OKSIGENASI 1

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Satya Excel Site -

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LAPORAN PENDAHULUAN GANGGUAN

PEMENUHAN OKSIGENASI

LAPORAN PENDAHULUAN

ASUHAN KEPERAWATAN PADA PASIEN

DENGAN GANGGUAN PEMENUHAN OKSIGENASI

Disusun Oleh

Satya Putra Lencana

M11.01.0015
http://satyaexcel.blogspot.co.id/?m=1http://satyaexcel.blogspot.co.id/?m=1


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PROGRAM STUDI S! KEPERAWATAN

SEKOLAH TINGGI ILMU KESEHATAN MADANI

"OG"AKARTA

#$!#

LAPORAN PENDAHULUAN

KEBUTUHAN OKSIGEN

1. PENGERTIAN

O%si&enasi a'alah (e()e*i%an ali*an &as O# le)ih 'a*i #!+ ,a'a te%anan at(s.e*

sehin&&a %nsent*asi %si&en (enin&%at 'ala( tu)uh/

0htt,11athea*)iansyah/)l&s,t/c(2

O%si&en a'alah salah satu %(,nen &as 'an unsu*e 3ital 'ala( ,*ses (eta)lis(euntu% (e(,e*tahan%an %elan&sun&an hi'u, selu*uh sel 4 sel tu)uh/ Seca*a n*(alele(en te*se)ut 'i,e*leh 'n&an ca*a (en&hi*u, %si&en setia, %ali )e*na,as/

Peny(,aian O#%e5a*in&an tu)uh 'itentu%an leh syste( *es,i*asi6 %a*'i3as%ule*6 'an

%ea'aan he(aatl&i/ Dala( %ea'aan )iasa6 (anusia (e()utuh%an se%ita* 7$$ cc

%si&en seha*i 0#8 5a(2 atau se%ita* $69 cc tia, (enit/

Res,i*asi )e*,e*an 'ala( (e(,e*tahan%an %elan&sun&an (eta)lis(e sel/ Sehin&&a

'i,e*lu%an .un&si *es,i*asi yan& a'e%uat/ A&a* sel (ela%u%an (eta)lis(e untu%

(en&hasil%an ene*&i6 sel (e(e*lu%an su,lai %si&en 'an nut*isi yan& cu%u, ,a'a tu)uh/

Nut*isi 'i,e*leh 'a*i asu,an 0inta%e2 (a%anan 'an cai*an/

P*ses *es,i*asi a'alah ,*ses %elua* (asu%nya u'a*a %e ,a*u 4 ,a*u 'an te*5a'i

,e*tu%a*an &as/

(Tarwoto & Wartonah,hal 9)

Res,i*asi 5u&a )e*a*ti &a)un&an a%ti3itas (e%anis(a yan& )e*,e*an 'ala( ,*ses su,lai

O#%e selu*uh tu)uh 'an ,e()uan&an :O#0 hasil ,e()a%a*an sel2/

(Iman Somantri, hal 1)

;u(lah %si&en yan& 'ia()il (elalui u'a*a ,e*na,asan te*&antun& %e)utuhan/

actor ! "actor yan# mem$en#aruhi %eutuhan o%'i#en yaitu

!/


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1. Menu*unnya %e(a(,uan (en&i%at %si&en se,e*ti ,a'a ane(ia/

2. Menu*unya %nsent*asi %si&en yan& 'iins,i*asi se,e*ti ,a'a )st*u%si salu*an

,e*na,asan )a&ian atas/

3. Hi,3le(ia6 sehin&&a te%anan 'a*ah (enu*un yan& nen&a%i)at%an te*&an&&unya

O#/

4. Menin&%atnya (eta)lis(e se,e*ti a'anya in.e%si6 'e(a(6 i)u ha(il6 lu%a 'll/

5. Kn'isi yan& (e(,en&a*uhi ,e*&e*a%an 'in'in& 'a'a se,e*ti ,a'a %eha(ilan6

)esitas6 (us%ulus s%eletn yan& a)n*(al6 ,enya%it %*nis se,e*ti T=: ,a*u/

2. asa tua6 a'anya ,*ses ,enuaan yan& (en&a%i)at%an %e(un&%inan

a*te*iscle*sis6 elastisitas (enu*un6 e%s,ansi ,a*u (enu*un/

3.


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2. TUJUAN PEMBERIAN OKSIGEN

1) Untu% (e(,e*tah%an %si&en yan& a'e%uat ,a'a 5a*in&an/

2) Untu% (enu*un%an %e*5a 5antun&/

3) Untu% (enu*un%an %e*5a ,a*u-,a*u/

3. ANATOMI SISTEM PERNAPASAN

1) Saluran Perna$a'an a#ian

*ta' a/ Hi'un&

Hi'un& 'i)entu% leh tulan& se5ati 0s2 'an tulan& *a>an 0%a*tila&2/ Te*'i*i 'a*i

)a&ian inte*nal 'an e%ste*nal/ =a&ian inte*nal (e*u,a%an )a&ian *n&&a yan&

)e*l*n& yan& 'i,isah%an (en5a'i *n&&a hi'un& %anan 'an %i*i leh ,e()a&i

3ent*i%el yan& se(,it6 yan& 'ise)ut 'e$tum.Rn&&a hi'un& (en&an'un& *a()ut

0.i()*iae2 yan& )e*.un&si se)a&ai ,enya*in& 0.ilte*2 %asa* te*ha'a, )en'a asin&

yan& (asu%/

Pe*(u%aan hi'un& 0(u%sa2 te*'a,at e,itel )e*sislia yan& (en&an'un& sel

&)let/ Se)a&ai sel yan& (en&elua*%an len'e* sehin&&a 'a,at (enan&%a, )en'a

asin& yan& (asu% %e 'ala( salu*an ,e*na,asan/

Hi'un& )e*.un&si se)a&ai salu*an utnu% u'a*a (en&ali* %e' an 'a*i ,a*u-,a*u/

Dan 5u&a )e*.un&si se)a&ai 5alan na,as6 ,en&atu* %ele()a,an u'a*a 0hu(i'i.i%asi26

,en&atu* suhu6 ,elin'un& 'an ,enya*in& u'a*a6 in'*a ,enciu(an6 'an *esnat*

sua*a/ Rese,t* )au te*leta% ,a'a c*i)i.*( ,alte6 'i 'ala(nya te*'a,at u5un& sa*a.

