tag:blogger.com,1999:blog-19988834670648033732024-03-13T08:04:29.349+07:00Jurnal KesehatanKumpulan Jurnal Kesehatan Asuhan Keperawatan GratisAnonymoushttp://www.blogger.com/profile/10554290151381141431noreply@blogger.comBlogger48125tag:blogger.com,1999:blog-1998883467064803373.post-53942638813798591452012-12-15T23:50:00.000+07:002012-12-15T23:50:01.410+07:00Penyakit Ginjal<br />
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="http://4.bp.blogspot.com/-aqBUWc6PIuA/UMyp4-N69TI/AAAAAAAAAXA/UKRzxp4hAEA/s1600/Ginjal.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="200" src="http://4.bp.blogspot.com/-aqBUWc6PIuA/UMyp4-N69TI/AAAAAAAAAXA/UKRzxp4hAEA/s200/Ginjal.jpg" width="170" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Penyakit-ginjal</td></tr>
</tbody></table>
Ginjal adalah sepasang organ penting dalam tubuh, bentuknya seperti kacang dan terletak di kedua sisi tulang belakang. Ukuran ginjal sendiri berfariativ tergantung usia dan jenis kelamin serta ada atau tidaknya.<br />
<br />
<u><b>Fungsi Ginjal</b> </u><br />
Ginjal adalah organ penting yang mempunyai fungsi sebagai filter, namun ginjal juga memiliki fungsi lain yaitu :<br />
<ol>
<li>Mengekskresi zat urea, amoniak, asam urat, creatinin, bacteri dan sisa obat-obatan yang merugikan bagi tubuh.</li>
<li>Mengekskresi kelebihan gula dalam darah.</li>
<li>Mempertahankan tekanan osmotik ekstraseslular.</li>
<li>Mengatur ke-seimbangan asam basa darah dan,</li>
<li>Ginjal mempertahankan pH plasma darah.</li>
</ol>
<u><b>Penyakit Ginjal</b> </u><br />
Penyakit ginjal diklasifikasikan kedalam dua bagian yaitu penyakit ginjal merupakan cacat bawaan dan di dapat sebagai berikut :<br />
<br />
<i>Bawaan</i> :<br />
<ul>
<li>Asidosis tubulus renalis</li>
<li>Congenital hydroneprosis</li>
<li>Duplicated ureter</li>
<li>Ginjal sepatu kuda</li>
<li>Renal dysplasia </li>
<li>Unilateral small kidney</li>
<li>Congenital obstruction of urinary tract</li>
</ul>
<i>Didapat</i> :<br />
<ul>
<li>Diabetic nephropaty</li>
<li>Glomerulonephritis</li>
<li>Hydronephrosis</li>
<li>Intertitial nephritis</li>
<li>Batu ginjal</li>
<li>Tumor ginjal</li>
<li>Lupus nephritis</li>
<li>Minimal change disease</li>
<li>Pyelonephritis</li>
<li>Gagal ginjal</li>
</ul>
<b><u>Gejala Penyakit Ginjal</u></b><br />
Gejala pada penyakit ginjal sangat bervariasi tergantung pada penyebab yang mendasarinya, namun secara umum sebagai berikut :<br />
<ul>
<li>Nyeri pinggang yang mendasar </li>
<li>Nyeri pada saat berkemih/ buang air kecil</li>
<li>Urin bercampur darah</li>
<li>Menggigil atau demam</li>
<li>Udeum/ bengkak pada pergelangan kaki dan jika ditekan meninggalkan bekas tekanan.</li>
</ul>
Nah itulah tanda dan gejala yang umum dan sering terjadi pada orang yang menderita penyakit ginjal. Anonymoushttp://www.blogger.com/profile/10554290151381141431noreply@blogger.com9tag:blogger.com,1999:blog-1998883467064803373.post-11931612288203506282012-12-07T14:34:00.000+07:002012-12-07T14:38:19.408+07:00Asuhan Keperawatan<b>Asuhan Keperawatan</b> adalah merupakan suatu tindakan kegiatan atau proses dalam praktik keperawatan yang diberikan secara langsung kepada klien (pasien) untuk memenuhi kebutuhan objektif klien, sehingga dapat mengatasi masalah yang sedang dihadapinya, dan asuhan keperawatan dilaksanakan berdasarkan kaidah-kaidah ilmu keperawatan.<br />
<br />
Menurut Abraham Maslow asuhan keperawatan diberikan dalam upaya memenuhi kebutuhan klien, dalam hal ini Abraham Maslow menerangkan ada lima kebutuhan dasar manusia yaitu :<br />
<ol>
<li>Kebutuhan Fisiologis meliputi nutrisi, cairan dan oksigen.</li>
<li>Kebutuhan rasa aman dan perlindungan.</li>
<li>Kebutuhan rasa cinta dan saling memiliki. </li>
<li>Kebutuhan akan harga diri.</li>
<li>Kebutuhan aktualisasi diri.</li>
</ol>
<b>Tujuan Asuhan Keperawatan</b><br />
Tujuan dalam pemberian asuhan keperawatan meliputi :<br />
<ol>
<li>Membantu individu (klien/ pasien) untuk mandiri.</li>
<li>Mengajak individu, kelompok masyarakat untuk berpartisipasi dalam bidang kesehatan.</li>
<li>Membantu individu mengembangkan potensi dalam memelihara derajat kesehatan secara optimal sehingga diharapkan tidak ketergantungan pada orang lain dalam memelihara kesehatannya.</li>
<li>Membantu individu mendapatkan derajat kesehatan yang optimal.</li>
</ol>
<b>Proses Keperawatan</b><br />
Dalam proses keperawatan ada beberapa tahapan yaitu :<br />
<ol>
<li><b>Pengkajian</b>, adalah upaya untuk mengumpulkan data secara lengkap, dan sistematis untuk dilakukan pengkajian dan dianalisa, sehingga masalah kesehatan yang dihadapi klien (pasien) baik fisik, mental, sosial maupun spiritual dapat ditentukan. Dalam tahap ini mencakup tiga kegiatan yaitu dimulai dari <b>Pengumpulan Data</b>, <b>Analisa Data</b>, dan <b>Penentuan Masalah</b> kesehatan serta keperawatan.</li>
<li><b>Diagnosa Keperawatan</b>, adalah suatu pernyataan yang menjelaskan status kesehatan atau resiko perubahan pola dari klien, individu atau kelompok, sehingga perawat secara akuntabilitas dapat mengidentifikasi dan memberikan intervensi secara pasti. Adapun perumusan dignosa keperawatan sebagai berikut : <b><i>Actual</i></b>, <b><i>Resiko</i></b>, <b><i>Kemungkinan</i></b>, <b><i>Wellness</i></b>, <b><i>Syndrome</i></b>.</li>
<li><b>Rencana Keperawatan, </b>semua tindakan yang dilakukan oleh perawat untuk membantu klien dari status kesehatan sekarang ini ke-status kesehatan yang diuraikan dalam hasil yang diharapkan.</li>
<li><b>Implementasi Keperawatan</b>, merupakan inisiatif dari rencana tindakan untuk mencapai tujuan yang spesifik.</li>
<li><b>Evaluasi</b>, perencanaan evaluasi memuat criteria keberhasilan proses dan
keberhasilan tindakan keperawatan. Keberhasilan proses dapat dilihat
dengan jalan membandingkan antara proses dengan pedoman/rencana proses
tersebut. Sedangkan keberhasilan tindakan dapat dilihat dengan
membandingkan antara tingkat kemandirian pasien dalam kehidupan
sehari-hari dan tingkat kemajuan kesehatan pasien dengan tujuan yang
telah di rumuskan sebelumnya.</li>
</ol>
Anonymoushttp://www.blogger.com/profile/10554290151381141431noreply@blogger.com18tag:blogger.com,1999:blog-1998883467064803373.post-61721775264458030852012-11-16T13:02:00.000+07:002012-11-16T13:10:11.929+07:00Askep Skizofrenia<div style="line-height: 150%; margin: 0cm 0cm 12pt; text-align: justify; text-indent: 36pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;">Skizofrenia
adalah suatu gangguan psikosis fungsional berupa gangguan mental
berulang yang ditandai dengan gejala-gejala psikotik yang khas dan oleh
kemunduran fungsi sosial, fungsi kerja, dan perawatan diri. Skizofrenia
merupakan penyakit otak yang timbul akibat ketidakseimbangan pada
dopamin, yaitu salah satu sel kimia dalam otak. Ia adalah gangguan jiwa
psikotik paling lazim dengan ciri hilangnya perasaan afektif atau
respons emosional dan menarik diri dari hubungan antarpribadi normal.
Sering kali diikuti dengan delusi (keyakinan yang salah) dan halusinasi
(persepsi tanpa ada rangsang pancaindra). Pada pasien penderita,
ditemukan penurunan kadar transtiretin atau pre-albumin yang merupakan
pengusung hormon tiroksin, yang menyebabkan permasalahan pada fluida
cerebrospinal. Skizofrenia bisa mengenai siapa saja. </span></div>
<div style="line-height: 150%; margin: 0cm 0cm 12pt; text-align: justify; text-indent: 36pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;">Data
American Psychiatric Association (APA) tahun 1995 menyebutkan 1%
populasi penduduk dunia menderita skizofrenia. 75% Penderita skizofrenia
mulai mengidapnya pada usia 16-25 tahun. Usia remaja dan dewasa muda
memang berisiko tinggi karena tahap kehidupan ini penuh stresor. Kondisi
penderita sering terlambat disadari keluarga dan lingkungannya karena
dianggap sebagai bagian dari tahap penyesuaian diri. Pengenalan dan
intervensi dini berupa obat dan psikososial sangat penting karena
semakin lama ia tidak diobati, kemungkinan kambuh semakin sering dan
resistensi terhadap upaya terapi semakin kuat. Seseorang yang mengalami
gejala skizofrenia sebaiknya segera dibawa ke psikiater dan psikolog.</span></div>
<div style="line-height: 150%; margin: 0cm 0cm 12pt; text-align: justify; text-indent: 36pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;">Gangguan
jiwa skizofrenia merupakan gangguan jiwa yang berat dan gawat yang
dapat dialami manusia sejak muda dan dapat berlanjut menjadi kronis dan
lebih gawat ketika muncul pada lanjut usia (lansia) karena menyangkut
perubahan pada segi fisik, psikologis dan sosial-budaya. Skizofrenia
pada lansia angka prevalensinya sekitar 1% dari kelompok lanjut usia
(lansia) (Dep.Kes.1992).Banyak pembahasan yang telah dikeluarkan para
ahli sehubungan dengan timbulnya skizofrenia pada lanjut usia (lansia).
Hal itu bersumber dari kenyataan yang terjadi pada lansia bahwa terdapat
hubungan yang erat antara gangguan parafrenia, paranoid dan
skizofrenia. Parafrenia lambat (late paraphrenia) digunakan oleh para
ahli di Eropa untuk pasien-pasien yang memiliki gejala paranoid tanpa
gejala demensia atau delirium serta terdapat gejala waham dan halusinasi
yang berbeda dari gangguan afektif.</span></div>
<div style="line-height: 150%; margin: 0cm 0cm 12pt; text-align: justify; text-indent: 36pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;">Skizofrenia
terjadi dengan frekuensi yang sangat mirip di seluruh dunia.
Skizofrenia terjadi pada pria dan wanita dengan frekuensi yang sama.
Gejala-gejala awal biasanya terjadi pada masa remaja atau awal dua
puluhan. Pria sering mengalami awitan yang lebih awal daripada wanita.</span></div>
<div style="line-height: 150%; margin: 0cm 0cm 12pt; text-align: justify;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;">Gangguan skizofrenia sebenarnya dapat dibagi menjadi beberapa tipe, yaitu:</span><br />
<ol>
<li><span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;">Skizofrenia paranoid (curiga, bermusuhan, garang dsb)·</span><span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;"> </span></li>
<li><span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;">Skizofrenia katatonik (seperti patung, tidak mau makan, tidak mau minum, dsb)</span><span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;"> </span></li>
<li><span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;">Skizofrenia hebefrenik (seperti anak kecil, merengek-rengek, minta-minta, dsb)</span><span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;"> </span></li>
<li><span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;">Skizofrenia simplek (seperti gelandangan, jalan terus, kluyuran)·</span><span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;"> </span></li>
<li><span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;">Skizofrenia Latent (autustik, seperti gembel)</span></li>
</ol>
</div>
<div style="line-height: 150%; margin: 0cm 0cm 12pt; text-align: justify; text-indent: 36pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;">Pada
umumya, gangguan skizofrenia yang terjadi pada lansia adalah
skizofrenia paranoid, simplek dan latent. Sulitnya dalam pelayanan
keluarga, para lansia dengan gangguan kejiwaan tersebut menjadi kurang
terurus karena perangainya dan tingkahlakunya yang tidak menyenangkan
orang lain, seperti curiga berlebihan, galak, bersikap bermusuhan, dan
kadang-kadang baik pria maupun wanita perilaku seksualnya sangat
menonjol walaupun dalam bentuk perkataan yang konotasinya jorok dan
porno (walaupun tidak selalu). </span></div>
<div style="line-height: 150%; margin: 0cm 0cm 12pt; text-align: justify;">
<b><span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;">Gangguan Jiwa Afektif</span></b><span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;"></span></div>
<div style="line-height: 150%; margin: 0cm 0cm 12pt; text-align: justify; text-indent: 36pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;">Gangguan
jiwa afektif adalah gangguan jiwa yang ditandai dengan adanya gangguan
emosi (afektif) sehingga segala perilaku diwarnai oleh ketergangguan
keadan emosi. Gangguan afektif ini antara lain:</span></div>
<div style="line-height: 150%; margin: 0cm 0cm 12pt 18pt; text-align: justify; text-indent: -18pt;">
<b><i><span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;">a. Gangguan Afektif tipe Depresif</span></i></b><span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;">
--- Gangguan ini terjadi relatif cepat dalam beberapa bulan. Faktor
penyebabnya dapat disebabkan oleh kehilangan atau kematian pasangan
hidup atau seseorang yang sangat dekat atau oleh sebab penyakit fisik
yang berat atau lama mengalami penderitaan.Gangguan ini paling banyak
dijumpai pada usia pertengahan, pada umur 40 – 50 tahun dan kondisinya
makin buruk pada lanjut usia (lansia). Pada usia pertengahan tersebut
prosentase wanita lebih banyak dari laki-laki, akan tetapi diatas umur
60 tahun keadaan menjadi seimbang. Pada wanita mungkin ada kaitannya
dengan masa menopause, yang berarti fungsi seksual mengalami penurunan
karena sudah tidak produktif lagi, walaupun sebenarnya tidak harus
begitu, karena kebutuhan biologis sebenarnya selama orang masih sehat
dan masih memerlukan tidak ada salahnya bila dijalankan terus secara
wajar dan teratur tanpa menggangu kesehatannya.</span></div>
<div style="line-height: 150%; margin: 0cm 0cm 12pt; text-align: justify; text-indent: 18pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;">Gejala
gangguan afektif tipe depresif adalah: sedih, sukar tidur, sulit
berkonsentrasi, merasa dirinya tak berharga, bosan hidup dan
kadang-kadang ingin bunuh diri. Beberapa pandangan menganggap bahwa
terdapat 2 jenis depresi yaitu Depresi tipe Neurotik dan Psikotik. Pada
tipe neurotik kesadaran pasien tetap baik, namun memiliki dorongan yang
kuat untuk sedih dan tersisih. Pada depresi psikotik, kesadarannya
terganggu sehingga kemampuan uji realitas (reality testing ability) ikut
terganggu dan berakibat bahwa kadang-kadang pasien tidak dapat
mengenali orang, tempat, maupun waktu atau menjadi seseorang yang tak
tahu malu, tak ada rasa takut, dsb.</span></div>
<div style="line-height: 150%; margin: 0cm 0cm 12pt 18pt; text-align: justify; text-indent: -18pt;">
<b><i><span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;">b. Gangguan Afektif tipe Manik</span></i></b><span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;">
--- Gangguan ini sering timbul secara bergantian pada pasien yang
mengalami gangguan afektif tipe depresi sehingga terjadi suatu siklus
yang disebut gangguan afektif tipe Manik Depresif. Dalam keadaan Manik,
pasien menunjukkan keadaan gembira yang tinggi, cenderung berlebihan
sehingga mendorong pasien berbuat sesuatu yang melampaui batas
kemampuannya, pembicaraan menjadi tidak sopan dan membuat orang lain
menjadi tidak enak. Kondisi ini lebih jarang terjadi dari pada tipe
depresi. Kondisi semacam ini kadang-kadang silih berganti, suatu ketika
pasien menjadi eforia, aktif, riang gembira, pidato berapi-api,
marah-marah, namun tak lama kemudia menjadi sedih, murung, menangis
tersedu-sedu yang sulit dimengerti.</span></div>
<div style="line-height: 150%; margin: 0cm 0cm 12pt 18pt; text-align: justify; text-indent: -18pt;">
<b><i><span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;">c. Neurosis</span></i></b><span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;">
--- Gangguan neurosis dialami sekitar 10-20% kelompok lanjut usia
(lansia). Sering sukar untuk mengenali gangguan ini pada lanjut usia
(lansia) karena disangka sebagai gejala ketuaan. Hampir separuhnya
merupakan gangguan yang ada sejak masa mudanya, sedangkan separuhnya
lagi adalah gangguan yang didapatkannya pada masa memasuki lanjut usia
(lansia). Gangguan neurosis pada lanjut usia (lansia) berhubungan erat
dengan masalah psikososial dalam memasuki tahap lanjut usia (lansia).
Gangguan ini ditandai oleh kecemasan sebagai gejala utama dengan daya
tilikan (insight) serta daya menilai realitasnya yang baik.
Kepribadiannya tetap utuh, secara kualitas perilaku orang neurosis tetap
baik, namun secara kuantitas perilakunya menjadi irrasional. Sebagai
contoh : mandi adalah hal yang biasa dilakukan oleh orang normal sehari 2
kali, namun bagi orang neurosis obsesive untuk mandi, ia akan mandi
berkali-kali dalam satu hari dengan alasan tidak puas-puas untuk mandi.
Secara umum gangguan neurosis dapat dikategorikan sebagai berikut:</span></div>
<div style="line-height: 150%; margin: 0cm 0cm 12pt; text-align: justify;">
<ul>
<li><span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;">Neurosis cemas dan panic</span><span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;"> </span></li>
<li><span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;">Neurosis obsesif kompulsif</span><span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;"> </span></li>
<li><span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;">Neurosis fobik</span><span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;"> </span></li>
<li><span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;">Neurosis histerik (konversi)</span><span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;"> </span></li>
<li><span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;">Gangguan somatoform </span></li>
</ul>
</div>
<div style="line-height: 150%; margin: 0cm 0cm 12pt; text-align: justify;">
<b><span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;">Faktor resiko</span></b><span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;"> penyakit ini termasuk:</span><br />
<ol>
<li><span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;">Riwayat skizofrenia dalam keluarga</span><span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;"> </span></li>
<li><span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;">Perilaku premorbid yang ditandai dengan kecurigaan, eksentrik, penarikan diri, dan/atau impulsivitas.</span><span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;"> </span></li>
<li><span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;">Stress lingkungan</span><span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;"> </span></li>
<li><span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;">Kelahiran pada musim dingin. Faktor ini hanya memiliki nilai prediktif yang sangat kecil.</span><span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;"> </span></li>
<li><span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;">Status sosial ekonomi yang rendah sekurang-kurangnya sebagian adalah karena dideritanya gangguan ini</span></li>
</ol>
</div>
<div style="line-height: 150%; margin: 0cm 0cm 12pt; text-align: justify; text-indent: 36pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;">Tidak
ada jalur etiologi tunggal yang telah diketahui menjadi penyebab
skizofrenia. Penyakit ini mungkin mewakili sekelompok heterogen gangguan
yang mempunyai gejala-gejala serupa. Secara genetik, sekurang-kurangnya
beberapa individu penderita skizofrenia mempunyai kerentanan genetic
herediter. Kemungkinan menderita gangguan ini meningkat dengan adanya
kedekatan genetic dengan, dan beratnya penyakit, probandnya. Penelitian <i>Computed Tomography </i>(CT)
otak dan penelitian post mortem mengungkapkan perbedaan-perbedaan otak
penderita skizofrenia dari otak normal walau pun belum ditemukan pola
yang konsisten. Penelitian aliran darah, glukografi, dan <i>Brain Electrical Activity Mapping</i>
(BEAM) mengungkapkan turunnya aktivitas lobus frontal pada beberapa
individu penderita skizofrenia. Status hiperdopaminergik yang khas untuk
traktus mesolimbik (area tegmentalis ventralis di otak tengah ke
berbagai struktur limbic) menjadi penjelasan patofisiologis yang paling
luas diterima untuk skizofrenia.</span></div>
<div style="line-height: 150%; margin: 0cm 0cm 12pt; text-align: justify; text-indent: 36pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;">Semua
tanda dan gejala skizofrenia telah ditemukan pada orang-orang bukan
penderita skizofrenia akibat lesi system syaraf pusat atau akibat
gangguan fisik lainnya. Gejala dan tanda psikotik tidak satu pun khas
pada semua penderita skizofrenia. Hal ini menyebabkan sulitnya
menegakkan diagnosis pasti untuk gangguan skizofrenia. Keputusan klinis
diambil berdasarkan sebagian pada:</span></div>
<div style="line-height: 150%; margin: 0cm 0cm 12pt; text-align: justify;">
<ol>
<li><span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;">Tanda dan gejala yang ada</span><span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;"> </span></li>
<li><span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;">Riwayat psikiatri</span><span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;"> </span></li>
<li><span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;">Setelah menyingkirkan semua etiologi organic yang nyata seperti keracunan dan putus obat akut.</span></li>
</ol>
</div>
<div style="line-height: 150%; margin: 0cm 0cm 12pt; text-align: justify;">
<b><span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;">Gejala - Gejala</span></b><span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;"></span></div>
<div style="line-height: 150%; margin: 0cm 0cm 12pt; text-align: justify; text-indent: 36pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;">Indikator
premorbid (pra-sakit) pre-skizofrenia antara lain ketidakmampuan
seseorang mengekspresikan emosi: wajah dingin, jarang tersenyum, acuh
tak acuh. Penyimpangan komunikasi: pasien sulit melakukan pembicaraan
terarah, kadang menyimpang (tanjential) atau berputar-putar
(sirkumstantial). Gangguan atensi: penderita tidak mampu memfokuskan,
mempertahankan, atau memindahkan atensi. Gangguan perilaku: menjadi
pemalu, tertutup, menarik diri secara sosial, tidak bisa menikmati rasa
senang, menantang tanpa alasan jelas, mengganggu dan tak disiplin.</span></div>
<div style="line-height: 150%; margin: 0cm 0cm 12pt; text-align: justify; text-indent: 36pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;">Secara umum, gejala-gejala yang muncul pada penderita skizofrenia adalah sebagai berikut:</span></div>
<div style="line-height: 150%; margin: 0cm 0cm 12pt; text-align: justify;">
<ul>
<li><span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;"><b><i>muncul delusi dan halusinasi</i></b>.
