Medical Surgical Nursing (MSN) 2 PDF

Medical Surgical Nursing (MSN) 2 KELENJAR TIROID/ Thyroid Gland Dosen Pengampu/Lecturer Ns. Jon Parulian Simarmata M. Kep.  Sub CPMK  Mampu menerapkan prinsip-prinsip asuhan keperawatan holistik dalam praktik laboratorium dan klin...

Medical Surgical Nursing (MSN) 2 KELENJAR TIROID/ Thyroid Gland Dosen Pengampu/Lecturer Ns. Jon Parulian Simarmata M. Kep.  Sub CPMK  Mampu menerapkan prinsip-prinsip asuhan keperawatan holistik dalam praktik laboratorium dan klinik pada pasien dengan gangguan tiroid. Able to apply the principles of holistic nursing care in laboratory and clinical practice in patients with thyroid disorders  Mampu merumuskan pengkajian, diagnosis, intervensi, implementasi dan evaluasi keperawatan yang tepat dan sistematis pada pasien dengan gangguan tiroid/Able to formulate appropriate and systematic assessment, diagnosis, intervention, implementation and evaluation of nursing in patients with thyroid disorders  Mampu menginterpretasi evidence based practice dan menerapkannya dalam praktik keperawatan pada pasien dengan gangguan tiroid/Able to interpret evidence-based practise and apply it in nursing practice in patients with thyroid disorders  Definisi/Definition Kelenjar Tiroid adalah kelenjar yang berbentuk kupu-kupu di leher, tepat di bawah laring. Kelenjar tiroid berguna untuk mengendalikan proses metabolic di dalam tubuh. Di belakang kelenjar tiroid terdapat kelenjkar paratiroid yang berperang mengatur kadar serum kalsium. Thyroid Gland is a butterfly-shaped gland in the neck, just above the thyroid gland is a butterfly-shaped gland in the neck, just below the larynx. The thyroid gland is useful for controlling metabolic processes in the body. Behind the thyroid gland is the parathyroid gland which is to regulating serum calcium levels  Fungsi Kelenjar Tiroid/ Funtions Of Thyroid Gland: 1. Proses pertumbuhan dan maturase sel dan jaringan seluruh tubuh/The process of growth and maturation of cells and tissues throughout the body 2. Pertumbuhan saraf janin dan bayi serta metabolik, neurologis, kardiovaskuler respirasi sepanjang hidup/Fetal and infant nerve growth as well as metabolic, neurological, cardiovascular, respiration throughout life 3. Metabolisme protein, lemak dan glukosa, sehingga produksi panas dan kebutuhan oksigen meningkat/Metabolism of proteins, fats and glucose, so heat production and oxygen demand increase 4. Mengoptimalisasi kerja hormon lain dan neurotransmitter/Optimizes the work of other hormones and neurotransmitters Sekresi Hormon Thyroid/ Secretion Thyroid Hormon  Gangguan-Gangguan Fungsi Tiroid Thyroid Function Disorders 1.Hyperthyroid 2.Hipothyroid  1. HYPERTHYROID  Hipertiroidisme, juga dikenal sebagai penyakit Grave, penyakit Basedow, atau tirotoksikosis yaitu ketidakseimbangan metabolik akibat berlebihnya hormon tiroid triiodothyronine (T3) dan tiroksin (T4). Hyperthyroidism, also known as Grave's disease, Basedow's disease, or thyrotoxicosis is metabolic imbalance due to excess thyroid hormones triiodothyronine (T3) and thyroxine (T4). Thyromegaly  JENIS HYPERTIROIDISME TYPES OF HYPERTHYROIDISM 1. Hipetiroidisme Primer→ gangguan pada kelenjar tiroid langsung Hyperthyroidism Primer→ disorders of the thyroid gland directly 2. Hipertiroidisme Sekunder→ gangguan pada kelenjar ptuitari (hipofisis) Hyperthyroidism Sekunder→ disorders of the ptuitary gland (pituitary)  Hyperthyroid Bentuk yang paling umum adalah penyakit Graves/ The most common form is Graves' disease Badai tiroid ( Thyroid Storm) adalah manifestasi yang jarang/ Thyroid storm is a rare manifestation Keadaan biokimia metabolic yang berlebihan. / Excessive metabolic biochemical state Penyakit multi system dengan peningkatan kadar FT4 atau FT3 atau keduanya/ Multi-system disease with increased levels of FT4 or FT3 or both  Causes of Hyperthyroidism 7. Kanker thyroid metastatic 1. Graves Disease – Toxic (fungsional)/ Metastatic thyroid Difuse Goiter. 