LAPORAN INDIVIDU

Disusun untuk Memenuhi Kompetensi Profesi Ners

Departemen Keperawatan Medikal di R.!
R" Dr. "aiful Anwar Malan#

Disusun Oleh :

Sheradika Intan R 150070300113006

PRO$RAM "%UDI ILMU K&P&RA'A%A

K&P&RA'A%AN
N
(AKUL%A" K&DOK%&RAN
UNIV&R"I%A" )RA'I*A+A
,-
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LAPORAN P&NDA/ULUAN DAN A"U/AN K&P&RA'A

K&P&RA'A%AN
%AN
PA"I&N D&N$AN %U)&RKULO"I" PARU

Disusun untuk Memenuhi Kompetensi Profesi Ners

Departemen Keperawatan Medikal di R.!
R" Dr. "aiful Anwar Malan#

Disusun Oleh :

Sheradika Intan R 150070300113006

PRO$RAM "%UDI ILMU K&P&RA'A%A

K&P&RA'A%AN
N
(AKUL%A" K&DOK%&RAN
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%U)&RKULO"I" PARU

A. Definisi
Tube
Tubercu
rculo
losis
sis adala
adalah
h penya
penyakit
kit ineks
ineksii !enula
!enularr yan"
yan" diseb
disebabk
abkan
an oleh
oleh
tuberculosis # $u!an batan" tahan aerobic dan tahan asa!
Mycobacterium tuberculosis
ini dapat !erupakan or"anis!e pato"en !aupun saproit %Sil&ia ' (rice)
*005
*005+#
+# Tube
Tuberc
rcul
ulos
osis
is %T,+
%T,+ adal
adalah
ah peny
penyak
akit
it ine
ineks
ksiu
ius)
s) yan"
yan" teru
teruta
ta!a
!a
!enyeran
!enyeran"
" parenki!
parenki! paru) den"an
den"an a"en ineksius
ineksius uta!a Mycobacterium
tuberculosis %S!elt-er
tuberculosis %S!elt-er . ,are)
,are) *001+#
*001+# Tuberc
Tuberculos
ulosis
is paru adalah penyakit
penyakit
ineksi
ineksi pada paru yan"
yan" disebabk
disebabkan
an oleh Mycobacterium tuberculosis yaitu
Mycobacterium tuberculosis
suatu bakteri yan" tahan asa! %Suriadi) *001+# Dari beberapa pen"ertian
diatas dapat disi!pulkan bah/a Tuberculosis (aru adalah penyakit ineksi
yan" disebabka
disebabkan
n oleh Mycobakterium tuberculosis suatu basil yan" tahan
Mycobakterium tuberculosis
asa! yan" !enyeran" parenki! paru atau ba"ian lain dari tubuh !anusia#

). Klas
lasifi
ifikasi
 'da beberapa
beberapa klasiikasi Tb paru yaitu !enurut
!enurut Depkes %*007+
%*007+ yaitu:
a# $lasiikasi berdasarkan or"an tubuh yan"
yan" terkena:
terkena:
1# Tube
Tuberk
rkul
ulos
osis
is paru
paru
Tube
Tuberku
rkulo
losis
sis paru
paru adala
adalahh tuberk
tuberkul
ulosi
osis
s yan"
yan" !enye
!enyeran
ran"" arin
arin"an
"an
%parenki
%parenki!+
!+ paru tidak ter!asuk
ter!asuk pleura
pleura %selaput
%selaput paru+ dan kelenar 
kelenar 
pada hilus#
*# Tube
Tuberku
rkulo
losis
sis ekstra
ekstra paru
paru
Tuberkulosis yan" !enyeran" or"an tubuh lain selain paru) !isalnya
pleura)
pleura) selaput
selaput otak)
otak) selaput
selaput antun"
antun" %pericar
%pericardiu
diu!+)
!+) kelena
kelenarr ly!e)
ly!e)
tulan") persendian) kulit) usus) "inal) saluran kencin") alat kela!in)
dan lainlain#
b# $lasiikasi berdasarkan hasil pe!eriksaan
pe!eriksaan dahak
dahak !ikroskopis)
!ikroskopis) yaitu pada
pada
Tb (aru:
1# Tube
Tuberku
rkulo
losis
sis paru
paru ,T'
,T' posi
positi 
ti 
 Sekuran"kuran"nya * dari 3 spesi!en dahak S(S hasilnya ,T'

