BAB II KBM

8/19/2019 BAB II KBM

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Asuhan Keperawatan Dengan Gangguan Sistem Endokrin Pre Dan Post Operasi Akibat

Hipertrofi Kelenjar : Struma Endemik

Di susun oleh :

Aliia Primadani

!isa Diana Sandi

"A Keperawatan

Pembimbing :

#as Suriani S$kep% &ers

PO!'EKKES KE(E&KES 'A&)*&GP+&A&G

P,OD+ KEPE,A-A'A& 'A&)*&GP+&A&G

"./0


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DA1'A, +S+

HALAMAN JUDUL

KATA PENGANTAR................................................................................................i

DAFTAR ISI............................................................................................................ii

BAB I PENDAHULUAN........................................................................................1

1.1. Latar Belakang...........................................................................................1

1.2. R!"an Ma"ala#......................................................................................1

1.$. T%an Penli"an........................................................................................1

1.$. Man&aat Penli"an......................................................................................2

BAB II TINJAUAN TE'RITIS...............................................................................$2.1. Anat(!i )an Fi"i(l(gi................................................................................$

2.1.1 Anat(!i.............................................................................................*

2.1.2 Fi"i(l(gi............................................................................................*

2.2. K(n"e+ Pen,akit Str!a En)e!ik............................................................$

2.2.1 De&ini"i Str!a En)e!ik..................................................................-

2.2.2 Eti(l(gi

Str!a En)e!ik..................................................................-

2.2.$ Mani&e"ta"i

Str!a En)e!ik............................................................

2.2.- Pat(&i"i(l(gi

Str!a En)e!ik..........................................................*

/'0 Str!a En)e!ik.....................................................................

2.2. K(!+lika"i Str!a En)e!ik............................................................-

2.2. Penatalak"anaan

Str!a En)e!ik....................................................-

2.2. Pe!erik"aan Penn%ang

Str!a En)e!ik........................................$

2.2.3 A"#an ke+era4atan )engan Str!a En)e!ik.................................-

BAB III PENUTUP................................................................................................15

$.1. Ke"i!+lan..............................................................................................15

$.2. Saran.........................................................................................................15

DAFTAR PUSTAKA.................................................................................................

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US/Downloads/MAKALAH%20MEDIA%20KELOMPOK%208%20(2).docx#__RefHeading___Toc387528390http://c/Users/ASUS/Downloads/MAKALAH%20MEDIA%20KELOMPOK%208%20(2).docx#__RefHeading___Toc387528392http://c/Users/ASUS/Downloads/MAKALAH%20MEDIA%20KELOMPOK%208%20(2).docx#__RefHeading___Toc387528391http://c/Users/ASUS/Downloads/MAKALAH%20MEDIA%20KELOMPOK%208%20(2).docx#__RefHeading___Toc387528392http://c/Users/ASUS/Downloads/MAKALAH%20MEDIA%20KELOMPOK%208%20(2).docx#__RefHeading___Toc387528392http://var/www/apps/conversion/tmp/Downloads/MAKALAH%20MEDIA%20KELOMPOK%208%20(2).docx#__RefHeading___Toc387528390http://var/www/apps/conversion/tmp/Downloads/MAKALAH%20MEDIA%20KELOMPOK%208%20(2).docx#__RefHeading___Toc387528389http://var/www/apps/conversion/tmp/Downloads/MAKALAH%20MEDIA%20KELOMPOK%208%20(2).docx#__RefHeading___Toc387528388http://var/www/apps/conversion/tmp/Downloads/MAKALAH%20MEDIA%20KELOMPOK%208%20(2).docx#__RefHeading___Toc387528387http://var/www/apps/conversion/tmp/Downloads/MAKALAH%20MEDIA%20KELOMPOK%208%20(2).docx#__RefHeading___Toc387528386http://var/www/apps/conversion/tmp/Downloads/MAKALAH%20MEDIA%20KELOMPOK%208%20(2).docx#__RefHeading___Toc387528385http://var/www/apps/conversion/tmp/Downloads/MAKALAH%20MEDIA%20KELOMPOK%208%20(2).docx#__RefHeading___Toc387528384http://var/www/apps/conversion/tmp/Downloads/MAKALAH%20MEDIA%20KELOMPOK%208%20(2).docx#__RefHeading___Toc387528383http://var/www/apps/conversion/tmp/Downloads/MAKALAH%20MEDIA%20KELOMPOK%208%20(2).docx#__RefHeading___Toc387528382http://var/www/apps/conversion/tmp/Downloads/MAKALAH%20MEDIA%20KELOMPOK%208%20(2).docx#__RefHeading___Toc387528396