2. Plummer disease – Multi Nodular Goiter (MNG)  cancer (functional) 8. Struma Ovarii (Dermoid and Ovarian tumours) toxic 9. Thyrotoxicosis Factitia 3. Fase toksik pada 10. Pemakaian Iodine berlebihan Sub Thyroiditis Akut dan terus menerus/ Excessive and – SAT continuous use of Iodine 4. Toksik Single 11. Thyroid nodules/benjolan. Adenoma – TSA 5. Tumor Hipofisis - Over TSH 6. Kehamilan molar/ molar pregnancy & Choriokarsinoma (↑↑ βHCG)  a. Graves Disease Penyebab paling umum terjadinya Thyrotoxicosis (50-80%)/ The most common cause of Thyrotoxicosis (50-80%).  Dominan pada Perempuan/ Dominant in Women Penyebab belum diketahui/ The cause is not yet known for sure Penyakit otoimum/antibody  Auto-antibody terpenting yaitu :  Thyroid Stimulating Immunoglobulin (TSI) or TSA  TSI merangsang reseptor TSH and stimulates T4 dan T3  b. Toxic Multinodular Goiter (TMNG)   TMNG adalah hipertiroidisme (20%)/ TMNG i s H y p e r t hy ro i d i s m (20%)  Lebih umum pada orang lanjut usia/ More common in older people  Kelenjar tiroid yang bergelombang/ Thyroid gland that is enlarged  Manifestasi yang lebih ringan/ Milder manifestations  Elevasi ringan FT4 dan FT3/ FT4 and FT3 light elevation  Kemajuan perlahan seiring waktu/ Progress slowly  Secara klinis beberapa nodul tegas-plumer/Clinically multiple firm nodules-plumers  Scintigraphy menunjukkan - area panas dan normal/ Scintigraphy shows - hot and normal areas Toxic Multinodular Goiter(TMG)  c. Sub Acute Thyroiditis (SAT) ❑ SATadalah hipertiroidisme paling umum berikutnya 15% / SAT is the next most common hyperthyroidism→ 15% ❑ Penghancuran kekebalan tiroid karena infeksi virus/ Destruction of thyroid immunity due to viral infections. ❑ Pelepasan hormon tiroid preformed yang merusak/ Destructive release of preformed thyroid hormones ❑ Kelenjar tiroid terasa nyeri dan teraba lembut saat dipalpasi/ The thyroid gland feels pain and soft palpation when it is palpated  d. Toxic Single Adenoma (TSA)   Adenoma di kelenjar tiroid/Adenoma in the thyroid gland  Biasanya hanya satu/Usually only one  Berukuran lebih dari 2,5 cm/Measuring more than 2.5 cm  Penyebab dari hipertiroid (5%)/Causes of hyperthyroidism (5%)  Nuclear scintigraphy menunjukkan nodul Tunggal/Nuclear scintigraphy shows a single nodule  Age and Sex Usia/ Age  Graves disease 20 to 40  Toxic M N G > 50 yrs  Toxic Single Adenoma 35 to 50  Sub Acute Thyroiditis Any age  Jenis Kelamin/ Gender M : F ratio  Graves Disease 1: 5 to 1:10  Toxic M N G 1: 2 to 1: 4  Specific to Graves Disease 1. Pembesaran kelenjar tiroid yang tidak nyeri dan  keras/Painless and hard thyroid gland enlargement 2. Tiroid bruit 3. Ophthalmopathy 4. Pasir di mata, edema periorbital, edema konjungtiva (kemosis), penutupan kelopak mata yang buruk, disfungsi otot ekstraokular, diplopia, nyeri pada gerakan mata dan proptosis/ Sand in the eye, periorbital edema, conjunctival edema (chemosis), poor eyelid closure, extraocular muscle dysfunction, diplopia, pain in eye movements and proptosis 5. Dermoacropathy Exopthalmus  Huge Toxic MNG Diffuse Graves Thyroid Ophthalmopathy in Graves  Chemosis  Thyroid Dermopathy  Papula dan kulit berwana pink, plak di tulang kering/ Papules and skin are pink colored, plaque on the shins Graves with Acropathy Graves Goiter Acropathy Clubbing and Osteoarthropathy, Onycholysis   Pemeriksaan Diagnostik/ Diagnostic Test  1. TSH yang sangat ditekan (