positi#
 1 spesi!en dahak S(S hasilnya ,T' positi dan oto toraks dada
!enunukkan "a!baran tuberkulosis#
 1 spesi!en dahak S(S hasilnya ,T' positi dan biakan ku!an Tb
positi#
 1 atau lebih spesi!en dahak hasilnya positi setelah 3 spesi!en
dahak S(S pada pe!eriksaan sebelu!nya hasilnya ,T' ne"ati 
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*# Tuberkul
Tuberkulosis
osis paru ,T' ne"ati#
ne"ati# $riteria
$riteria dia"nostik
dia"nostik Tb paru ,T' ne"at
ne"ati 
i 
harus !eliputi:
 (alin" tidak 3 spesi!en dahak S(S hasilnya ,T' ne"ati#
 2oto toraks abnor!al !enunukkan "a!baran tuberkulosis#
 Tidak ada perbaikan setelah pe!berian antibiotika non O'T#
 Ditentukan %diperti!ban"kan+
%diperti!ban"kan+ oleh dokter untuk diberi pen"obatan#
c# $lasi
$lasiik
ikasi
asi berda
berdasar
sarkan
kan tipe
tipe pasie
pasien
n diten
ditentuk
tukan
an berda
berdasar
sarkan
kan ri/ay
ri/ayat
at
pen"obatan sebelu!nya# 'da beberapa tipe pasien yaitu:
1# $asus baru
 'dalah pasien yan" belu! pernah diobati den"an O'T atau sudah
pernah !enelan O'T kuran" dari satu bulan % !in""u+#
*# $asu
$asuss ka!b
ka!buh
uh %re
%rela
laps
ps++
 'dalah pasien tuberkulosis yan" sebelu!nya
sebelu!nya pernah !endapat
pen"obatan tuberkulosis dan telah dinyatakan se!buh tetapi ka!buh
la"i#
3# $asus
$asus setel
setelah
ah putus
putus berob
berobat
at %dea
%deaul
ultt +
 'dalah pasien yan" telah berobat dan putus berobat * bulan atau
lebih den"an ,T' positi#
# $asus
$asus sete
setela
lah
h "a"al
"a"al %ailu
%ailure+
re+
 'dalah pasien yan" hasil pe!eriksaan dahaknya tetap positi atau
ke!b
ke!bal
alii !en
!enad
adii posi
positi
ti pada
pada bula
bulan
n keli
keli!a
!a atau
atau lebi
lebih
h sela
sela!a
!a
pen"obatan#
5# $asus lain
 'dalah se!ua kasus yan" tidak !e!enuhi ketentuan diatas) dala!
kelo!p
kelo!pok
ok ini ter!as
ter!asuk
uk kasus
kasus kroni
kronik)
k) yaitu
yaitu pasie
pasien
n den"an
den"an hasil
hasil
pe!eriksaan !asih ,T' positi setelah selesai pen"obatan ulan"an
%Depkes RI) *006+#

0. &pide
idemiolo
iolo#
#i
1# 4!ur  
Tb (aru enyeran" siapa saa tua) !uda bahkan anakanak# Seba"ian
besar penderita Tb (aru di e"ara berke!ban" beru!ur diba/ah 50
tahu
tahun#
n# Data
Data 8O
8O !enu
!enun
nuk
ukka
kan
n bah/
bah/a
a kasu
kasus
s Tb paru
paru di ne"a
ne"ara
ra
berk
berke!
e!ba
ban"
n" bany
banyak
ak terd
terdap
apat
at pada
pada u!ur
u!ur prod
produk
ukti
ti 15*
15*9
9 tahu
tahun#
n#
(enelitia
(enelitian
n Ri-kiya
Ri-kiyani
ni pada tahun
tahun *00 !enunuk
!enunukkan
kan u!lah
u!lah penderi
penderita
ta
baru Tb (aru positi 7)6; berasal dari usia produkti %155 tahun+
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(enyakit Tb (aru !enyeran" oran" de/asa dan anakanak) lakilaki dan