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4/29

PE&DAH*!*A&

/$/ !atar 2elakang

Ke"ei!6angan #(r!(n +enting ntk !en%aga &ng"i t6# teta+ n(r!al. Jika

tergangg; akan ter%a)i !a"ala# ke"e#atan; ter!a"k +en,akit "tr!a. Fng"i kelen%ar

g(n)(k ,ang !e!6e"ar )an !eta6(li"!e t6# ,ang !eningkat >#i+er!eta6(li"!e?

%ga terka)ang )i"ertai kelela#an; %ari7%ari ge!etar ata tre!(r )an !ata !en(n%(l.

Ter%a)in,a g(iter ata +en,akit g(n)(k !e!ang terkait kelainan ,ang !en,erang

kelen%ar tir(i) ,ang letakn,a )i )e+an le#er )i 6a4a# %akn. Kelen%ar ini !eng#a"ilkan

#(r!(n tir(i) ,ang &ng"in,a !engen)alikan ke


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• A+a "a%a K(!+lika"i Str!a en)e!ik C

• A+a "a%a Penatalak"anaan Me)i" "tr!a en)e!ik C

• A+a "a%a Pe!erik"aan Penn%ang Str!a en)e!ik C

• Bagai!ana A"#an Ke+era4atan Dengan Ganggan Si"te! En)(krin Pre Dan P("t

'+era"i Aki6at Hi+ertr(&i Kelen%ar 9 Str!a En)e!ik C

/$4 (anfaat Penulisan

Se6agai 6a#an +enge!6angan +engeta#an )ala! keil!an ke+era4atan !e)ikal 6e)a#

)ala! !ateri ke+era4atan en)(krin k#""n,a tentang a"#an ke+era4atan +a)a klien

)engan "tr!a en)e!ik. Ha"il +e!a+aran ini %ga )i#ara+kan 6er!an&aat 6agi +ela,anan

ke+era4atan "e6agai )a"ar +erti!6angan )ala! +e!6erian a"#an ke+era4atan +a)a

klien )engan "tr!a en)e!ik.


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2A2 ++

'+&)A*A& 'EO,+'+S

"$/ A&A'O(+ DA& 1+S+O!OG+

"$/$/ A&A'O(+

Glan)la t#,r(i)ea ter)iri ata" l(6" kiri )an kanan ,ang )i#6ngkan (le#

i"t#!" ,ang "e!+it. Setia+ l(6" 6er6entk 6a# a(ka); )engan +n

Kelen%ar tir(i) !elekat +a)a trakea )an fascia pretrachealis )an !elingkari )a+ertiga

6a#kan "a!+ai tiga+ere!+at lingkaran. A. carotis communis, v. jugularis interna; )an

n. vagus terletak 6er"a!a )i )ala! "at rang tertt+ )i later()(r"al tir(i). N.

recurrens terletak )i )(r"al "e6el! !a"k ke laring. N. phrenicus )an truncus

symphaticus ti)ak !a"k ke )ala! rang antara fascia media )an prevertebralis.

Li!&e )ari kelen%ar tir(i) terta!a )i


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Selr# T-? ,ang

ke!)ian 6er6a# !en%a)i 6entk akti&n,a ,ait tri,()(tir(nin >T$?. I()i!

n(n(rgani< ,ang )i"era+ )ari "alran t#,r(i) 6in)ing gl(6lin; TBG? ata +real6!in +engikat al6!in >t#,r(ine

6in)ing +real6!ine; TBPA?. H(r!(n "ti!lat(r tir(i) >t#,r(i) "ti!lati!g #(r!(ne;

TSH? !e!egang +eranan +enting ntk !engatr "ekre"i )ari kelen%ar tir(i). TSH


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)i#a"ilkan (le# l(6" anteri(r kelen%ar #i+(&i"i". Pr("e" ,ang )ikenal "e6agai negatie

&ee)6aT-?; )an trii()(tir(nin >T$?;

"erta #(r!(n kal"it(nin ,ang !engatr !eta6(li"!e kal"i! 6er"a!a )engan

+arat#(r!(n ,ang )i#a"ilkan (le# kelen%ar +aratir(i) >G,t(n an) Hall; 255?.