Delusi adalah keyakinan/pemikiran yang salah dan tidak sesuai
kenyataan, namun tetap dipertahankan sekalipun dihadapkan pada cukup
banyak bukti mengenai pemikirannya yang salah tersebut. Delusi yang
biasanya muncul adalah bahwa penderita skizofrenia meyakini dirinya
adalah Tuhan, dewa, nabi, atau orang besar dan penting. Sementara
halusinasi adalah persepsi panca indera yang tidak sesuai dengan
kenyataan. Misalnya penderita tampak berbicara sendiri tetapi ia
mempersepsikan ada orang lain yang sedang ia ajak berbicara.</span><span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;"><b><i> </i></b></span></li>
<li><span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;"><b><i>kehilangan energi dan minat</i></b>
untuk menjalani aktivitas sehari-hari, bersenang-senang, maupun
aktivitas seksual, berbicara hanya sedikit, gagal menjalin hubungan yang
dekat dengan orang lain, tidak mampu memikirkan konsekuensi dari
tindakannya, menampilkan ekspresi emosi yang datar, atau bahkan ekspresi
emosi yang tidak sesuai konteks (misalkan tiba-tiba tertawa atau
marah-marah tanpa sebab yang jelas).</span><span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;"><b><i> </i></b></span></li>
<li><span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;"><b><i>menampilkan perilaku tidak terorganisir</i></b>,
misalnya menampilkan pose tubuh yang aneh, pembicaraan yang tidak
tertata dengan baik (bicara melompat-lompat dari satu topik ke topik
yang lain atau 'tidak nyambung').</span></li>
</ul>
</div>
<div style="line-height: 150%; margin: 0cm 0cm 12pt; text-align: justify;">
<b><i><span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;">Gejala-gejala skizofrenia pada umumnya bisa dibagi menjadi dua kelas:</span></i></b><span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;"></span></div>
<div style="line-height: 150%; margin: 0cm 0cm 12pt 18pt; text-align: justify; text-indent: -18pt;">
<b><span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;">1. Gejala-gejala Positif. </span></b><span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;">Termasuk
halusinasi, delusi, gangguan pemikiran (kognitif). Gejala-gejala ini
disebut positif karena merupakan manifestasi jelas yang dapat diamati
oleh orang lain.</span></div>
<div style="line-height: 150%; margin: 0cm 0cm 12pt 18pt; text-align: justify; text-indent: -18pt;">
<b><span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;">2. Gejala-gejala Negatif. </span></b><span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;">Gejala-gejala
yang dimaksud disebut negatif karena merupakan kehilangan dari ciri
khas atau fungsi normal seseorang. Termasuk kurang atau tidak mampu
menampakkan/ mengekspresikan emosi pada wajah dan perilaku, kurangnya
dorongan untuk beraktivitas, tidak dapat menikmati kegiatan-kegiatan
yang disenangi dan kurangnya kemampuan bicara (alogia).</span></div>
<div style="line-height: 150%; margin: 0cm 0cm 12pt; text-align: justify; text-indent: 36pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;">Meski
bayi dan anak-anak kecil dapat menderita skizofrenia atau penyakit
psikotik yang lainnya, keberadaan skizofrenia pada grup ini sangat sulit
dibedakan dengan gangguan kejiwaan seperti autisme, sindrom Asperger
atau ADHD atau gangguan perilaku dan gangguan Post Traumatic Stress
Dissorder. Oleh sebab itu diagnosa penyakit psikotik atau skizofrenia
pada anak-anak kecil harus dilakukan dengan sangat berhati-hati oleh
psikiater atau psikolog yang bersangkutan.</span></div>
<div style="line-height: 150%; margin: 0cm 0cm 12pt; text-align: justify; text-indent: 36pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;">Pada
remaja perlu diperhatikan kepribadian pra-sakit yang merupakan faktor
predisposisi skizofrenia, yaitu gangguan kepribadian paranoid atau
kecurigaan berlebihan, menganggap semua orang sebagai musuh. Gangguan
kepribadian skizoid yaitu emosi dingin, kurang mampu bersikap hangat dan
ramah pada orang lain serta selalu menyendiri. Pada gangguan skizotipal
orang memiliki perilaku atau tampilan diri aneh dan ganjil, afek
sempit, percaya hal-hal aneh, pikiran magis yang berpengaruh pada
perilakunya, persepsi pancaindra yang tidak biasa, pikiran obsesif tak
terkendali, pikiran yang samar-samar, penuh kiasan, sangat rinci dan
ruwet atau stereotipik yang termanifestasi dalam pembicaraan yang aneh
dan inkoheren.</span></div>
<div style="line-height: 150%; margin: 0cm 0cm 12pt; text-align: justify; text-indent: 36pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;">Tidak
semua orang yang memiliki indikator premorbid pasti berkembang menjadi
skizofrenia. Banyak faktor lain yang berperan untuk munculnya gejala
skizofrenia, misalnya stresor lingkungan dan faktor genetik. Sebaliknya,
mereka yang normal bisa saja menderita skizofrenia jika stresor
psikososial terlalu berat sehingga tak mampu mengatasi. Beberapa jenis
obat-obatan terlarang seperti ganja, halusinogen atau amfetamin
(ekstasi) juga dapat menimbulkan gejala-gejala psikosis.</span></div>
<div style="line-height: 150%; margin: 0cm 0cm 12pt; text-align: justify; text-indent: 36pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;">Penderita
skizofrenia memerlukan perhatian dan empati, namun keluarga perlu
menghindari reaksi yang berlebihan seperti sikap terlalu mengkritik,
terlalu memanjakan dan terlalu mengontrol yang justru bisa menyulitkan
penyembuhan. Perawatan terpenting dalam menyembuhkan penderita
skizofrenia adalah perawatan obat-obatan antipsikotik yang
dikombinasikan dengan perawatan terapi psikologis.</span></div>
<div style="line-height: 150%; margin: 0cm 0cm 12pt; text-align: justify;">
<b><span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;">Terapi Penyakit Skizofrenia</span></b><span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;"></span></div>
<div style="line-height: 150%; margin: 0cm 0cm 12pt; text-align: justify;">
<b><i><span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;">Pemberian obat-obatan</span></i></b><span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;"></span></div>
<div style="line-height: 150%; margin: 0cm 0cm 12pt; text-align: justify; text-indent: 36pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;">Obat neuroleptika selalu diberikan, kecuali obat-obat ini terkontraindikasi, karena <b>75% penderita skizofrenia memperoleh perbaikan dengan obat-obat neuroleptika</b>.
Kontraindikasi meliputi neuroleptika yang sangat antikolinergik seperti
klorpromazin, molindone, dan thioridazine pada penderita dengan
hipertrofi prostate atau glaucoma sudut tertutup. Antara sepertiga
hingga separuh penderita skizofrenia dapat membaik dengan lithium.
Namun, karena lithium belum terbukti lebih baik dari neuroleptika,
penggunaannya disarankan sebatas obat penopang. Meskipun terapi
elektrokonvulsif (ECT) lebih rendah dibanding dengan neuroleptika bila
dipakai sendirian, penambahan terapi ini pada regimen neuroleptika
menguntungkan beberapa penderita skizofrenia.</span></div>
<div style="line-height: 150%; margin: 0cm 0cm 12pt; text-align: justify;">
<b><i><span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;">Pendekatan Psikologi</span></i></b><span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;"></span></div>
<div style="line-height: 150%; margin: 0cm 0cm 12pt; text-align: justify; text-indent: 36pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;">Hal yang penting dilakukan adalah <b>intervensi psikososial</b>.
Hal ini dilakukan dengan menurunkan stressor lingkungan atau
mempertinggi kemampuan penderita untuk mengatasinya, dan adanya dukungan
sosial. Intervensi psikososial diyakini berdampak baik pada angka
relaps dan kualitas hidup penderita. Intervensi berpusat pada keluarga
hendaknya tidak diupayakan untuk mendorong eksplorasi atau ekspresi
perasaan-perasaan, atau mempertinggi kewaspadaan impuls-impuls atau
motivasi bawah sadar.</span></div>
<div style="line-height: 150%; margin: 0cm 0cm 12pt; text-align: justify;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;">Tujuannya adalah:</span><br />
<ol>
<li><span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;">Pendidikan pasien dan keluarga tentang sifat-sifat gangguan skizofrenia.</span><span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;"> </span></li>
<li><span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;">Mengurangi rasa bersalah penderita atas timbulnya penyakit ini. Bantu penderita memandang bahwa <b>skizofrenia adalah gangguan otak</b>.</span><span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;"> </span></li>
<li><span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;">Mempertinggi toleransi keluarga akan perilaku disfungsional yang tidak berbahaya. <b>Kecaman dari keluarga dapat berkaitan erat dengan relaps</b>.</span><span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;"> </span></li>
<li><span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;">Mengurangi keterlibatan orang tua dalam kehidupan emosional penderita. <b>Keterlibatan yang berlebihan juga dapat meningkatkan resiko relaps</b>.</span><span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;"> </span></li>
<li><span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;">Mengidentifikasi
perilaku problematik pada penderita dan anggota keluarga lainnya dan
memperjelas pedoman bagi penderita dan keluarga.</span></li>
</ol>
</div>
<div style="line-height: 150%; margin: 0cm 0cm 12pt; text-align: justify; text-indent: 36pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;">Psikodinamik
atau berorientasi insight belum terbukti memberikan keuntungan bagi
individu skizofrenia. Cara ini malahan memperlambat kemajuan. Terapi
individual menguntungkan bila dipusatkan pada penatalaksanaan stress
atau mempertinggi kemampuan social spesifik, serta bila berlangsung
dalam konteks hubungan terapeutik yang ditandai dengan empati, rasa
hormat positif, dan ikhlas. Pemahaman yang empatis terhadap kebingungan
penderita, ketakutan-ketakutannya, dan demoralisasinya amat penting
dilakukan. </span></div>
<div style="line-height: 150%; margin: 0cm 0cm 12pt; text-align: justify; text-indent: 36pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;">Skizofrenia
adalah gangguan jiwa yang parah dan sulit ditangani. Penderita
skizofrenia tidak dapat disembuhkan secara total, dalam arti halusinasi
dan delusi tidak dapat hilang total, karena tanpa pengobatan yang
terus-menerus dan dukungan dari lingkungan, maka gejala-gejala
skizofrenia dapat kembali muncul saat individu berada dalam tekanan atau
mengalami stres. Intervensi sejak dini merupakan hal yang sangat
penting dan bermanfaat dalam penanganan skizofrenia demi mencegah
perkembangan gangguan ke arah yang semakin parah. Penanganan gangguan
skizofrenia membutuhkan berbagai pendekatan selain dengan obat-obatan,
tetapi juga dengan terapi-terapi baik terapi individu, kelompok
(difokuskan pada keterampilan sosial, penyelesaian masalah, perubahan
pemikiran, dan keterampilan persiapan memasuki dunia kerja), maupun
keluarga.</span></div>
<div style="line-height: 150%; margin: 0cm 0cm 12pt; text-align: justify; text-indent: 36pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;">Dalam
terapi keluarga, diberikan informasi dan edukasi mengenai skizofrenia
dan pengobatannya, selain itu terapi juga diarahkan untuk menghindarkan
sikap saling menyalahkan dalam keluarga, meningkatkan komunikasi dan
keterampilan pemecahan masalah dalam keluarga, mendorong penderita dan
keluarga untuk mengembangkan kontak sosial, dan meningkatkan motivasi
penderita skizofrenia dan keluarganya. </span></div>
<div style="line-height: 150%; margin: 0cm 0cm 12pt; text-align: justify;">
<b><span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;">Prognosis Penyakit Skizofrenia</span></b><span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;"></span></div>
<div style="line-height: 150%; margin: 0cm 0cm 12pt; text-align: justify; text-indent: 36pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;">Fase
residual sering mengikuti remisi gejala psikotik yang tampil penuh,
terutama selama tahun-tahun awal gangguan ini. Gejala dan tanda selama
fase ini mirip dengan gejala dan tanda pada fase prodromal;
gejala-gejala psikotik ringan menetap pada sekitar separuh penderita.
Penyembuhan total yang berlangsung sekurang-kurangnya tiga tahun terjadi
pada 10% pasien, sedangkan perbaikan yang bermakna terjadi pada sekitar
dua per tiga kasus. Banyak penderita skizofrenia mengalami eksaserbasi
intermitten, terutama sebagai respon terhadap situasi lingkungan yang
penuh stress. Pria biasanya mengalami perjalanan gangguan yang lebih
berat dibanding wanita. <i>Sepuluh persen penderita skizofrenia meninggal karena bunuh diri.</i> </span></div>
<div style="line-height: 150%; margin: 0cm 0cm 12pt; text-align: justify; text-indent: 36pt;">
<i><span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;">Prognosis baik berhubungan dengan</span></i><span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;">
tidak adanya gangguan perilaku prodromal, pencetus lingkungan yang
jelas, awitan mendadak, awitan pada usia pertengahan, adanya konfusi,
riwayat untuk gangguan afek, dan system dukungan yang tidak kritis dan
tidak terlalu intrusive. Skizofrenia Tipe I tidak selalu mempunyai
prognosis yang lebih baik disbanding Skizofrenia Tipe II. Sekitar <i>70% penderita skizofrenia yang berada dalam remisi mengalami relaps dalam satu tahun.</i> Untuk itu, terapi selamanya diwajibkan pada kebanyakan kasus. </span></div>
<div style="line-height: 150%; margin: 0cm 0cm 12pt; text-align: left; text-indent: 36pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;">Referensi : http://www.psychologymania.com/2011/09/gangguan-skizofrenia-merupakan-gangguan.html </span></div>
<div style="line-height: 150%; margin: 0cm 0cm 12pt; text-align: left; text-indent: 36pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;"><br /></span></div>
<div style="line-height: 150%; margin: 0cm 0cm 12pt; text-align: left; text-indent: 36pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt; line-height: 150%;"><a href="http://adf.ly/EsosM" target="_blank">Download</a> Askep Skizofrenia <a href="http://adf.ly/EsosM" target="_blank">disini</a></span></div>
Anonymoushttp://www.blogger.com/profile/10554290151381141431noreply@blogger.com9tag:blogger.com,1999:blog-1998883467064803373.post-33853336803461108222012-10-13T10:12:00.000+07:002012-10-13T10:12:17.100+07:00Konsep Dasar Keperawatan1. Proses Keperawatan didasarkan pada suatu teori ilmu yang sangat luas.<br />
Proses Keperawatan :<br />
<ul>
<li>Metode</li>
<li>Dimana suatu konsep diterapkan dalam praktik keperawatan</li>
<li>Disebut juga sebagai suatu pendekatan Problem-Solving yang memerlukan ilmu, teknik dan keterampilan interpersonal dan ditujukan untuk memenuhi kebutuhan pasien dan keluarga.</li>
<li>Proses Keperawatan terdiri atas 5 tahapan yang saling berhubungan :</li>
</ul>
<ol>
<li>Pengkajian</li>
<li>Diagnosis</li>
<li>Perencanaan</li>
<li>Pelaksanaan</li>
<li>Dan Evaluasi</li>
</ol>
<ul>
<li>Lima tahap tersebut berintegrasi terhadap fungsi intelektual Problem-Solving dalam mendefinisikan suatu tindakan keperawatan. </li>
</ul>
2. Tujuan<br />
<ul>
<li>Proses Keperawatan secara umum adalah untuk membuat suatu kerangka konsep berdasarkan kebutuhan individu, klien, keluarga, dan masyarakat dapat terpenuhi. </li>
<li>Tindakan yang ditujukan untuk memenuhi tujuan keperawatan.</li>
</ul>
<br /><br />Anonymoushttp://www.blogger.com/profile/10554290151381141431noreply@blogger.com8tag:blogger.com,1999:blog-1998883467064803373.post-1067643979121898932012-09-21T13:36:00.001+07:002012-12-18T21:39:33.370+07:00Penyakit Lupus<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"><b>Penyakit LUPUS</b> adalah penyakit baru
yang mematikan setara dengan kanker. Tidak sedikit pengindap penyakit ini tidak
tertolong lagi, di dunia terdeteksi penyandang penyakit Lupus mencapai 5 juta
orang, lebih dari 100 ribu kasus baru terjadi setiap tahunnya.</span><br />
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Arti kata lupus sendiri dalam bahasa
Latin berarti “anjing hutan”. Istilah ini mulai dikenal sekitar satu abad lalu.
Awalnya, penderita penyakit ini dikira mempunyai kelainan kulit, berupa
kemerahan di sekitar hidung dan pipi . Bercak-bercak merah di bagian wajah dan
lengan, panas dan rasa lelah berkepanjangan , rambutnya rontok, persendian
kerap bengkak dan timbul sariawan. Penyakit ini tidak hanya menyerang kulit,
tetapi juga dapat menyerang hampir seluruh organ yang ada di dalam tubuh.</span><br />
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Gejala-gejala penyakit dikenal
sebagai Lupus Eritomatosus Sistemik (LES) alias Lupus. Eritomatosus artinya
kemerahan. sedangkan sistemik bermakna menyebar luas keberbagai organ tubuh.
Istilahnya disebut LES atau Lupus. Gejala-gejala yang umum dijumpai adalah:</span></div>
<ol start="1" type="1">
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Kulit yang mudah gosong akibat sinar matahari serta
timbulnya gangguan pencernaan.</span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Gejala umumnya penderita sering merasa lemah, kelelahan
yang berlebihan, demam dan pegal-pegal. Gejala ini terutama didapatkan
pada masa aktif, sedangkan pada masa remisi (nonaktif) menghilang.</span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Pada kulit, akan muncul ruam merah yang membentang di
kedua pipi, mirip kupu-kupu. Kadang disebut (butterfly rash). Namun ruam
merah menyerupai cakram bisa muncul di kulit seluruh tubuh, menonjol dan
kadang-kadang bersisik. Melihat banyaknya gejala penyakit ini, maka wanita
yang sudah terserang dua atau lebih gejala saja, harus dicurigai mengidap Lupus.</span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Anemia yang diakibatkan oleh sel-sel darah merah yang
dihancurkan oleh penyakit LUPUS ini</span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Rambut yang sering rontok dan rasa lelah yang
berlebihan</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"> </span></li>
</ol>
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Dr. Rahmat Gunadi dari Fak.
Kedokteran Unpad/RSHS menjelaskan, penyakit lupus adalah penyakit sistem imunitas
di mana jaringan dalam tubuh dianggap benda asing. Reaksi sistem imunitas bisa
mengenai berbagai sistem organ tubuh seperti jaringan kulit, otot, tulang,
ginjal, sistem saraf, sistem kardiovaskuler, paru-paru, lapisan pada paru-paru,
hati, sistem pencernaan, mata, otak, maupun pembuluh darah dan sel-sel darah.</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"> </span>“Penyakit ini dapat mengenai semua
lapisan masyarakat, 1-5 orang di antara 100.000 penduduk, bersifat genetik,
dapat diturunkan. Wanita lebih sering 6-10 kali daripada pria, terutama pada
usia 15-40 tahun. Bangsa Afrika dan Asia lebih rentan dibandingkan kulit putih.
Dan tentu saja, keluarga Odapus. Timbulnya penyakit ini karena adanya faktor
kepekaan dan faktor pencetus yaitu adanya infeksi, pemakaian obat-obatan,
terkena paparan sinar matahari, pemakaian pil KB, dan stres,” ujarnya. Penyakit
ini justru kebanyakaan diderita wanita usia produktif sampai usia 50 tahun
sekalipun ada juga pria yang mengalaminya. Oleh karena itu dianggap diduga
penyakit ini berhubungan dengan hormon estrogen.<br />
<br />
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Pada kehamilan dari perempuan yang
menderita lupus, sering diduga berkaitan dengan kehamilan yang menyebabkan
abortus, gangguan perkembangan janin atau pun bayi meninggal saat lahir. Tetapi
hal yang berkebalikan juga mungkin atau bahkan memperburuk geja LUPUS. Sering
dijumpai gejala Lupus muncul sewaktu hamil atau setelah melahirkan.</span><br />
<br />
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Tubuh memiliki kekebalan untuk
menyerang penyakit dan menjaga tetap sehat. Namun, dalam penyakit ini kekebalan
tubuh justru menyerang organ tubuh yang sehat. Penyakit Lupus diduga berkaitan
dengan sistem imunologi yang berlebih. Dalam tubuh seseorang terdapat antibodi
yang berfungsi menyerang sumber penyakit yang akan masuk dalam tubuh. Uniknya,
penyakit Lupus ini antibodi yang terbentuk dalam tubuh muncul berlebihan.
Hasilnya, antibodi justru menyerang sel-sel jaringan organ tubuh yang sehat.