pere!puan#Tb
pere!puan#Tb paru !enyeran" seba"ian besar lakilaki usia produkti#
3# Stas
tasus "i-i
Status
Status nutri
nutrisi
si !erup
!erupaka
akan
n salah
salah satu
satu aktor
aktor yan"
yan" !enetu
!enetukankan un"si
un"si
selu
seluru
ruh
h sist
siste!
e! tubu
tubuh
h ter!
ter!as
asuk
uk sist
siste!
e! i!un
i!un#S
#Sis
iste
te!
! keke
kekeba
bala
lan
n
dibut
dibutuhk
uhkan
an !anusi
!anusia
a untuk
untuk !e!pro
!e!protek
teksi
si tubuh
tubuh terut
teruta!a
a!a !ence"
!ence"ah
ah
teradinya
teradinya ineksi yan" disebabkan oleh !ikroor"anis!e# ,ila daya tahan
tubuh sedan" rendah) ku!an Tb paru akan !udah !asuk ke dala!
tubu
tubuh
h# $u!an
!an ini akan
kan berk
erku!p
u!pul dala! paru
aruparu ke!u
ke!ud
dian
berke!ban" biak#Tetapi) oran" yan" terineksi ku!an T, (aru belu!
tentu
tentu !ende
!enderit
rita
a Tb paru#
paru# 8al
8al ini
ini ber"a
ber"antu
ntun"
n" pada
pada daya
daya tahan
tahan tubuh
tubuh
oran" tersebut# 'pabila) daya tahan tubuh kuat !aka ku!an akan terus
tertidur di dala! t ubuh %dor!ant+ dan tidak berke!ban" !enadi
!enadi penyakt
na!u
na!un
n apab
apabil
ila
a daya
daya taha
tahan
n tubu
tubuh
h le!a
le!ah
h !aka
!akan
n ku!a
ku!an
n Tb akan
akan
berke!ban" !enadi penyakit# (enyakit Tb paru >ebih do!inan teradi
pada
pada !asya
!asyarak
rakat
at yan"
yan" status
status "i-i
"i-i renda
rendah
h karen
karena
a siste!
siste! i!un
i!un yan"
yan"
le!ah sehin""a !e!udahkan ku!an Tb asuk dan berke!ban" biak#
# >in"kun"an
T, paru
paru !erup
!erupaka
akan
n salah
salah satu
satu penya
penyakit
kit berba
berbasis
sis lin"k
lin"kun"
un"an
an yan"
yan"
ditul
ditulark
arkan
an !elal
!elalui
ui udara#
udara# $eada
$eadaan
an berba
berba"ai
"ai lin"
lin"kun
kun"an
"an yan"
yan" dapat
dapat
!e!pen"a
!e!pen"aruhi
ruhi penyeba
penyebaran
ran Tb paru salah
salah satunya
satunya adalah
adalah lin"kun"
lin"kun"an
an
yan"
yan" ku!uh)
ku!uh)kot
kotor
or## (ender
(enderita
ita Tb (aru
(aru lebih
lebih banya
banyak
k terda
terdapat
pat pada
pada
!asyarakat yan" !enetap pada lin"kun"an yan" ku!uh dan kotor#

5# $ond
$ondis
isii sosi
sosial
al eko
ekono
no!i
!i
Seba"ai penderita Tb paru adalah dari kalan"an !iskin# Data 8O pada
tahun
tahun *011
*011 yan" !enyataka
!enyatakan
n bah/a
bah/a an"ka
an"ka ke!atian
ke!atian akibat Tb paru
seba"aian
seba"aian besar berada di ne"ara yan" relati !iskin#

D. &tiolo#i
(enyakit
(enyakit Tb paru adalah
adalah suatu penyakit
penyakit ineksi
ineksi yan" disebabk
disebabkan
an oleh
bakter
bakterii ycob
ycobakt
akteri
eriu!
u! tuberk
tuberkul
ulosi
osis#
s# ,akter
,akterii ini berbe
berbentu
ntuk
k batan
batan"
" dan
dan
bersiat
bersiat tahan
tahan asa! sehin""a
sehin""a dikenal u"a seba"ai
seba"ai ,atan"
,atan" Tahan 'sa!
%,T'+
%,T'+## Su!ber
Su!ber penular
penularan
an adalah
adalah penderita
penderita tuberkul
tuberkulosis
osis ,T' positi
positi pada
/aktu batuk atau bersin# (enderita !enyebarkan ku!an ke udara dala!
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terineksi kalau droplet tersebut terhirup ke dala! saluran

pernaasa
pernaasan#Se
n#Setela
telah
h ku!an
ku!an tuberkul
tuberkulosis
osis !asuk
!asuk ke dala!
dala! tubuh !anusia
!anusia
!elalui pernaasan) ku!an tuberkulosis tersebut dapat !enyebar dari paru
keba"ian tubuh lainnya !elalui siste! peredaran darah) saluran naas) atau
penyebaran lan"sun" ke ba"ianba"ian tubuh lainnya# Daya penularan dari
seoran" penderita ditentukan oleh banyaknya ku!an yan" dikeluarkan dari
paruny
parunya#
a# akin
akin tin""
tin""ii dera
deraat
at posit
positi
i hasil
hasil pe!er
pe!eriks
iksaa
aan
n dahak
dahak)) !akin
!akin
!enular
!enular penderita
penderita tersebut#
tersebut# ,ila hasil
hasil pe!eriksa
pe!eriksaan
an dahak
dahak ne"ati
ne"ati %tidak
%tidak
terlihat ku!an+) !aka penderita tersebut dian""ap tidak !enular# Seseoran"
terineksi tuberkulosis ditentukan oleh konsentrasi droplet dala! udara dan
la!anya !en"hirup udara tersebut#

