martensson,L.2005.Subcutaneous Versus Intracutaneous Injections of Sterile Water for Labour Analgesia. British International Journal of Obstetrics & Gynaecology 107(10):1248-1251

Complimentary/Alternative Therapies for Labor and Childbirth

by Carolyn Rafferty, RN, BSN

Americans spent nearly $14 billion on alternative therapies in 1998 and there were more alternative health care provider visits than primary health care visits (McFarlin, Gibson, O'Rear, & Harman, 1999). Complimentary and alternative therapies are the fastest growing areas of healthcare. The main difference between conventional medicine and complimentary medicine is the inclusion of the emotional, spiritual, and physical components of well-being; complimentary methods utilize the client's own energy to enhance the healing potential. The inclusion of complimentary therapies in maternity care vastly increases the choices available to women throughout pregnancy and childbirth (Tiran & Mack, 2000). Therapy Modalities that use the Gate Theory of Pain Control The gate theory of pain control is described as a transfer of nerve impulses, pain sensations, which travel along a sensory nerve pathway; according to the gate theory, only one sensation can travel on the pathway at a time. If the sensory pathway is occupied by a sensation caused by stroking, massaging, hot water, electrical stimulation, or pressure the pain sensation is effectively blocked from getting to the brain and being perceived as pain (Lowdermilk, et al, 2000). Acupuncture and Acupressure The ancient, traditional, Chinese art of acupuncture is the process of inserting thin needles in the body at any one, or more, of the 2000 specific points thought to control, correct, or alter various aspects of body function. The obstetric use of acupuncture is used most readily by midwives and has gained popularity over the last 20 years (Beal, 1999). The first deliveries recorded that utilized acupuncture for pain relief, were done in 1972 in England. In addition to intrapartum and postpartum pain relief, many women find acupuncture useful for relieving pregnancy discomforts such as nausea, headache, hemorrhoids, and backache. The World Health Organization sites sufficient evidence supporting the therapeutic effects of acupuncture for it to be considered as an important part of primary health care and that it should be fully integrated with conventional medicine (Tiran & Mack, 2000). Acupressure is similar to acupuncture, however, no needles are used; rather, the hands, fingers and/or thumbs are used to create pressure over the same stimulation points. Shiatsu, Japanese for finger pressure, can relieve symptoms of pregnancy such as, breathlessness, hemorrhoids, nausea and vomiting, carpal tunnel syndrome, heartburn, edema, coughs, urinary frequency, cramps, insomnia, lumbarsacral pain, headaches, and fatigue (Tiran & Mack, 2000).In spite of the potential benefits of acupuncture and acupressure, and the growing interest in complimentary and alternative therapies, very few hospital systems integrate either treatment modality; women seeking them must seek independent practitioners and gain permission to utilize the treatments in their chosen birth site (Beal, 1999).

Hydrotherapy Warm water, in the form of a Jacuzzi bath, shower, or a simple warm soak are methods of hydrotherapy. Warm water has been used for it's healing powers for centuries, and it has been found effective in managing the discomforts of the first and second stages of labor. Hydrotherapy is an economical and drug free method of utilizing the gate theory mechanism of pain reduction. Basically, the hot water competes with the pain impulses for neuropathway access. Hot water effectively blocks the sensation of pain while allowing the woman's body to relax and allow her body to work at moving the baby closer to birth (Teschendorf & Evans, 2000). There are virtually no side effects with hydrotherapy; women and fetus may experience tachycardia if the water is too hot; the baseline fetal heart rate can rise 10-20 beats per minute during the bath, but return to baseline within 30 minutes after the bath. The water temperature should be monitored closely and maintained between 96 and 98F. Most women report a more satisfying birth experience and better pain tolerance when the tub is used during labor (Teschendorf & Evans, 2000). It is important to mention that getting in the tub too soon, before labor is really active, could slow labor progress (Simkin, 1995). Infection control protocols are used to reduce the potential of infection (Teschenforf & Evans, 2000). Transcutaneous Electrical Nerve Stimulation Transcutaneous Electrical Nerve Stimulation (TENS) utilizes electrical impulses that are sent to the skin and may work by increasing endorphins at the sight if stimulation. The laboring woman controls the intensity of the electrical stimulation via the battery operated control device that she holds in her hand. A tingling sensation at the site of the electrode elicits the gait response as the neuropathways sense the tingling rather than the sensation of discomfort. There are relatively no side effects, however, TENS units may cause interference with electronic fetal monitoring. The benefit is that some women find great relief and are able to delay or avoid epidural anesthesia by using them (Simkin, 1995). Subcutaneous Water Papules Subcutaneous Water Papules are a method of pain relief using a similar principal to TENS. This was established in Scandinavia and is not wide spread in North America. This technique may help some women avoid pain meds. Injecting sterile water just under the skin on the lower back causes four small papules. The strategically placed papules provide pressure and employ the gate method of pain reduction. There is a stinging sensation for 20 to 30 seconds after each injection. Subcutaneous Water Papules are primarily used for relief of low back pain and pressure in labor (Simkin, 1997). More Complimentary Therapies Aromatherapy