Kelainan ini disebut autoimunitas . Antibodi yang berlebihan ini, bisa masuk ke
seluruh jaringan dengan dua cara yaitu :</span><br />
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Pertama, antibodi aneh ini bisa
langsung menyerang jaringan sel tubuh, seperti pada sel-sel darah merah yang
menyebabkan selnya akan hancur. Inilah yang mengakibatkan penderitanya
kekurangan sel darah merah atau anemia.</span><br />
<br />
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Kedua, antibodi bisa bergabung
dengan antigen (zat perangsang pembentukan antibodi), membentuk ikatan yang disebut
kompleks imun.Gabungan antibodi dan antigen mengalir bersama darah, sampai
tersangkut di pembuluh darah kapiler akan menimbulkan peradangan. Dalam keadaan
normal, kompleks ini akan dibatasi oleh sel-sel radang (fagosit) Tetapi, dalam
keadaan abnormal, kompleks ini tidak dapat dibatasi dengan baik. Malah sel-sel
radang tadi bertambah banyak sambil mengeluarkan enzim, yang menimbulkan
peradangan di sekitar kompleks. Hasilnya, proses peradangan akan berkepanjangan
dan akan merusak organ tubuh dan mengganggu fungsinya. Selanjutnya, hal ini
akan terlihat sebagai gejala penyakit. Kalau hal ini terjadi, maka dalam jangka
panjang fungsi organ tubuh akan terganggu.</span><br />
<br />
<span style="color: black; font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Kesembuhan total dari penyakit ini,
tampaknya sulit. Dokter lebih berfokus pada pengobatan yang sifatnya
sementara.Lebih difokuskan untuk mencegah meluasnya penyakit dan tidak
menyerang organ vital tubuh.</span><br />
<br />
<span style="color: black; font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Sumber : <span style="color: #003399;">http://doktersehat.com/lupus-apa-itu-penyakit-lupus/</span></span><br />
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<![endif]-->Anonymoushttp://www.blogger.com/profile/10554290151381141431noreply@blogger.com7tag:blogger.com,1999:blog-1998883467064803373.post-13033028246774289132012-09-20T14:45:00.000+07:002012-12-18T21:40:59.811+07:00Penyakit Mata Retinoblastoma<span style="font-family: "Times New Roman","serif";"><b>Pengertian</b></span><br />
<span style="font-family: "Times New Roman","serif";">Retinoblastoma adalah suatu neoplasma yang berasal dari neuroretina (sel kerucut sel batang) atau sel glia yang bersifat ganas. Merupakan tumor ganas intraokuler yang ditmukan pada anak-anak, terutama pada anak usia dibawah lima tahun.</span><br />
<br />
<span style="font-family: "Times New Roman","serif";"><b>Etiologi</b></span><br />
<span style="font-family: "Times New Roman","serif";">Terjadi karena kehilangan kedua kromosom sel dominan protektif yang berada dalam pita kromosom 13q14. Bisa karena mutasi atau diturunkan. Penyebabnya adalah tidak terdapatnya gen penekan tumor, yang sifatnya diturunkan. Kanker dapat menyerang salah satu mata yang bersifat somatik maupun kedua mata yang merupakan kelainan yang diturunkan secara autosom dominan. Kanker bisa menyebar ke kantung mata dan ke otak melalui saraf penglihatan (<i>Nervus Optikus</i>).</span><br />
<br />
<span style="font-family: "Times New Roman","serif";"><b>Patofisiologi</b></span><br />
<span style="font-family: "Times New Roman","serif";">Pertumbuhan tumor ini dapat menyebabkan metastasis dengan invasi tumor melalui : <i>nervus optikus</i> ke otak, sclera ke jaringan orbita dan sinus paranasal, dan metastasis jauh kesumsum tulang melalui pembuluh darah. Pada fundus terlihat adanya bercak kuning mengkilat, dan dapat menonjol. Dipermukaan terdapat neovaskularisasi dan perdarahan. Warna iris menjadi tidak normal.</span><br />
<br />
<span style="font-family: "Times New Roman","serif";"><b>Manifestasi Klinis</b></span><br />
<span style="font-family: "Times New Roman","serif";">Gejala retinoblastoma dapat menyerupai penyakit lain dimata. Bila letak tumor di makula, gejala awal yang dapat timbul adalah <i>strabismus</i>. Masa tumor yang makin membesar akan memperlihatkan gejala leukokoria, tanda-tanda perasangan di vitreus yang menyerupai endoftalmitis. Bila sel-sel tumor terlepas dan masuk ke segmen anterior mata, akan menyebabkan glaukoma.</span><br />
<br />
<span style="font-family: "Times New Roman","serif";"><b>Diagnosis Banding</b></span><br />
<span style="font-family: "Times New Roman","serif";">Fibroplasia retrolental, displasia retina, endoftalmitis nematoda, katarak, dan ablasi retina.</span><br />
<br />
<span style="font-family: "Times New Roman","serif";"><b>Penatalaksanaan</b></span><br />
<span style="font-family: "Times New Roman","serif";">Pada penatalaksanaan tergantung pada klasifikasi tumor.</span><br />
<br />
<span style="font-family: "Times New Roman","serif";">Untuk lebih lengkap silahkan <a href="http://adf.ly/D0jcL" target="_blank">download Askep retinoblsatoma</a> </span>Anonymoushttp://www.blogger.com/profile/10554290151381141431noreply@blogger.com5tag:blogger.com,1999:blog-1998883467064803373.post-13575767262336539572012-09-19T15:23:00.000+07:002012-09-19T15:33:44.106+07:00Asuhan Keperawatan Anak<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman";">Saya persembahkan <i><b>kumpulan asuhan
keperawatan pada anak</b></i>, sehingga membantu rekan-rekan yang sedang
membutuhkan-nya untuk dipelajari, silahkan download secara gratis.</span><br />
<br />
<i><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman";"><b>Askep Anak</b> Dengan <b>BBLR</b> download <a href="http://adf.ly/CySVy"><span style="color: blue;">disini</span></a></span></i><i><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman";"><b> </b></span></i><br />
<i><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman";"><b>Askep Anak</b> Dengan <b>Child Abuse</b> download <a href="http://adf.ly/CySkp"><span style="color: blue;">disini</span></a></span></i><span style="font-family: "Times New Roman","serif";"><i><b> </b></i></span><i><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman";"><b> </b></span></i><br />
<i><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman";"><b>Askep Anak </b>Dengan <b>Diare</b> download <a href="http://adf.ly/CyT90"><span style="color: blue;">disini</span></a></span></i><span style="font-family: "Times New Roman","serif";"><i><b> </b></i></span><i><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman";"><b> </b></span></i><br />
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<i><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman";"><b>Askep Anak</b> Dengan <b>Demam Febris</b> download <a href="http://adf.ly/CyTe0"><span style="color: blue;">disini</span></a></span></i><span style="font-family: "Times New Roman","serif";"><i><b> </b></i></span><i><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman";"><b> </b></span></i><br />
<i><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman";"><b>Askep Anak</b> Dengan <b>Kejang Demam</b> download <a href="http://adf.ly/CyTsi"><span style="color: blue;">disini</span></a></span></i><span style="font-family: "Times New Roman","serif";"><i><b> </b></i></span><i><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman";"><b> </b></span></i><br />
<i><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman";"><b>Askep Anak </b>Dengan <b>TB Paru</b> download <a href="http://adf.ly/CyU5s"><span style="color: blue;">disini</span></a></span></i><span style="font-family: "Times New Roman","serif";"><i><b> </b></i></span><i><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman";"><b> </b></span></i><br />
<i><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman";"><b>Askep Anak</b> Dengan <b>Meningitis</b> download <a href="http://adf.ly/CyULo"><span style="color: blue;">disini</span></a></span></i><span style="font-family: "Times New Roman","serif";"><i><b> </b></i></span><i><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman";"><b> </b></span></i><br />
<i><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman";"><b>Askep Anak</b> Dengan <b>Marasmus</b> download <a href="http://adf.ly/CyUaK"><span style="color: blue;">disini</span></a></span></i><span style="font-family: "Times New Roman","serif";"><i><b> </b></i></span><i><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman";"><b> </b></span></i><br />
<i><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman";"><b>Askep Anak</b> Dengan <b>Talasemia</b> download <a href="http://adf.ly/CyUvh"><span style="color: blue;">disini</span></a></span></i><br />
<ol>
</ol>
<ul style="margin-top: 0cm;" type="disc">
</ul>
Anonymoushttp://www.blogger.com/profile/10554290151381141431noreply@blogger.com0tag:blogger.com,1999:blog-1998883467064803373.post-69025306001201401262012-07-31T22:05:00.000+07:002012-12-18T21:42:09.422+07:00Meningitis<br />
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<i><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">A. Pengertian</span></b></i></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Meningitis adalah radang pada
meningen (membran yang mengelilingi otak dan medula spinalis) dan disebabkan
oleh virus, bakteri atau organ-organ jamur(Smeltzer, 2001).</span></div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><br />
Meningitis merupakan infeksi akut dari meninges, biasanya ditimbulkan oleh
salah satu dari mikroorganisme pneumokok, Meningokok, Stafilokok, Streptokok,
Hemophilus influenza dan bahan aseptis (virus) (Long, 1996).</span></div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><br />
Meningitis adalah peradangan pada selaput meningen, cairan serebrospinal dan
spinal column yang menyebabkan proses infeksi pada sistem saraf pusat (Suriadi
& Rita, 2001).</span></div>
<div class="MsoNormal" style="line-height: normal;">
<br /></div>
<div class="MsoNormal" style="line-height: normal;">
</div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;">
<i><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">B. Etiologi</span></b></i></div>
<ol start="1" type="1">
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Bakteri : Mycobacterium tuberculosa, Diplococcus
pneumoniae (pneumokok), Neisseria meningitis (meningokok), Streptococus
haemolyticuss, Staphylococcus aureus, Haemophilus influenzae, Escherichia
coli, Klebsiella pneumoniae, Peudomonas aeruginosa.</span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Penyebab lainnya lues, Virus, Toxoplasma gondhii dan
Ricketsia.</span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Faktor predisposisi : jenis kelamin lakilaki lebih
sering dibandingkan dengan wanita.</span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Faktor maternal : ruptur membran fetal, infeksi
maternal pada minggu terakhir kehamilan.</span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Faktor imunologi : defisiensi mekanisme imun,
defisiensi imunoglobulin.</span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Kelainan sistem saraf pusat, pembedahan atau injury
yang berhubungan dengan sistem persarafan.</span></li>
</ol>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;">
<i><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">C. Klasifikasi</span></b></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><br />
<br />
Meningitis dibagi menjadi 2 golongan berdasarkan perubahan yang terjadi pada
cairan otak, yaitu :</span></div>
<ol start="1" type="1">
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Meningitis serosa<br />
Adalah radang selaput otak araknoid dan piameter yang disertai cairan otak
yang jernih. Penyebab terseringnya adalah Mycobacterium tuberculosa.
Penyebab lainnya lues, Virus, Toxoplasma gondhii dan Ricketsia.</span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Meningitis purulenta<br />
Adalah radang bernanah arakhnoid dan piameter yang meliputi otak dan
medula spinalis. Penyebabnya antara lain : Diplococcus pneumoniae
(pneumokok), Neisseria meningitis (meningokok), Streptococus
haemolyticuss, Staphylococcus aureus, Haemophilus influenzae, Escherichia
coli, Klebsiella pneumoniae, Peudomonas aeruginosa.</span></li>
</ol>
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Download
Askep Meningitis <a href="http://www.blogger.com/goog_912050487">disini</a></span><a href="http://adf.ly/BOq6v" target="_blank"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"> </span></a>Anonymoushttp://www.blogger.com/profile/10554290151381141431noreply@blogger.com0tag:blogger.com,1999:blog-1998883467064803373.post-12790239759666633162012-07-28T22:34:00.002+07:002013-01-01T00:25:42.806+07:00Epitaksis<br />
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Definisi</span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Epitaksis atau sering disebut juga
mimisan yaitu, satu keadaan pendarahan dari hidung yang keluar melalui lubang
hidung akibat adanya kelainan lokal pada rongga hidung ataupun karena kelainan
yang terjadi di tempat lain dari tubuh. Mimisan terjadi pada hidung karena
hidung punya banyak pembuluh darah, terutama di balik lapisan tipis cupingnya.
Mimisan sendiri bukan merupakan suatu penyakit tetapi merupakan gejala dari
suatu penyakit, itu artinya mimisan bisa terjadi karena bermacam sebab dari
yang ringan sampai yang berat. Pada umumnya ini terjadi pada anak-anak karena
pembuluh darahnya masih tipis dan sensitive. </span><br />
<br />
</div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Etiologi</span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: 36.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Beberapa penyebab epistaksis dapat digolongkan menjadi
etiologi lokal dan sistemik.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;">
<i style="mso-bidi-font-style: normal;"><u><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Etiologi lokal</span></u></i><br />
<ol>
<li><span style="mso-bidi-font-style: normal;"></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Trauma lokal misalnya setelah
membuang ingus dengan keras, mengorek hidung, fraktur hidung atau trauma
maksilofasia lainnya.</span></li>
<li><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tumor, baik tumor hidung maupun
sinus yang jinak dan yang ganas. Tersering adalah tumor pembuluh darah seperti
angiofibroma dengan ciri perdarahan yang hebat dan karsinoma nasofaring dengan
ciri perdarahan berulang ringan bercampur lendir atau ingus.</span></li>
<li><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Idiopatik yang merupakan 85% kasus
epistaksis, biasanya ringan dan berulang pada anak dan remaja.</span></li>
</ol>
</div>
<div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.75pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ketiga
etiologi diatas ini merupakan penyebab lokal tersering.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;">
<i style="mso-bidi-font-style: normal;"><u><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Etiologi lainnya</span></u></i></div>
<ul type="disc">
<li class="MsoNormal" style="line-height: 150%; mso-list: l2 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Iritasi gas atau zat kimia yang
merangsang ataupun udara panas pada mukosa hidung;</span></li>
<li class="MsoNormal" style="line-height: 150%; mso-list: l2 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Keadaan lingkungan yang sangat
dingin</span></li>
<li class="MsoNormal" style="line-height: 150%; mso-list: l2 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tinggal di daerah yang tinggi
atau perubahan tekanan atmosfir yang tiba tiba</span></li>
<li class="MsoNormal" style="line-height: 150%; mso-list: l2 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Latrogenik akibat operasi</span></li>
<li class="MsoNormal" style="line-height: 150%; mso-list: l2 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemakaian semprot hidung
steroid jangka lama</span></li>
<li class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-list: l2 level1 lfo1; tab-stops: list 36.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Benda asing atau rinolit dengan
keluhan epistaksi ringan unilateral clsertai Ingus berbau busuk.</span></li>
</ul>
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;">
<i style="mso-bidi-font-style: normal;"><u><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Etiologi sistemik</span></u></i><i style="mso-bidi-font-style: normal;"><u><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span style="color: #ff6600;"></span></span></u></i><br />
<ol>
<li><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hipertensi dan penyakit
kardiovaskuler lainnya seperti arteriosklerosis. Hipertensi yan disertai atau
anpa arteriosklerosis rnerupakan penyebab epistaksis tersering pada usia 60-70
lahun, perdarahan biasanya hebat berulang dan mempunyai prognosis yang kurang
baik. </span></li>
<li><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kelainan perdarahan misalnya
leukemia, hemofilia, trombositopenia dll. </span></li>
<li><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Infeksi, misalnya demam berdarah
disertai trornbositopenia, morbili, demam tifoid dll.</span></li>
</ol>
</div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;">
<i style="mso-bidi-font-style: normal;"><u><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Termasuk etiologi sistemik lain</span></u></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><br />
<ul>
<li><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Lebin
jarang terjadi adalah gangguan keseimbangan hormon misalnya pada kehamilan,
menarke dan menopause</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span></li>
<li><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kelainan
kongenital misalnya hereditary hemorrhagic Telangieclasis atau penyakit
Rendj-Osler-Weber;</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span></li>
<li><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Peninggian
tekanan vena seperti pada ernfisema, bronkitis, pertusis, pneumonia, tumor
leher dan penyakit jantung</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span></li>
<li><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pada
pasien dengan pengobatan antikoagulan.</span></li>
</ul>
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Tanda
dan Gejala</span></b></div>
<div class="MsoNormal">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Epistaksis
dibagi menjadi 2 kelompok :</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><br />
<ul>
<li><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Epistaksis anterior : perdarahan
berasal dari septum (pemisah lubang hidung kiri dan kanan) bagian depan, yaitu
dari pleksus Kiesselbach atau arteri etmoidalis anterior. Biasanya perdarahan
tidak begitu hebat dan bila pasien duduk, darah akan keluar dari salah satu
lubang hidung. Seringkali dapat berhenti spontan dan mudah diatasi.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span></li>
<li><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Epistaksis posterior : perdarahan
berasal dari bagian hidung yang paling dalam, yaitu dari arteri sfenopalatina dan
arteri etmoidalis posterior. Epistaksis posterior sering terjadi pada usia
lanjut, penderita hipertensi, arteriosklerosis atau penyakit kardiovaskular.
Perdarahan biasanya hebat dan jarang berhenti spontan. Darah mengalir ke
belakang, yaitu ke mulut dan tenggorokan.</span></li>
</ul>
</div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Diagnosa</span></b></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Diagnosis ditegakkan berdasarkan gejala
dan hasil pemeriksaan fisik, sedangkan untuk memperkuat diagnosis epistaksis,
sebaiknya lakukan :</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><br />
<ul>
<li><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemeriksaan
Laboratorium</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span></li>
<li><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemeriksaan
darah tepi lengkap.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span></li>
<li><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Fungsi
hemostatis</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span></li>
<li><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">EKG</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span></li>
<li><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tes
fungsi hati dan ginjal</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span></li>
<li><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemeriksaan
foto hidung, sinus paranasal, dan nasofaring.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span></li>
<li><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">CT
scan dan MRI dapat diindikasikan untuk menentukan adanya rinosinusitis, benda
asing dan neoplasma. </span></li>
</ul>
</div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Untuk
lebih lengkapnya teman-teman download aja Askep Epistaksis <a href="http://adf.ly/CyMc5" target="_blank">disini</a> </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">
</span></div>
Anonymoushttp://www.blogger.com/profile/10554290151381141431noreply@blogger.com1tag:blogger.com,1999:blog-1998883467064803373.post-63661464445477448602012-07-23T21:05:00.000+07:002012-12-18T21:43:41.940+07:00Herpes Zoster<br />
<div style="margin-bottom: .0001pt; margin: 0cm; tab-stops: 36.0pt;">
<i><b style="mso-bidi-font-weight: normal;">Definisi</b></i></div>
<div style="margin-bottom: .0001pt; margin: 0cm; tab-stops: 36.0pt;">
<i>herpes zoster</i>
adalah salah satu penyakit kulit (radang kulit) disebabkan oleh virus Varisella
zoster dan memiliki sifat yang khas yaitu terdapat vesikel yang tersusun berkelompok
sepanjang persyarafan sensorik sesuai dengan dermatomnya dan biasanya
unilateral.</div>
<div style="margin: 0cm 0cm 0.0001pt;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0cm; text-align: justify;">
<i><b>Patogenesis</b></i></div>
<div style="margin-bottom: .0001pt; margin: 0cm; text-align: justify;">
Masa tunasnya
7-12 hari masa aktif penyakit berupa lesi baru dan yang tetap timbul
berlangsung kira-kira 1-2 minggu virus berdiam di ganglion posterior susunan
syaraf tepi dan ganglion kronialis. </div>
<div style="margin-bottom: .0001pt; margin: 0cm; text-align: justify;">
Lokasi kelainan
kulit sekitar daerah persyarafan ganglion kadang-kadang virus menyerang
gangguan arterior bagian motorik kranolis sehingga memberikan gejala gangguan
motorik.</div>
<div style="margin: 0cm 0cm 0.0001pt; text-align: justify;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0cm; text-align: justify;">
<i><b>Manifestasi
Klinik</b></i></div>
<div style="margin-bottom: .0001pt; margin: 0cm; tab-stops: 36.0pt; text-align: justify;">
<u>Gejala
prodormal</u></div>
<div style="margin-bottom: .0001pt; margin: 0cm; text-align: justify;">
Gejala sistemik
seperti demam, pusing, malaise, dan lokal (nyeri otot, tulang, gatal, pegal
dsb) pada dermatom yang terserang.</div>
<div style="margin-bottom: .0001pt; margin: 0cm; text-align: justify;">
<u>Stadium</u></div>
<div style="margin-bottom: .0001pt; margin: 0cm; text-align: justify;">
Timbul popula
atau plakat berbentuk urtika setelah 1-2 hari akan timbul gerombolan vesikel
dengan dasar kulit yang eritematosa dan odema vesikel air berisi cairan yang
jernih. </div>
<div style="margin: 0cm 0cm 0.0001pt; text-align: justify;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0cm; text-align: justify;">
<i><b>Stadium
Krutasi</b></i></div>
<div style="margin-bottom: .0001pt; margin: 0cm; text-align: justify;">
Vesikel menjadi
puruler dapat menjadi pustula dan krusta kadang-kadang vesikel mengandung darah
disebut herpes zoster haemorasik krusta akan lepas dalam waktu 1-2 minggu dapat
timbul infeksi sekunder sehingga menimbulkan ulkus dengan penyumbatan tanpa
sikasrek sering terjadi neuralgia pasca hepatica terutama pada orangtua yang
dapat berlangsung berbulan-bulan yang bersifat sementara.</div>
<div style="margin-bottom: .0001pt; margin: 0cm; text-align: justify;">
<u>Ciri khas
herpes zoster</u> :</div>
<ul>
<li><span style="font-size: 7pt; line-height: 150%;"> </span>Nyeri
radikuler</li>
<li>Unilateral</li>
<li>Gerombolan
vesikel yang tersebar sesuai dengan dermatom yang meruasi oleh satu ganglion
syaraf sensorik.</li>
</ul>
<div style="margin-bottom: .0001pt; margin: 0cm; text-align: justify;">
<u>Gejala
lainnya</u> :</div>
<ul>
<li>Pembesaran
KGB regional</li>
<li>Kelainan
motorik berupa kelainan sentral daripada perifer</li>
<li>Fuper
parostesi pada daerah yang terkena</li>
<li>Kelainan
pada muka akibat gangguan trigenirus (dengan gangguan gaseri) atau n. fasialis
& optikus (dari gangguan garikulotum) </li>
</ul>
<div style="margin: 0cm 0cm 0.0001pt; text-align: justify;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0cm; text-align: justify;">
<i><b>Klasifikasi
Herpes Zoster</b></i></div>
<ul>
<li><i>Herpes
Zoster Optalnikus </i>terjadi infeksi cabang pertama N. Trigenirus yang
menimbulkan kelainan pada mata cabang kedua dan ketiga yang menyebabkan
kelainan kulit pada daerah persyarafan.</li>
<li><i>Sindrom
Ramsay Hurt </i>diakibatkan gangguan N. Fasiolis dan optikus sehingga
memberikan gejala paralysis otot muka (paralisis Bell) kelainan
kulit sesuai tingkat persyarafan, kliris vertigo, gangguan pendengaran,
regtagnius dan raisea juga terdapat gangguan pengecapan.</li>
<li><i>Herpes Zoster
Abortif</i> berlangsung dalam waktu singkat dan kelainan kulitnya hanya
berupa beberapa vesikel dan eritem.</li>
<li><i>Herpes
Zoster Generaligata</i> kelainan kulit unilateral dan segmental ditambah yang
menyebar secara generalisata berupa vesikel soliter dan ada umbilikasi. Kasus
ini terutama terjadi pada orang tua atau pada orang yang kondisi fisiknya
sangat lemah, misalnya penderita : Umforra malignum. </li>
</ul>
<div style="margin: 0cm 0cm 0.0001pt; text-align: justify;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0cm; text-align: justify;">
<i><b>Komplikasi</b></i></div>
<div style="margin-bottom: .0001pt; margin: 0cm; text-align: justify;">
Pada usia diatas
40 tahun kemungkinan terjadi neuralgia pasca herpetic.</div>
<div style="margin: 0cm 0cm 0.0001pt; text-align: justify;">
<br /></div>
<div style="margin: 0cm 0cm 0.0001pt; text-align: justify;">
<b> </b></div>
<div style="margin-bottom: .0001pt; margin: 0cm; text-align: justify;">
<i><b>Pemeriksaan
Penunjang </b></i></div>
<div style="margin-bottom: .0001pt; margin: 0cm; text-align: justify;">
Pada pemeriksaan
percobaan T. Zarck dapat ditemukan sel dativa berinti banyak.</div>
<div style="margin: 0cm 0cm 0.0001pt; text-align: justify;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0cm; text-align: justify;">
<i><b>Diagnosa
Banding</b></i></div>
<ul>
<li>Herpes simplek
</li>
<li>Varicella
</li>
<li>Dermatis
Contacta alergika</li>
<li>Penyakit dengan
efloresersi bulla ; pemfisus vulgaris</li>
<li>Dermatis
herpenformis dan dutega </li>
<li>Bulos pumfigord</li>
</ul>
<div style="margin: 0cm 0cm 0.0001pt; text-align: justify;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0cm; text-align: justify;">
<i><b>Penatalaksanaan</b></i></div>
<ol>
<li>Therapi sistemik
umumnya bersifat simptomatik untuk nyeri diberikan analgetik jika disertai
infeksi sekunder diberikan antibiotik.</li>
<li>Bila syaraf
oftalnikus cabang dari syaraf trigenirus terkena muka dirujuk ke arah mata karena
dapat terjadi perporasi kornea. </li>
<li>Pemberian
kortikosteroid sistemik diri dapat mencegah timbulnya neuralgia post herpatica
dan untuk mencegah fibrosis garcialia.</li>
<li>Therapi topical
bergantung pada stadium : Stadium vesikel
agar tidak terjadi infeksi sekunder. Bila erosif
diberikan kompres terbuka. Bila ulserasi
dapat diberikan salep antibiotik. </li>
<li>Kompres pada
daerah yang terserang : Bila lokal
kering, bedak berisi aodum berikulm 10%, Oksisum Zursi 10% dan mentol 1%. Bila basah
kompres garam tadi, kompres solutio burowl</li>
<li>Istirahat </li>
</ol>
Download Askep Herpes <a href="http://adf.ly/B2YPL" target="_blank">disini </a>Anonymoushttp://www.blogger.com/profile/10554290151381141431noreply@blogger.com7tag:blogger.com,1999:blog-1998883467064803373.post-56146001584673574312012-07-18T17:59:00.003+07:002012-12-18T21:44:44.607+07:00Ensefalitis<b>Definisi</b><br />
Ensefalitis adalah infeksi pada jaringan otak yang disebabkan oleh berbagai mikroorganisme<br />
<br />
<b>Etiologi</b><br />
Berbagai macam mikroorganisme yang dapat menyebabkan ensefalitis, salah satunya bacteri, protozoa, cacing, jamur, spirokaeta penyebab utama yang sering adalah virus.<br />
<br />
<b>Patogenesis</b><br />
Virus masuk kedalam tubuh pasien melalui kulit, saluran nafas, dan saluran pencernaan. setelah masuk kedalam tubuh virus akan menyebar keseluruh tubuh melalui cara :<br />
<ol>
<li>Setempat : virus hanya menginfeksi selaput lendir, permukaan atau organ tertentu</li>
<li>Penyebaran hematogen primer : virus masuk kedalam darah kemudian menyebar keberbagai organ dan berkembang biak pada organ tersebut.</li>
<li>Penyebaran hematogen sekunder : virus berkembang biak di daerah pertamakali ia masuk (peermukaan selaput lendir) kemudian menyebar ke organ lain.</li>
<li>Penyebaran melalui syaraf : virus berkembang biak dipermukaan selaput lendir dan menyebar melalui sistim syaraf.</li>
</ol>
Pada awal permulaan timbul demam, akan tetapi belum ada kelainan neurologis. Virus akan terus berkembang biak kemudian akan meyerang susunan syaraf pusat dan akhirnya diikuti dengan kelainan neurologis.<br />
Kelainan pada pasien ensefalitis disebabkan oleh :<br />
<ol>
<li>Invasi dan perusakan langsung pada jaringan otak oleh virus yang sedang berkembang biak </li>
<li>Reaksi jaringan syaraf pasien terhadap antigen virus yang akan berakibat kerusakan vaskular, dan para vaskular. Sedangkan virusnya sendiri sudah tidak ada dalam jaringan otak</li>
<li>Reaksi aktivasi virus neurotropik yang bersifat laten</li>
</ol>
<b>Gejala Klinis</b><br />
Masa prodromal berlangsung 1-14 hari, yang ditandai dengan adanya demam, sakit kepala, mual-muntah, nyeri tenggorokan, malaise, nyeri ekstremitas dan pucat. Kemudian akan di ikuti oleh tanda ensefalitis yang berat ringannya tergantung pada distribusi dan luas lesi pada neuron. Gejalanya yaitu gelisah, irritable, screaming attack, perubahan perilaku, gangguan kesadaran, dan kejang. Terkadang disertai juga dengan tanda neurologis fokal berupa afasia, hemifaresis, hemiplegia, ataksia, dan paralysis saraf otak.<br />
<br />
<b>Komplikasi</b><br />
Retardasi mental, irritable, gangguan motorik, epilepsy, emosi tidak stabil, insomnia, halusinasi, enuresis, dan berakibat anak menjadi perusak dan melakukan tindakan asosial lain.<br />
<br />
<b>Pemeriksaan Penunjang</b><br />
<ul>
<li>Darah rutin lengkap, gula darah, elektrolit dan biakan darah.</li>
<li>Pungsi lumbal cairan jemih, jumlah sel diatas normal, hitung jenis didominasi oleh limfosit, protein dan glukosa normal atau meningkat.</li>
<li>Pemeriksaan CT atau MRI kepala menunjukan gambaran edema otak</li>
<li>Pada pemeriksaan EEG didapatkan gambaran penurunan aktivitas atau perlambatan</li>
</ul>
<b>Diagnosa</b><br />
Diagnosa klinis dapat ditegakkan berdasarkan gejalanya<br />
<br />
<b>Diagnosis Banding</b><br />
Meningitis TB, abses otak, tumor otak, ensefalopati<br />
<br />
<b>Penatalaksanaan</b><br />
Medika mentosa <br />
Tidak ada pengobatan spesifik tergantung pada etiologi<br />
Suportif : Atasi kejang, hiperpireksia, gangguan cairan dan elektrolit<br />
Rujukan : Rawat diruang intensif<br />
<br />
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Anonymoushttp://www.blogger.com/profile/10554290151381141431noreply@blogger.com0tag:blogger.com,1999:blog-1998883467064803373.post-37343533008578790442012-07-15T14:16:00.000+07:002012-07-15T14:50:48.698+07:00Syphilis<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify; text-indent: -.25in;">
</div>
<div style="font-family: Arial,Helvetica,sans-serif; line-height: 200%; margin: 0in 0in 0.0001pt; text-align: justify;">
<span style="font-size: small;"><b>"Syphilis"</b> penyakit yang disebabkan
oleh bakteri<b><i> </i><i>Treponema</i> </b><i><b>pallidum</b> </i>dan merupakan penyakit umum dan
berbahaya yang dapat ditularkan dari orang ke orang lain melalui hubungan
seksual. Penyakit ini bisa menular dari ibu ke janin yang sedang dikandungnya.