&. Patofisiol
iolo#i
Te!pat !asuk ku!an !ycobacteriu! adalah saluran pernaasan) ineksi
tuberculo
tuberculosis
sis teradi
teradi !elalui
!elalui %airborn
%airborn++ yaitu
yaitu !elalui
!elalui instalasi
instalasi dropet
dropet yan"
!en"andu
!en"andun"
n" ku!anku
ku!anku!an
!an basil
basil tuberkel
tuberkel yan" berasal dari oran"
oran" yan"
yan"
terineksi
terineksi## ,asil
,asil tuberkel
tuberkel yan"
yan" !e!puny
!e!punyai
ai per!uka
per!ukaan
an al&eoli
al&eolis
s biasany
biasanya
a
diinstalasi seba"ai suatu basil yan" cenderun" tertahan di saluran hidun"
atau caban" besar bronkus dan tidak !enyebabkan penyakit#
Setelah berada dala! ruan"an al&eolus biasanya di ba"ian lobus atau
paruparu atau ba"ian atas lobus ba/ah basil tuberkel ini !e!ban"kitkan
reaksi
reaksi peradan"
peradan"an)
an) leukosit
leukosit poli!orto
poli!ortonukl
nuklear
ear pada te!pat
te!pat tersebut
tersebut dan
!e!a"osit na!un tidak !e!bunuh or"anis!e tersebut# Setelah harihari
perta!a !asa leukosit di"anti oleh !akroa"# 'l&eoli yan" terseran" akan
!en"al
!en"ala!i
a!i konso
konsolid
lidasi
asi dan ti!bu
ti!bull "eal
"eala
a pneu!o
pneu!onia
nia akut#
akut# (neu!
(neu!on
onia
ia
seluler ini dapat se!buh den"an sendirinya) sehin""a tidak ada sisa yan"
tertin""al atau proses dapat u"a beralan terus dan bakteri terus dia"osit
atau berke!ban" biak) dala! sel basil u"a !enyebar !elalui "estasi benin"
re"inal#
re"inal# akroa"
akroa" yan" !en"adak
!en"adakan
an iniltras
iniltrasii !enadi
!enadi lebih
lebih panan"
panan" dan
seba"ian bersatu sehin""a !e!bentuk sel tuberkel epiteloid yan" dikelilin"i
oleh li!osit) nekrosis ba"ian sentral lesi yan" !e!berikan "a!baran yan"
relati padat dan seperti keulesi nekrosis kaseora dan arin"an "ranulasi di
sekitarnya terdiri dari sel epiteloid dan ibrosis !eni!bulkan respon berbeda)
 arin"an "ranulasi !enadi lebih ibrasi !e!bentuk arin"an parut akhirnya
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ko!plet
ko!plet "hon den"an !en"ala!
!en"ala!ii pen"apur
pen"apuran#
an# Respon
Respon lain yan" dapat
dapat
teradi pada daerah nekrosis adalah pencairan di!ana bahan cairan lepas
ke dala!
dala! bronku
bronkus
s den"a
den"an
n !eni!b
!eni!bulk
ulkan
an kapil
kapiler
er !ater
!aterii tuberk
tuberkel
el yan"
yan"
dile
dilepa
pask
skan
an dari
dari dind
dindin
in"
" ka&i
ka&iti
tis
s akan
akan !asu
!asuk
k ke dala
dala!
! perc
percab
aban
an"a
"an
n
keobronkial# (roses ini dapat terulan" ke!bali di ba"ian lain dari paruparu
atau basil dapat terba/a sa!pai ke larin") telin"a ten"ah atau usus#
$a&itis untuk kecil dapat !enutup sekalipun tanpa pen"obatan den"an
!enin"
!enin""al
"alkan
kan arin
arin"an
"an parut
parut yan"
yan" terdap
terdapat
at dekat
dekat den"an
den"an perba
perbatas
tasan
an
bronkus ron""a# ,ahan perkiaan dapat !en"ontrol sehin""a tidak dapat
!en"ali
!en"alirr !elalui
!elalui saluran
saluran pen"hubu
pen"hubun")
n") sehin""a
sehin""a ka&itasi
ka&itasi penuh
penuh den"an
den"an
bahan perkiuan dan lesi !irip den"an lesi berkapsul yan" terlepas# $eadaan
ini dapat tidak !eni!bulkan "eala dala! /aktu la!a dan !e!bentuk la"i
hubun"an den"an bronkus dan !enadi li!pal peradan"an akti#
(enyakit
(enyakit dapat
dapat !enyebar
!enyebar !elalui
!elalui "etah
"etah benin"
benin" atau pe!buluh
pe!buluh darah#
darah#
Or"anis!e
Or"anis!e atau lobus
lobus dari kelenar
kelenar betah
betah benin"
benin" akan !encapai
!encapai aliran
aliran
darah
darah dala!
dala! u!lah
u!lah kecil)
kecil) yan" kadan"k
kadan"kadan
adan"
" dapat
dapat !eni!bul
!eni!bulkan
kan lesi
pada berba"ai or"an lain# =enis penyebaran ini dikenal seba"ai penyebaran
li!oh
li!ohe!a
e!ato"
to"en
en yan"
yan" biasa
biasany
nya
a se!bu
se!buh
h sendir
sendiri)
i) peny
penyeba
ebaran
ran ini
ini terad
teradii
apabila okus nekrotik !erusak pe!buluh darah sehin""a banyak or"anis!e
!asuk ke dala! siste! &askuler dan tersebar ke or"anor"an tubuh %(rice .
ilson) *005+
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(. Manife
nifes
stasi
tasi kli
klini
nis
s
Tandatanda yan" di te!ukan pada pe!eriksaan isik ter"antun" luas dan
kelainan struktural paru# (ada lesi !ini!al) pe!eriksaan isis dapat nor!al
atau dapat dite!ukan tanda konsolidasi paru uta!anya apeks paru# Tanda
pe!eri
pe!eriksa
ksaan
an isik
isik paru
paru terseb
tersebut
ut dapat
dapat berup
berupa:
a: okal
okal re!it
re!itus
us !ein"
!ein"kat
kat))
perkusi redup) bunyi napas bronko&esikuler atau adanya ronkhi teruta!a di
apeks paru# (ada lesi luas dapat pula dite!ukan tandatanda seperti de&iasi
trakea ke sisi paru yan" terineksi) tanda konsolidasi) suara napas a!porik
pada ca&itas atau tanda adanya penebalan pleura#

