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59
Lampiran 1.
LEMBAR PENELITIAN
Ruang perawatan Intensive Care Unit (ICU)
No Kriteria Data
1. No. CM RSDK
2. No. CM penelitian
3. Nama L/P
5. Tanggal Lahir
6. Alamat
7. Indikasi penggunaan
ventilator mekanik
Gagal Napas
Penurunan kesadaran
Frekuensi napas > 35x/menit
Hipoksemia
Komplikasi kardiovaskuler
Komplikasi lain
Telah menggunakan NIPPV
lainnya
8. Tanggal masuk ICU / / Jam
9. Mulai penggunaan Ventilator
mekanik
/ / Jam
Berakhir penggunaan
Ventilator mekanik
/ / jam
10. Ventilator bundle
Elevasi tempat tidur Kontraindikasi :
60
(Head Of the Bed) 30 º
sampai 45 º, kecuali
kontraindikasi medis
frakturspinal,
frakturpelvis,
Intra-Aortic Balloon Pump (IABP
ulkus parah akibat tekanan pada daerah
sacrum
Penghentian secara berkala
agen sedasi dan penilaian
kesiapan ekstubasi
Obat sedasi :
midazolam
lorazepam
dexmedetomidine atau propofol
Lainnya
profilaksis trombosis vena
dalam (kecuali
kontraindikasi medis)
Obat Profilaksis TVD
Heparin
Enoxaparin (Lovenox)
Nandroparin Fraxiparin
Lainnya
Profilaksis ulkus
peptikum
Obat yang digunakan :
PPI
Sukralfat
Antagonis H2
Lainnya
Oral care secara berkala
dengan chlorhexidine
0,12%
0,2%
61
Lainnya
Kontraindikasi lainnya Pasien on pressors (vasopressor)
Pasien dengan ciri-ciri kematian
Pasien dengan blokade neuromuscular
Pasien dengan resiko perdarahan
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