Pengobatan yang umum dilakukan adalah memberi antibiotik kepada penderita, dan
jika tidak segera dilakukan perawatan, infeksi ini akan menjalar dan dapat
merusak bagian organ lain.<i><b> </b></i></span><br />
<span style="font-size: small;"><i><b>Klasifikasi</b></i></span></div>
<div style="font-family: Arial,Helvetica,sans-serif; line-height: 200%; margin: 0in 0in 0.0001pt; text-align: justify;">
<span style="font-size: small;">Klasifikasi kuman penyebab penyakit
syphilis adalah sebagai berikut :</span></div>
<div style="font-family: Arial,Helvetica,sans-serif; line-height: 200%; margin: 0in 0in 0.0001pt; text-align: justify; text-indent: 0.25in;">
<span style="font-size: small;"><span lang="EN-GB">Kingdom
: Eubacteria</span></span></div>
<div style="font-family: Arial,Helvetica,sans-serif; line-height: 200%; margin: 0in 0in 0.0001pt; text-align: justify; text-indent: 0.25in;">
<span style="font-size: small;"><span lang="EN-GB">Phylum
: Spirochaete</span><span lang="EN-GB" style="color: black;"> </span></span></div>
<div style="font-family: Arial,Helvetica,sans-serif; line-height: 200%; margin: 0in 0in 0.0001pt; text-align: justify; text-indent: 0.25in;">
<span style="font-size: small;"><span lang="EN-GB" style="color: black;">Class
: </span><span lang="EN-GB">S</span>piro<span lang="EN-GB">c</span>haete</span></div>
<div style="font-family: Arial,Helvetica,sans-serif; line-height: 200%; margin: 0in 0in 0.0001pt; text-align: justify; text-indent: 0.25in;">
<span style="font-size: small;">Ordo
: Spirochaetales </span></div>
<div style="font-family: Arial,Helvetica,sans-serif; line-height: 200%; margin: 0in 0in 0.0001pt; text-align: justify; text-indent: 0.25in;">
<span style="font-size: small;">Famili
: Spirochaetaceae </span></div>
<div style="font-family: Arial,Helvetica,sans-serif; line-height: 200%; margin: 0in 0in 0.0001pt; text-align: justify; text-indent: 0.25in;">
<span style="font-size: small;">Genus
: Treponema</span></div>
<div style="font-family: Arial,Helvetica,sans-serif; line-height: 200%; margin: 0in 0in 0.0001pt; text-align: justify; text-indent: 0.25in;">
<span style="font-size: small;">Spesies
: <i>Treponema pallidum</i> </span></div>
<div style="font-family: Arial,Helvetica,sans-serif; line-height: 200%; margin: 0in 0in 0.0001pt; text-align: justify; text-indent: 0.25in;">
<span style="font-size: small;">Spiroketa
merupakan bakteri spiral yang besar, heterogen, dan dapat bergerak. Treponema
merupakan basil gram negatif yang panjang, tipis, bergulung secara heliks,
berbentuk spiral atau seperti pembuka tutup botol (cork screw). <i>Treponema
pallidum</i> memiliki selubung luar atau pelapis glikosaminoglikan. Bagian
dalam selubung adalah selaput luar yang mengandung peptidoglikan dan menjaga
keutuhan struktur dari organisme. Endoflagel (filamen aksial) merupakan organel
seperti flagel dalam ruang periplasma yang ditutupi oleh selaput luar.
Endoflagel dimulai pada setiap ujung organisme dan berputar mengelilinginya,
meluas dan bertumpang tindih sampai pada titik tengah. Bagian dalam endoflagel
adalah selaput dalam (selaput sitoplasma) yang menimbulkan stabilitas osmotik
dan menutupi silinder sitoplasma. Rangkaian tubula sitoplasma (fibril badan)
berada di bagian dalam sel di dekat selaput dalam. Treponema dibentuk kembali
melalui pemisahan transversa. <i><b> </b></i></span><br />
<span style="font-size: small;"><i><b>Morfologi
Treponema Pallidum</b></i></span></div>
<div style="font-family: Arial,Helvetica,sans-serif; line-height: 200%; margin: 0in 0in 0.0001pt; text-align: justify;">
<span style="font-size: small;">Ciri-ciri khas dari <i>Treponema pallidum</i>
ini berbentuk spiral langsing, berukuran lebar kira-kira 0,2 µm dan panjang
5-15 µm. Spiralnya melilit teratur berjarak 1 µm satu sama lain. Organisme ini
bergarak secara aktif, terus menerus berputar mengelilingi sumbu panjangnya.
Sumbu panjang spiral biasanya lurus tetapi kadang-kadang dapat bengkok,
sehingga pada suatu saat organisme ini membentuk lingkaran lurus yang normal.
Karena begitu tipis, mikroorganisme ini tidak jelas terlihat, kecuali dengan
penerangan lapangan gelap atau dengan pewarnaan imunofluoresensi.<i><b> </b></i></span><br />
<span style="font-size: small;"><i><b>Gambaran
Klinis</b></i></span></div>
<div style="font-family: Arial,Helvetica,sans-serif; line-height: 200%; margin: 0in 0in 0.0001pt; text-align: justify;">
<span style="font-size: small;">Secara garis besar syphilis dapat
dikelompokkan sebagai berikut :</span></div>
<div style="font-family: Arial,Helvetica,sans-serif; line-height: 200%; margin: 0in 0in 0.0001pt 0.5in; text-align: justify; text-indent: -0.25in;">
<span style="font-size: small;">a.<span style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Syphilis yang didapat</span></div>
<div style="font-family: Arial,Helvetica,sans-serif; line-height: 200%; margin: 0in 0in 0.0001pt; text-align: justify; text-indent: 15.3pt;">
<span style="font-size: small;">Infeksi alamiah
oleh <i>Treponema pallidum</i> terbatas pada manusia. Infeksi pada manusia
biasanya disebarkan melalui kontak seksual. Lesi penyebab infeksi terdapat pada
kulit atau selaput mukosa alat kelamin. Namun, pada 10-20% kasus, lesi
primernya terdapat di dalam rektum, perianal, mulut, atau dimana saja di tubuh.
Treponema mungkin dapat menembus selaput mukosa utuh, atau dapat masuk melalui
epidermis yang rusak.</span></div>
<div style="font-family: Arial,Helvetica,sans-serif; line-height: 200%; margin: 0in 0in 0.0001pt; text-align: justify; text-indent: 15.3pt;">
<span style="font-size: small;">Spiroketa
berkembang biak pada tempat masuknya, dan sebagian menyebar ke kelenjar getah
bening yang terdekat, kemudian mencapai aliran darah. Dalam 2-10 minggu setelah
infeksi, timbul papula pada tempat infeksi dan pecah membentuk ulkus dengan
dasar yang bersih dan keras. Peradangan ditandai terutama oleh limfosit dan
sel-sel plasma. Lesi primer ini selalu sembuh, tetapi 2-10 minggu kemudian
timbul lesi-lesi sekunder, yaitu lesi yang terdiri atas ruam makulopapuler
merah di seluruh tubuh, dan papula pucat basah (kondiloma) pada daerah
anogenital, ketiak, dan mulut. Juga dapat terjadi meningitis syphilis,
korioretinitis, hepatitis, nefritis, atau periostitis syphilis. Lesi sekunder
juga mereda secara spontan. Lesi primer dan sekunder mengandung banyak
spiroketa dan sangat menular. Lesi yang menular dapat timbul lagi dalam 3-5
tahun setelah infeksi, tetapi sesudah itu orang tersebut tidak dapat menularkan
penyakit lagi. Infeksi syphilis dapat tetap sub klinik, dan penderita dapat
melewati stadium primer atau sekunder atau keduanya tanpa gejala ataupun tanda,
namun kemudian timbul lesi tersier.</span></div>
<div style="font-family: Arial,Helvetica,sans-serif; line-height: 200%; margin: 0in 0in 0.0001pt; text-align: justify; text-indent: 15.3pt;">
<span style="font-size: small;">Pada kira-kira
30% kasus, infeksi dini syphilis berkembang secara spontan sampai sembuh
sempurna tanpa pengobatan. Pada 30% lainnya, infeksi yang tidak diobati akan
tetap laten. Pada sisanya, penyakit berkembang menjadi stadium tersier, yang
ditandai dengan timbulnya lesi-lesi granulomatosa (gumma) pada kulit, tulang,
hati, dan perubahan degenerasi pada susunan saraf pusat. Pada semua lesi
tersier, Treponema sangat jarang ditemukan. Adanya respon jaringan yang
berlebihan diakibatkan oleh beberapa bentuk hipersensitivitas terhadap
organisme. Namun kadang-kadang Treponema dapat ditemukan dalam mata atau
susunan saraf pusat pada syphilis yang lanjut.</span></div>
<div style="font-family: Arial,Helvetica,sans-serif; line-height: 200%; margin: 0in 0in 0.0001pt 0.5in; text-align: justify; text-indent: -0.25in;">
<span style="font-size: small;">b.<span style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Syphilis Kongenital</span></div>
<div style="font-family: Arial,Helvetica,sans-serif; line-height: 200%; margin: 0in 0in 0.0001pt; text-align: justify; text-indent: 15.3pt;">
<span style="font-size: small;">Wanita hamil
penderita syphilis dapat menularkan <i>Treponema pallidum</i> pada janin
melalui plasenta mulai kira-kira minggu ke-10 sampai minggu ke-15 kehamilan.
Beberapa janin yang terinfeksi akan mati dan mengakibatkan keguguran, lainnya
dapat lahir hidup tetapi menunjukkan tanda-tanda syphilis kongenital pada anak.
Pengobatan yang adekuat pada ibu selama masa kehamilan dapat mencegah syphilis
kongenital.</span></div>
<div style="font-family: Arial,Helvetica,sans-serif; line-height: 200%; margin: 0in 0in 0.0001pt; text-align: justify; text-indent: 15.3pt;">
<span style="font-size: small;"><span style="color: black;">Gejala-gejala
syphilis kongenital pada bayi yang baru lahir adalah sebagai berikut :</span></span></div>
<div style="font-family: Arial,Helvetica,sans-serif; line-height: 200%; margin: 0in 0in 0.0001pt; text-align: justify; text-indent: -0.25in;">
<span style="font-size: small;">·<span style="line-height: 200%;">
</span><span style="color: black;">Bayi sering
rewel</span></span></div>
<div style="font-family: Arial,Helvetica,sans-serif; line-height: 200%; margin: 0in 0in 0.0001pt; text-align: justify; text-indent: -0.25in;">
<span style="font-size: small;">·<span style="line-height: 200%;">
</span><span style="color: black;">Pembesaran
kelenjar getah bening, hati, dan limpa</span></span></div>
<div style="font-family: Arial,Helvetica,sans-serif; line-height: 200%; margin: 0in 0in 0.0001pt; text-align: justify; text-indent: -0.25in;">
<span style="font-size: small;">·<span style="line-height: 200%;">
</span><span style="color: black;">Berat badannya
tidak bertambah atau gagal berkembang</span></span></div>
<div style="font-family: Arial,Helvetica,sans-serif; line-height: 200%; margin: 0in 0in 0.0001pt; text-align: justify; text-indent: -0.25in;">
<span style="font-size: small;">·<span style="line-height: 200%;">
</span><span style="color: black;">Wajahnya tampak
seperti orang yang sudah tua</span></span></div>
<div style="font-family: Arial,Helvetica,sans-serif; line-height: 200%; margin: 0in 0in 0.0001pt; text-align: justify; text-indent: -0.25in;">
<span style="font-size: small;">·<span style="line-height: 200%;">
</span><span style="color: black;">Bibirnya
pecah-pecah</span></span></div>
<div style="font-family: Arial,Helvetica,sans-serif; line-height: 200%; margin: 0in 0in 0.0001pt; text-align: justify; text-indent: -0.25in;">
<span style="font-size: small;">·<span style="line-height: 200%;">
</span><span style="color: black;">Dari hidungnya
keluar lendir berdarah</span></span></div>
<div style="font-family: Arial,Helvetica,sans-serif; line-height: 200%; margin: 0in 0in 0.0001pt; text-align: justify; text-indent: -0.25in;">
<span style="font-size: small;">·<span style="line-height: 200%;">
</span><span style="color: black;">Lepuhan kecil
pada telapak tangan dan telapak kaki</span></span></div>
<div style="font-family: Arial,Helvetica,sans-serif; line-height: 200%; margin: 0in 0in 0.0001pt; text-align: justify; text-indent: -0.25in;">
<span style="font-size: small;">·<span style="line-height: 200%;">
</span><span style="color: black;">Ruam
makulopapuler berwarna tembaga pada wajah, telapak tangan, dan telapak kaki</span></span></div>
<div style="font-family: Arial,Helvetica,sans-serif; line-height: 200%; margin: 0in 0in 0.0001pt; text-align: justify; text-indent: -0.25in;">
<span style="font-size: small;">·<span style="line-height: 200%;">
</span><span style="color: black;">Ruam pada tepi
mulut alat kelamin dan anus </span></span></div>
<div style="font-family: Arial,Helvetica,sans-serif; line-height: 200%; margin: 0in 0in 0.0001pt; text-align: justify; text-indent: -0.25in;">
<span style="font-size: small;">·<span style="line-height: 200%;">
</span><span style="color: black;">Hidungnya datar</span></span></div>
<div style="font-family: Arial,Helvetica,sans-serif; line-height: 200%; margin: 0in 0in 0.0001pt; text-align: justify; text-indent: -0.25in;">
<span style="font-size: small;">·<span style="line-height: 200%;">
</span><span style="color: black;">Meningitis</span></span></div>
<div style="font-family: Arial,Helvetica,sans-serif; line-height: 200%; margin: 0in 0in 0.0001pt; text-align: justify; text-indent: -0.25in;">
<span style="font-size: small;">·<span style="line-height: 200%;">
</span><span style="color: black;">Koroiditis</span></span></div>
<div style="font-family: Arial,Helvetica,sans-serif; line-height: 200%; margin: 0in 0in 0.0001pt; text-align: justify; text-indent: -0.25in;">
<span style="font-size: small;">·<span style="line-height: 200%;">
</span><span style="color: black;">Kejang</span></span></div>
<div style="font-family: Arial,Helvetica,sans-serif; line-height: 200%; margin: 0in 0in 0.0001pt; text-align: justify; text-indent: -0.25in;">
<span style="font-size: small;">·<span style="line-height: 200%;">
</span><span style="color: black;">Hidrosefalus</span><b> <i> </i></b></span><br />
<span style="font-size: small;"><b><i> Patogenesis</i></b></span></div>
<div style="font-family: Arial,Helvetica,sans-serif; line-height: 200%; margin: 0in 0in 0.0001pt; text-align: justify; text-indent: 0.5in;">
<span style="font-size: small;">Patogenesis
syphilis adalah sebagai berikut :</span></div>
<div style="font-family: Arial,Helvetica,sans-serif; line-height: 200%; margin: 0in 0in 0.0001pt 0.5in; text-align: justify; text-indent: -0.25in;">
<span style="font-size: small;">1.<span style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Tahap Masuknya Treponema</span></div>
<div style="font-family: Arial,Helvetica,sans-serif; line-height: 200%; margin: 0in 0in 0.0001pt; text-align: justify; text-indent: 15.3pt;">
<span style="font-size: small;"><i>Treponema
pallidum </i>masuk ke dalam
tubuh melalui lesi kulit atau selaput lendir. Jika melalui kulit harus ada
mikro/makro lesi, sedangkan jika melalui selaput lendir dapat dengan tanpa ada
lesi. Pada tempat masuknya kuman dapat mengadakan multiplikasi dan tubuh akan
bereaksi dengan timbulnya infiltrat yang terdiri atas limfosit dan sel plasma
yang secara klinis dapat dilihat sebagai papula. Reaksi radang tersebut tidak
hanya terbatas pada tempat masuknya kuman, tetapi juga di daerah perivaskuler.</span></div>
<div style="font-family: Arial,Helvetica,sans-serif; line-height: 200%; margin: 0in 0in 0.0001pt 0.5in; text-align: justify; text-indent: -0.25in;">
<span style="font-size: small;">2.<span style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Stadium I (SI)</span></div>
<div style="font-family: Arial,Helvetica,sans-serif; line-height: 200%; margin: 0in 0in 0.0001pt; text-align: justify; text-indent: 15.3pt;">
<span style="font-size: small;">Kerusakan
vaskuler ini mengakibatkan aliran darah pada daerah tersebut berkurang sehingga
terjadi erosi atau ulkus, dan keadaan ini disebut <i>afek primer SI. </i>Treponema
masuk aliran darah dan limfe, kemudian menyebar ke seluruh jaringan tubuh,
termasuk kelenjar getah bening regional. Bila sudah mengenai kelenjar getah
bening regional disebut <i>kompleks primer SI.</i></span></div>
<div style="font-family: Arial,Helvetica,sans-serif; line-height: 200%; margin: 0in 0in 0.0001pt 0.5in; text-align: justify; text-indent: -0.25in;">
<span style="font-size: small;">3.<span style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Stadium II (SII)</span></div>
<div style="font-family: Arial,Helvetica,sans-serif; line-height: 200%; margin: 0in 0in 0.0001pt; text-align: justify; text-indent: 15.3pt;">
<span style="font-size: small;">Perjalanan secara
hematogen akan menyebarkan kuman ke seluruh jaringan tubuh, tetapi
manifestasinya baru akan tampak kemudian. Reaksi jaringan terhadap multiplikasi
ini akan terlihat 6-8 minggu setelah kompleks primer dan reaksi ini
bermanifestasi sebagai SII dengan berbagai bentuk kelainan yang biasanya
didahului oleh gejala prodromal. Lesi primer perlahan-lahan menghilang karena
kuman di tempat tersebut berkurang jumlahnya dan penyembuhan terjadi tanpa atau
dengan jaringan parut tipis. Lesi SII secara perlahan-lahan juga menghilang dan
akhirnya tidak terlihat sama sekali dalam waktu kurang lebih 9 bulan.</span></div>
<div style="font-family: Arial,Helvetica,sans-serif; line-height: 200%; margin: 0in 0in 0.0001pt 0.5in; text-align: justify; text-indent: -0.25in;">
<span style="font-size: small;">4.<span style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Stadium Laten</span></div>
<div style="font-family: Arial,Helvetica,sans-serif; line-height: 200%; margin: 0in 0in 0.0001pt; text-align: justify; text-indent: 15.3pt;">
<span style="font-size: small;">Stadium laten
adalah stadium tanpa tanda atau gejala klinis, tetapi infeksi masih ada dan
aktif yang ditandai dengan S.T.S (Serologic Test for Syphilis) positif.