c*anial I 0Ne*3us Ol.act*ius2/

)/ Sinus Pa*anasalis

Me*ua%an 'ae*ah yan& te*)u%a ,a'a tulan& %e,ala/ Sinus ,a*anasaliste*(asu% e(,at ,asan& *n&&a )e*tualn& yan& 'ila,isi leh (u%sa hi'un& 'an

e,itel %lu(na* )e*tin&%at se(u )e*silia/ "aitu sinus .*ntalis6 sinus eth(i'alis6

sinus s,heni'alis6 'an sinus (axila*is 0sesuai 'en&an leta%nya2/ Sinus se)a&ai

te(,at u(u( te*5a'inya in.e%si/


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3. an 0%a*tila&2 %*i%i'/ Pen&hu)un& hi'un& 'an *n&&a (ulut

%e la*in&/

ah %a*tila& ti*i'2/

9/ Ka*tila& A*iteni'

Di&una%an ,a'a ,e*&e*a%an ,ita sua*a 'an %a*tila& ti*i'/

B/ Pita sua*a

Li&a(en yan& 'i%nt*l leh &e*a%an tt yan& (en&hasil%an sua*a 'an

(ele%at ,a'a lu(en la*in&/


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5. T*a%hea

Dise)ut 5u&a %antn& ten&&*% yan& (e*u,a%an ,e*,an5an&an 'a*i al*in& ,a'a

%etin&&ian tulan& 3e*te)*ae te*%al %e-C yan& )e*caa)an& (en5a'i 'ua )*n%us/

U5un& ca)an& t*a%ea 'ise)ut carina/ T*a%ea )e*si.at san&at .le%si)el6 )e*tt6

'en&an ,n5an& !# c( 'en&an cincin (e()entu% hu*u. :/

+) Saluran Perna$a'an a#ian awah

a/ =*n%hus

Te*)a&i (en5a'i )a&ian %anan 'an %i*i/ "aitu )*nchus l)a*is %anan 0 7 l)us2

'an )*nchus l)a*is %i*i 0 # l)us2/ =*nchus %anan le)ih ,en'e%6 le)ih )esa*6 'an

cen'e*un& le)ih 3e*tical 'a*i,a'a yan& %i*i/ Sehin&&a )en'a asin& le)ih (u'ah

(asu% %e 'ala( ca)an& se)elah %anan 'a*i,a'a ca)an& )*nchus se)elah %i*i/

=*nchus l)a*is %anan te*)a&i (en5a'i !$ )*n%hus se&(ental 'an )*nchus

l)a*is %i*i te*)a&i (en5a'i )*n%hus se&(ental/ Se&(en ini %e(u'ian te*)a&i la&i

(en5a'i su)se&(en yan& 'i%elillin&i 5a*in&an i%at yan& (e(ili%i a*te*i6 li(.ati%6 'an

sa*a./

)/ =*n%hilus

Se&(en )*n%us )e*ca)an& (en5a'i )*n%ilus yan& (en&an'un& %elen5a*

su)(u%sa yan& (e(,*'u%si len'i* yan& (e()entu% seli(ut ti'a% te*,utus untu%

(ela,isi )a&ian 5alan na,as/

c/ =*n%hilus Te*(inalis

Me()entu% ,e*ca)an&an yan& ti'a% (e(,unyai %elen5a* len'i* 'an silia/

'/ =*n%hilus Res,i*at*y

"an& %e(u'ian a%an (en5a'i )*n%ilus *es,i*at*y yan& 'ian&&a, se)a&ai

salu*an t*ansisinal anta*a 5alan na,as %n'u%si 'an 5alan na,as ,e*tu%a*an &as/

e/ Du%tus Al3ela* 'an Sa%us Al3ela*

=*nchus *es,i*at*y %e(u'ian (en&a*ah %e 'ala( 'u%tus al3ela* 'an sa%us

al3ela*/ "an& %e(u'ian (en5a'i al3eli/

6. Al3eli

Se)a&ai te(,at ,e*tu%a*an O#'an :O#/ te*'a,at se%ita* 7$$ 5uta yan& 5i%a

)e*satu a%an (e()entu% satu le()a* 'en&an luas C$ (/


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Te*)a&i atas 7 ti,e

1) Sel 4 sel al3ela* ti,e I a'alh sel e,itel ,e()entu% 'in'in&/

2) Sel 4 sel al3ela* ti,e II a'alah sel yan& a%ti. seca*a (eta)li%'an (ense%*esi

su*.a%tan/

3) Sel 4 sel al3ela* ti,e III a'alah (a%*.a& yan& (e*u,a%an sel 4 sel

.a&sitsis/

7. Pa*u 4 ,a*u

Me*u,a%an *&an yan& elastis )e*)entu% %e*ucut/ Te*leta% 'ala( *n&&&a 'a'a/

Ke'ua ,a*u 'i,isah%an leh (e'iastinu( sent*al yan& )e*isi 5antun& 'an )e)e*a,a

,e()uluh 'a*ah )esa*/

Setia, ,a*u (e(,unyai a,e%s 'an )asis/ Pa*u %anan le)ih )esa* 'an te*)a&i(en5a'i 7 l)us leh .isu*a inte*l)a*is/ Pa*u %i*i le)ih %ecil 'an te*)a&i (en5a'i #

l)us/ L)us te*se)ut %e(u'ian te*)a&i (en5a'i )e)e*a,a se&(en/

h/ Pleu*a

Me*u,a%an la,isan ti,is yan& (en&an'un& %la&en 'an 5a*in&an elastic/ Te*)a&i

(en5a'i

1. Pleu*a ,a*ietalis yaitu yan& (ela,isi *n&&&a 'a'a/

2. Pleu*a 3ise*alis yaitu yan& (enyelu)un&i setia, ,a*u/

Di anta*a ,leu*a te*se)ut a'a )a&ian *n&&a yan& )e*isi cai*an ti,is ,leu*a yan&

)e*.un&si (e(u'ah%an %e'ua ,e*(u%aan )e*&e*a% sela(a ,e*na,asan san

(ence&ah ,e(isahan t*a%s 'en&an ,a*u 4 ,a*u/

Te%anan 'ala( ,leu*a le)ih *en'ah 'a*i te%anan at(s.e* yan& )e*tu5uan untu%

(ence&ah %la,s ,a*u/


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2. Penyesuaian %(,sisi asa( )asa 'a*ah 'an cai*an tu)uh lain/