Str!a )i"e6t %ga g(iter a)ala# "at +e!6engkakan +a)a le#er (le# karena

+e!6e"aran kelen%ar tir(i) aki6at kelainan glan)la tir(i) )a+at 6er+a ganggan

&ng"i ata +er6a#an ""nan kelen%ar )an !(r&(l(gin,a.

Da!+ak "tr!a ter#a)a+ t6# terletak +a)a +e!6e"aran kelen%ar tir(i) ,ang )a+at

!e!+engar#i ke))kan (rgan7(rgan )i "ekitarn,a. Di 6agian +("teri(r !e)ial

kelen%ar tir(i) ter)a+at trakea )an e"(+#ag". Str!a )a+at !engara# ke )ala!

"e#ingga !en)(r(ng trakea; e"(+#ag" )an +ita "ara "e#ingga ter%a)i ke"litan

6erna+a" )an )i"&agia. Hal ter"e6t akan 6er)a!+ak ter#a)a+ ganggan +e!en#an

(k"igen; ntri"i "erta Sri Hartini; Ilmu Penyakit Dalam, %ili) I; #al. -1; FKUI; 255?

Str!a a)ala# +e!6e"aran kelen%ar g(n)(k ,ang )i"e6a6kan (le# +ena!6a#an

%aringan kelen%ar g(n)(k ,ang !eng#a"ilkan #(r!(n tir(i) )ala! %!la# 6an,ak

"e#ingga !eni!6lkan kel#an "e+erti 6er)e6ar7)e6ar; keringat; ge!etaran; 6i


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Str!a n()("a n(n t(k"ik a)ala# +e!6e"aran kelen%ar t,r(i) ,ang "e


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2. Ber)a"arkan klini"n,a 9

2.1 N(n7T(k"ik >etir(i) )an #i+(tir(i)?

a. Di&"a 9 en)e!ik g(iter; grai)

6. N()"a 9 ne(+la"!a

2.2 T(k"ik >#i+ertir(i)?

a. Di&" 9 grae; tir(t(k"ik("i" +ri!er

6. N()"a 9 tir(t(k"ik("i" "kn)er

$. Ber)a"arkan !(r&(l(gin,a 9

$.1 Str!a H,+er+la"ti!i"al; +6erta"; lakta"i; ke#a!ilan; "tre"";

)"6.? ata )e&i"ien"i i()ine tela# ter6ant !elali #i+er+la"i; kelen%ar akan ke!6ali

n(r!al )engan !engala!i in(l"i. Se6agai #a"il e"ikel )i"ten"i )engan k(l(i) )an

kran kelen%ar !e!6e"ar.

$.$ Str!a N()lar

Bia"an,a ter%a)i +a)a "ia $5 ta#n ata le6i# ,ang !er+akan "eelae )ari "tr!a


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la!a )ari tir(k"in. A)a ganggan 6erlang )ari #i+er+la"i tir(i) )an in(l"i +a)a

!a"ing7!a"ing +eri()e ke#a!ilan; lakta"i; )an e!("i(nal >&a"e ke6t#an?.

Se#ingga ter)a+at )aera# #i+erin(l"i; )aera# #i+er+la"i )an )aera# kelen%ar

n(r!al. A)a )aera# n()l #i+er+la"i )an %ga +e!6entkan n()l )ari %aringan

tir(i) ,ang #i+erin(l"i.

Tia+ &(likel n(r!al !elali "at "ikl" "ekre"i )an i"tira#at ntk !e!6erikan

ke6t#an akan tir(k"in t6#. Saat "at g(l(ngan "ekre"i; g(l(ngan lain i"tira#at ntk

akti& ke!)ian. Pa)a "tr!a n()lar; ke6an,akan &(likel 6er#enti a!6il 6agian )ala!

"ekre"i "e#ingga #an,a "e6agian kein(l"i ,ang 6erle6i#an!engeane!ia grai"; arteri(ene" "#nt;

a(rta in"&&i


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-. Ge!etar

Ka)ang7ka)ang +a"ien !enggerakkan tangann,a tan+a t%an tertent; ti!6l

tre!(r #al" +a)a tangan

. Geli"a#

Peningkatan ek"ita6ilita" ner(!"