Kadang-kadang proses imunitas gagal mengendalikan infeksi, sehingga <i>Treponema
pallidum</i> berkebang lagi dan menimbulkan lesi seperti pada SI atau SII dan
stadium ini disebut <i>stadium rekuren. </i>Stadium ini terjadi tidak lebih
dari 2 tahun terhitung sejak permulaan infeksi. Stadium laten lanjut dapat
berlangsung beberapa tahun, antibody tetap ada dalam serum penderita (S.T.S
positif). </span></div>
<div style="font-family: Arial,Helvetica,sans-serif; line-height: 200%; margin: 0in 0in 0.0001pt 0.5in; text-align: justify; text-indent: -0.25in;">
<span style="font-size: small;">5.<span style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Stadium Gumma</span></div>
<div style="font-family: Arial,Helvetica,sans-serif; line-height: 200%; margin: 0in 0in 0.0001pt; text-align: justify; text-indent: 15.3pt;">
<span style="font-size: small;">Keseimbangan
antara Treponema dan jaringan dapat tiba-tiba berubah, sebabnya belum jelas,
mungkin trauma merupakan salah satu faktor untuk timbulnya SIII yang berbentuk
gumma. Pada stadium gumma ini, Treponema sukar ditemukan tetapi reaksinya
bersifat destruktif. Lesi sembuh dengan berangsur-angsur dengan pembentukan
jaringan fibrotik dan lesi tersier ini dapat berlangsung beberapa tahun.
Treponema pallidum dapat mencapai sistem kardiovaskuler dan saraf pusat dalam
waktu dini tetapi kerusakan yang ditimbulkannya terjadi perlahan-lahan sehingga
perlu waktu bertahun-tahun untuk menimbulkan gejala klinis. Hampir 2/3 kasus
dengan stadium laten dapat meneruskan hidupnya tanpa menimbulkan gejala klinis </span></div>
<div style="font-family: Arial,Helvetica,sans-serif; line-height: 200%; margin: 0in 0in 0.0001pt; text-align: justify; text-indent: -0.25in;">
<span style="font-size: small;"> <b>
<i>Tanda-Tanda Penyakit Syphilis</i></b></span></div>
<div style="font-family: Arial,Helvetica,sans-serif; line-height: 200%; margin: 0in 0in 0.0001pt; text-align: justify;">
<span style="font-size: small;">Tanda-tanda yang tampak dari infeksi <i>Treponema
pallidum,</i> penyebab penyakit syphilis adalah :</span></div>
<div style="font-family: Arial,Helvetica,sans-serif; line-height: 200%; margin: 0in 0in 0.0001pt; text-align: justify; text-indent: -0.25in;">
<span style="font-size: small;">a.<span style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Tanda yang pertama biasanya luka atau
borok, yang disebut chancre. Chancre ini timbul 2 sampai 5 minggu setelah
hubungan kelamin dengan seorang penderita syphilis. Luka chancre tersebut
terlihat seperti jerawat, lepuh atau borok yang terluka. Biasanya chancre terdapat
pada daerah kelamin laki-laki atau wanita. Borok ini penuh dengan kuman, yang
mudah ditularkan kepada orang lain. Borok tersebut biasanya tidak sakit, dan
jika terdapat dalam vagina, mungkin wanita tersebut tidak menyadari bahwa ia
menderita syphilis, tetapi ia dapat menularkannya kepada orang lain.</span></div>
<div style="font-family: Arial,Helvetica,sans-serif; line-height: 200%; margin: 0in 0in 0.0001pt; text-align: justify; text-indent: -0.25in;">
<span style="font-size: small;">b.<span style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Luka chancre hanya berlangsung beberapa
hari dan kemudian hilang sendiri tanpa pengobatan. Namun, penyakitnya terus
menyebar diseluruh tubuh.</span></div>
<div style="font-family: Arial,Helvetica,sans-serif; line-height: 200%; margin: 0in 0in 0.0001pt; text-align: justify; text-indent: -0.25in;">
<span style="font-size: small;">c.<span style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Beberapa minggu atau beberapa bulan
kemudian, dapat terjadi sakit leher, panas ringan, luka-luka pada mulut atau
pembengkakan sendi-sendi. Atau salah satu diantara tanda-tanda tersebut dapat
muncul pada kulit berupa :</span></div>
<div style="font-family: Arial,Helvetica,sans-serif; line-height: 200%; margin: 0in 0in 0.0001pt; text-align: justify; text-indent: -0.25in;">
<span style="font-size: small;">·<span style="line-height: 200%;">
</span>Jerawat atau ruam yang sakit
di seluruh tubuh</span></div>
<div style="font-family: Arial,Helvetica,sans-serif; line-height: 200%; margin: 0in 0in 0.0001pt; text-align: justify; text-indent: -0.25in;">
<span style="font-size: small;">·<span style="line-height: 200%;">
</span>Bilur-bilur yang berbentuk
lingkaran </span></div>
<div style="font-family: Arial,Helvetica,sans-serif; line-height: 200%; margin: 0in 0in 0.0001pt; text-align: justify; text-indent: -0.25in;">
<span style="font-size: small;">·<span style="line-height: 200%;">
</span>Ruam yang gatal pada tangan
atau kaki.</span></div>
<div style="font-family: Arial,Helvetica,sans-serif; line-height: 200%; margin: 0in 0in 0.0001pt; text-align: justify;">
<span style="font-size: small;">Ketiga tanda diatas biasanya dapat hilang
dengan sendirinya, dan penderitanya mengira ia telah sembuh, tetapi sebenarnya
penyakit tersebut masih ada.</span></div>
<div style="font-family: Arial,Helvetica,sans-serif; line-height: 200%; margin: 0in 0in 0.0001pt; text-align: justify; text-indent: -0.25in;">
<span style="font-size: small;"><i><b>
Epidemiologi </b></i></span></div>
<div style="font-family: Arial,Helvetica,sans-serif; line-height: 200%; margin: 0in 0in 0.0001pt; text-align: justify; text-indent: 0.25in;">
<span style="font-size: small;">Saat ini, insiden
syphilis meningkat di berbagai dunia. Semua syphilis diperoleh melalui hubungan
seksual, kecuali syphilis kongenital dan syphilis pada tenaga medis yang
diperoleh akibat kontak di tempat kerja. Insiden tertinggi terdapat pada
laki-laki homoseksual, dan sering reinfeksi pada orang yang telah diobati<i>.</i></span></div>
<div style="font-family: Arial,Helvetica,sans-serif; line-height: 200%; margin: 0in 0in 0.0001pt; text-align: justify; text-indent: 0.25in;">
<span style="font-size: small;">Mayoritas khasus
infeksi syphilis terjadi pada orang yang aktif secara seksual dalam kelompok
usia 20 hingga 40 tahun. Sebagai akibat dari infeksi ini, chancres (luka)
terjadi diseluruh bagian luar alat kelamin, vagina, anus, atau dubur. Chancre
ini mungkin juga dapat berkembang di bibir atau di dalam mulut. Infeksi
menyebar melalui kontak langsung dan melalui hubungan seksual. </span></div>
<div style="font-family: Arial,Helvetica,sans-serif; line-height: 200%; margin: 0in 0in 0.0001pt; text-align: justify; text-indent: -0.25in;">
<span style="font-size: small;"> <b> <i>Dampak
Sosial </i></b></span></div>
<div style="font-family: Arial,Helvetica,sans-serif; line-height: 200%; margin: 0in 0in 0.0001pt; text-align: justify; text-indent: 0.25in;">
<span style="font-size: small;">Seperti dalam
kasus penyakit menular seksual lainnya, orang yang terinfeksi syphilis juga
menghadapi diskriminasi dan prasangka karena stigma sosial yang berat terkait
dengan penyakit ini. Diskriminasi entah terlahir dari rasa muak bagi para
korban, yang dianggap promiscuous (khususnya wanita), karena fakta bahwa mereka
memperoleh penyakit tersebut akibat hubungan seksual. Individu yang terinfeksi
mungkin sering berakhir diperlakukan sebagai orang buangan oleh masyarakat.<b> </b></span><br />
<span style="font-size: small;"><b><i>Pencegahan dan Pengawasan</i></b></span></div>
<div style="font-family: Arial,Helvetica,sans-serif; line-height: 200%; margin: 0in 0in 0.0001pt; text-align: justify; text-indent: 0.25in;">
<span style="font-size: small;">Pencegahan dan
pengawasan dari penularan penyakit syphilis meliputi :</span></div>
<div style="font-family: Arial,Helvetica,sans-serif; line-height: 200%; margin: 0in 0in 0.0001pt; text-align: justify; text-indent: -0.25in;">
<span style="font-size: small;">1.<span style="line-height: 200%;">
</span>Pengobatan cepat dan memadai
terhadap khasus yang ditemukan.</span></div>
<div style="font-family: Arial,Helvetica,sans-serif; line-height: 200%; margin: 0in 0in 0.0001pt; text-align: justify; text-indent: -0.25in;">
<span style="font-size: small;">2.<span style="line-height: 200%;">
</span>Pemantauan sumber infeksi
dan pengawasan yang memadai.</span></div>
<div style="font-family: Arial,Helvetica,sans-serif; line-height: 200%; margin: 0in 0in 0.0001pt; text-align: justify; text-indent: -0.25in;">
<span style="font-size: small;">3.<span style="line-height: 200%;">
</span>Pencegahan pada waktu
hubungan seksual, baik secara mekanik misalnya dengan menggunakan pengaman saat
melakukan hubungan seksual yaitu kondom.<b><i> </i></b></span><br />
<span style="font-size: small;"><b><i> Pengobatan</i></b></span></div>
<div style="font-family: Arial,Helvetica,sans-serif; line-height: 200%; margin: 0in 0in 0.0001pt; text-align: justify; text-indent: 0.25in;">
<span style="font-size: small;">Penisilin dalam
konsentrasi 0,003 unit/ml mempunyai aktifitas treponemisidal yang nyata, dan
penisilin merupakan pengobatan pilihan. Pada syphilis dengan masa sakit kurang
dari satu tahun (syphilis dini), kadar penisilin dipertahankan selama dua
minggu dengan penyuntikan tunggal benzatin penisilin G 2,4 juta unit secara
intramuskuler. Pada syphilis laten atau syphilis lanjut, dosis yang sama
diberikan 3 kali dalam interval satu minggu. Kadang-kadang penisilin dapat
digantikan dengan antibiotika lain seperti tetrasiklin atau eritromisin.
Pengobatan dengan antibiotika harus terus diamati apalagi bila digunakan secara
terus menerus.</span></div>
<div style="font-family: Arial,Helvetica,sans-serif; line-height: 200%; margin: 0in 0in 0.0001pt; text-align: justify; text-indent: -0.25in;">
<span style="font-size: small;"><b> <i>
Pemeriksaan Serologi untuk Syphilis</i></b></span></div>
<div style="font-family: Arial,Helvetica,sans-serif; line-height: 200%; margin: 0in 0in 0.0001pt; text-align: justify; text-indent: 0.25in;">
<span style="font-size: small;"><span style="color: black;">Berdasarkan
antigen yang dipakai, tes serologis untuk syphilis (STS = Serologic Tests for
Syphilis) ada dua macam, yaitu : </span></span></div>
<div style="font-family: Arial,Helvetica,sans-serif; line-height: 200%; margin: 0in 0in 0.0001pt; text-align: justify; text-indent: 0.25in;">
<span style="font-size: small;"><span style="color: black;">a.
Non Treponemal</span></span></div>
<div style="font-family: Arial,Helvetica,sans-serif; line-height: 200%; margin: 0in 0in 0.0001pt; text-align: justify;">
<span style="font-size: small;"><span style="color: black;">Pada tes ini digunakan
antigen tidak spesifik yaitu kardiolipin yang dikombinasikan dengan lesitin dan
kolesterol, karena ini tes ini dapat memberi Reaksi Biologik Semu.</span></span></div>
<div style="font-family: Arial,Helvetica,sans-serif; line-height: 200%; margin: 0in 0in 0.0001pt; text-align: justify;">
<span style="font-size: small;"><span style="color: black;">Antibodinya disebut reagin,
yang terbentuk setelah infeksi dengan <i>Treponema pallidum</i>, tetapi zat
tersebut terdapat pula pada bagian penyakit lain dan selama kehamilan. Reagin
ini dapat bersatu dengan suspensi ekstrak lipid dari binatang atau tumbuhan,
menggumpal membentuk massa yang dapat dilihat pada tes flokulasi. Massa
tersebut juga dapat bersatu dengan komplemen yang merupakan dasar bagi tes
ikatan komplemen.</span></span></div>
<div style="font-family: Arial,Helvetica,sans-serif; line-height: 200%; margin: 0in 0in 0.0001pt; text-align: justify;">
<span style="font-size: small;"><span style="color: black;">Contoh dari tes ini adalah :</span></span></div>
<div style="font-family: Arial,Helvetica,sans-serif; line-height: 200%; margin: 0in 0in 0.0001pt; text-align: justify;">
<span style="font-size: small;"><span style="color: black;">Tes flokulasi : Veneral Disease
Research Laboratories (VDRL)</span></span></div>
<div style="font-family: Arial,Helvetica,sans-serif; line-height: 200%; margin: 0in 0in 0.0001pt; text-align: justify;">
<span style="font-size: small;"><span style="color: black;">Uji Ikatan Komplemen (CF =
Complement Fixation)</span></span></div>
<div style="font-family: Arial,Helvetica,sans-serif; line-height: 200%; margin: 0in 0in 0.0001pt; text-align: justify;">
<span style="font-size: small;"><span style="color: black;">Tes Imobilisasi : TPI
(Treponema Pallidum Imobilization Test)</span></span></div>
<div style="font-family: Arial,Helvetica,sans-serif; line-height: 200%; margin: 0in 0in 0.0001pt; text-align: justify;">
<span style="font-size: small;"><span style="color: black;">Tes fiksasi komplemen : RPCF
(Reiter Protein Complement Fixation Test)</span></span></div>
<div style="font-family: Arial,Helvetica,sans-serif; line-height: 200%; margin: 0in 0in 0.0001pt; text-align: justify;">
<span style="font-size: small;"><span style="color: black;">Tes imunofluoresen : FTA-Abs
(Fluorecent Treponemal Test Antibody Absorption Test)</span></span></div>
<div style="font-family: Arial,Helvetica,sans-serif; line-height: 200%; margin: 0in 0in 0.0001pt; text-align: justify;">
<span style="font-size: small;"><span style="color: black;">Tes Hemoglutinasi : TPHA
(Treponema Pallidum Hemaglutination Assay)</span></span></div>
<span style="color: black; font-family: "Cambria","serif"; font-size: 12pt; line-height: 200%;"></span><br />
<span style="color: black; font-family: "Cambria","serif"; font-size: 12pt; line-height: 200%;"></span><span style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 200%;"></span>Anonymoushttp://www.blogger.com/profile/10554290151381141431noreply@blogger.com0tag:blogger.com,1999:blog-1998883467064803373.post-37498030319799221072012-03-03T22:00:00.001+07:002012-08-06T20:48:26.812+07:00Ikterus Neonatorum<link href="file:///C:%5CDOCUME%7E1%5CAdmin%5CLOCALS%7E1%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_filelist.xml" rel="File-List"></link><link href="file:///C:%5CDOCUME%7E1%5CAdmin%5CLOCALS%7E1%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_themedata.thmx" rel="themeData"></link><link href="file:///C:%5CDOCUME%7E1%5CAdmin%5CLOCALS%7E1%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_colorschememapping.xml" rel="colorSchemeMapping"></link>
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<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 1cm;">
<span style="font-size: 12pt; line-height: 150%;">Billirubin dalam darah mengalami proses dan berubah
menjadi billirubin direct. Billirubin direct kemudian diekskresikan ke usus dan sebagian dikeluarkan dalam bentuk
billirubin direct dan sebagian lagi dalam bentuk sterkobilin, bila terjadi
hambatan/gangguan dalam usus maka oleh pengaruh enzim B glukorodinasi
billirubin sebagian dirubah menjadi billirubin indirect yang kemudian diserap
ke sirkulasi darah.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 1cm;">
<span style="font-size: 12pt; line-height: 150%;">Billirubin ini kemudian diangkut ke hepar untuk di
proses lagi, pada janin sebagian billirubin ini diekskresikan ke plasenta. Pada
BBL ekskresi melalui plasenta terputus sehingga masuk lagi ke hepar. Karena itu
bila fungsi hepar belum sempurna/ terdapat gangguan, misal : hypoxia,
kekurangan glukosa maka kadar billirubin indirect dalam darah meningkat yang
dapat menimbulkan icterus.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18pt; text-align: justify; text-indent: -18pt;">
<i><b><span style="font-size: 12pt; line-height: 150%;">A.<span style="font: 7pt "Times New Roman";"> </span></span></b></i><b><span style="font-size: 12pt; line-height: 150%;"><i>TANDA-TANDA</i><o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 49.6pt; text-align: justify; text-indent: -21.25pt;">
<span style="font-size: 12pt; line-height: 150%;">-<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-size: 12pt; line-height: 150%;">Timbul pada hari ke-2 dan ke-3<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 49.6pt; text-align: justify; text-indent: -21.25pt;">
<span style="font-size: 12pt; line-height: 150%;">-<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-size: 12pt; line-height: 150%;">Kadar billirubin direct tidak melebihi 10 mg % pada
neonatus cukup bulan dan 12,5 mg % pada neonatus kurang bulan.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 49.6pt; text-align: justify; text-indent: -21.25pt;">
<span style="font-size: 12pt; line-height: 150%;">-<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-size: 12pt; line-height: 150%;">Kecepatan peningkatan kadar billirubin tidak melebihi
5 mg % /hari.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 49.6pt; text-align: justify; text-indent: -21.25pt;">
<span style="font-size: 12pt; line-height: 150%;">-<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-size: 12pt; line-height: 150%;">Kadar billirubin direct tidak melebihi 1 mg %.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 49.6pt; text-align: justify; text-indent: -21.25pt;">
<span style="font-size: 12pt; line-height: 150%;">-<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-size: 12pt; line-height: 150%;"> Icterus
menghilang pada 10 hari pertama.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 49.6pt; text-align: justify; text-indent: -21.25pt;">
<span style="font-size: 12pt; line-height: 150%;">-<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-size: 12pt; line-height: 150%;">Tidak terbukti mempunyai hubungan dengan keadaan
patologis.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18pt; text-align: justify; text-indent: -18pt;">
<i><b><span style="font-size: 12pt; line-height: 150%;">B.<span style="font: 7pt "Times New Roman";"> </span></span></b></i><b><span style="font-size: 12pt; line-height: 150%;"><i>PENYEBAB</i><o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.35pt; text-align: justify; text-indent: -18pt;">
<span style="font-size: 12pt; line-height: 150%;">-<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-size: 12pt; line-height: 150%;">Penambahan volume sel darah<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.35pt; text-align: justify; text-indent: -18pt;">
<span style="font-size: 12pt; line-height: 150%;">-<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-size: 12pt; line-height: 150%;">Umur sel darah merah janin yang pendek<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.35pt; text-align: justify; text-indent: -18pt;">
<span style="font-size: 12pt; line-height: 150%;">-<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-size: 12pt; line-height: 150%;">Billirubin meningkat karena sel yang rusak<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.35pt; text-align: justify; text-indent: -18pt;">
<span style="font-size: 12pt; line-height: 150%;">-<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-size: 12pt; line-height: 150%;">Meningkatnya reabsorpsi billirubin dari usus<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.35pt; text-align: justify; text-indent: -18pt;">
<span style="font-size: 12pt; line-height: 150%;">-<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-size: 12pt; line-height: 150%;">Pemberian minum terlambat<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18pt; text-align: justify; text-indent: -18pt;">
<i><b><span style="font-size: 12pt; line-height: 150%;">C.<span style="font: 7pt "Times New Roman";"> </span></span></b></i><b><span style="font-size: 12pt; line-height: 150%;"><i>PENATALAKSANAAN</i><o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.35pt; text-align: justify; text-indent: -18pt;">
<span style="font-size: 12pt; line-height: 150%;">-<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-size: 12pt; line-height: 150%;">Pemberian ASI diteruskan<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.35pt; text-align: justify; text-indent: -18pt;">
<span style="font-size: 12pt; line-height: 150%;">-<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-size: 12pt; line-height: 150%;">Bayi ditidurkan di dekat jendela untuk mendapatkan
sinar matahari<o:p></o:p></span></div>
<h1 style="line-height: 150%; text-align: justify;">
<span style="font-size: 12pt; line-height: 150%;">ICTERUS
PATOLOGIS<o:p></o:p></span></h1>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18pt; text-align: justify; text-indent: -18pt;">
<span style="font-size: 12pt; line-height: 150%;">A.<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-size: 12pt; line-height: 150%;">Definisi<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 1cm; text-align: justify;">
<span style="font-size: 12pt; line-height: 150%;">Adalah icterus yang mempunyai dasar patologis/kadar
billirubin mencapai nilai yang disebut hyperbillirubinemia.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18pt; text-align: justify; text-indent: -18pt;">
<span style="font-size: 12pt; line-height: 150%;">B.<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-size: 12pt; line-height: 150%;">Patofisiologi<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 1cm; text-align: justify;">
<span style="font-size: 12pt; line-height: 150%;">Sama dengan icterus fisiologi.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18pt; text-align: justify; text-indent: -18pt;">
<span style="font-size: 12pt; line-height: 150%;">C.<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-size: 12pt; line-height: 150%;">Tanda<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.35pt; text-align: justify; text-indent: -18pt;">
<span style="font-size: 12pt; line-height: 150%;">-<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-size: 12pt; line-height: 150%;">Icterus terjadi 24 jam pertama<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.35pt; text-align: justify; text-indent: -18pt;">
<span style="font-size: 12pt; line-height: 150%;">-<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-size: 12pt; line-height: 150%;">Kadar billirubin indirect melebihi 10 mg % /hari<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.35pt; text-align: justify; text-indent: -18pt;">
<span style="font-size: 12pt; line-height: 150%;">-<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-size: 12pt; line-height: 150%;">Peningkatan billirubin lebih dari 5 mg % /hari<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.35pt; text-align: justify; text-indent: -18pt;">
<span style="font-size: 12pt; line-height: 150%;">-<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-size: 12pt; line-height: 150%;">Icterus menetap sesudah 2 minggu pertama<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.35pt; text-align: justify; text-indent: -18pt;">
<span style="font-size: 12pt; line-height: 150%;">-<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-size: 12pt; line-height: 150%;">Kadar billirubin indirect melebihi 1 mg %<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.35pt; text-align: justify; text-indent: -18pt;">
<span style="font-size: 12pt; line-height: 150%;">-<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-size: 12pt; line-height: 150%;">Mempunyai hubungan dengan proses patologis<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18pt; text-align: justify; text-indent: -18pt;">
<i><b><span style="font-size: 12pt; line-height: 150%;">D.<span style="font: 7pt "Times New Roman";"> </span></span></b></i><b><span style="font-size: 12pt; line-height: 150%;"><i>PENYEBAB</i><o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.35pt; text-align: justify; text-indent: -18pt;">
<span style="font-size: 12pt; line-height: 150%;">-<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-size: 12pt; line-height: 150%;">Terjadi penghancuran eritrosit yang hebat<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.35pt; text-align: justify; text-indent: -18pt;">
<span style="font-size: 12pt; line-height: 150%;">-<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-size: 12pt; line-height: 150%;">Fungsi hepar belum sempurna<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.35pt; text-align: justify; text-indent: -18pt;">
<span style="font-size: 12pt; line-height: 150%;">-<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-size: 12pt; line-height: 150%;">Terlambat mengikat tali pusat<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.35pt; text-align: justify; text-indent: -18pt;">
<span style="font-size: 12pt; line-height: 150%;">-<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-size: 12pt; line-height: 150%;">Hypoxia<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18pt; text-align: justify; text-indent: -18pt;">
<i><b><span style="font-size: 12pt; line-height: 150%;">E.<span style="font: 7pt "Times New Roman";"> </span></span></b></i><b><span style="font-size: 12pt; line-height: 150%;"><i>PENATALAKSANAAN</i><o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.35pt; text-align: justify; text-indent: -18pt;">
<span style="font-size: 12pt; line-height: 150%;">-<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-size: 12pt; line-height: 150%;">Berikan banyak minum ASI<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.35pt; text-align: justify; text-indent: -18pt;">
<span style="font-size: 12pt; line-height: 150%;">-<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-size: 12pt; line-height: 150%;">Pemberian fototherapi<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.35pt; text-align: justify; text-indent: -18pt;">
<span style="font-size: 12pt; line-height: 150%;">-<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-size: 12pt; line-height: 150%;">Pemberian plasma/albumin 1 gr/kg BB<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.35pt; text-align: justify; text-indent: -18pt;">
<span style="font-size: 12pt; line-height: 150%;">-<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-size: 12pt; line-height: 150%;">Tranfusi tukar<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.35pt; text-align: justify; text-indent: -18pt;">
<span style="font-size: 12pt; line-height: 150%;">-<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-size: 12pt; line-height: 150%;">Test diagnostik<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 1cm;">
