Landasan Teori DM pada Kehamilan

DIABETES MELLITUS

Pengertian

Diabetes mellitus merupakan penyakit metabolik dengan penyebab yang beragam, ditandai adanya hiperglikemi kronis serta perubahan metabolisme karbohidrat, lemak dan protein akibat defek sekresi atau kerja insulin, atau keduanya.

( Ilmu Kebidanan : Sarwono Praworohajdo : 2008 )

Diabetes merupakan komplikasi medik yang sering terjadi pada kehamilan. ada dua macam perempuan hamil dengan diabetes, yaitu :

1.      Perempuan hamil dengan diabetes yang sudah diketahui sejak sebelum perempuan tersebut hamil ( pregestasional ).

2.      Perempuan hamil dengan diabetes yang baru diketahui setelah perempuan tersebut hamil ( diabetes mellitus gestasional ).

( Ilmu Kebidanan : Sarwono Praworohajdo : 2008 )

Diabetes Gestasional adalah gangguan dari glukosa yang dipacu oleh kehamilan, biasanya menghilang setelah melahirkan ( Murray et al.,2002 ). Diabetes yang dialami oleh seorang ibu yang pernah menderita DM sebelum hamil dan ibu mengalami DM pada saat hamil disebut diabetes mellitus gestasional. ( syafei Pilialing,1993 ).

( Asuhan Keperawatn Maternitas :2009 )

Diabetes mellitus gestasional didefinisikan sebagai intoleransi karbohidrat dengan berbagai tingkat keparahan, yang awitannya atau pertama kali dikenali selama masa hamil saat ini.

( Keperawatn Maternitas : Bobak :2005 )

Etiologi

Penyakit diabetes mellitus yang terjadi selama kehamilan disebabkan karena kurangnya jumlah insulin yang dihasilkan oleh tubuh yang dibutuhkan untuk membawa glukosa melewati membran sel.

( Asuhan Keperawatn Maternitas :2009 )

Faktor Resiko

Hal-hal yang menjadi faktor resiko pada diabetes mellitus adalah sebagai berikut :

1.      Riwayat keluarga dengan DM

2.      Glukosuria dua kali berturut-turut

3.      Kegemukan

4.      Keguguran kehamilan yang tidak bisa dijelaskan ( abortus spontan )

5.      Adanya hidramnion

6.      Kelahiran anak sebelumnya besar

( Asuhan Keperawatn Maternitas :2009 )

Klasifikasi Diabetes

Ada beberapa macam klasifikasi, salah satunya menurut White ( 1965 ) :

1.      Kelas A : diabetes kimiawi disebut juga diabetes laten/subklinus atau diabetes kehamilan dengan kadar gula darah normal setelah makan, tetapi terjadi peningkatan kadar glukosa 1 atau 2 jam. Ibu tidak memerlukan insulin, cukup diobati dengan pengaturan diet.

2.      Kelas B : diabetes dewasa, terjadi setelah usia 19 tahun dan berlangsung selama 10 tahun, tidak disertai kelainan pembuluh darah.

3.      Kelas C : diabetes yang diderita pada usia 10-19 tahun dan berlangsung selama 10-19 tahun dengan tidak disertai penyakit vaskuler.

4.      Kelas D : diabetes yang sudah lebih dari 20 tahun, tetapi diderita sebelum usia 10 tahun disertai dengan kelainan pembuluh darah.

5.      Kelas E : diabetes yang disertai pengapuran pada pembuluh darah panggul, termasuk arteri uterusna.

6.      Kelas F : diabetes dengan nefropati, termasuk glomerulonefritis dan pielonefritis.

( Asuhan Keperawatn Maternitas :2009 )

Terdapat 4 macam klasifikasi diabetes, yaitu :

1.      Diabetes Type 1 : disebabkan oleh destruksi sel yang akan menyebabkan defisiensi absolut insulin.

2.      Diabetes Type 2 : disebabkan oleh defek sekresi insulin yang progresif karena adanya insulin yang resisten.

3.      Type Spesifik Diabetes lainnya : disebabkan oleh faktor genetik, penyakit eksokrin pankreas, atau obat-obatan.

4.      Diabetes Mellitus Gestasional

( Ilmu Kebidanan : Sarwono Praworohajdo : 2008 )

Patofisiologis

Metabolisme karbohidrat selama kehamilan karena insulin yang berlebih masih banyak dibutuhkan sejalan dengan perkembangan kehamilan. progesteron dan HPL menyebabkan jaringan ibu resisten terhadap insulin dan menghasilkan enzim yang disebut insulinase yang dihasilkan oleh plasenta, sehingga mempercepat terjadinya insulin.