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15. Sara "erak

Str!a )a+at !engara# ke)ala! "e#ingga !en)(r(ng +ita "ara; "e#ingga ter)a+at

+enekanan +a)a +ita "ara ,ang !en,e6a6kan "ara !en%a)i "erak ata +ara.

"$"$4 Patofisiologi Struma Endemik

Ganggan +a)a %alr TRH7TSH #(r!(n tir(i) ini !en,e6a6kan +er6a#an )ala!

"trktr )an &ng"i kelen%ar tir(i) g(n)(k. Rang"angan TSH re"e+t(r tir(i) (le# TSH;

TSH7Re"e+(r Anti6()i ata TSH re"e+t(r ag(ni"; "e+erti


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$. Di"&agia

Di6agian +("teri(r !e)ial kelen%ar tir(i) ter)a+at tra,()i! ra)i(akti&; tir(i)ekt(!i "6t(tal?.

a. '6at antitir(i)


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In)ika"i 9

• Tera+i ntk !e!+er+an%ang re!i"i ata !en)a+atkan re!i"i ,ang !eneta+;

+a)a +a"ien !)a )engan "tr!a ringan "a!+ai "e)ang )an tir(t(k"ik("i".

• '6at ntk !eng(ntr(l tir(t(k"ik("i" +a)a &a"e "e6el! +eng(6atan; ata

"e")a# +eng(6atan +a)a +a"ien ,ang !en)a+at ,()i! akti&.

• Per"ia+an tir(i)ekt(!i

• Peng(6atan +a"ien #a!il )an (rang lan%t "ia.

• Pa"ien )engan kri"i" tir(i).

'6at antitir(i) ,ang "ering )ignakan 9

'6at D("i" a4al

>!g#ari?

Pe!eli#araan

>!g#ari?

Kar6i!a@(l $575 725

Meti!a@(l $575 725

Pr(+ilt(ra"il $55755 7255

6. Peng(6atan )engan ,()i! ra)i(akti&

In)ika"i 9

• Pa"ien !r $ ta#n ata le6i#

• Hi+ertir(i)i"!e ,ang ka!6# "e")a# +en6erian )i(+era"i

• Gagal !en


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• A)en(!a t(k"ik; g(iter !ltin()lar t(k"ik

I()i! ra)i(akti& )i6erikan !elali !lt; )ala! 6entk


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Tir(i)ekt(!i a)ala# "e6a# (+era"i ,ang !eli6atkan (+era"i +e!in)a#an "e!a ata

"e6agian )ari kelen%ar tir(i). Kla"i&ika"i )ari tir(i)ekt(!i a)ala# t(tal tir(i)ekt(!i )an

n,ari" t(tal tir(i)ekt(!i. In)ika"i )ilakkan tir(i)ekt(!i a)ala# g(n)(k; kanker tir(i);

#i+ertir(i)i"!e; ge%ala (6"trk"i; k("!etik. Tir(i)ekt(!i +ar"ial ata t(tal )a+at

)ilak"anakan "e6agai tera+i +ri!er ter#a)a+ kar"in(!a tir(i); #i+ertir(i)i"!e; )an

#i+er+aratir(i)i"!e.

• Tir(i)ekt(!i t(tal 9 kelen%ar tir(i) )iangkata "elr#n,a

• Tir(i)ekt(!i +ar"ial 9 !engangkat "e6agian kelen%ar tir(i)

2. Str!a N()lar T(k"ik

Tera+i )engan +eng(6atan antitir(i) ata 6eta 6l(ker )a+t !engrangi ge%ala teta+i

6ia"an,a krang e&ekti& )ari +a)a +en)erita +en,akit Grae". Ra)i(tera+i ti)ak e&ekti&

"e+erti +en,akit Grae" karena +enga!6ilan ,ang ren)a# )an karena +en)erita ini

!e!6t#kan )("i" ra)ia"i ,ang 6e"ar. Untk n()l ,ang "(liter; n()lekt(!i ata

l(6ekt(!i tir(i) a)ala# tera+i +ili#an karena kanker %arang ter%a)i. Untk "tr!a

!ltin()lar t(k"ik; l(6ekt(!i +a)a "at "i"i )an "6t(tal l(6ekt(!i +a)a "i"i ,ang lain

a)ala# )ian%rkan >Sa)ler et al; 1***?.