<span style="font-size: 12pt; line-height: 150%;">Apabila bayi hari pertama sudah kuning dan 3 hari
masih dalam keadaan kuning bayi segera dirujuk ke RS.</span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br />
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<b><span style="font-size: 12pt; line-height: 200%;">ASKEP PADA BAYI DENGAN ICTERUS NEONATORUM <a href="http://adf.ly/Avuou" target="_blank">Download</a> <o:p></o:p></span></b></div>Anonymoushttp://www.blogger.com/profile/10554290151381141431noreply@blogger.com2tag:blogger.com,1999:blog-1998883467064803373.post-76162587610865520222012-01-23T22:26:00.000+07:002012-01-26T21:06:57.659+07:00Epilepsi<link href="file:///C:%5CDOCUME%7E1%5CAdmin%5CLOCALS%7E1%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_filelist.xml" rel="File-List"></link><link href="file:///C:%5CDOCUME%7E1%5CAdmin%5CLOCALS%7E1%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_themedata.thmx" rel="themeData"></link><link href="file:///C:%5CDOCUME%7E1%5CAdmin%5CLOCALS%7E1%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_colorschememapping.xml" rel="colorSchemeMapping"></link>
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Epilepsi disebut juga penyakit ayan
dikenal sebagai satu penyakit tertua di dunia (2000 tahun SM). Penyakit ini
cukup sering dijumpai dan bersifat menahun. Penderita akan menderita selama
bertahun-tahun. Sekitar 0,5 – 1 % dari penduduk adalah penderita epilepsy
(Lumbantobing, 1998). Askep Epilepsi<o:p></o:p></span></div>
<u1:p></u1:p>
<br />
<div class="MsoNormal" style="line-height: normal;">
<b><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">DEFINISI</span></i><u2:p></u2:p></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><o:p></o:p></span></div>
<u1:p></u1:p>
<br />
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Bangkitan epilepsy adalah manifestasi
gangguan otak dengan berbagai gejala klinis, disebabkan oleh lepasnya muatan
listrik dari neuron-neuron otak secara berlebihan dan berkala tetapi reversible
dengan bernagai etiologi (Tjahjadi, dkk, 1996).<o:p></o:p></span></div>
<u1:p></u1:p>
<br />
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Epilepsy adalah kompleks gejala dari
beberapa kelainan fungsi otak yang ditandai dengan terjadinya kejang secara
berulang. Dapat berkaitan dengan kehilangan kesadaran, gerakan yang berlebihan,
atau kehilangan tonus atau gerakan otot, dan gangguan prilaku suasana hati,
sensasi dan persepsi (Brunner dan suddarth, 2000).<o:p></o:p></span></div>
<u1:p></u1:p>
<br />
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Kejang adalah terbebasnya sekelompok
neuron secara tiba-tiba yang mengakibatkan suatu kerusakan kesadaran, gerak,
sensasi atau memori yang besifat sementara. Istilah epilepsy biasanya merupakan
suatu kelaianan yang bersifat kronik yang timbul sebagai suatu bentuk kejang
berulang (Hudak dan Gallo, 1996). <a name='more'></a><o:p></o:p></span></div>
<u1:p></u1:p>
<br />
<div class="MsoNormal" style="line-height: normal;">
<b><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">ETIOLOGI</span></i><u2:p></u2:p></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><o:p></o:p></span></div>
<u1:p></u1:p>
<br />
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Tumor
otak
Trauma otak (5-50%)<o:p></o:p></span></div>
<u1:p></u1:p>
<br />
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Bekuan darah pada
otak
Meningitis<o:p></o:p></span></div>
<u1:p></u1:p>
<br />
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Gangguan
elektrolit
Ensefalitis<o:p></o:p></span></div>
<u1:p></u1:p>
<br />
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Gejala putus
alcohol/obat
Gangguan metabolic<o:p></o:p></span></div>
<u1:p></u1:p>
<br />
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Toksik
substans
Anoksia cerebral<o:p></o:p></span></div>
<u1:p></u1:p>
<br />
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Sebagian kejang merupakan idiopatik <o:p></o:p></span></div>
<u1:p></u1:p>
<br />
<div class="MsoNormal" style="line-height: normal;">
<b><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">MANIFESTASI KLINIK</span></i><u2:p></u2:p></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><o:p></o:p></span></div>
<u1:p></u1:p>
<br />
<div class="MsoNormal" style="line-height: normal;">
<b><u2:p></u2:p><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Kejang Parsial
Sederhana</span><u2:p></u2:p></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><o:p></o:p></span></div>
<u1:p></u1:p>
<br />
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Hanya jari atau tangan yang bergetar;
atau mulut yang bergerenyut tak terkontrol; bicara tidak dapat dimengerti;
mungkin pening; dapat mengalami perubahan penglihatan, suara, bau atau
pengecapan yang tak lazim atau tak menyenangkan.<o:p></o:p></span></div>
<u1:p></u1:p>
<br />
<div class="MsoNormal" style="line-height: normal;">
<b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Kejang Parsial Kompleks</span><u2:p></u2:p></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><o:p></o:p></span></div>
<u1:p></u1:p>
<br />
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Masih dalam keadaan sedikit bergerak
atau gerakan secara otomatis tetapi tidak bertujuan; dapat mengalami perubahan
emosi, ketakutan, marah, kegirangan, atau peka rangsang yang berlebihan; tidak
mengingat periode tersebut ketika sudah berlalu.<o:p></o:p></span></div>
<u1:p></u1:p>
<br />
<div class="MsoNormal" style="line-height: normal;">
<b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Kejang Umum (kejang grand Mal)</span><u2:p></u2:p></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><o:p></o:p></span></div>
<u1:p></u1:p>
<br />
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Mengenai kedua hemisfer otak, kekuatan
yang kuat dari seluruh tubuh diikuti dengan perubahan kedutan dari relaksasi
otot dan kontraksi (kontraksi tonik klonik umum)<o:p></o:p></span></div>
<u1:p></u1:p>
<br />
<div class="MsoNormal" style="line-height: normal;">
<b><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">FASE SERANGAN KEJANG</span></i><u2:p></u2:p></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><o:p></o:p></span></div>
<u1:p></u1:p>
<br />
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">1. Fase
Prodromal<o:p></o:p></span></div>
<u1:p></u1:p>
<br />
<div class="MsoNormal" style="line-height: normal;">
<u2:p></u2:p><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Beberapa
jam/hari sebelum seranga kejang. Berupa perubahan alam rasa (mood),
tingkah laku<o:p></o:p></span></div>
<u1:p></u1:p>
<br />
<div class="MsoNormal" style="line-height: normal;">
<u2:p></u2:p><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">2.
Fase Aura<o:p></o:p></span></div>
<u1:p></u1:p>
<br />
<div class="MsoNormal" style="line-height: normal;">
<u2:p></u2:p><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Merupakan fase
awal munculnya serangan. Berupa gangguan perasaan, pendengaran, penglihatan,
halusinasi, reaksi emosi afektif yang tidak menentu.<o:p></o:p></span></div>
<u1:p></u1:p>
<br />
<div class="MsoNormal" style="line-height: normal;">
<u2:p></u2:p><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">3.
Fase Iktal<o:p></o:p></span></div>
<u1:p></u1:p>
<br />
<div class="MsoNormal" style="line-height: normal;">
<u2:p></u2:p><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Merupakan fase
serangan kejang, disertai gangguan muskuloskletal.<o:p></o:p></span></div>
<u1:p></u1:p>
<br />
<div class="MsoNormal" style="line-height: normal;">
<u2:p></u2:p><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Tanda lain :
hipertensi, nadi meningkat, cyanosis, tekanan vu meningkat, tonus spinkter ani
meningkat, tubuh rigid-tegang-kaku, dilatasi pupil, stridor, hipersalivasi,
lidah resiko tergigit, kesadaran menurun.<o:p></o:p></span></div>
<u1:p></u1:p>
<br />
<div class="MsoNormal" style="line-height: normal;">
<u2:p></u2:p><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">4.
Fase Post Iktal<o:p></o:p></span></div>
<u1:p></u1:p>
<br />
<div class="MsoNormal" style="line-height: normal;">
<u2:p></u2:p><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Merupakan fase
setelah serangan. Ditandai dengan : confuse lama, lemah, sakit kepala, nyeri
otot, tidur lama, amnesia retrograd, mual, isolasi diri.<o:p></o:p></span></div>
<u1:p></u1:p>
<br />
<div class="MsoNormal" style="line-height: normal;">
<b><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">PEMERIKSAAN DIAGNOSTIK</span></i><u2:p></u2:p></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><o:p></o:p></span></div>
<u1:p></u1:p>
<br />
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">1.
Elektroensefalografi (EEG) membentu dalam mengklasifikasikan tipe kejang.<o:p></o:p></span></div>
<u1:p></u1:p>
<br />
<div class="MsoNormal" style="line-height: normal;">
<u2:p></u2:p><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">2.
CT Scan untuk mendeteksi lesi, abnormalitas fokal, abnormalitas vaskuler
cerebral, dan perubahan degeneratif serebral.<o:p></o:p></span></div>
<u1:p></u1:p>
<br />
<div class="MsoNormal" style="line-height: normal;">
<u2:p></u2:p><b><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">PENATALAKSANAAN</span></i><u2:p></u2:p></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><o:p></o:p></span></div>
<u1:p></u1:p>
<br />
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Penatalaksaan epilepsy direncanakan
sesuai dengan program jangka panjang dan dibuat untuk memenuhi kebutuhan khusus
masing-masing klien.<o:p></o:p></span></div>
<u1:p></u1:p>
<br />
<div class="MsoNormal" style="line-height: normal;">
<u2:p></u2:p><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Tujuan dari
pengobatan adalah untuk menghentikan kejang sesegera mungkin, untuk menjamin
oksigenasi serebral yang adekuat, dan untuk mempertahankan klien dalam status
bebas kejang.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal;">
<br /></div>
<div class="MsoNormal" style="line-height: normal;">
<b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Asuhan keperawatan pada klien dengan
epilepsi download <a href="http://www.ziddu.com/download/18341472/ASKEPEPILEPSI.doc.html" target="_blank">disini</a></span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><o:p></o:p></span></div>Anonymoushttp://www.blogger.com/profile/10554290151381141431noreply@blogger.com2tag:blogger.com,1999:blog-1998883467064803373.post-74761349286715831482012-01-23T22:17:00.001+07:002012-01-24T21:14:48.441+07:00Hepatitis<link href="file:///C:%5CDOCUME%7E1%5CAdmin%5CLOCALS%7E1%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_filelist.xml" rel="File-List"></link><link href="file:///C:%5CDOCUME%7E1%5CAdmin%5CLOCALS%7E1%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_themedata.thmx" rel="themeData"></link><link href="file:///C:%5CDOCUME%7E1%5CAdmin%5CLOCALS%7E1%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_colorschememapping.xml" rel="colorSchemeMapping"></link>
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<b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><i>Definisi</i><o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Hepatitis virus merupakan infeksi
sistemik oleh virus disertai nekrosis sampai inflamaasi pada sel-sel hati yang
menghasilkan kumpulan perubahan klinis, biokimiawi serta selular yang khas.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Menurut Sujono, Hepatitis adalah suatu
proses peradangan difus pada jaringan yang dapat disebabkan oleh infeksi virus
dan oleh reaksi toksik terhadap obat-obatan serta bahan-bahan kimia. (Sujono
Hadi, 1999).<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal;">
<b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><i>Etiologi</i><o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Penyebab utama hepatitis adalah : Virus
dan Non Virus sedangkan insiden yang sering terjadi adalah hepatitis yang
disebabkan oleh virus.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpFirst" style="line-height: normal; text-indent: -18pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">1.<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Virus
penyebab meliputi : Virus Hepatitis A (HVA), Virus Hepatitis B (HVB), Virus
Hepatitis C (HCV), Virus Hepatitis D dan Virus Hepatitis E.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpLast" style="line-height: normal; text-indent: -18pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">2.<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Hepatitis
non virus disebabkn oleh agen bakteri, cedera fisik atau kimia.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal;">
<b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><i>Patofisiologi</i><o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Berbeda dengan hepatitis A dan hepatitis
E yang ditularkan melalui jalur fekal oral, hepatitis B, hepatitis C dan
hepatitis D ditulrkan melalui darah. Virus tersebutdapat ditemukan didalam
darah, saliva, semen, serta secret vagina serta ditularkan melalui membrane
mukosa dan luka pada kulit.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Proses perjalanan penyakit yang
berkembang menjadi disfungsi hepatoselular dapat disebabkan oleh penyebab yang
menular seperti bakteri dan virus. Disfungsi hati terjadi akibat kerusakan pada
sel-sel parenkim hati yang bisa secara langsung disebabkan oleh penyakit primer
hati atau secara tidak langsung oleh obstruksi aliran empedu atau gangguan
sirkulasi hepatic. Disfungsi hati bersifat akut dan kronik, namun demikian
disfungsi yang kronis jauh lebih sering dari pada yang akut.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal;">
<b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><i>Tanda
dan Gejala</i><o:p></o:p></span></b></div>
<div class="MsoListParagraphCxSpFirst" style="line-height: normal; text-indent: -18pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">1.<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Fase
Prodomal (1-3 minggu)<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 2cm; text-indent: -21.25pt;">
<span style="font-family: Symbol; font-size: 12pt;">·<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Gangguan
gastrointestinal : Nausea, vomitus, anoreksia, konstipasi.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 2cm; text-indent: -21.25pt;">
<span style="font-family: Symbol; font-size: 12pt;">·<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Nyeri
perut kuadran kanan atas<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 2cm; text-indent: -21.25pt;">
<span style="font-family: Symbol; font-size: 12pt;">·<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Lemas<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 2cm; text-indent: -21.25pt;">
<span style="font-family: Symbol; font-size: 12pt;">·<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Hepatomegali<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 2cm; text-indent: -21.25pt;">
<span style="font-family: Symbol; font-size: 12pt;">·<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Urine
pekat, feses pucat<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; text-indent: -18pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">2.<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Fase
Ikterus<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 2cm; text-indent: -21.25pt;">
<span style="font-family: Symbol; font-size: 12pt;">·<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Kuning
pada jaringan permukaan kulit, semakin meningkat pada hari ke-2 dan menetap
pada minggu ke 6-8.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 2cm; text-indent: -21.25pt;">
<span style="font-family: Symbol; font-size: 12pt;">·<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Gangguan
gastrointestinal berkurang sampai hilang<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 2cm; text-indent: -21.25pt;">
<span style="font-family: Symbol; font-size: 12pt;">·<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Hepar
mengecil (atrofi)<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; text-indent: -18pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">3.<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Fase
post Ikterus (3-4 bulan)<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 2cm; text-indent: -21.25pt;">
<span style="font-family: Symbol; font-size: 12pt;">·<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Hepar
mengalami regenerasi<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpLast" style="line-height: normal; margin-left: 2cm; text-indent: -21.25pt;">
<span style="font-family: Symbol; font-size: 12pt;">·<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Pasien
merasa lebih baik<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal;">
<b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><i>Komplikasi</i><o:p></o:p></span></b></div>
<div class="MsoListParagraphCxSpFirst" style="line-height: normal; text-indent: -18pt;">
<span style="font-family: Symbol; font-size: 12pt;">·<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Varices
esophagus, lambung dan hemoroid<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; text-indent: -18pt;">
<span style="font-family: Symbol; font-size: 12pt;">·<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Penumpukan
cairan dalam rongga abdomen (asites)<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; text-indent: -18pt;">
<span style="font-family: Symbol; font-size: 12pt;">·<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Defisiensi
nutrisi yang terjadi akibat ketidakmampuan sel-sel hati untuk memetabolisme
vitamin tertentu<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpLast" style="line-height: normal; text-indent: -18pt;">
<span style="font-family: Symbol; font-size: 12pt;">·<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Ensepalopati
Hepatik dan koma hepatic<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal;">
<b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><i>Pemeriksaan
Diagnostik</i><o:p></o:p></span></b></div>
<div class="MsoListParagraphCxSpFirst" style="line-height: normal; text-indent: -18pt;">
<span style="font-family: Symbol; font-size: 12pt;">·<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Tes
fungsi hati : Abnormal (4-10 kali dari normal). Untuk membedakan hepatitis
virus dan non virus<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; text-indent: -18pt;">
<span style="font-family: Symbol; font-size: 12pt;">·<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">AST
(SGOT)/ALT (SGPT)<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; text-indent: -18pt;">
<span style="font-family: Symbol; font-size: 12pt;">·<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Leukopenia
: Trombositopenia mungkin ada (Splenomegali)<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; text-indent: -18pt;">
<span style="font-family: Symbol; font-size: 12pt;">·<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Albumin
serum : Menurun<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; text-indent: -18pt;">
<span style="font-family: Symbol; font-size: 12pt;">·<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Gula
darah : Hiperglikemi transien atau hipoglikemia (gangguan fungsi hati)<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; text-indent: -18pt;">
<span style="font-family: Symbol; font-size: 12pt;">·<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Feses
: Warna seperti tanah liat, steatorea (Penurunan fungsi hati)<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpLast" style="line-height: normal; text-indent: -18pt;">
<span style="font-family: Symbol; font-size: 12pt;">·<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Alkali
fosfatase : Agak meningkat kecuali ada kolestasis berat<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal;">
<b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><i>Penatalaksanaan</i><o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Tirah baring selama stadium akut,
selanjutnya aktivitas dibatasi sampai gejala pembesaran hati dan kenaikan kadar
bilirubun serta enzim hati dalam serum kembali normal. Obat-obatan tambahan
seperti vitamin, asam-amino dan obat lipotropik tak diperlukan. Obat
kortikosteroid tidak mengubah derajat nekrosis sel hati, tidak mempercepat
penyembuhan, ataupun mempertinggi imunisasi hepatitis viral.</span><br />
<br />
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Hepatitis
kronik tidak dianjurkan untuk istirahat di tempat tidur, aktivitas latihan
kebugaran jasmani (physical fitness) dapat dilanjutkan secara bertahap. Tidak
ada aturan diet tertentu tetapi alkohol dilarang. Sebelum pemberian terapi
perlu dilakukan biopsi hati, adanya hepatitis kronik aktif berat merupakan
petunjuk bahwa terapi harus segera diberikan. kasus dengan tingkat penularan
tinggi harus dibedakan dari kasus pada stadium integrasi yang relatif noninfeksius;
karena itu perlu diperiksa status HbeAg, antiHBe dan DNA VHB.<br />
<br />
Pada kasus hepatitis karena obat atau toksin dan idiosinkrasi metabolik dapat
diberikan cholestyramine untuk mengatasi pruritus yang hebat. Terapi-terapi
lainnya hanya bersifat suportif.<o:p></o:p></span></div>
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Asuhan Keperawatan
pada Pasien dengan Hepatitis download disini</span>Anonymoushttp://www.blogger.com/profile/10554290151381141431noreply@blogger.com2tag:blogger.com,1999:blog-1998883467064803373.post-87531284809099689142012-01-16T22:48:00.001+07:002012-01-24T23:59:28.759+07:00Nursing Care Plan for Stroke<link href="file:///C:%5CDOCUME%7E1%5CAdmin%5CLOCALS%7E1%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_filelist.xml" rel="File-List"></link><link href="file:///C:%5CDOCUME%7E1%5CAdmin%5CLOCALS%7E1%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_themedata.thmx" rel="themeData"></link><link href="file:///C:%5CDOCUME%7E1%5CAdmin%5CLOCALS%7E1%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_colorschememapping.xml" rel="colorSchemeMapping"></link>
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<b><i><span style="font-family: "Times New Roman , serif; font-size: 12pt;">Stroke</span></i></b><span style="font-family: "Times New Roman , serif; font-size: 12pt;">
is also referred to as a brain attack, and it occurs when a blood vessel
leading to the brain ruptures or gets blocked due to plaque deposits. When
plaque accumulates on the wall of arteries, it is known as arthrosclerosis.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman , serif; font-size: 12pt;">A
<b><i>stroke</i></b> leads to several complications because the patient
experiences weakness, paralysis and they cannot perform daily living
activities. Their quality of life reduces, as they cannot shop, socialize and
feed themselves. A stroke also leaves a person with visual defects and this
causes them to eat their meals partially. They will consume just what they can
see. The visual orientation might get affected from left to right. A visual
problem can lead to the grave neglect of food and diet, and leaves a deficit in
their nutrition.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman , serif; font-size: 12pt;">Signs
such as difficulty walking or trouble keeping their balance and coordination
are some of the signs a stroke victim will display and very important if the
problems are stemming from the same side of the body. Our brain has two halves
and doctors know that a stroke only affects one side under normal
circumstances. For their own safety if you see they are having trouble being
steady, encourage them to remain seated until they receive help.<a name='more'></a></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman , serif; font-size: 12pt;">Another
sign of a stroke is a headache, not the run of the mill headache that people
will randomly experience, but a severe one that does not respond to treatment.
Many stroke victims report no headaches during the stroke, however those who
did reported a very severe one and it is usually accompanied by other symptoms
such as vomiting, dizziness and/or an altered consciousness.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman , serif; font-size: 12pt;">There
are several available treatments for Stroke. Oxygen may be given to be sure
that your brain is getting the maximal amount. Taking birth control pills is
generally safe for young, healthy women. Treatment of blood pressure that is
too high or too low may be necessary in treating a stroke. Ischemic stroke is
treated by removing obstruction and restoring blood flow to the brain.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman , serif; font-size: 12pt;">Rehabilitation
can also take place at a nursing facility. The rehabilitation process can
include some or all of the following:<br />
(1) speech therapy to relearn talking and swallowing;<br />
(2) occupational therapy to regain dexterity in the arms and hands;<br />
(3) physical therapy to improve strength and walking; and<br />
(4) family education to orient them in caring for their loved one at home and
the challenges they will face.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal;">
<b><i><span style="font-family: "Times New Roman , serif; font-size: 12pt;">Nursing
Care Plan for Stroke with Nursing Diagnosis</span></i></b><span style="font-family: "Times New Roman , serif; font-size: 12pt;"><br />
<b><i>Nursing Diagnosis for Stroke</i></b></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">
<span style="font-family: "Times New Roman , serif; font-size: 12pt;">1.