3. Penin&%atan %a,asitas ,en&an&%utan O#'an ,enin&%atan cu*ah 5antun&/

2. Salu*an u'a*a yan& utuh

Pe*na,asan )isa te*&an&&u 1 ti'a% %a*ena .aa%t* ,en&ha()at ,a'a salu*an

,e*na,asan 0se,e*ti a'anya )st*u%si2/

3. a O#,a'a sel tu)uh/

6. Suatu syste( si*%ulasi yan& utuh 'an ,(,a 5antun& e.e%i./

7. =e*.un&sinya ,usat ,e*na,asan/

4. FISIOLOGI SISTEM PERNAPASAN

=e*na,as 1 ,e*na,asan (e*u,a%an ,*ses ,e*tu%a*an u'a*a 'ianta*a in'i3i'u 'an

lin&%un&annya 'i(ana O#yan& 'ihi*u, 'an :O#yan& 'i)uan&/

Pe*na,asan ini te*5a'i seca*a t(atis >alau 'a,al( %ea'aan te*ti'u* se%ali,un %a*ena

,en&a*uh susunan sa*a. tn(/ Menu*ut te(,at te*5a'inya6 ,e*na,asan te*'i*i 'a*i

1. Pe*na,asan Lua*

A'alah ,e*tu%a*an u'a*a yan& te*5a'i anta*a u'a*a 'ala( al3elus 'en&an 'a*ah

'ala( %a,ile*/

#/ Pe*na,asan Dala(

A'alah ,e*na,aasan yan& te*5a'i anta*a 'a*ah 'ala( %a,ile* 'en&an sel 4 sel tu)uh/

5. PROSES RESPIRASI EKSTERNAL

1) Fentilasi

Di(ulai 'a*i ,*ses ins,i*asi 'i(ana u'a*a )e*&e*a% 'a*i u'a*a lua* %e 'ala( t*a%ea6

)*nchus6 )*n%hilus6 'an al3eli/ Sela(a e%s,i*asi6 &as yan& te*'a,at 'ala(

al3elus/ P*sesnya sa(a se,e*ti ins,i*asi 'en&an alu* )ali%/


9/43

ah

te%anan at(s.e*/ "an& a%an (enye)a)%an u'a*a te*ta*i% (elalui t*a%ea 'an

)*nchus lalu (asu% hin&&a (asu% %e 'ala( al3eli/ Se'an&%an saat e%s,i*asi

se)ali%nya6 'ia.*a&(a *ela%sasi 'an ,a*u 4 ,a*u (en&e(,is6 sehin&&a te*5a'i

,enu*unan luas *in&&a 'a'a/ Te%anan al3eli (ele)ihi te%anan at(s.e*(6

sehin&&a u'a*a te*'esa% %elua* 'a*i ,a*u 4 ,a*u (enu5u %e at(s.e*/

)/ Resistensi 5alan u'a*a

Penin&%atan te%anan ca)an& )*nchus 'an a'anya )en'a asin& 'ala( salu*an

na,as a%an (enye)a)%an u'a*a te*ha()at (asu% %e 'ala( al3elus/

3. K(,lian ,a*u 4,a*u

A'alah %e(a(,uan ,a*u 4,a*u untu% (en&e()an& 'an (en&e(,is/

#2 Di.usi

Gas 4 &as (elintasi (e()*ane anta*a al3ela* 4 %a,ile* yan& ti,is 0 $69 ((H&2 a%i)at

selilsih te%anan ,a*sial anta*a 'a*ah 'an .ase &as/ Te%anan O#'ala(at(s.e* sa(a 'ena&n te%anan laut 0@ !8 ((H&2/

Saat ins,i*asi te%anan ,a*sial ini (en&ala(i ,enu*unan @!$7 ((H& se)a&ai a%i)at

'a*i u'a*a yan& te*ca(,u* 'en&an *uan&n *u&i anat(is ,a'a salu*an u'a*a 'en&an

ua, ai*/

a%tu te*tentu/

3. Se(a%in ti,is (e()*ane se(a%in ce,at 'i.usi &as (elalui (e()*ane te*se)ut %e

)a&ian yan& )e*la>anan/

4. Ke.isien 'i.usi seca*a lan&sun&n )e*)an'in& lu*us te*ha'a, %e(a(,uan te*la*ut

suatu &as 'ala( cai*an ,a*u 4 ,a*u 'an )e*)an'in& te*)ali% te*ha'a, u%u*an

(le%ul/

Nilai %e.isien 'i.usi O# !6 nit*&en $6976 'an :O# #$67/ Pe*)an'in&an

te*se)ut (en&&a(3a*%an )ah>a :O# ,alin& (u'ah la*ut 'an N# ,alin& %u*an&

'a,at la*ut/


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72 T*ans,*tasi

Meli,uti

1. T*ans,* %si&en 'ala( 'a*ah

Pen&an&%utan O#%e 5a*in&an te*tentu te*&antun& ,a'a

1 ;u(lah %si&en yan& (asu% ,a*u 4,a*u/

2 Pe*tu%a*an &as yan& cu%u,/

3 Ali*an 'a*ah %e 5a*in&an/

4 Ka,asitas ,en&an&%utan %si&en leh 'a*ah/

Dina(i%a *ea%si H) 'en&an O#san&at (e(u'ah%an ,en&an&%utan O#/ H) a'alah

,*tein yan& te*susun 'a*i e(,at su)unit6 (asin& 4 (asin& (en&an'un& he(e

yan& te*i%at ,a'a *antai ,li,e,ti'a/

O%si&en 'isalu*%an 'a*i ,a*u-,a*u %e 5a*in&an (elalui 'ua ca*a yaitu seca*a .isi%

la*ut 'ala( ,las(a atau seca*a %i(ia )e*i%atan 'en&an H) tin&%at 5a*in&an 'ise)ut

He(&l)in te*e'u%si/ "an& )e*>a*na un&u 'an (enye)a)%an >a*na )i*u ,a'a

'ae*ah 3ena 03ena su,e*.icial2/

)/ T*ans,*t %a*)n'i%si'a 'ala( 'a*ah

Dila%u%an 'en&an 7 ca*a yaitu

1 !$+ seca*a .isi% la*ut 'ala( ,las(a/

2 #$+ )e*i%atan 'en&an &u&us a(in ,a'a H) 'ala( sel 'a*ah (e*ah/ H) yan&

)ei%atan 'en&an :O#'ise)ut %arominohemo#loin.