$. Str!a N(n T(k"i"

Tera+i )engan +eng(6atan antitir(i) ata 6eta 6l(ker )a+t !engrangi ge%ala teta+i

6ia"an,a krang e&ekti& )ari +a)a +en)erita +en,akit Grae". Ra)i(tera+i ti)ak e&ekti&

"e+erti +en,akit Grae" karena +enga!6ilan ,ang ren)a# )an karena +en)erita ini

!e!6t#kan )("i" ra)ia"i ,ang 6e"ar. Untk n()l ,ang "(liter; n()lekt(!i ata

l(6ekt(!i tir(i) a)ala# tera+i +ili#an karena kanker %arang ter%a)i. Untk "tr!a

!ltin()lar t(k"ik; l(6ekt(!i +a)a "at "i"i )an "6t(tal l(6ekt(!i +a)a "i"i ,ang lain

a)ala# )ian%rkan >Sa)ler et al; 1***?.

In)ika"i (+era"i +a)a "tr!a n()("a n(n t(k"ika iala# 9

• Kegana"an

• Penekanan

• K("!etik


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Tin)akan (+era"i ,ang )iker%akan tergantng %!la# l(6" tir(i) ,ang terkena. Bila

#an,a "at "i"i "a%a )ilakkan "6t(tal l(6ekt(!i; "e)angkan ke)a l(6" terkena

)ilakkan "6t(tal tir(i)ekt(!i. Bila ter)a+at +e!6e"aran kelen%ar geta# 6ening le#er

!aka )iker%akan %ga )e"ek"i kelen%ar le#er &ng"i(nal ata )e"ek"i kelen%ar le#er

ra)ikal!()i&ika"i tergantng a)a ti)akn,a ek"ten"i )an la"n,a ek"ten"i )i lar

kelen%ar geta# 6ening.

Ra)i(tera+i )i6erikan +a)a kegana"an tir(i) ,ang 9

a. In(+era6el

6. K(ntrain)ika"i (+era"i


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$. Pa)a +e!erik"aan la6(rat(ri!; )ite!kan "er! T- >tr(k"in? )an T$

>tri,()(tir(nin? )ala! 6ata" n(r!al.

Nilai n(r!al 9

• T- "er! 9 -.* O 12.5 g)L

• Tir(k"in 6e6a" 9 5. O 2.3 g)L

• T$ "er! 9 11 7 1*5 g)L

• TSH "er! 9 5. O - g)L

• FT1 "er! 9 .- 7 15 Q

-. Pa)a +e!erik"aan USG >ltra"(n(gra&i?

Da+at !enentkan a+aka# le"i ter"e6t ki"tik ataka# +a)at. Ke6an,akan kar"in(!a

a)ala# +a)at; ke6an,akan le"i ,ang ki"tik ata


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• Da+at !e!6e)akan antara le"i tir(i) +a)at )an ki"tik.

• Da+at !engkr (l!e )ari n()l tir(i).

• Da+at !en)etek"i a)an,a %aringan kanker tir(i) re"i)i& ,ang ti)ak !enangka+

i()i!; ,ang ti)ak terli#at )engan "i)ik tir(i).

• Pa)a ke#a!ilan )i !ana +e!erik"aan "i)ik tir(i) ti)ak )a+at )ilakkan;

+e!erik"aan USG "angat !e!6ant !engeta#i a)an,a +e!6e"aran tir(i).

• Untk !engeta#i l(ka"i )engan te+at 6en%(lan tir(i) ,ang akan )ilakkan

6i(+"i terara#.

• Da+at )i+akai "e6agai +enga!atan lan%t #a"il +eng(6atan.

. Pe!erik"aan "i)ik tir(i).