Ineffective Airway Clearance<br />
2. Ineffective Cerebral Tissue Perfusion<br />
3. Impaired Physical Mobility<br />
4. Impaired Verbal Communication<br />
5. Disturbed Sensory Perception<br />
6. Imbalanced Nutrition Less Than Body Requirements<br />
7. Self-Care Deficit</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">
<span style="font-family: "Times New Roman , serif; font-size: 12pt;">8.
Risk of Injury<br />
9. Deficient Knowledge</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><o:p></o:p></span></div>
<br />
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"><o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Source : http://nursing-care-plan.blogspot.com/<o:p></o:p></span></div>Anonymoushttp://www.blogger.com/profile/10554290151381141431noreply@blogger.com1tag:blogger.com,1999:blog-1998883467064803373.post-21434935826267987452012-01-16T22:44:00.003+07:002012-01-23T22:28:27.480+07:00Nursing Care Plan for Pneumonia<link href="file:///C:%5CDOCUME%7E1%5CAdmin%5CLOCALS%7E1%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_filelist.xml" rel="File-List"></link><link href="file:///C:%5CDOCUME%7E1%5CAdmin%5CLOCALS%7E1%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_themedata.thmx" rel="themeData"></link><link href="file:///C:%5CDOCUME%7E1%5CAdmin%5CLOCALS%7E1%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_colorschememapping.xml" rel="colorSchemeMapping"></link>
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<div class="MsoNormal" style="line-height: normal;">
<i><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Pneumonia</span></b></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"> is a common type of pulmonary disease that involves
inflammation and infection of the lungs, triggering an overproduction of mucus
at the level of the respiratory tract.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><i><b>Symptoms of pneumonia</b></i>:<br />
<br />
The symptoms of pneumonia vary from person to person, and few people experience
all of them.<br />
<br />
The possible symptoms may be :<br />
<br />
- Fever, which may be less common in older adults.<br />
- Fast heartbeat is one of the primary symptom of pneumonia.<br />
- Feeling very tired or feeling very weak .<br />
- Loss of appetite may occur in case of pneumonia.<br />
- Vague pain under and around the breast bone may occur, but the severe chest
pain associated with typical bacterial pneumonia is uncommon.<br />
- Patients may experience a severe hacking cough, but it usually does not
produce sputum.<br />
- Cough, often producing mucus from the lungs. Mucus may be rusty or green or
tinged with blood.<br />
- Wheezing<br />
- Difficulty breathing<br />
- Sometimes nausea, vomiting, muscle aches occurs.<br />
- Mental confusion.<br />
- Coughing up sputum containing pus or blood.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">
<i><b>Nursing Assessment for Pneumonia </b></i><br />
<br />
1. Patient Bios: Name, age, gender, marital status, religion, tribe / nation,
education, occupation, address and registration number.<br />
<br />
2. Bios Responsible Person: Name, age, gender, marital status, religion, tribe
/ nation, education, occupation, income, address.<br />
<br />
3. Patient Medical History:<br />
Formerly Medical History<br />
Health History Now<br />
Family Health History<br />
<br />
4. Everyday habits:<br />
Eating and Drinking<br />
Elimination: bladder and bowel<br />
Personal Hygiene<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">5. Physical Examination / Head To
Toe<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal;">
</div>
<div class="MsoNormal" style="line-height: normal;">
<i><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Nursing Diagnosis for Pneumonia</span></b></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">1. Impaired Gas Exchange related to
impaired oxygen delivery.<br />
<br />
2. Risk for Infection related to inadequate primary defenses.<br />
<br />
3. Ineffective airway clearance related to the formation of edema.<br />
<br />
4. Activity Intolerance related to insufficiency of oxygen for everyday
activities.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Source : http://nursing-care-plan.blogspot.com/<o:p></o:p></span></div>Anonymoushttp://www.blogger.com/profile/10554290151381141431noreply@blogger.com0tag:blogger.com,1999:blog-1998883467064803373.post-39376639897578640362012-01-16T22:29:00.000+07:002012-07-23T21:23:07.064+07:00Nursing Care Plan for Hydrocephalus<link href="file:///C:%5CDOCUME%7E1%5CAdmin%5CLOCALS%7E1%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_filelist.xml" rel="File-List"></link><link href="file:///C:%5CDOCUME%7E1%5CAdmin%5CLOCALS%7E1%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_themedata.thmx" rel="themeData"></link><link href="file:///C:%5CDOCUME%7E1%5CAdmin%5CLOCALS%7E1%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_colorschememapping.xml" rel="colorSchemeMapping"></link>
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<b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Hydrocephalus</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><br />
<br />
<i><b>Hydrocephalus</b></i> is a condition wherein there is an interruption to the
normal flow, absorption, and production of the brain's CSF (Cerebrospinal
Fluid), which is the medium that carries all the nutrients needed by the brain
to remain healthy and fully-functional. If there's an interruption or
overproduction of CSF - such as in hydrocephalus - it will build up inside the
brain that is shown through the swelling of a child's or adult's skull.<br />
<br />
Hydrocephalus of one kind or another is especially prevalent at the two
extremes of the life cycle -- in the very young and the very old -- but can
occur at any age. In infancy, hydrocephalus can be caused by malformed
brain-tissue. In contrast, adults with hydrocephalus were usually born with
normal brain anatomy, but acquired a blockage due to a tumor, injury, bleed or
infection. However, many cases of hydrocephalus in adults occur without a history
of these preceding illnesses.<br />
<br />
All of these ventricles, passageways, and spaces are filled with a special
fluid called cerebrospinal fluid (CSF). This fluid is constantly moving. It
begins in one of the ventricles. Located inside each of the four ventricles is
a structure called a choroid plexus. An essential component of the choroid
plexus is a compact network of blood capillaries. The function of the choroid
plexus is to remove fluid from the blood inside the capillaries and place that
fluid inside the ventricle. Once the fluid is inside the ventricle, it is
called cerebrospinal fluid.<br />
<br />
<i><b>Nursing Diagnosis Nursing Care Plan for Hydrocephalus</b></i><br />
<br />
<b>Ineffective cerebral tissue perfusion</b> <i>related to</i> increased volume
of cerebrospinal fluid<br />
<br />
<b>NOC</b>: Circulation Status<br />
<br />
<i><b>Expected outcomes NOC</b></i><o:p></o:p></span></div>
<ol start="1" type="1">
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Indicates the status of circulation, characterized by
the following indicators:<o:p></o:p></span></li>
<ul type="circle">
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Systolic and diastolic blood pressure in the range
expected<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">No orthostatic hypotension<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">No noisy large blood vessels<o:p></o:p></span></li>
</ul>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Demonstrate cognitive abilities, characterized by
indicators:<o:p></o:p></span></li>
<ul type="circle">
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Communicate clearly and in accordance with the age and
ability<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Show attention, concentration and orientation<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Demonstrate long-term memory and is currently<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Process information<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Making the right decision<o:p></o:p></span></li>
</ul>
</ol>
<div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">
<i><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">NIC interventions</span></b></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><br />
<br />
Monitor the following matters :<o:p></o:p></span></div>
<ul type="disc">
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Vital signs<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Headache<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Level of awareness and orientation<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Nystagmus diplopia, blurred vision, visual acuity<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Monitoring ICT<o:p></o:p></span></li>
<ul type="circle">
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Monitoring of ICT and the patient's neurological
response to maintenance activities<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Monitor the pressure of tissue perfusion<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Note the change in the patient in response to stimulus<o:p></o:p></span></li>
</ul>
</ul>
<ol start="1" type="1">
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Management of peripheral sensation<o:p></o:p></span></li>
<ul type="circle">
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Monitor the presence of paresthesias: a sense of
numbness or tingling<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Monitor the status of fluid intake and output
including<o:p></o:p></span></li>
</ul>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Collaborative activity <o:p></o:p></span></li>
<ul type="circle">
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Keep the thermodynamic parameters within the
recommended range<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Give the drugs to increase intravascular volume, as
requested<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Give the drug which causes hypertension to maintain
cerebral perfusion pressure according to demand<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Elevate the head of the bed 0 to 45 degrees, depending
on the patient's condition and medical demands<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Give loap and osmotic diuretics, according to demand.<o:p></o:p></span></li>
</ul>
</ol>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Source : http://nursing-care-plan.blogspot.com/</span><br />
<br />
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"><o:p>Asuhan Keperawatan Hydrocephalus dapat anda download <a href="http://adf.ly/B2ZKA" target="_blank">disini</a></o:p></span></div>Anonymoushttp://www.blogger.com/profile/10554290151381141431noreply@blogger.com0tag:blogger.com,1999:blog-1998883467064803373.post-31520029959195406162012-01-16T22:18:00.000+07:002012-01-23T22:30:48.042+07:00Genital Herpes - Causes, Symtoms and Treatment<link href="file:///C:%5CDOCUME%7E1%5CAdmin%5CLOCALS%7E1%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_filelist.xml" rel="File-List"></link><link href="file:///C:%5CDOCUME%7E1%5CAdmin%5CLOCALS%7E1%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_themedata.thmx" rel="themeData"></link><link href="file:///C:%5CDOCUME%7E1%5CAdmin%5CLOCALS%7E1%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_colorschememapping.xml" rel="colorSchemeMapping"></link>
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">by: <b>James S. Pendergraft</b></span> <br />
<br />
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">HSV
or 'Herpes Simplex Virus' is the virus which causes Genital Herpes. This virus
is highly infectious and transmits from one to another due to contact with
skin, like oral, vaginal or anal sex. <br />
<br />
<i><b>Causes of Genital Herpes</b></i>: <br />
The presence of HSV on the facade of the skin is enough to be transmitted to a
partner. This virus is transmitted easily through the moist parts of the skin
like the anus, genitals and the mouth. In a few cases, there are chances of
getting infected even through other parts of the body like the skin or the
eyes, which would be affected by 'Herpes Simplex'. <br />
<br />
Genital herpes does not get transmitted through cups, towels or cutlery, as the
virus is short lived when is not on the skin. Once diagnosed with HSV, this
virus is reactivated very fast and causes a 'new bout of genital herpes'. This
phenomenon is called
'recurrence'. Once you are infected by this virus, it lives within the nerves
of the skin, but there are no symptoms. This is mostly inactive, but it gets
reactivated every now and then. <br />
<br />
The reason for the recurrence of HSV is not known, but there are certainly a
few causes which accountable for the indications of the recurrence of genital
herpes. For instance, abrasion in the genital area could be at the time of
intercourse, which could be a cause of recurrence. There are other causes like,
stress, excessive intake of alcohol, falling ill and the genital area being exposed to
strong sunlight. <br />
<br />
<i><b>Symptoms of Genital Herpes</b></i> :` <br />
In most cases of HSV, there are no symptoms at the initial stages and this in
turn does not make the sufferer aware of the condition. It is to be noted that,
the symptoms of this virus are not known for a long period of time and in some
cases not known for years too. In case you face any indications of the
infection initially, it might be between four to seven days after being
infected by HSV. This indication which appears is known as the primary infection. In case of
indications of a primary infection, the condition is known to be a lot more severe as
compared to the recurrent infections. <br />
<br />
Symptoms of primary genital herpes are; vaginal discharge in case of women,
fever, red blisters which are painful, these blisters burst and <span style="color: #006600;">leave</span> behind ulcers on the buttocks, rectum, <span style="color: #006600;">external</span>
genital area and thighs, <span style="color: #006600;">pain</span>
while passing urine, in case of women there is ulceration and blister on the
cervix and a general feeling of being unwell. <br />
<br />
These symptoms generally tend to last for about twenty days. In case of
recurrent infections the symptoms would be again ulceration and blisters on the
cervix in case of women, red blisters which are painful and a <span style="color: #006600;">burning</span> or
tingling feeling in the area surrounding the genitals before the appearance of
the blister. These symptoms tend to last for about seven to ten days. <br />
<br />
<i><b>Treatment of Genital Herpes</b></i> : <br />
Treatment of genital herpes depends on whether the treatment is for recurrent
infection or for the first time. In case it is the first time, the treatment is
done by a GUM that is Genito Urinary Medicine specialist in case you are not
able to meet a GUM specialist you should at least consult a general physician
who would put you on a course of anti viral tablets. In case of recurrent
infection your general physician would treat you with a mild dose as the
infection is less when it recurs. <br />
<br />
There is also an episodic treatment for 6 recurrent infections in a year.
Besides, there is the suppressive treatment done in case of more than six
recurrent infections in a year. <br />
<br />
<br />
Source : <i>http://www.womenscenter.com/</i><o:p></o:p></span></div>Anonymoushttp://www.blogger.com/profile/10554290151381141431noreply@blogger.com20tag:blogger.com,1999:blog-1998883467064803373.post-73680358517065614382012-01-15T23:20:00.001+07:002012-07-23T21:19:59.097+07:00Askep pada klien dengan miokarditis<link href="file:///C:%5CDOCUME%7E1%5CAdmin%5CLOCALS%7E1%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_filelist.xml" rel="File-List"></link><link href="file:///C:%5CDOCUME%7E1%5CAdmin%5CLOCALS%7E1%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_themedata.thmx" rel="themeData"></link><link href="file:///C:%5CDOCUME%7E1%5CAdmin%5CLOCALS%7E1%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_colorschememapping.xml" rel="colorSchemeMapping"></link>
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<b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Pengertian</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Miocarditis adalah
peradangan pada otot jantung atau miokardium. hal ini disebabkan oleh
penyakit-penyakit infeksi, akan tetapi dapat sebagai akibat reaksi alergi terhadap
obat-obatan dan efek toxin bahan-bahan kimia dan radiasi (FKUI, 1996).
Miocarditis adalah peradangan dinding otot jantung yang disebabkan oleh infeksi
atau penyebab lain sampai yang tidak diketahui (idiopatik) (Dorland,
2002). Miokarditis adalah inflamasi fokal atau menyebar dari otot jantung
(miokardium) (Doenges, 1999). Indrus Alwi dalam Buku Ilmu Penyakit Dalam,2009
mengatakan miokarditis adalah penyakit inflamasi pada miokard yang bisa
disebabkan karena infeksi akut atau respon autoimun pasca infeksi viral.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pada sebagian besar, miokarditis tidak dapat diduga karena
disfungsi jantung bersifat subklinis, asimtomatik dan sembuh sendiri (<i>self
limited</i>) oleh karena miokarditis asimtomatik, maka data epidemiologi yang
ada berasal dari penelitian pasca mortem. Pada pemeriksaan pasca mortem
miokarditis ditemukan sekitar 1-9%, sehingga dapat diduga miokarditis adalah penyebab
utama kematian. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dari pengertian di atas dapat disimpulkan bahwa miocarditis
adalah peradangan/inflamasi otot jantung yang disebabkan oleh berbagai penyebab, terutama
agen-agen infeksi yang dapat berakibat fatal bagi si penderita.</span><m:smallfrac m:val="off"><m:dispdef><m:lmargin m:val="0"><m:rmargin m:val="0"><m:defjc m:val="centerGroup"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span></m:defjc></m:rmargin></m:lmargin></m:dispdef></m:smallfrac></div>
<br />
<b><span style="font-family: "Times New Roman","serif";">Etiologi</span></b><br />
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Umumnya miokarditis ini disebabkan oleh penyakit akan tetapi
dapat juga disebabkan oleh sebagai akibat reaksi alergi terhadap obat-obatan serta efek toksik
bahan-bahan kimia radiasi dan infeksi.<o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pada miokarditis karena difteri yaitu kerusakan miokardium
disebabkan toksik yang dikeluarkan hasil mikrobakteri. Toksin akan menghambat
sintesis protein dan secara mikroskopis akan didapatkan miosit dengan
infiltrasi lemak serat otot mengalami nekrosis hialin.<o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">
Beberapa organism dapat menyerang dinding arteri kecil, terutama pada arteri
koronaria intramuskuler yang akan memberikan reaksi radang perivaskuler
miokardium. Hal ini dsebabkan oleh pseudomonas serta beberapa jenis jamur
seperti aspergilus dan kandida. Sebagian kecil mikroorganisme menyerang
langsung terhadap sel-sel miokardium yang menyebabkan reaksi radang. <o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">
Miokarditis biasanya diakibatkan oleh proses infeksi, infeksi, terutama oleh
virus, bakteri, jamur, parasit, protozoa, dan spirozeta atau dapat juga
disebabkan oleh keadaan hipersensitifitas seperti demam rematik.</span></div>
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<br /></div>
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<b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p>Patofisiologi</o:p></span></b></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Jantung
merupakan organ otot. Bila serabut otot sehat, jantung dapat berfungsi dengan
baik, jika ada cedera katup yang berat; dan serabut otot rusak maka hidup
dapat terancam. Miokarditis dapat menyebabkan dilatasi jantung, thrombus dalam
dinding jantung, infiltrasi sel darah yang beredar disekitar pembuluh koroner, serabut otot dan degenerasi serabut otot itu sendiri.</span></div>
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</style><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kerusakan miokard oleh kuman-kuman infeksius ini dengan
melalui tiga mekanisme dasar :<o:p></o:p></span></m:defjc></m:rmargin></m:lmargin></m:dispdef></m:smallfrac></div>
<ul>
<li><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Invasi
langsung ke miokard.<o:p></o:p></span></li>
</ul>
<ul>
<li><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Proses
imunologis terhadap miokard.<o:p></o:p></span></li>
</ul>
<ul>
<li><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mengeluarkan
toksin yang merusak miokard.</span></li>
</ul>
<div style="text-align: justify;">
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</style><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Proses
miokarditis viral ada 2 tahap :</span></m:defjc></m:rmargin></m:lmargin></m:dispdef></m:smallfrac><br />
<ol>
<li><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">
Fase akut berlangsung kira-kira satu minggu, dimana terjadi invasi virus ke
miokard, replikasi virus dan lisis sel. Kemudian terbentuk neutralizing
antibody dan virus akan dibersihkan atau dikurangi jumlahnya dengan bantuan
makrofag dan natural killer cell (sel NK).</span></li>
<li><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Pada fase berikutnya miokard diinfiltrasi oleh sel-sel radang dan system immune
akan diaktifkan antara lain dengan terbentuknya antibody terhadap miokard,
akibat perubahan permukaan sel yang terpajan oleh virus. Fase ini berlangsung
beberapa minggu sampai beberapa bulan dan diikuti kerusakan miokard dari yang
minimal sampai yang berat (FKUI, 1999).</span></li>
</ol>
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"><b>Tanda dan Gejala</b> </span></div>
<div style="text-align: justify;">
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Menurut
DEPKES, 1993 tanda dan gejala miokarditis adalah :<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Menggigil<o:p></o:p>, demam<o:p></o:p>, anoreksia, nyeri
dada, dispnea
dan disritmia, tamponade
ferikardial/kompresi (pada efusi perikardial).<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Menurut
Griffith, 1994 tanda dan gejala yang timbul pada klien dengan miokarditis : <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Letih, napas pendek (cepat dan sesak), detak
jantung tidak teratur, demam,dan gejala-gejala
lain karena gangguan yang mendasarinya.<o:p><b> </b></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p><b>Manifestasi Klinis</b></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p>Manifestasi klinis pada miokarditis yaitu sebagai berikut :<b> </b></o:p></span></div>
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<li><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tergantung pada jenis infeksi dan kerusakan jantung.</span></li>
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gejala ringan atau tidak sama sekali</span></li>
<li><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span>
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sering mengalami kelalahan dan
dipsnea, bedebar-debar, </span></li>
<li><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Merasa tidak nyaman di dada dan perut atas</span></li>
<li><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Terdapat bunyi jantung tambahan, gallop ventrikel dan mungkin pembesaran jantung.</span></li>
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<b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penatalaksanaan</span></b></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penanganan
pada pasien dengan Miokarditis adalah :<o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pasien
diberi pengobatan khusus terhadap penyebab yang mendasari (penisilin untuk
streptokokus hemolitikus).<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pasien
dibaringkan ditempat tidur untuk mengurangi beban jantung. Berbaring juga
membantu mengurangi kerusakan miokardial residual dan komplikasi miokarditis.<o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Fungsi
jantung dan suhu tubuh harus selalu dievaluasi.<o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bila
terjadi gagal jantung kongestiv harus diberikan obat untuk memperlambat
frekuensi jantung dan meningkatkan kekuatan kontraksi.</span></div>
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<br />
<b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p>Komplikasi</o:p></span></b></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Komplikasi yang mugkin muncul jika terkena
Miokarditis adalah :<o:p></o:p></span></div>
<ul>
<li><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kardiomiopati</span></li>
<li><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span>
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Payah jantung kongresif</span></li>
<li><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span>
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Efusi pericardial</span></li>
<li><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span>
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">AV block total</span></li>
<li><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span>
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Trobi kardiak</span></li>
<li><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span>
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gagal jantung</span></li>
</ul>
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div>
<div style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p>ASUHAN KEPERAWATAN PADA KLIEN DENGAN MIOKARDITIS Selengkapnya dapat anda Download <a href="http://adf.ly/B2Yv5" target="_blank">disini</a></o:p></span><br />
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;">
</div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div>Anonymoushttp://www.blogger.com/profile/10554290151381141431noreply@blogger.com0tag:blogger.com,1999:blog-1998883467064803373.post-69599542662934720682012-01-13T18:57:00.002+07:002012-09-19T13:47:44.440+07:00Penyakit Apendisitis<link href="file:///C:%5CDOCUME%7E1%5CAdmin%5CLOCALS%7E1%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_filelist.xml" rel="File-List"></link><link href="file:///C:%5CDOCUME%7E1%5CAdmin%5CLOCALS%7E1%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_themedata.thmx" rel="themeData"></link><link href="file:///C:%5CDOCUME%7E1%5CAdmin%5CLOCALS%7E1%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_colorschememapping.xml" rel="colorSchemeMapping"></link><m:smallfrac m:val="off"><m:dispdef><m:lmargin m:val="0"><m:rmargin m:val="0"><m:defjc m:val="centerGroup"><m:wrapindent m:val="1440"><m:intlim m:val="subSup"><m:narylim m:val="undOvr"></m:narylim></m:intlim></m:wrapindent></m:defjc></m:rmargin></m:lmargin></m:dispdef></m:smallfrac>
<br />
<div class="MsoNoSpacing">
<span style="font-size: 12pt;"><i>DEFINISI</i><o:p></o:p></span></div>
<br />
<span lang="IN" style="font-size: 12pt;">Apendisitis merupakan inflamasi dari appendiks vermiformis yang merupakan
p</span><span style="font-size: 12pt;">r</span><span lang="IN" style="font-size: 12pt;">oyeksi dari ujung caecum. Merupakan kegawat
daruratan bedah abdomen yang paling sering dan menyerang 7% sapai 12% dari
populasi. Paling sering terjadi antara usia 20 dan 30 tahun, namun dapat
terjadi pada usia berapa saja.<o:p></o:p></span>
<br />
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
<span lang="IN" style="font-size: 12pt;"><i>PATOFISIOLOGI</i><o:p></o:p></span></div>
<div class="MsoNoSpacing">
<span lang="IN" style="font-size: 12pt;">Penyebab pasti apendisitis masih diperdebatkan. Obstruksi lumen oleh tinja, tumor, atau benda
asing dengan konsekuensi peningkatan tekanan intra lumen, iskemia, infeksi bakterial,
dan inflamasi merupakan teori yang umum disebutkan. Lumen yang tersumbat
menyebabkan tidak terjadinya drainase appendiks, dan karena sekresi mukosa
terus terjadi maka tekanan intra lumen akan meningkat. Peningkatan tekanan inra
lumen akan menurunkan aliran darah mukosa, dan appendiks menjadi hipo</span><span style="font-size: 12pt;">k</span><span lang="IN" style="font-size: 12pt;">sia. Mukosa menjadi luka dan menyebabkan invasi bakteri
atau mikroba lain dengan inflamasi lebih lanjut dan edema. Inflamasi dapat
melibatkan bagian ujung atau keseluruhan appendiks. Dapat terjadi ganggen
karena thrombosis pembuluh darah lumen yang diikuti oleh perforasi.<o:p></o:p></span></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
<span lang="IN" style="font-size: 12pt;"><i>MANIFESTASI KLINIS</i><o:p></o:p></span></div>
<div class="MsoNoSpacing">
<span lang="IN" style="font-size: 12pt;">Gejala khas inflamasi apendiks adalah nyeri epigastrium atau
periumbilikal. Nyerinya mula-mula tidak jelas, intensitasnya meningkat dalam 3
sampai 4 jam. Nyeri ini dapat mereda dan kemudian timbul lagi pada regio kanan</span><span lang="IN" style="font-size: 12pt;"> </span><span lang="IN" style="font-size: 12pt;">ba</span><span style="font-size: 12pt;">w</span><span lang="IN" style="font-size: 12pt;">ah. Nyeri terokalisasi di
daerah ini karena ada rekasi inflamasi jaringan sekitar. Biasa terjadi mual,
muntah dan tidak ada nafsu makan, serta demam setelah timbulnya nyeri. Diare
dapat terjadi pada beberapa penderita, khususnya pada anak-anak, pada penderita
lainnya justru dapat terjadi konstipasi. Perforasi, peritonitis dan terbentukya
abses merupakan komplikasi paling serius dari appendi</span><span style="font-size: 12pt;">s</span><span lang="IN" style="font-size: 12pt;">itis.<o:p></o:p></span></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
<span lang="IN" style="font-size: 12pt;"><i>EVALUASI DAN TERAPI</i><o:p></o:p></span></div>
<div class="MsoNoSpacing">
<span lang="IN" style="font-size: 12pt;">Selain gejala dan tanda klinis, klinisi basanya dapat menentukan
lokasinyeri dengan satu jari. Nyeri lepas biasanya terjadi pada bagianperut
kanan awah. Sel darah putih (lekosit) akan meningkat mulai dari 10000 sampai
16000/mm3, dengan peningkatan netrofil, protein C-reaktif (CRP). Pemerikasaan
radiologi, CT-scan, dan USG dapat membantu menegakkan diagnosis.<o:p></o:p></span></div>
<div class="MsoNoSpacing">
<span lang="IN" style="font-size: 12pt;">Pemberian antibiotika dan appendektomi merupakan terapi appendicitis baik
yang biasa maupun yang dengan perforasi. Operasi dengan laparaskopi dapat
mengurangi waktu penyembuhan. Penyembuhan akan lebih lama bila telah terjadi
perfororasi.</span><br />
<br />
<span lang="IN" style="font-size: 12pt;"><span style="font-family: ""serif"","serif";">Untuk lebih
lengkapnya teman-teman download aja Askep Apendisitis <a href="http://adf.ly/CyP6b" target="_blank">disini</a></span> </span></div>
<div class="MsoNoSpacing">
<span style="font-size: 12pt;">source :<o:p></o:p></span></div>
<div class="MsoNoSpacing">
<span lang="IN" style="font-size: 12pt;">Huether SE. Alterations of digestive system. In: McCance KL, Huether SE.