The practice of aromatherapy is an ancient art and the term "aromatherapy" was first used in the 1920's. Over the last 10-15 years aromatherapy has been gaining in popularity. Women benefit from massage with essential oils that have therapeutic properties. Some of the oils that are used in labor and delivery are used as adjuncts to conventional pain relief measures and they include: clary sage, lavender, mandarin, and jasmine; they may be added to massage lotions, used to scent the room, or added to the bath. Only a those with experience and knowledge of the effects produced should use essential oils with pregnant or laboring women (Tiran & Mack, 2000). Hypno-birthing Hypnosis is a state of deep relaxation that offers a sense of extreme wellbeing. When hypnosis is used in labor the perception of pain can be greatly reduced. If the client truly believes that it will work for her, and she has practiced her method of induction adequately, it can be a truly remarkable source of pain relief (Tiran & Macke, 2000). The founder of Hypno-birthing TM is Marie Mongan; her philosophy is, that every woman instinctively knows how to birth, and that when fear is replaced with knowledge, and a faith that her body will work the way it was designed to work, her birth will be experienced with satisfaction and fewer interventions. Through a series of classes, the woman learns about the natural flow and rhythm of labor, breathing patterns, and visualizations; the goal is to reach a sense of profound relaxation through fear release and self hypnosis enabling her to have a safe, satisfying birth (Mongan, 1998). Dr. Goldman, a practitioner of Hypno-birthing says, " The goal is not painless childbirth but to be in control from start to finish" and "to have a warm picture of labor as apposed to [a picture of'] panic" (Kelomattox, 1999). Cold and Heat The use of cold and heat provides a very inexpensive comfort measure. Heat feels great on an achy back. Warm compresses to the perineum help avoid tears and episiotomies. Heating pads, hot water bottles, or homemade hot packs can be very effective. A hot pack can be made by filling a cotton sock with rice, adding a bit of lavender oil, if you like; then tie it closed and warm it in the microwave for a few minutes; the warmth and smell of lavender is appreciated by many. After the birth, cold packs to the perineum decrease swelling and provide a local numbing effect (Simkin, 1997). Herbs Herbal remedies are the earliest form of medicine and have been a historical part of many cultural healing traditions. Until the 1800's people routinely consulted herbalists for health care (Tiran & Macke, 2000). Herbs are used medicinally to cure many illnesses and it is important to remember that herbs are medications. Herbs can have side effects just like other drugs; they must be taken

with respect and it would be best if the use of herbs were shared with health care providers. Tiran & Mack, (2000) report that the World Health Organization calculated that 75% of the world's population uses traditional medicine and most cultures use herbs for the transitional moments of dying and being born. An increase in the use of herbal therapies has brought about additional education needs for many health care providers. The health care provider should be knowledgeable and current with herbal medicine. The main principals of herbal medicine are; holism, an entire body approach to health care; individuality, a treatment plan tailored to the specific client; diversity, many philosophies are accepted; empowerment, the consumer takes responsibility for their own healing; and connectedness, a connection to the earth and plants used to create the herbal remedies. Historically herbs have been used for childbearing by various cultures; the safety and efficacy of their use has not been well documented. Herbs are used in pregnancy as antiemetics, to augment labor, slow bleeding, encourage lactation and much more. Certified Nurse Midwives (CNM) and Certified Professional Midwives (CPM) are more likely to use herbs. The most common herbs used by CNM's are herbs to facilitate labor; 64% of CNM's responding to a recent study said that they used blue cohosh, 45% used black cohosh, and 93% used castor oil, to stimulate labor; and raspberry leaf to enhance uterine tone, and evening primrose oil to expedite cervical ripening. More reporting of statistical data surrounding the safety and efficacy of such practices would make more CNM's comfortable with the practice (Beal, 1999).
References: Beal, M. (1999). Acupuncture and acupressure: Applications to women's reproductive health care. Journal of Nurse-Midwifery, 44 (3), 217-230. Kelomattox, K. (Producer) . (1999, September) . NBC Dateline. New York: National Broadcasting Company. Lay, M. (2000). Lowdermilk, D. , Perry, S. , & Bobak, I. (2000). Maternity and women's health care (7th ed.). St. Louis, MO: Mosby, Inc.. McFarlin, B., Gibson, M., O'Rear, J., & Harman, P. (1999). A national survey of herbal preparation and use by nurse-midwives for labor stimulation. Journal of NurseMidwifery, 44 (3), 205-216. Mongan, M. (1998). Hypnobirthing- A celebration of life (Expanded ed.). Concord, NH: Rivertree Publishing. Simkin, P. (Producer), & Wilbert, D. (Director). (1995). Comfort measures for childbirth [Film]. (Available from Penny Simkin, Inc., 1100-23rd Avenue East, Seattle, WA 98112) Simkin, P. (1997). Simkin's ratings of comfort measures for childbirth. Waco, TX: Childbirth Graphics.