a# ?ea
?eala
la sist
siste!
e!ik
ik@u
@u!u
!u!!
1# (enuruna
(enurunan n nasu
nasu !akan
!akan dan
dan berat
berat badan#
badan#
*# (erasaan
(erasaan tidak
tidak enak
enak %!alaise
%!alaise+)
+) le!ah#
le!ah#
3# De!a
De!a! ! tida
tidakk terl
terlal
alu
u tin"
tin""i
"i yan"
an" berl
berlan
an"s
"sun
un"
" la!a
la!a)) bias
biasan
anya
ya
diras
dirasaka
akan
n !ala!
!ala! hari
hari diser
disertai
tai kerin
kerin"at
"at !ala!#
!ala!# $adan"
$adan"ka
kada
dan"
n"
seran"an de!a! seperti inluen-a dan bersiat hilan" ti!bul#

b# ?e
?eala
ala kh
khusus
sus
1# ,ila
,ila ter
terad
adii su!b
su!bat
atan
an seba
seba"i
"ian
an bron
bronku
kus
s %sal
%salur
uran
an yan"
yan" !enu
!enuu
u ke
paruparu+ akibat penekanan kelenar "etah benin" yan" !e!besar)
akan !eni!bulkan suara A!en"iA) suara naas !ele!ah yan" disertai
sesak#
*# =ika
=ika ada
ada cair
cairan
an diro
diron"
n""a
"a pleu
pleura
ra %pe!
%pe!bu
bun"
n"ku
kus
s paru
parup
par
aru+
u+)) dapa
dapatt
disertai den"an keluhan sakit dada#

Tanda
Tanda dan "eala
"eala tubercul
tuberculosis
osis !enurut
!enurut (erhi!pu
(erhi!punan
nan Dokter
Dokter (enyakit
(enyakit
Dala! %*006+ dapat ber!aca!!aca! antara lain :
1# De!a!
4!u!n
4!u!nya
ya subeb
subebris
ris)) kadan
kadan"k
"kada
adan"
n" 01
010B
0B)) keada
keadaan
an ini
ini san"at
san"at
dipen"aruhi oleh daya tahan tubuh pasien dan berat rin"annya ineksi
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(ada "eala a/al atau penyakit

penyakit rin"an
rin"an belu!
belu! dirasaka
dirasakan
n sesak
sesak naas#
naas#
Sesak naas akan dite!ukan pada penyakit yan" sudah lanut di!ana
iniltrasinya sudah seten"ah ba"ian paruparu#
# yeri dada
?eala
?eala ini
ini dapat
dapat dite!
dite!uka
ukan
n bila
bila inil
iniltra
trasi
si radan
radan"
" sudah
sudah sa!pai
sa!pai pada
pada
pleura) sehin""a !eni!bulkan pleuritis) akan tetapi) "eala ini akan aran"
dite!ukan#
5# alaise
(enyakit T,B paru bersiat radan" yan" !enahun# ?eala !alaise serin"
dite!ukan anoreksia) berat badan !akin !enurun) sakit kepala) !erian")
nyeri otot dan kerin"at !ala!# ?eala se!akin la!a se!akin berat dan
hilan" ti!bul secara tidak teratur#