3 C$+ 'it*ans,* se)a&ai )i%a*)nat ,las(a/

Kesei()an&an asa( )asa san&at 'i,en&a*uhi leh .un&si ,a*u 4 ,a*u se*ta

h(estasis %a*)n'i%si'a/

Untu% (enyei()an&%an asa( )asa 'ala( tu)uh6 te*'a,at 'ua .ase yan& )e*hu)un&an

yaitu

1. Asi'sis 'ise)ut se)a&ai hi,e*3entilasi/

Se%*esi in hy'*&en tu)ulus ha*us cu%u, 'itin&%at%an untu% (en&a)s*,si

)i%a*)nat 'an )isa (ena()ah 5u(lah )i%a*)nat 'ala( 'a*ah/

Ran&san&an ,alin& ,entin& utnu% (enin&%at%an se%*esi in hy'*&en leh tu)ulus

'ala( %ea'aan asi'sis

1 Penin&%atan P:O#cai*an e%st*aselule*/


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1 Penin&%atan %nsent*asi in hy'*&en cai*an e%st*aselula* 0,enu*unan ,H2/

Penu*unan ,H yan& te*5a'i %a*ena ,enin&%atan P:O#'ise)ut se)a&ai a'io'i'

re'$iratori%. Atau 'ise)ut 5u&a se)a&ai %e&a&alan syste( ,e*na,asan 'ala(

(e()uan& :O#'a*i cai*an tu)uh/ Ke*usa%an ,e*na,asan6 ,enin&%atan P:O#a*te*i 'i atas 89 ((H& 'enn&an ,enu*unan ,H C679/

Penye)a)nya ,enya%it )st*u%si6 *est*i%si ,a*u6 ,li(ielitis6 ,enu*unan a%ti3itas,usat ,e*na,asan 0t*au(a %e,ala6 ,e*'a*ahan6 na*%ti%6 'll2/

)/ Al%alsis 'ise)ut se)a&ai hi,3entilasi/

Pen&u*an&an se%*esi in hy'*&en leh tu)ulus sa(,ai san&at *en'ah hinn&&a

ti'a% te*5a'i *ea)s*,si )i%a*)nat len&%a,6 yan& (e()uat &in5al (a(,u

(enin&%at%an e%s%*esi )i%a*)nat/

Keti'a%sei()an&an asa( )asa al%alsis 'ise)ut se)a&ai al%alo'i' re'$iratori%.

"an& 'ise)a)%an a%i)at %ehilann&an :O#'a*i ,a*u 4 ,a*u ,a'a %ece,atan yan&

le)ih tin&&i 'a*i ,*'u%sinya 5a*in&an/ Hal ini (enin)ul%an P:O #a*te*i 79 ((H&6,H C689/

Penye)a)nya hi,e*3entilasi al3ela*6 anxietas6 'e(a(6 (enin&itis6 %e*acunan

as,i*in6 ,neu(nia6 'an e()li ,a*u/

6. REFLEKS PERNAPASAN

1. Re.lex =atu% 0:u&h2

Di(ulai %eti%a te*an&san&nya )a&ian ,e%a salu*an ,e*na,asan se,e*ti la*in&6 t*achea6

'an )*nchus/ Ran&san& 'itan&%a, leh sens* ta%til 'an %e(*ese,t* a.e*en (elallui

ne*3us Fa&us (enu5u (e'ulla )ln&ata 0,usat ,e*na,asan26 (isalnya )en'a asin/

Ke(u'ian ,usat ,e*na,asan (e(e*intah%an untu% (ela%u%an *e.lex )atu% a&a* )en'a

itu %elua*/ Tu)uh (e*es,n 'en&an (en&ins,i*asi u'a*a %e ,a*u 4 ,a*u6 (enutu,nya

&lttis leh e,i&lttis6 (enutu, ,ita sua*a a&a* u'a*a ins,i*asi te*tahan 'i a,*u 4 ,a*u/

Sehin&&a te*5a'i te%anan ,a'a al3elus yan& (enye)a)%an tt 4tt a)'(en 'an

inte*%stalis inte*na )e*%nt*a%si 'an te*5a'i e%s,i*asi (en'a'a%/ E%s,i*asi %uat

(e()uat e,i&ltis 'an ,ita sua*a te*)u%a sehin&&a u'a*a 'en&an ce,at le>at

)*nchus 'an t*achea sehin&&a )en'a asin& itu %elua*/

#/ Re.lex =e*sin 0Snee?e2

=e*)ali% 'en&an *e.lex )atu%6 *an&san& 'itan&%a, leh *ese,t* ta%til hi'un& 'ite*us%an

Ne*3us T*i&e(inus 'an 'ilan5ut%an %e ,usat ,e*na,asan 'i (e'ulla )ln&ata/

Re.lex ini )e*(an.aat utnu% (en&elua*%an )en'a asin& 'a*i *n&&a hi'un& atau

salu*an na,as )a>ah/


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G. FAKTOR FAKTOR ANG MEMPENGARUHI PERNAPASAN

!/

Taha,#/ Pe*%e()an&an

Saat lahi* te*5a'i ,e*u)ahan *es,i*asi yan& )esa* yaitu ,a*u 4,a*u yan& se)elu(nya

)e*isi cai*an (en5a'i )e*isi u'a*a/ =ayi (e(ili%i 'a'a yan& %ecil 'an 5alan na,as yan&

,en'e%/ =entu% 'a'a )ulat ,a'a >a%tu )ayi 'an (asa %ana% 4 %ana%6 'ia(ete* 'a*i

'e,an %e )ela%an& )e*%u*an& 'en&an ,*,*si te*ha'a, 'ia(ete* t*ans3e*sal/ Pa'a

*an& 'e>asa th*a%s 'iasu(si%an )e*)entu% 3al/ Sa(,ai lan5ut usia a%an te*5a'i

,e*u)ahan ,a'a th*a%s 'an ,la na,as/

#/

Lin&%un&an7/

Ketin&&ian6 ,anas6 'in&in6 'an ,lusi (e(,en&a*uhi %si&enasi/ Ma%in tin&&i 'a*atan6

