definition Bleeding occurs when blood vessels break or rupture .Bleeding outside bleeding severe bleeding , hypovolemic shock can harm Klafisikasi : capillary bleeding , bleeding arterial , venous bleeding .Nursing CareassessmentABCD
assessment , pale , cool and moist skin , blood pressure drops , rapid
but weak pulse , and rapid breathing in , decreased urine production .nursing diagnosesLess volume of body fluids associated with active blood loss .Decrease in cardiac output associated with decreased preload , blood loss .Changes in tissue perfusion associated with blood loss .Changes in sensory perception associated with decreased cerebral perfusion .The purpose of nursing Controlling bleeding . sirkulasiadekuat Maintaining blood volume for oxygenation . Prevent shock .emergency managementCut shirt patients to identify areas of bleeding and do a physical assessment quickly . Give emphasis on the bleeding area .• Emphasis directApply
direct pressure to the bleeding area hands or use pads or kainyang
clean for about 15 minutes , and the tide strong pressure bandage .• Emphasis arteryEmphasis is made on the appropriate arterial end ( the end where the artery is pressed against the bone which are below ) .Six main point suppression temporal artery : at the front area of each ear and can be pressed in the skull . facial Artery : located 2.5 cm below the chin and next to the chin . common carotid artery : at the side of the trachea . Observation time of the patient's breathing and pressure should not be on both carotid arteries at the same time . subclavian Artery : located under both sides of the clavicle ( collar bone ) . Emphasis should be made on the transverse position behind and about - about half the length of the clavicle .
brachial artery : at midway between the elbow and shoulder , lies in
the deeper regions of the upper arm between the biceps and triceps
muscles . femoral artery : can be felt in the groin .• Tourniquets Pemasanagan tourniquet on extremities only as a last resort when the bleeding can not be controlled by other methods .Tourniquets installed just proximal to the wound ; tourniquet tight enough to control the flow of arterial blood .Give marks on the patient's skin with a pen or tape to mark T , stating the location and time of installation tourniquets . Loosen the tourniquet as directed to prevent vascular or neurological damage . If there is no bleeding artery , lepasakan tourniquets and try again with a pressure bandage . In traumatic amputation scene , do not remove the tourniquet until the patient entered the operating room . or elevasikan Elevate the wound to slow the flow of blood . Lay the victim to reduce blood pouring out .
Provide appropriate fluid replacement suggestions , include isotonic
electrolyte fluid , plasma or plasma protein , or blood component
therapy (depending on the type and estimated volume of fluid lost ) .• Fresh blood is given when there is massive blood loss .•
supplemental platelets and blood clotting factor is given when a large
amount of blood needed for replacement of blood clotting factor
deficiencies . Perform arterial blood test to determine blood gas and hemodynamic pressure monitoring . Supervise sign - sign of shock or heart failure due to hypovolemia and anoxia .
REFERENCES
Brunner and Suddarth. 2001. Keperawatan Medikal Bedah, Ed.8 Vol.3. EGC : Jakarta.
Hudak, Carolyn M. 1996. Keperawatan Kritis-Pendekatan holistic, Ed. 6. Vol. 2. EGC : Jakarta.
Pusponegoro, A.D. Dkk . Buku Panduan Penanggulangan Penderita gawat Darurat. Ambulance 118 : Jakarta.
Skeet, Muriel. 1995. Tindakan paramedic Terrhadap Kegawatan dan Pertolongan Pertama, Ed. 2. EGC : Jakarta.
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