$. Peme
Pemeri
riks
ksaa
aann Dia
Dia#n
#nos
osis
is
Dia"nosis tuberkulosis paru dite"akkan !elalui pe!eriksaan "eala klinis)
!ikrob
!ikrobiol
iolo"i
o"i)) radiol
radiolo"i
o"i)) dan patolo
patolo"i
"i klinik
klinik## (ada
(ada pro"ra
pro"ra!
! tuberk
tuberkul
ulosi
osis
s
nasi
nasion
onal
al)) pene
pene!u
!uan
an ,T'
,T' !ela
!elalu
luii pe!e
pe!eri
riks
ksaa
aan
n daha
dahak
k !ikr
!ikros
osko
kopi
pis
s
!erupakan dia"nosis uta!a# (e!eriksaan lain seperti radiolo"i) biakan dan
ui kepekaan
kepekaan dapat
dapat di"unaka
di"unakan
n seba"ai
seba"ai penuna
penunan"
n" dia"nosi
dia"nosis
s sepana
sepanan"
n"
sesuai
sesuai den"an
den"an indikasin
indikasinya#
ya# Tidak
Tidak dibenark
dibenarkan
an !endia"n
!endia"nosis
osis tuberkul
tuberkulosis
osis
hanya berdasarkan pe!eriksaan oto toraks saa# 2oto toraks tidak selalu
!e!berikan "a!baran yan" khas pada T, paru) sehin""a serin" teradi
o&erdia"nosis#
a# (e!er
(e!eriks
iksaa
aan
n dahak
dahak !ikros
!ikroskop
kopis
is
(e!eriksa
(e!eriksaan
an dahak
dahak berun"si
berun"si untuk
untuk !ene"akk
!ene"akkan
an dia"nosi
dia"nosis)
s) !enilai
!enilai
kebe
keberh
rhas
asil
ilan
an pen"
pen"ob
obat
atan
an dan
dan !ene
!enent
ntuk
ukan
an pote
potens
nsii penu
penula
lara
ran#
n#
(e!er
(e!eriks
iksaa
aan
n dahak
dahak untuk
untuk pene"
pene"aka
akan
n dia"n
dia"nosi
osis
s dilaku
dilakukan
kan den"an
den"an
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*# ( %pa"i+ : Dahak diku!pulkan di ru!ah pada pa"i

hari kedua) se"era setelah ban"un tidur# (ot diba/a
dan diserahkan sendiri kepada petu"as#
3# S %se/aktu+ : Da
D ahak diku!pulkan pada ha
h ari
kedua) saat !enyerahkan dahak pa"i hari#
(e!e
(e!eri
riks
ksaa
aan
n !ikr
!ikros
osko
kopi
pisn
snya
ya dapa
dapatt diba
diba"i
"i !en
!enad
adii dua
dua yaitu
aitu
pe!eriksaan
pe!eriksaan !ikroskopis biasa di !ana pe/arnaannya
pe/arnaannya dilakukan den"an
Cieh
Ciehll iel
ielse
sen
n dan
dan pe!e
pe!eri
riks
ksaa
aan
n !ikr
!ikros
osko
kopi
pis
s luo
luore
rese
sens
ns di !ana
!ana
pe/arnaa
pe/arnaanny
nnya
a dilakuk
dilakukan
an den"an
den"an aura!in
aura!inrhod
rhoda!in
a!in %khususny
%khususnya
a untuk
penapisan+#

Inter
Interpre
pretas
tasii pe!eri
pe!eriksa
ksaan
an !ikros
!ikroskop
kopis
is dibac
dibaca
a den"an
den"an skala
skala I4'T>
I4'T>D
D
%Internati
%International
onal 4nion
4nion '"ains
'"ainstt Tuber
Tuberculo
culosis
sis and lun" Tuber
Tuberculo
culosis+
sis+ yan"
yan"
!erupakan reko!endasi dari 8O#
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biaka
biakan
n secara
secara cepat
cepat untuk
untuk !e!ba
!e!bantu
ntu !ene"
!ene"akk
akkan
an dia"n
dia"nosi
osis
s dan
dan
!elakukan ui kepekaan#,entuk lain teknik ini adalah den"an !e!akai
ycobacteria ?ro/th Indicator Tube %?IT+#

c# (e!e
(e!eri
riks
ksaa
aan
n dara
darah
h
8asil pe!eriksaan darah rutin kuran" !enunukan
!enunukan indikator yan" spesiik
untuk Tb paru# >au ndap Darah % >D + a! perta!a dan a! kedua
dibutuhkan# Data ini dapat di pakai seba"ai indikator tin"kat kestabilan
keadaan nilai kesei!ban"an penderita) sehin""a dapat di"unakan untuk
salah
salah satu respon
respon terhadap
terhadap pen"oba
pen"obatan
tan penderita
penderita serta ke!un"ki
ke!un"kinan
nan
seba"ai predeteksi tin"kat penye!buhan penderita# De!ikian pula kadar 
li!osit dapat !en""a!barkan daya tahan tubuh penderita# >D serin"
!eni
!enin"
n"ka
katt pada
pada pros
proses
es akti
akti)
) teta
tetapi
pi >D
>D yan"
yan" nor!
nor!al
al u"a
u"a tida
tidak
k
!enyin"kirkan
!enyin"kirkan dia"nosa T,B#