(a%in *en'ah PaO#6 sehin&&a se(a%in se'i%it %si&en yan& 'a,at 'ihi*u,in'i3i'u/ Se)a&ai *es,n ,anas6 ,e()uluh 'a*ah ,e*i.e* a%an )e*'ilatasi6 sehin&&a

'a*ah a%an (en&ali* %e %ulit/

Gaya7/ Hi'u,

A%ti3itas 'an latihan .isi% (enin&%at%an la5u6 %e'ala(an ,e*na,asan 'an 'enyut

5antun&/

Status8/ Kesehatan

O*an& yan& sehat syste( %a*'i3as%ule* 'an ,e*na,san 'a,at (enye'ia%an %si&en

yan& cu%u, untu% (e(enuhi %e)utuhan tu)uh/

Na*%ti%a9/

Se,e*ti (*.in 'a,at (enu*un%an la5u 'an %e'ala(an ,e*na,asan %eti%a 'e,*esi ,usat

,e*na,asan 'i (e'ulla/ Sehin&&a )ila (e()e*i%an )at-)atan na*%ti% anal&eti%

,e*a>at ha*us (e(antau la5u 'an %e'ala(an ,e*na,asan/

Pe*u)ahanB/ 1 Gan&&uan ,a'a


13/43

Pe*na,asan n*(al 'ila%u%an tan,a usaha/ =e*na,as yan& sulit 'ise)ut 'y,sne

0sesa% na,as2/ Ka'an& 4 %a'an& te*'a,at ,e*na,asan cu,in& hi'un&/ O*th,ne yaitu

%eti'a%(a(,uan untu% )e*na,as %ecuali ,a'a ,sisi 'u'u% 'an e*'i*i se,e*ti ,a'a

,en'e*ita as(a/

O)st*u%siJ/ ;alan Na,as

O)st*u%si len&%a, atau se)a&ian 'a,at te*5a'i se,an5an& sallu*an ,e*na,asan 'i

se)elah atas atau )a>ah/

O)st*u%si se)a&ian 5alan na,as 'itan'ai 'en&an a'anya sua*a (en&*% sela(a

inhalasi 0ins,i*asi2/

H. MEKANISME PERNAPASAN

Pe*na,asan!/ Da'a

"aitu ,e*na,asan yan& (eli)at%an tt anta*a tulan& *usu%/ Me%anis(enya )e*u,a

1.


14/43

1. Kece(asan

2. In.e%si1se,sis

3. Ke*acunan )at 4 )atan/

4. Keti'a%sei()an&an asa( )asa se,e*ti asi'sis (eta)lic/

Tan'a 'an &e5ala )e*u,a na,as ,en'e%6 nye*i 'a'a6 (enu*unnya%nsent*asi6'is*ientasi6 'an tinnitus/

Hi,3entilasi#/

Te*5a'i %eti%a 3entilasi sl3ela* ti'a% a'e%uat (e(enuhi ,en&&unaan O#untu%

(en&elua*%an :O#'en&an cu%u,/ Se,e*ti a,'a atele%ta%sis 0%la,s ,a*u2/

Tan'a 'an &e5ala )e*u,a nye*i %e,ala6 ,enu*unan %esa'a*an6 'is*ientasi6

%a*'ia%'is*it(ia6 %eti'a%sei()an&an ele%t*lit6 %e5ann&6 'an %a*'ia% a**est/

Hi,%sia7/

"aitu suatu %n'isi %eti'a%cu%u,an O#'i 'ala( tu)uh yan& 'iins,i*asi sa(,ai 5a*in&an/