Bila pankreas tidak dapat memproduksi insulin secara adekuat, maka akan timbul suatu keadaan yang disebut hiperglikemia, sehingga dapat menimbulkan kondisi kompensasi tubuh seperti meningkatnya rasa haus ( polidipsi ), mengekskresikan cairan ( poliuri ), dan mudah lapar ( polifagi ).

( Asuhan Keperawatn Maternitas :2009 )

Pengaruh DM pada kehamilan :

1.      Hiperemesis gravidarum

2.      Pemakaian glikogen bertambah

3.      Meningkatnya metabolisme basal

( Asuhan Keperawatn Maternitas :2009 )

Damapk DM pada kehamilan adalah sebagai berikut :

1.      Abortus dan partus prematurus

2.      Preeklamsia

3.      Hidramnion

4.      Kelainan letak janin

5.      Insufisiensi

( Asuhan Keperawatn Maternitas :2009 )

Pengaruh DM pada bayi yang dilahirkan adalah sebagai berikut :

1.      Kematian hasil konsepsi dalam kehamilan muda mengakibatkan abortus

2.      Cacat bawaan

3.      Dismaturitas

4.      Janin besar

5.      Kelainan neurologis

( Asuhan Keperawatn Maternitas :2009 )

Tanda dan Gejala Klinis menurut Mansjoer, (2000) :

1.      Polifagia

2.      Poliuria

3.      Polidipsi

4.      Lemas

5.      BB menurun

6.      Kesemutan

7.      Gatal

8.      Mata kabur

9.      Pruritus vulva

10.  Ketonemia

11.  Glikosuria

12.  Gula darah sewaktu > 200 mg/dl

13.  Gula darah puasa > 126 mg/dl

Penanganan

1.      Diet

Penyuluhan gizi merupakan landasan utama dalam penatalaksanaan. Tujuan terapi ini adalah :

-         Untuk memberikan zat gizi yang diperlukan bagi ibu dan janinnya

-         Untuk mengendalikan kadar glukosa

-         Untuk mencegah ketosis akibat kelaparan

2.      Olahraga

Pasien bebas melakukan program olahraga apapun. Jovanovicpeterson dkk membuktikan bahwa suatu program latihan pengondisian kardiovaskuler memperbaiki kontrol glikemik apabila dibandingkan dengan diet saja. Olahraga yang sesuai adalah yang menggunakan otot-otot tubuh bagian atas tidak banyak menimbulkan stress mekanis pada daerah badan selama latihan.

3.      Insulin

Biasanya pemberian insulin mengharuskan pasien dirawat inap agar dosis dapat dititrasi dengan aman dan pasien dapat dididik untuk melakukan sendiri penyuntikan dan pengukuran kadar glukosa kapiler.

4.      Obat Hipoglikemik Oral

Obat-obat penurun kadar glukosa oral tidak dianjurkan bagi wanita hamil karena efek teratogenitasnya yang tinggi dan dapat diekskresikan dalam jumlah besar melalui ASI.

( Obstetri William eds 21: 2002 )

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Format ASKEB Nifas

 

Nama Mahasiswa            : …………………………………………

Semester                         : …………………………………………

Tanggal Ujian                  : …………………………………………

Penguji                            : 1. ………………………………………

                                                  2. ………………………………………

   I.      PENGKAJIAN

A.  Data Histori Pasien/ Riwayat

1.      Identitas Pasien

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2.      Keluhan Utama

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3.      Riwayat Keluhan Utama (PQRST)

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4.      Riwayat penyakit sekarang

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5.      Riwayat penyakit yang lalu

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6.      Riwayat penyakit keluarga

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7.      Riwayat kehamilan, persalinan, nifas, yang lalu

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8.      Riwayat kehamilan, persalinan sekarang

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9.      Kebutuhan dasar sehari-hari

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10.  Data psikososial

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11.  Pengetahuan dan kemampuan ibu tentang

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B.  Pemeriksaan Fisik

1.         Pemeriksaan keadaan umum

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2.         Kulit

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3.         Muka dan kepala

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4.         Mata

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5.         Hidung

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6.         Mulut dan tenggorokan

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7.         Leher

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8.         Buah dada/ Payudara

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9.         Abdomen (GIT)

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10.     Abdomen (Obstetri)

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11.     Genetalia Eksterna

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12.     Ekstrimitas atas

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13.     Ekstrimitas bawah

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C.  Pemeriksaan Penunjang

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D. Pengobatan / tindakan yang sudah didapat :

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 II.      DIAGNOSA KEBIDANAN

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III.      PERENCANAAN/ INTERVENSI

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IV.      IMPLEMENTASI

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  V.      EVALUASI

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Sidoarjo,……………………………………………….

Penguji I __________________________ Nama Penguji & Tanda Tangan

Pemberi Asuhan _____________________________ Nama Mahasiswa  & Tanda Tangan

                   

                                                       

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