d# (e!er
(e!eriks
iksaa
aan
n radiol
radiolo"
o"is
is
(e!er
(e!eriks
iksaa
aan
n stand
standar
ar adalah
adalah oto
oto toraks
toraks ('# (e!eri
(e!eriksa
ksaan
an lain
lain atas
atas
indikasi ialah oto lateral) top lordotik) oblik) BTScan#
BTScan# (ada kasus di!ana
pada pe!eriksaan sputu! S(S positi) oto toraks tidak diperlukan la"i#
(ada beberapa kasus den"an hapusan positi perlu dilakukan oto toraks
bila:
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1# 2ibrotik)
2ibrotik) teruta
teruta!a
!a pada se"!e
se"!en
n apical
apical dan atau
atau posterior
posterior lobus
lobus atas
atas
dan atau se"!en superior lobus ba/ah#
*# $alsi
alsii
ika
kasi
si##
3# (ene
(eneba
bala
lan
n pleu
pleura
ra##
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!e!belah
!e!belah## Siat
Siat la!bat
la!bat !e!belah
!e!belah yan"
yan" di!iliki
di!iliki !ikobakte
!ikobakteri
ri !erupaka
!erupakan
n
salah
salah satu
satu aktor
aktor yan"
yan" !enye
!enyebab
babkan
kan perke!
perke!ban
ban"an
"an pene!u
pene!uan
an obat
obat
anti!ikobakteri
anti!ikobakteri baru auh lebih sulit dan la!bat dibandin"kan
dibandin"kan antibakteri lain#
=enis
=enis obat
obat uta!a
uta!a %lini
%lini 1+ yan"
yan" di"un
di"unaka
akann adalah
adalah:: I8)
I8) Ria!
Ria!pi
pisin
sin))
Strepto!isin) ta!butol# =enis obat ta!bahan lainnya %lini *+: $ana!isin)
 '!ikasin) $uinolon#
$uinolon#

(en"obatan Tb paru pada oran" de/asa di ba"i dala! beberapa kate"ori

yaitu:
-. Kate
Kate#o
#ori
ri - 1 /R
/R2&
2&34
34/5
/5R5
R5
Sela!a * bulan !inu! obat I8) ria!pisin) pira-ina!id) dan eta!butol
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5. Kate
Kate#o
#ori
ri 5 1 /R2
/R234
34/5
/5R5
R5
Diberikan kepada penderita ,T' %F+ dan ront"en paru !endukun" akti#
4. Kate
Kate#o
#ori
ri 41 R/2&
R/2&"
"
Diberikan
Diberikan pada kasus Tb kronik #
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c# ,ronkietak
taksis %pelebaran bronkus sete!pat+ dan ibrosis
%pe!bentukan arin"an ikat pada proses pe!ulihan atau reakti+ pada
paru
d# (ne!ot
(ne!otora
oraks
ks sponta
spontan)
n) yaitu
yaitu kolaps
kolaps sponta
spontan
n karen
karena
a bula@b
bula@blep
lep yan"
pecah
e# (enye
(enyeba
baran
ran ineksi
ineksi ke or"an
or"an lain seperti
seperti otak)
otak) tulan
tulan")
") sendi)
sendi) "inal
"inal))
dan seba"ainya