Dise)a)%an lleh

1. Menu*unnya H)/

2. =e*%u*an&nya %nsent*asi %si&en 5i%a 'i ,e&unun&an/

3. Keti'a%(a(,uan 5a*in&an (en&i%at %si&en se,e*ti ,a'a %e*acunan/

4. Menu*unnya 'i.usi O#se,e*ti ,a'a ,neu(nia/

5. Menu*unnya ,e*.usi 5a*in&an6 se,e*ti sy%/

6. Ke*usa%an1 &an&&uan 3entilasi/

Tan'a hi,%sia %elelahan6 %ece(asan6 (enu*unnya %nsent*asi6 na'i (enin&%at6

,e*na,asan ce,at 'an 'ala(6 siansis6 sesa% na,as6 'an clu))in&/

J. PEMERIKSAAN DIAGNOSIS PADA PASIEN DENGAN GANGGUAN SISTEM

PERNAPASAN/

Met'e!/ M*.l&is

1. Ra'il&i

Pa*en%i( ,a*u yan& )e*isi u'a*a (e()e*i%an *esistensi yan& %ecil te*ha'a,

5alannya sina* sehin&&a (e()e*i )ayan&an yan& san&at (e(anca*/ =a&ian

,a'at u'a*a a%an (e()e*i%an u'a*a )ayan&an yan& le)ih ,a'at %a*ena sulit

'ite()us sina* / )en'a yan& ,a'at (e()e* %esan >a*na le)ih ,utih 'a*i )a&ian

)e*)entu% u'a*a/

)/ =*n%s%,i


15/43

Me*u,a%an te%ni% yan& (e(un&%in%an 3isualisasi lan&sun& t*achea 'an ca)an&

uta(anya/ =iasanya 'i&una%an untu% (e(asti%an %a*sin(a )*n%&eni%6 atau

untu% (e()uan& )en'a asin&/ Setelah tin'a%an ini ,asien ti'a% )lelh (a%an atau

(inu( sela(a # -7 5a( sa(,ai ti%()ul *e.lex (untah/ ;i%a ti'a%6 ,asien (un&%in

a%an (en&ala(i as,i*asi %e 'ala( ca)an&a t*a%e)*n%eal/

3. Pe(e*i%saan =i,si

Man.aat )i,sy ,a*u 4,a*u te*uta(a )e*%aitan 'en&an ,enya%it ,a*u yan& )e*si.at

(enye)a* yan& ti'a% 'a,at 'i'ia&nsis 'en&an ca*a lain/

'/ Pe(e*i%asaan S,utu(

=e*si.at (i%*s%,i% 'an ,entin& untu% (en'ia&nsis etil&i )e*)a&ai ,enya%it

,e*na,asan/ Da,at 'i&una%an untu% (en5elas%an *&anis(e ,enye)a) ,enya%it

)e*)a&ai ,neu(nia6 )acte*ial6 tu)e*%ulsa6 se*ta 5a(u*/ Pe(e*i%saan sitl&i

e%s,litati. ,a'a s,utu( (e()antu ,*ses 'ia&nsis %a*sin(a ,a*u/ Wa%tu yan&

)ai% untu% ,en&u(,ulan s,utu( a'alah ,a&i ha*i )an&un ti'u* %a*ena se%*esi

a)n*(al )*n%us cen'e*un& )e*%u(,ul >a%tu ti'u*/

Met'e#/


16/43

"aitu 5u(lah u'a*a ,a*u ,a'a a%hi* *es,i*asi )iasa 0atan-%e)utuhan-

%si&enasi/ht(l/

Ta*>t Wa*tnah/ #$$7/ -M an Pro'e' -e$erawatan/ ;a%a*ta Sale()a Me'i%a "eni

Kustanti6 :h*istina/ #$$B/ Pemeri%'aan i'i% Thora%'."&ya%a*ta AKPER =ethes'a

S(ant*i6 I(an/ #$$J/ -M *'uhan -e$erawatan $aa Pa'ien en#an /an##uan

Si'temPerna$a'an. ;a%a*ta Sale()a Me'i%a

=*unne* Su''a*th/ #$$!/ u%u *ar -e$erawatan Mei%al eah ol. 1/ ;a%a*ta

EG: Guytn Hall/ !C. u%u *ar i'iolo#i -eo%teran.;a%a*ta EG:
http://athearobiansyah.blogspot.com/2008/03/asuhan-keperawatan-kebutuhan-oksigenasi.htmlhttp://athearobiansyah.blogspot.com/2008/03/asuhan-keperawatan-kebutuhan-oksigenasi.htmlhttp://athearobiansyah.blogspot.com/2008/03/asuhan-keperawatan-kebutuhan-oksigenasi.htmlhttp://athearobiansyah.blogspot.com/2008/03/asuhan-keperawatan-kebutuhan-oksigenasi.htmlhttp://athearobiansyah.blogspot.com/2008/03/asuhan-keperawatan-kebutuhan-oksigenasi.htmlhttp://athearobiansyah.blogspot.com/2008/03/asuhan-keperawatan-kebutuhan-oksigenasi.htmlhttp://athearobiansyah.blogspot.com/2008/03/asuhan-keperawatan-kebutuhan-oksigenasi.html


17/43

ASUHAN KEPERA!ATAN

PENGKAJIAN

1. IDENTITAS

Ientita' $a'ien, menca%u$

1 Na(a

2 Ala(at

3 U(u*

4 Status

5 A&a(a

6 Su%u )an&sa1)an&sa

7 Pen'i'i%an

8 Pe%e*5aan

9 Te(,at1tan&&al lahi*

10 N/ :M

11 Dia&nse (e'is

Ientira' Penan##un#awa

12 Na(a

13 Ala(at

14 Te(,at1tan&&al lahi*

15 Status

16 A&a(a

17 Su%u )an&sa1)an&sa

18 Pen'i'i%an

19 Pe%e*5aan

20 Hu)un&an 'an&an ,asien

RI!AAT KESEHATAN

1. Keluhan uta(a

"an& )iasa (uncul ,a'a ,asien 'en&an &an&uan si%lus O#'an :O#anta*a

lain )atu%6 ,enin&%atan ,*'u%si s,utu(6 'i,snea6 he(,tisis6 >hee?in&6

st*i'*6 'an nye*i 'a'a/


18/43

1 =atu% 0:u&h2

"an& ,e*lu 'i%a5i yaitu la(anya6 )a&ai(ana ti()ulnya6 hu)un&annya

'en&an a%ti3itas6 a'anya s,utu( atau 'aha%/

Penin&%atan ,*'u%si s,utu( (eli,uti >a*na6 %nsistensi6 )au6 5u(lah

%a*ena hal itu (enun5u%%an %ea'aan 'a*i ,*ses ,atl&is/ ;i%a a'a in.e%si

s,utu( a%an )e*>a*na %unin& atau hi5au6 ,utih atau %ela)u6 'an 5e*nih/ ;i%a

e'e(a ,a*u6 s,utu( )e*>a*na (e*ah (u'a %a*ena (en&an'un& 'a*ah

'ala( 5u(lah yan& )anya%/

2 Di,snea

Me*u,a%an ,e*se,si %esulitan )e*na,as1 na,as ,en'e% 'an se)a&ai

,e*asaan su)5e%ti. ,asien/ "an& ,e*lu 'i%a5i6 a,a%ah ,asien sesa% saat

)e*5alan6 'll/

1 He(,tisis

"aitu 'a*ah yan& %elua* (elalui (ulut saat )atu%/ Kea'aan ini )iasanya

(enan'a%an a'anya %elainan )e*u,a )*nchitis %*nis6 )*n%hie%tasis6 T=-

,a*u6 cystic .i)*sis6 u,,e* ai*>ay nec*ti?in& &*anul(a6 e()li ,a*u6

,neu(nia6 %an%e* ,a*u6 'an a)ses ,a*u/

1 :hest ,ain

Nye*i 'a'a )isa )e*%aitan 'en&an (asalah 5antun& se,e*ti &an&&uan%n'u%si 0'is*it(ia26 ,e*u)ahan %a*'ia% ut,ut6 %e*usa%an .un&si %atu,6 atau

in.a*%6 'll/ Pa*u ti'a% (e(ili%i sa*a. yan& sensiti3e te*ha'a, nye*i ta,i sa*a.