Ha"il +e!erik"aan )engan ra)i(i"(t(+e a)ala# teraan kran; 6entk l(ka"i; )an ,ang

ta!a iala# &ng"i 6agian76agian tir(i). Pa)a +e!erik"aan ini +a"ien )i6eri Na +er(ral

)an "etela# 2- %a! "e


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3. Bi(+", )an Sit(l(gi Tir(i)

Bi(+", ini )ilakkan k#"" +a)a kea)aan ,ang !en&ine

nee)le a"+i(rati(n 6i(+",; FNA?. 0ara +e!erik"aan ini


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/$ Pengkajian Keperawatan

a. I)entita" Pa"ien

Na!a; "ia; +en)i)ikan

Jeni" kela!in

Peker%aan

Ala!at

6. I)entita" Penaggng %a4a6

I)entita" ,ang #ar" )iketa#i +era4at !eli+ti na!a; !r; %eni" kela!in;

ala!at; ke+er


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ke"litan !enelan; tera"a "lit 6erna+a" )an "e"ak; keringatan;k("nti+a"i !ata

!e!6e"ar.

2. Ri4a,at Ke"e#atan Da#l

Tan,akan +a)a +a"ien ri4a,at +en,akit )a#l ,ang 6er#6ngan )engan

+en,akit g(n)(k; !i"aln,a +erna# !en)erita g(n)(k le6i# )ari "at kali; tetangga

ata +en))k "ekitar 6er+en,akit g(n)(k. Tan,akan +la +a)a +a"ien !engenai

+(la !akan; a+aka# !akanan ,ang "ering )ik(n"!"i klien; "e+erti !akanan;

Sa,r7Ma,r %eni" Bra""i !i"aln,a; k6i"; l(6ak


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Na)i 9....!enit

S# 9....(0

Re"+irat(r, Rate >RR? 9....!enit

Pa)a klien ,ang


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1. A)an,a 6en%(lan )i le#er

2. A"i!etri le#er

$. N,eri tekan +a)a le#er

-. A)an,a +e!6e"aran kelen%ar li!&e

. Di"+nea

. "akit tengg(r(kan

. "lit 6erna+a"

. Pe!erik"aan Jantng

7 In"+ek"i 9 li#at a+aka# a)a kelainan ke"i!etri"an 6entk )a)a; li#at a+akanter)a+at !a""a ata 6en%(lan. Tan,akan +a)a +a"ien !engenai kel#an ,ang

)ira"akan. Per#atikan re"+(n +a"ien ter#a)a+ "etia+ +ertan,aan ,ang )ia%kan;

ter)a+at +er6e)aan rat !ka.

7 A"klta"i 9 6n,i %antng ta!6a#an 6ia"an,a ti)ak )i)a+atkan +a)a ka""

k(!+lika"i ringan.

7 Pal+a"i 9 +l"a"i +a)a )in)ing t(rak" tera6a le!a#; kat ata ti)ak tera6a;

+er#atikan )an


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7 A"klta"i 9 )engarkan "ara na&a" area e"ikler >6er"i##al"ka"ar?; area

6r(n6er"i##al"ka"ar?; area 6r(nk(e"ikler >6er"i##al"ka"ar?; "ara

ta!6a#an ,ang ter)engar 9 rele"r(nk#i4#ee@ing+leral &ri


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$? Higiene

Tan)a 9 ke!n)ran ke6er"i#an gigi. Ke6t#an 6antan +era4atan )a"ar.

-? Ner("en"(ri

Ge%ala 9 Di+l(+ia >+engli#atan gan)a?; ketlian.

Tan)a 9 He!i+are"i" 4a%a# >keterli6atan +ar(ti) )an "6!an)i6lar?. Para

!eneta+ ata ke#ilangan "ara >ge%ala )(!inan )an )ini kanker laring

intrin"ik?. Ke"litan !enelan. Ker"akan !e!6ran !k("a.

? N,eri ata Ken,a!anan

Ge%ala 9 Sakit tengg(r(k kr(ni"; 6en%(lan +a)a tengg(r(k. Pen,e6aran n,eri

ke telinga; n,eri 4a%a# >ta#a+ ak#ir; ke!ngkinan !eta"ta"e?. N,eri ata ra"a

ter6akar )engan +e!6engkakan >k""n,a )engan


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Ge%ala 9 !a"ala# tentang ke!a!+an 6erk(!nika"i; )an 6erga6ng )ala!

interak"i "("ial.

Tan)a 9 Para !eneta+; +er6a#an tinggi "ara; 6i


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DA1'A, P*S'AKA

Pear2555?; Ka+ita Selekta Ke)(kteran; e)i"i ke III; +ener6it FKUI; Jakarta.

D(enge" Maril,nn; E; )kk; >1***? Ren

BAB II KBM

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