*. Pen#ka7ian
(en"kaian ter"antun" pada tahap penyakit dan deraat yan" terkena
1# 'kti&itas
'kti&itas atau istiraha
istirahatt
?eala
?eala : kelela
kelelahan
han u!u!
u!u! dan kele!a
kele!ahan
han)) !i!pi
!i!pi buruk)
buruk) naas
naas pendek
pendek
karena kera) kesulitan tidur pada !ala! hari) !en""i"il atau berkerin"at#
Tanda : takikardia# takipnea@dispnea pada kera) kelelahan otot) nyeri dan
sesak %tahap lanut+#
*# Inte"r
Inte"rita
itas
s ?O
?O
?eala : adanya aktor stress la!a) !asalah keuan"an ru!ah) perasaan
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6# $ea!
$ea!ananan
an
?eala : adanya kondisi penekanan i!un# contoh: 'IDS) kanker#
Tanda : de!a! rendah atau sedikit panas akut#
7# Intera
Interaksi
ksi sosial
sosial
?eala : perasaan isolasi@penolakan karena penyakit !enular) perubahan
bisa dala
ala! tan"
tan""
"un"
n"a/ab
a/ab@p
@pe
erub
rubahan kapa
kapasi
sita
tas
s isi
isik
k untu
ntuk
!elaksanakan peran#
# (e!eriksa
(e!eriksaan
an (enunan
(enunan"
"
(e!eriksaan penunan" pada pasien tuberculosis paru yaitu:
 $ultur sputu!: positi untuk !ycobacteriu! tuberculosis pada tahap
akhir penyakit#
 Ciehleelsen
Ciehleelsen %pe!akaian asa! cepat pada "elas kaca untuk usapan
cairan darah+ positi untuk basil asa! cepat#
 Tes kulit %!antouE) poton"an &oll!er+: reaksi positi %area indurasi 10
!! atau lebih besar) teradi 7* a! setelah ineksi intra der!al
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*# (ola
(ola naas
naas tidak
tidak eekti
eekti berhubun"a
berhubun"an
n den"an
den"an sekresi !ukopurul
!ukopurulen
en dan
kekuran"an upaya batuk
3# ?an""ua
?an""uan
n pertukara
pertukaran
n "as berhubun"a
berhubun"an
n den"an
den"an penurunan
penurunan per!ukaan
per!ukaan
eek paru# $erusakan !e!bran di al&eolar) kapiler) sekret ke&tal dan tebal
# (enin"katan
(enin"katan suhu tubuh berhubun"an
berhubun"an den"an proses
proses peradan"an
peradan"an
5# (erub
(erubah
ahan
an nutri
nutrisi
si kuran
kuran"
" dari
dari kebutu
kebutuhan
han tubuh
tubuh berhu
berhubu
bun"a
n"an
n den"an
den"an
!ual) !untah) anoreksia#
6# ?an""u
?an""uan
an pada
pada istira
istiraha
hatt tidur
tidur berhu
berhubun
bun"a
"an
n den"an
den"an sesak naas
naas dan
dan
batuk
7# Into
Intole
lera
rans
nsii akti
akti&i
&ita
tas
s berh
berhub
ubun
un"a
"an
n den"
den"an
an kele
keleti
tiha
han
n dan
dan inad
inadek
ekua
uatt
oksi"enasi
oksi"enasi untuk akti&itas
# $uran" pen"etahuan
pen"etahuan !en"enai kondisi
kondisi aturan
aturan tindakan
tindakan dan pence"ahan
pence"ahan
berhubun"an
berhubun"an den"an alan interpretasi inibrasi) keterbatasan ko"niti 
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Rasi
Rasion
onal
al : (en"
(en"el
elua
uara
ran
n suli
sulitt bila
bila sekr
sekret
et san"
san"at
at teba
teball sput
sputu!
u!
berdarah kental@darah cerah %!isal eek ineksi) atau tidak kuatnya
hidrasi+#
3+ ,erikan klien
klien posisi
posisi se!i atau o/ler
o/ler tin""i
Rasional
Rasional : (osisi
(osisi !e!bantu
!e!bantu !e!aksi!alk
!e!aksi!alkan
an ekspansi
ekspansi paru dan
!enurunkan upaya pernaasan#
+ ,ers
,ersih
ihka
kan
n sekr
sekret
et dari
dari !ulu
!ulutt dan
dan trak
trakea
ea)) pen"
pen"hi
hisa
sapa
pan
n sesu
sesuai
ai
keperluan
Rasion
Rasional
al : ence"
ence"ah
ah obstru
obstruksi
ksi respir
respirasi
asi)) pen"hi
pen"hisap
sapan
an dapat
dapat
diperlukan bila pasien tidak !a!pu !en"eluarkan sekret#
5+ (ertahankan !asukan
!asukan cairan
cairan sedikitnya
sedikitnya *500 !@hari kecuali kontra
indikasi
Rasional : (e!asukan tin""i cairan !e!bantu untuk
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b# $8 : !elapo
!elaporka
rkan
n tidak
tidak adany
adanya
a penur
penurun
unan
an dispne
dispnea)
a) !enun
!enunuk
ukkan
kan
perba
perbaik
ikan
an &entil
&entilasi
asi dan O* arin
arin"an
"an adeku
adekuat
at den"an
den"an '?( dala!
dala!
rentan" nor!al) bebes dari "eala) distres pernaasan#
c# Inter
Inter&en
&ensi
si dan rasio
rasional
nal
1+ $ai dispnea)
dispnea) takipnea)
takipnea) tidak nor!al atau !enurunny
!enurunnya
a bunyi
bunyi naas)
naas)
penin"katan upaya pernaasan) terbatasnya ekspansi dindin" dada
dan kele!ahan#
Rasional : T, paru !enyebabkan eek luas pada paru dari ba"ian
kecil bronkopneu!onia sa!pai inla!asi dius luas nekrosis eure
pleural untuk ibrosis luas#
*+ &alu
&aluasi
asi tin"ka
tin"katt kesada
kesadaran
ran)) catat
catat sianos
sianosis
is dan peruba
perubahan
han pada
pada
/arna kulit) ter!asuk !e!bran !ukosa dan kuku
Rasi
Rasion
onal
al : 'ku!u
ku!ula
lasi
si sekr
sekret
et@p
@pen
en"a
"aru
ruh
h ala
alan
n naa
naas
s dapa
dapatt
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Santosa)
Santosa) ,udi#
,udi# *007#
*007# (anduan
(anduan Dia"nosa
Dia"nosa $epera/
$epera/atan
atan 'D'
'D' *005*00
*005*006#
6#
=akarta: (ri!a edika

Ta!bayon") =# *003# (atoisiolo"i untuk $epera/atan# ?B : =akarta#