itu 'i(ili%i leh i&a6 tt6 ,leu*a ,a*ietal6 'an ,e*ca)an&an t*a%he)*n%hial/

2. Ri>ayat %esehatan se%a*an&

Ditanya%an 1 (en5elas%an %*nl&i )e*5alannya ,enya%it ,asien

1) Wa%tu te*5a'inya sa%it1 =e*a,a la(a su'ah te*5a'inya sa%it

2) P*ses te*5a'inya sa%it

1 Ka,an (ulai te*5a'inya sa%it

2 =a&ai(ana sa%it itu (ulai te*5a'i

3) U,aya yan& telah 'ila%u%an

1 Sela(a sa%it su'ah )e*)at %e(ana

2 O)at-)atan yan& ,e*nah 'i%nsu(si


19/43

4) Hasil ,e(e*i%saan se(enta*a 1 se%a*an&

1 TTF (eli,uti te%anan 'a*ah6 suhu6 *es,i*at*i% *ate6 'an na'i

2 A'anya ,at.isil&i lain se,e*ti saat 'iaus%ultasi a'anya *n%y6

>hee?in&/

3. Ri>ayat %esehatan te*'ahulu

Ditanya%an

1) Ri>ayat (e*%%6 yaitu se)a&i ,enye)a) uta(a %an%e* ,a*u 4 ,a*u6

e(.ise(a6 'an )*nchitis %*nis/ Ana(nesa ha*us (enca%u,

1 Usia (ulai (e*%% seca*a *utin

2 Rata 4 *ata 5u(lah *%% yan& 'ihisa, setia, ha*i/

3 Usai (en&henti%an %e)iasaan (e*%%/

2) Pen&)atan saat ini 'an (asa lalu

3) Ale*&i4) Te(,at tin&&al

4. Ri>ayat %esehatan %elua*&a

Tu5uan ,en&%a5ian ini

1 Penya%it in.e%si te*tentu se,e*ti T=: 'itula*%an (elalui *an& %e *an&/

2 Kelainan ale*&i se,e*ti as(a )*nchial6 (enu5u%%an suatu ,*e'is,sisi

%etu*unan te*tentu/ As(a )isa 5u&a te*5a'i a%i)at %n.li% %elua*&a/

3 Pasien )*nchitis %*nis (un&%in )e*(u%i( 'i 'ae*ah yan& tin&%at ,lusi

u'a*anya tin&&i/ Plusi ini )u%an se)a&ai ,enye)a) ti()ulnya ,enya%it

ta,i )isa (e(,e*)e*at/

5. Gen&*a(
http://www.blogger.com/post-edit.g?blogID=5233870946323552761&postID=5532430694106571477http://www.blogger.com/post-edit.g?blogID=5233870946323552761&postID=5532430694106571477


20/43

Kete*an&an

Pasien Menin&&al

Ayah ,asien Tin&&al se*u(ah

La%i-la%i

Pe*e(,uan

6. Ri>ayat %esehatan lin&%un&an/

POLA FUNGSI KESEHATAN "GORDON#

1. Pe*se,si te*ha'a, %esehatan 4 (ana5e(en %esehatan

1 Tin&%at ,en&etahuan %esehatan 1 ,enya%it

2 Pe*ila%u untu% (en&atasi (asalah %esehatan

3


21/43

4. Pla nut*isi - (eta)lic

Ditanya%an


22/43

1 =e*a,a %ali (a%an seha*i

2 Ma%anan %esu%aan

3 =e*at )a'an se)elu( 'an sesu'ah sa%it

4


23/43

1 Kn5un&ti3a ,ucat 0%a*ena ane(ia2

2 Kn5un&it3a siansis 0 %a*ena hi,%se(ia2

3 Kn5un&ti3a te*'a,at ,ethecia 0 %a*ena e()li le(a% atau en'%a*'itis2

2) Kulit

1 Siansis ,e*i.e* 03as%nt*i%si 'an (enu*unnya ali*an 'a*ah ,e*i.e*2/

2 Siansis seca*a u(u( 0hi,%se(ia2

3 Penu*unan tu*&* 0'ehi'*asi2

4 E'e(a

5 E'e(a ,e*i*)ital

3) ;a*i 'an %u%u

1 Siansis

2 :lu))in& .in&e*

4) Mulut 'an )i)i*

1 Me()*an (u%sa siansis

2 =e*na,as 'en&an (en&e*ut%an (ulut/

5) Hi'un&

1 Pe*na,asan 'en&an cu,in& hi'un&6 'e3iasi s,utu(6 ,e*.*asi6 'an

%esi(et*isan/

6) Fena Lehe*

1 A'anya 'istensi1 )en'un&an/

7) Da'a

1) Ins,e%si

1 Pe(e*i%saan (ulai 'a'a ,ste*i* sa(,ai yan& lainnya6 ,asien ha*us

'u'u%/

2 O)se*3asi 'a'a ,a'a sisi %anan atau %i*i se*ta 'e,an atau )ela%an&/

3 Da'a ,ste*i* a(ati a'anya s%a*6 lesi6 'an (asa se*ta &an&&uan tulan&

)ela%an& 0%i.sis6 s%lisis6 'an l*'sis2

4 :atat 5u(lah6 i*a(a6 %e'ala(an ,e*na,asan6 'an %esi(et*isan ,e*&e*a%an

'a'a/


24/43

1 O)se*3asi ,e*na,asan se,e*ti ,e*na,asan hi'un&6 atau ,e*na,asan

'ia.*a&(a se*ta ,en&&unaan tt )antu ,e*na,asan/

2 O)se*3asi 'u*asi ins,i*asi 'an e%s,i*asi/ E%s,i*asi yan& ,an5an&

(enan'a%an a'anya )st*u%si 5alan na,as se,e*ti ,a'a ,asien :h*nic

Ai*.l> Li(itatin 0:AL21 :h*nic O)st*ucti3e Pul(na*y Disease 0:OPD2/

3 Ka5i %n.i&u*asi 'a'a/

4 Kelainan )entu% 'a'a

=a**el chest

A%i)at 3e*in.latin ,a*u ,a'a ,asien e(.ise(a/

ah

ste*nu(/

Pi&en chest

A%i)at %eti'a%te,atan ste*nu( yan& (en&a%i)at%an ,enin&%atan

'ia(ete* AP/

K.is%lisis

Missal ,a'a ,asien ste,*sis 'an %elainan (usculs%eletal/

1 O)se*3asi %esi(et*isan ,e*&e*a%an 'a'a/ Gan&&uan ,e*&e*a%an 'in'in&

'a'a (en&in'i%asi%an a'anya ,enya%it ,a*u1 ,leu*a/

2 O)se*3asi *et*a%si a)n*(al *uan& inte*%stal sela(a in,si*asi yan&

(en&in'i%asi%an a'anya )st*u%si 5alan na,as/

2) Pal,asi

Untu% (en&%a5i %esi(et*isan ,e*&e*a%an 'a'a 'an (en&)se*3asi

a)n*(alitas6 (en&i'enti.i%asi %ea'aan %ulit6 'an (en&etahui tactil ,*e(itus

03i)*asi2/

3) Pe*%usi

Men&%a5i *esnansi ,ul(ne*6 *&an yan& a'a 'i se%ita*nya6 'an,en&e()an&an 0e%s%u*si2 'ia.*a&(a/ A'a 'ua sua*a ,e*%usi yaitu

