Penilaian Nyeri di Ruang Perawatan Intensif

Hadi Sumitro Jioe, Suwarman Suwarman

Abstract


Nyeri secara umum dikenal sebagai tanda vital kelima serta merupakan signal dari menurunnya fungsi fisiologis dari kebanyakan organ tubuh. Nyeri hebat dapat mencetuskan respon stres dan menstimulasi aktivitas adrenergik–simpatis menyebabkan takikardi, hipertensi, meningkatkan konsumsi oksigen dalam otot jantung serta dapat menyebabkan iskemik otot jantung pada pasien-pasien tertentu. Pada pasien dengan kondisi kritis nyeri dapat bermanifestasi sebagai gelisah dan delirium seringkali tidak tertangani dengan baik sehingga dapat menyebabkan sekuele psikis sebagai post-traumatic stress disorder. Manifestasi sistemik dari nyeri adalah systemic inflammatory response syndrome, hiperglikemi, imunosupresi, penyembuhan luka yang sulit, hiperkoagulabilitas, dan peningkatan reaksi katabolisme tubuh. Hal tersebut berujung pada peningkatan lama rawat di ruang perawatan intensif atau rumah sakit serta mortalitas. Pengukuran nyeri pada pasien dengan kondisi kritis jarang sekali menggunakan sistem penilaian yang tervalidasi dan penilaian berdasarkan respon fisiologis (denyut jantung, tekanan darah arteri, pola pernafasan) dapat berujung pada kesalahan. Penilaian intensitas nyeri secara rutin dapat meningkatkan kualitas dari penanganan nyeri dan kualitas hidup pasien pada ruang perawatan intensif hingga pasien dipulangkan. Oleh karena itu, penilaian nyeri pada pasien-pasien kritis yang dirawat di ruang perawatan intensif harus berdasarkan kriteria penilaian yang dapat diulang serta terpercaya dalam skala waktu tertentu sehingga dapat dilakukan evaluasi. Skala Behavioral Pain Scale (BPS) dan Critical care Pain Observation Tool (CPOT) dapat digunakan untuk menilai nyeri pada pasien dengan kondisi kritis baik sadar maupun tidak sadar yang menggunakan alat bantu pernafasan mekanik akan tetapi dengan perbedaan sensifitas dan spesifisitas. Penggunaan kedua skala nyeri secara bersamaan dapat meningkatkan nilai sensitifitas untuk penilaian nyeri.

Kata kunci: BPS, CPOT, penilaian nyeri, ruang perawatan intensif

PAIN ASSESSMENT IN INTENSIVE CARE UNIT

Abstract

Pain is widely known as fifth vital sign and often sign of decreasing physiological function. Severe pain can cause stress response stimulating adrenergic–sympathetic activity, such as: tachycardia, hypertension, and increasing oxygen consumption in cardiac muscle for certain patients. In critically sedated ill patients common manifestation of pain are anxiety and delirium, if it does not well managed it can cause post–traumatic stress disorder syndrome. Systemic manifestation of pain are systemic inflammatory response syndrome, hyperglycemia, immunosuppression, delayed wound healing, hypercoagulobility, and increasing of catabolism reaction. This can lead to increase length of stay in intensive care unit as well as hospital, moreover it can increase mortality. Clinicians whom asses pain in critically ill patient seldomly use a validated scale. Assessment based on physiological responses (heart rate, arterial blood pressure measurement, respiration pattern) can be mistaken. Adequate and routine pain assessment can increase quality of pain management as well as quality of life patients whom admitted in intensive care unit until they are discharged. Pain assessment in critically ill patients in intensive care unit must be based from a validated scale that can be re–assess within a period of time so that it can be re–evaluated. Either Behavioral Pain Scale (BPS) or Critical care Pain Observation Tool (CPOT) can be use individually as a validated pain scale for a conscious patient and an unconscious patients whom mechanically ventilated but with different sensitivity and specifity. Using both validated scales together can increase sensitivity of pain assessment.

Keywords: BPS, CPOT, intensive care unit, pain assessment


Keywords


BPS, CPOT, penilaian nyeri, ruang perawatan intensif

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References


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