D.0053
Disorganisasi Perilaku Bayi
Kategori : Fisiologis
Subkategori : Aktivitas/Istirahat
Definisi
Disintegrasi respon fisiologis dan neurobehaviour bayi terhadap lingkungan
Penyebab
1. Keterbatasan lingkungan fisik
2. Ketidaktepatan sensori
3. Kelebihan stimulasi sensorik
4. Imaturitas sistem sensoris
5. Prematuritas
6. Prosedur invasif
7. Malnutrisi
8. Gangguan motorik
9. Kelainan kongenital
10. Kelainan genetik
11. Terpapar teratogenik
Gejala dan Tanda Mayor
Subjektif
(tidak tersedia)
Objektif
1. Hiperekstensi ekstermitas
2. Jari-jari meregang atau tangan menggenggam
3. Respon abnormal terhadap stimulus sensorik
4. Gerakan tidak terkoordinasi
Gejala dan Tanda Minor
Subjektif
(tidak tersedia)
Objektif
1. Menangis
2. Tidak mampu menghambat respon terkejut
3. Iritabilitas
4. Gangguan refleks
5. Tonus motorik berubah
6. Tangan di wajah
7. Gelisah
8. Tremor
9. Tersentak
10. Aritmia
11. Bradikardia atau takikardia
12. Saturasi menurun
13. Tidak mau menyusu
14. Warna kulit berubah
Kondisi Klinis Terkait
1. Hospitalisasi
2. Prosedur invasif
3. Prematuritas
4. Gangguan neurologis
5. Gangguan pernapasan
6. Gangguan kardiovaskuler
Referensi
Ackley, B. J., Ladwig, G. B., & Makic, M. B. F. (2017). Nursing Diagnosis Handbook, An Evidence-Based Guide to Planning Caro. 11 Ed, St. Louis: Elsevier. Als, H., et al. (2005). The assessment of preterm infants' behavior (APIB): furthering the understanding and measurement of neurodevelopmental competence in preterm and full-term infants. Mental Retardation and Developmental Disabilities Research Reviews, 11(1), 94-102.Carpernito-Moyet, L. J. (2013), Nursing Diagnosis Application to Clinical Practice. 14"Ed. Philadelphia: Lippincott Williams & Wilkins. M. E., Moorhouse, M. F., & Murr, A. C. (2013). Nursing Diagnosis Manual Planning, Individualizing and Documenting Client Care. 4 Ed.Philadelphia: F. A. Davis Company.Doenges,Herdman, T. H., & Kamitsuru, S. (2014). Nursing Diagnosis Definitions and Classification 2015-2017. 10 Ed. Oxford: Wiley Blackwell. Newfield, S. A., Hinz, M. D., Tiley, D. S., Sridaromont, K. L., Maramba, P. J. (2012). Cox's Clinical Applicationts of Nursing Diagnosis Adult, Child, Women's Mental Health, Gerantic, and Home Health Considerations. 6 Ed. Philadelphia: F.A. Davis Company.