Sua*a ,e*%usi n*(al

Resnan 0sn*2 'ihasil%an ,a'a 5a*in&an ,a*u n*(al6 u(u(nya


25/43

)e*&aun& 'an )e*na'a *en'ah/

Dullness 'ihasil%an 'i atas 5antun& atau ,a*u/


26/43

Ty(,any 'ihasil%an 'i atas ,e*ut yan& )e*isi u'a*a/

1 Sua*a ,e*%usi a)n*(al

Hi,e*esnan le)ih *en'ah 'a*i *esnan se,e*ti ,a*u a)n*(al yan&

)e*isi u'a*a/


27/43

2 Exe*cise st*ess test

(2) Tes untu% (enentu%an %nt*a%si (i%a*'iu( ali*an 'a*ah/

1 Echca*'i&*a,hy


28/43

1 Katete*isasi 5antun&

2 An&i&*a.i

(3) Tes untu% (en&etahui 3entilasi 'an %si&enasi

1 Tes .un&si ,a*u 4 ,a*u 'en&an s,i*(et*i/

2 Tes ast*u,

3 O%si(et*i

4 Pe(e*i%saan 'a*ah len&%a,/

(4) Melihat st*u%tu* syste( ,e*na,asan

1 - Ray th*a%s

2 =*n%hs%,i

3 :T scan ,a*u

(5) Menentu%an sel a)n*(al1 in.e%si syste( ,e*na,asan

1 Kultu* a,us ten&&*%

2 Sitl&i

3 S,eci(en s,utu( 0=TA2

DIAGNOSA9/KEPERA!ATAN

A'a,un 'ia&nse yan& la?i( (uncul ,a'a ,asien 'en&an &an&&uan syste(

,e*na,asan yaitu

1. =e*sihan 5alan na,as ti'a% e.e%ti.

2. Pla na,as ti'a% e.e%ti.

3. Ke*usa%an ,e*tu%a*an &as

4. Dis.un&si *es,n ,enya,ihan 3entile*

5. Intle*ansi a%ti3itas

6. Resi% as,i*asiPEREN$ANAANB/


29/43

NO. TUJUAN INTER%ENSI

D&NO$ NI$

!/Setelah 'ila%u%an

Ai'()* Su+,i-ningtin'a%an %e,e*a>atan

sela(a x #8 5a( "310#

'iha*a,%an )e*sihan 5alan

na,as e.e%ti. sesuai Pasti%an

'en&an c*ite*ia %e)utuhan *al1

R/i'),-'* )u t*acheal)i'()* )/n+* "010#

suctinin&

$8!$$8


30/43

$8$7! Aus%ultasi sua*a na,as

'ala( *entan& n*(al/

Ai')i-n $-n'-4

"1516#

!!J$! Ma(,u (en&i'enti.i%asi

.act* *esi%

!!J$# Mence&ah

.act* *esi%/

(enun5u%%an

)*a'i%a*'i6 ,enin&%atan

satu*asi O#

Ai'()* 7)n)g/7/n "310#

1 =u%a 5alan na,as6 &una%an

te%ni% chin ly.t atau 5a> th*ust

)ila ,e*lu

2 Psisi%an ,asien untu%

(e(a%si(al%an %si&enasi

3 I'enti.i%asi ,asien ,e*lunya

,e(asan&an alat 5alan na,as

4 Pasan& alat )antu na,as *al

atau nas,ha*yn&eal )ila

,e*lu

5 La%u%an te*a,i .isite*a,i

'a'a )ila ,e*lu

6 Kelua*%an sec*et 'en&an

)atu% atau suctin

7 A5a*%an ca*a )atu% e.e%ti.

8 Aus%ultasi sua*a na,as6 catat

a'anya ,enu*unan 'an

,enin&%atan sua*a na,as


31/43

=e*i%an

hu(i'i.i%asi )ila

,e*lu

Atu* inta%e cai*an

untu%

(en&,ti(al%an%esei()an&an

cai*an

Mnit* status

*es,i*asi 'an

%si&enasi )ila

,e*lu

2.

Setelah 'ila%u%an

Ai'()* 7)n)g/7/ntin'a%an %e,e*a>atansela(a/#8 5a( "310#

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Lin% %e ,stin& ini

=uat se)uah Lin%

Q =e*an'aLihat 3e*si >e)

I M/
https://plus.google.com/103950427793307622560http://satyaexcel.blogspot.co.id/2012/06/laporan-pendahuluan-gangguan-pemenuhan.html?m=1http://void%280%29/https://www.blogger.com/blog-this.ghttp://satyaexcel.blogspot.co.id/2012/05/asidosis-tubulus-renalis-atr.html?m=1http://satyaexcel.blogspot.com/2012/06/laporan-pendahuluan-gangguan-pemenuhan.html?m=0https://plus.google.com/103950427793307622560http://satyaexcel.blogspot.co.id/2012/06/laporan-pendahuluan-gangguan-pemenuhan.html?m=1http://void%280%29/https://www.blogger.com/blog-this.ghttp://satyaexcel.blogspot.co.id/2012/05/asidosis-tubulus-renalis-atr.html?m=1http://satyaexcel.blogspot.com/2012/06/laporan-pendahuluan-gangguan-pemenuhan.html?m=0


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M/+/' K/
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I@ui BB

Lihat ,*.il len&%a,%u

Di)e*'aya%an leh =l&&e*/
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