Teschendorf, M., & Evans, C. (2000). Hydrotherapy during labor: An example of developing a practice policy. MCN, 25 (4), 198-203. Tiran, D. & Mack, S. (Eds.). (2000). Tiran, D. & Mack, S. (Eds.). (2000). Complimentary therapies for pregnancy and childbirth (2nd ed.). London: Harcourt Publishers Limited. Copyright 2001 Carolyn Rafferty, RN, BSN

Nyeri persalinan merupakan pengalaman subjektif tentang sensasi fisik yang terkait dengan kontraksi uterus, dilatasi dan penipisan serviks, serta penurunan janin selama persalinan. Berbagai upaya dilakukan untuk menurunkan nyeri pada persalinan, baik secara farmakologis napun nonfarmakologis. Salah satun dari terapi nonfarmakologis adalah Transcutaneous Electrical Nerves Stimulation (TENS). TENS merupakan suatu alat elektronik yang elektrodanya diletakkan di punngung tepatnya area T 11-L 1 untuk mengurangi nyeri saat persalinan. TENS bekerja dengan merangsang pengeluaran senyawa endorphin yang dapat Dalam artikel Complimentary/Alternative Therapies for Labor and Childbirth disebutkan bahwa tidak ada efek samping dalam penggunaan TENS, kecuali adanya pengaruh pada elektronik fetal monitoring. Keuntungan dari TENS adalah wanita yang mengalami nyeri bersalin mengalami penurunan nyeri dan mereka dapat menghindari epidural anestesi. Sedangkan pada buku Persalinan Normal Tanpa Rasa Sakit karangan Bonny Danuatmaja, menyebutkan bahwa pengaruh mesin TENS akan maksimal jika digunakan sejak awal persalinan. Hal itu dikarenakan butuh waktu kira-kira 1 jam bagi tubuh untuk merespon gelombang elektrik dengan mengeluarkan senyawa endorphin. Sehingga mesin ini tidak dapat bekerja menurunkan nyeri secara maksimal jika waktu penggunaannya belum mencapai satu jam. Selain itu, dalam buku ini juga disebutkan bahwa kelemahan TENS adalah hanya dapat membantu persalinan pada tahap I dan agak mengganggu ketika kontraksinya sangat kuat. Selain itu mesin ini harus dilepas jika ibu menjalani pemeriksaaan monitoring janin, padahal kerja mesin memproduksi senyawa endorphin menjadi terputus jika dilepas. Kelemahan yang lain adalah mesin juga tidak bisa digunakan pada persalinan di dalam air. Keuntungan TENS menurut buku ini adalah praktis, mudah digunakan pada persalinan di rumah, tidak berbahaya, sepenuhnya berada dalam kontrol ibu, serta tidak mengganggu pergerakan ibu dan tidak memberi efek samping pada bayi. Banyaknya terapi nonfarmakologis untuk nyeri persalinan, sering membuat ibu hamil bingung harus menggunakan terapi yang mana. Tidak jarang mereka mencari artikel mengenai keuntungan dan kerugian masing-masing terapi. Untuk itu hendaknya artikel yang ditulis dapat memuat secara lengkap dan

mendetail mengenai kekurangan dan kelebihan terapi sehingga pembaca dapat memilih metode / terapi sesuai dengan yang dikehendaki dan tidak ada penyesalan atas rekomendasi terapi tersebut.

Daftar Pustaka Rafferty,C. 2001. Complimentary/Alternative Therapies for Labor and Childbirth. http://onyx-ii.com/birthsong/page.cfm. Diakses tanggal 26 Maret 2010 Danuatmaja,B. 2004. Persalinan Normal Tanpa Rasa Sakit. Jakarta : Puspa Swara