Patophysiology 5<sup>th</sup> Ed.Evolve, 2006: 1385-1446</span><br />
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Anonymoushttp://www.blogger.com/profile/10554290151381141431noreply@blogger.com2tag:blogger.com,1999:blog-1998883467064803373.post-4401468361300074922012-01-12T21:17:00.000+07:002012-03-15T22:26:16.020+07:00Askep Bronchopneumoni pada Anak<link href="file:///C:%5CDOCUME%7E1%5CAdmin%5CLOCALS%7E1%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_filelist.xml" rel="File-List"></link><link href="file:///C:%5CDOCUME%7E1%5CAdmin%5CLOCALS%7E1%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_themedata.thmx" rel="themeData"></link><link href="file:///C:%5CDOCUME%7E1%5CAdmin%5CLOCALS%7E1%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_colorschememapping.xml" rel="colorSchemeMapping"></link>
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<h1 style="line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: left;">
<i style="font-family: Times,"Times New Roman",serif;"><span style="font-size: small;">Pengertian</span></i><br /><i><span style="font-size: 12pt; font-style: normal; line-height: 150%;"><o:p></o:p></span></i></h1>
<div class="MsoNormal" style="line-height: 150%; text-indent: 36pt;">
<i><span style="font-style: normal;">Bronchopneumonia adalah
radang paru-paru yang mengenai satu atau beberapa lobus paru-paru yang ditandai
dengan adanya bercak-bercak Infiltrat (Whalley and Wong, 1996).<o:p></o:p></span></i></div>
<div class="MsoNormal" style="line-height: 150%; text-indent: 36pt;">
<i><span style="font-style: normal;">Bronchopneumina adalah
frekwensi komplikasi pulmonary, batuk produktif yang lama, tanda dan gejalanya
biasanya suhu meningkat, nadi meningkat, pernapasan meningkat (Suzanne G. Bare,
1993).<o:p></o:p></span></i></div>
<div class="MsoNormal" style="line-height: 150%; text-indent: 36pt;">
<i><span style="font-style: normal;">Bronchopneumonia disebut
juga pneumoni lobularis, yaitu radang paru-paru yang disebabkan oleh bakteri,
virus, jamur dan benda-benda asing (Sylvia Anderson, 1994).<o:p></o:p></span></i></div>
<div class="MsoNormal" style="line-height: 150%; text-indent: 36pt;">
<i><span style="font-style: normal;">Berdasarkan beberapa
pengertian di atas maka dapat disimpulkan bahwa Bronkopneumonia adalah radang
paru-paru yang mengenai satu atau beberapa lobus paru-paru yang ditandai dengan
adanya bercak-bercak infiltrat yang disebabkan oleh bakteri,virus, jamur dan
benda asing.<o:p></o:p></span></i></div>
<div class="MsoNormal" style="line-height: 150%; text-indent: 36pt;">
<br /></div>
<h4 style="line-height: 150%; margin: 0cm 0cm 0.0001pt;">
<span style="font-family: Times,"Times New Roman",serif; font-size: small;"><i>Etiologi</i></span><i><span style="font-size: 12pt; font-style: normal; line-height: 150%;"><br /><o:p></o:p></span></i></h4>
<ul style="margin-top: 0cm;" type="disc">
<li class="MsoNormal" style="line-height: 150%;"><i><span style="font-style: normal;">Bakteri : Diplococus
Pneumonia, Pneumococcus, Stretococcus Hemoliticus Aureus, Haemophilus
Influenza, Basilus Friendlander (Klebsial Pneumoni), Mycobacterium
Tuberculosis. <o:p></o:p></span></i></li>
<li class="MsoNormal" style="line-height: 150%;"><i><span style="font-style: normal;">Virus : Respiratory
syntical virus, virus influenza, virus sitomegalik.<o:p></o:p></span></i></li>
<li class="MsoNormal" style="line-height: 150%;"><i><span style="font-style: normal;">Jamur : Citoplasma
Capsulatum, Criptococcus Nepromas, Blastomices Dermatides, Cocedirides
Immitis, Aspergillus Sp, Candinda Albicans, Mycoplasma Pneumonia. Aspirasi
benda asing.<o:p></o:p></span></i></li>
</ul>
<div class="MsoBodyTextIndent2" style="line-height: 150%; margin: 0cm 0cm 0.0001pt; text-indent: 36pt;">
<i><span style="font-style: normal;">Faktor lain yang mempengaruhi timbulnya Bronchopnemonia adalah daya
tahan tubuh yang menurun misalnya akibat malnutrisi energi protein (MEP),
penyakit menahun, pengobatan antibiotik yang tidak sempurna.<o:p></o:p></span></i></div>
<h4 style="line-height: 150%; margin: 0cm 0cm 0.0001pt;">
<i><span style="font-size: 12pt; font-style: normal; line-height: 150%;"> </span></i></h4>
<h4 style="font-family: Times,"Times New Roman",serif; line-height: 150%; margin: 0cm 0cm 0.0001pt;">
<span style="font-size: small; font-style: normal; line-height: 150%;"><i>Fatofisiologi</i></span></h4>
<div class="MsoBodyTextIndent3" style="line-height: 150%; margin: 0cm 0cm 0.0001pt; text-indent: 36pt;">
<i><span style="font-size: 12pt; font-style: normal; line-height: 150%;">Bronkopneumonia merupakan infeksi
sekunder yang biasanya disebabkan oleh virus penyebab Bronchopneumonia yang
masuk ke saluran pernafasan sehingga terjadi peradangan broncus dan alveolus.
Inflamasi bronkus ditandai adanya penumpukan sekret, sehingga terjadi demam,
batuk produktif, ronchi positif dan mual. Bila penyebaran kuman sudah mencapai
alveolus maka komplikasi yang terjadi adalah kolaps alveoli, fibrosis, emfisema
dan atelektasis.<o:p></o:p></span></i></div>
<div class="MsoBodyTextIndent2" style="line-height: 150%; margin: 0cm 0cm 0.0001pt; text-indent: 36pt;">
<i><span style="font-style: normal;">Kolaps alveoli akan mengakibatkan penyempitan jalan napas, sesak napas,
dan napas ronchi. Fibrosis bisa menyebabkan penurunan fungsi paru dan penurunan
produksi surfaktan sebagai pelumas yang berpungsi untuk melembabkan rongga
fleura. Emfisema (tertimbunnya cairan atau pus dalam rongga paru) adalah tindak
lanjut dari pembedahan. Atelektasis mngakibatkan peningkatan frekuensi napas,
hipoksemia, acidosis respiratori, pada klien terjadi sianosis, dispnea dan
kelelahan yang akan mengakibatkan terjadinya gagal napas. Secara singkat
patofisiologi dapat digambarkan pada skema proses. <o:p></o:p></span></i></div>
<div class="MsoBodyTextIndent2" style="font-family: Times,"Times New Roman",serif; line-height: 150%; margin: 0cm 0cm 0.0001pt; text-indent: 36pt;">
<span style="font-size: small;"><br /></span></div>
<h4 style="line-height: 150%; margin: 0cm 0cm 0.0001pt;">
<span style="font-family: Times,"Times New Roman",serif; font-size: small;"><i>Manifestasi Klinis</i></span><br /><i><span style="font-size: 12pt; font-style: normal; line-height: 150%;"><o:p></o:p></span></i></h4>
<div class="MsoBodyTextIndent2" style="line-height: 150%; margin: 0cm 0cm 0.0001pt; text-indent: 36pt;">
<i><span style="font-style: normal;">Biasanya didahului infeksi traktus respiratorius bagian atas. Penyakit
ini umumnya timbul mendadak, suhu meningkat 39-40O C disertai menggigil, napas
sesak dan cepat, batuk-batuk yang non produktif “napas bunyi” pemeriksaan paru
saat perkusi redup, saat auskultasi suara napas ronchi basah yang halus dan nyaring.<o:p></o:p></span></i></div>
<div class="MsoNormal" style="line-height: 150%; text-indent: 36pt;">
<i><span style="font-style: normal;">Batuk pilek yang mungkin
berat sampai terjadi insufisiensi pernapasan dimulai dengan infeksi saluran
bagian atas, penderita batuk kering, sakit kepala, nyeri otot, anoreksia dan
kesulitan menelan.<o:p></o:p></span></i></div>
<div class="MsoNormal" style="line-height: 150%;">
<i><span style="font-style: normal;">Pemeriksaan penunjang<o:p></o:p></span></i></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54pt; text-indent: -18pt;">
<i><span style="font-style: normal;">1. Pengambilan
sekret secara broncoscopy dan fungsi paru untuk preparasi langsung, biakan dan
test resistensi dapat menemukan atau mencari etiologinya, tetapi cara ini tidak
rutin dilakukan karena sukar.<o:p></o:p></span></i></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54pt; text-indent: -18pt;">
<i><span style="font-style: normal;">2. Secara
laboratorik ditemukan leukositosis biasa 15.000 – 40.000 / m dengan pergeseran
LED meninggi.<o:p></o:p></span></i></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54pt; text-indent: -18pt;">
<i><span style="font-style: normal;">3. Foto
thorax bronkopeumoni terdapat bercak-bercak infiltrat pada satu atau beberapa
lobus, jika pada pneumonia lobaris terlihat adanya konsolidasi pada satu atau
beberapa lobus.<o:p></o:p></span></i></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54pt; text-indent: -18pt;">
<br /></div>
<div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; line-height: 150%;">
<span style="font-size: small; font-style: normal;"><i><b>Penatalaksanaan</b></i></span></div>
<div class="MsoBodyTextIndent2" style="line-height: 150%; margin: 0cm 0cm 0.0001pt; text-indent: 36pt;">
<i><span style="font-style: normal;">Kemotherapi untuk mycoplasma pneumonia, dapat diberikan Eritromicin 4 X
500 mg sehari atau Tetrasiklin 3 – 4 mg sehari.<o:p></o:p></span></i></div>
<div class="MsoNormal" style="line-height: 150%; text-indent: 36pt;">
<i><span style="font-style: normal;">Obat-obatan ini
meringankan dan mempercepat penyembuhan terutama pada kasus yang berat.
Obat-obat penghambat sintesis SNA (Sintosin Antapinosin dan Indoksi Urudin) dan
interperon inducer seperti polinosimle, poliudikocid.<o:p></o:p></span></i></div>
<div class="MsoNormal" style="line-height: 150%;">
<i><span style="font-style: normal;">Pengobatan simtomatik seperti :<o:p></o:p></span></i></div>
<ol start="6" style="margin-top: 0cm;" type="1"><ol start="1" style="margin-top: 0cm;" type="1">
<li class="MsoNormal" style="line-height: 150%;"><i><span style="font-style: normal;">Istirahat, umumnya penderita tidak perlu dirawat, cukup istirahat
dirumah.<o:p></o:p></span></i></li>
<li class="MsoNormal" style="line-height: 150%;"><i><span style="font-style: normal;">Simptomatik terhadap batuk.<o:p></o:p></span></i></li>
<li class="MsoNormal" style="line-height: 150%;"><i><span style="font-style: normal;">Batuk yang produktif jangan ditekan dengan antitusif<o:p></o:p></span></i></li>
<li class="MsoNormal" style="line-height: 150%;"><i><span style="font-style: normal;">Bila terdapat obstruksi jalan napas, dan lendir serta ada febris,
diberikan broncodilator.<o:p></o:p></span></i></li>
<li class="MsoNormal" style="line-height: 150%;"><i><span style="font-style: normal;">Pemberian oksigen umumnya tidak diperlukan, kecuali untuk kasus
berat. Antibiotik yang paling baik adalah antibiotik yang sesuai dengan
penyebab yang mempunyai spektrum sempit.<o:p></o:p></span></i></li>
</ol>
</ol>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72pt;">
<br /></div>
<h4 style="line-height: 150%; margin: 0cm 0cm 0.0001pt;">
<span style="font-family: Times,"Times New Roman",serif; font-size: small;"><i><b>Komplikasi</b></i></span><i><span style="font-size: 12pt; font-style: normal; line-height: 150%;"><br /><o:p></o:p></span></i></h4>
<div class="MsoBodyTextIndent" style="line-height: 150%; margin: 0cm 0cm 0.0001pt;">
<i><span style="font-style: normal;">Komplikasi
dari bronchopneumonia adalah :<o:p></o:p></span></i></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54pt; text-indent: -18pt;">
<i><span style="font-style: normal;">a. Atelektasis
adalah pengembangan paru-paru yang tidak sempurna atau kolaps paru merupakan
akibat kurangnya mobilisasi atau refleks batuk hilang.<o:p></o:p></span></i></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54pt; text-indent: -18pt;">
<i><span style="font-style: normal;">b. Empisema
adalah suatu keadaan dimana terkumpulnya nanah dalam rongga pleura terdapat di
satu tempat atau seluruh rongga pleura.<o:p></o:p></span></i></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54pt; text-indent: -18pt;">
<i><span style="font-style: normal;">c. Abses
paru adalah pengumpulan pus dalam jaringan paru yang meradang.<o:p></o:p></span></i></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54pt; text-indent: -18pt;">
<i><span style="font-style: normal;">d. Infeksi
sitemik <o:p></o:p></span></i></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54pt; text-indent: -18pt;">
<i><span style="font-style: normal;">e. Endokarditis
yaitu peradangan pada setiap katup endokardial.<o:p></o:p></span></i></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54pt; text-indent: -18pt;">
<i><span style="font-style: normal;">f. Meningitis
yaitu infeksi yang menyerang selaput otak.<o:p></o:p></span></i></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54pt; text-indent: -18pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<i><span style="font-style: normal;">Tumbuh kembang anak usia 6 – 12 tahun <o:p></o:p></span></i></div>
<div class="MsoNormal" style="line-height: 150%; text-indent: 36pt;">
<i><span style="font-style: normal;">Pertumbuhan merupakan
proses bertambahnya ukuran berbagai organ fisik berkaitan dengan masalah
perubahan dalam jumlah, besar, ukuran atau dimensi tingkat sel. Pertambahan
berat badan 2 – 4 Kg / tahun dan pada anak wanita sudah mulai mengembangkan
ciri sex sekundernya.<o:p></o:p></span></i></div>
<div class="MsoNormal" style="line-height: 150%; text-indent: 36pt;">
<i><span style="font-style: normal;">Perkembangan
menitikberatkan pada aspek diferensiasi bentuk dan fungsi termasuk perubahan
sosial dan emosi.<o:p></o:p></span></i></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; text-indent: -18pt;">
<i><span style="font-style: normal;">a.<span style="font: 7pt "Times New Roman";"> </span></span></i><i><span lang="IN" style="font-style: normal;">Motorik
kasar</span></i><i><span style="font-style: normal;"><o:p></o:p></span></i></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 49.65pt; text-indent: -16.9pt;">
<i><span style="font-style: normal;">1. Loncat
tali<o:p></o:p></span></i></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 49.65pt; text-indent: -16.9pt;">
<i><span style="font-style: normal;">2. Badminton<o:p></o:p></span></i></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 49.65pt; text-indent: -16.9pt;">
<i><span style="font-style: normal;">3. Memukul<o:p></o:p></span></i></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 49.65pt; text-indent: -16.9pt;">
<i><span style="font-style: normal;">4. Motorik
kasar dibawah kendali kognitif dan secara bertahap meningkatkan irama dan
kehalusan.<o:p></o:p></span></i></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; text-indent: -18pt;">
<i><span style="font-style: normal;">b.<span style="font: 7pt "Times New Roman";"> </span></span></i><i><span lang="IN" style="font-style: normal;">Motorik
halus</span></i><i><span style="font-style: normal;"><o:p></o:p></span></i></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72pt; text-indent: -18pt;">
<i><span style="font-style: normal;">1. Menunjukan
keseimbangan dan koordinasi mata dan tangan<o:p></o:p></span></i></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72pt; text-indent: -18pt;">
<i><span style="font-style: normal;">2. Dapat
meningkatkan kemampuan menjahit, membuat model dan bermain alat musik.<o:p></o:p></span></i></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; text-indent: -18pt;">
<i><span style="font-style: normal;">c.<span style="font: 7pt "Times New Roman";"> </span></span></i><i><span lang="IN" style="font-style: normal;">Kognitif</span></i><i><span style="font-style: normal;"><o:p></o:p></span></i></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72pt; text-indent: -18pt;">
<i><span style="font-style: normal;">1. Dapat
berfokus pada lebih dari satu asfek dan situasi<o:p></o:p></span></i></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72pt; text-indent: -18pt;">
<i><span style="font-style: normal;">2. Dapat
mempertimbangkan sejumlah alternatif dalam pemecahan masalah<o:p></o:p></span></i></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72pt; text-indent: -18pt;">
<i><span style="font-style: normal;">3. Dapat
membalikan cara kerja dan melacak urutan kejadian kembali sejak awal<o:p></o:p></span></i></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72pt; text-indent: -18pt;">
<i><span style="font-style: normal;">4. Dapat
memahami konsep dahulu, sekarang dan yang akan dating<o:p></o:p></span></i></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; text-indent: -18pt;">
<i><span style="font-style: normal;">d.<span style="font: 7pt "Times New Roman";"> </span></span></i><i><span lang="IN" style="font-style: normal;">Bahasa</span></i><i><span style="font-style: normal;"><o:p></o:p></span></i></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72pt; text-indent: -18pt;">
<i><span style="font-style: normal;">1. Mengerti
kebanyakan kata-kata abstrak<o:p></o:p></span></i></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72pt; text-indent: -18pt;">
<i><span style="font-style: normal;">2. Memakai
semua bagian pembicaraan termasuk kata sifat, kata keterangan, kata penghubung
dan kata depan<o:p></o:p></span></i></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72pt; text-indent: -18pt;">
<i><span style="font-style: normal;">3. Menggunakan
bahasa sebagai alat komuniukasi verbal<o:p></o:p></span></i></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72pt; text-indent: -18pt;">
<i><span style="font-style: normal;">4. Dapat
memakai kalimat majemuk dan gabungan <o:p></o:p></span></i></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72pt; text-indent: -18pt;">
<i><span style="font-style: normal;"><o:p> </o:p></span></i></div>
<h1 style="line-height: 150%; margin: 0cm 0cm 0.0001pt;">
<b><span style="font-size: 12pt; font-style: normal; line-height: 150%;"><span style="font-weight: normal;"></span></span></b><span style="font-family: Times,"Times New Roman",serif; font-size: small; font-style: normal; line-height: 150%;"><span style="font-weight: normal;"><i><b>Dampak Hospitalisasi</b></i></span></span><i><span style="font-size: 12pt; font-style: normal; line-height: 150%;"><span style="font-weight: normal;"><br /></span><o:p></o:p></span></i></h1>
<div class="MsoNormal" style="line-height: 150%; text-indent: 36pt;">
<i><span style="font-style: normal;">Hospitalisasi atau sakit
dan dirawat di RS bagi anak dan keluarga akan menimbulkan stress dan tidak
merasa aman. Jumlah dan efek stress tergantung pada persepsi anak dan keluarga
terhadap kerusakan penyakit dan pengobatan.<o:p></o:p></span></i></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36pt;">
<i><span style="font-style: normal;">Penyebab anak stress
meliputi ;<o:p></o:p></span></i></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54pt; text-indent: -18pt;">
<i><span style="font-style: normal;">1. Psikososial<o:p></o:p></span></i></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54pt;">
<i><span style="font-style: normal;">Berpisah dengan orang tua,
anggota keluarga lain, teman dan perubahan peran <o:p></o:p></span></i></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54pt; text-indent: -18pt;">
<i><span style="font-style: normal;">2. Fisiologis<o:p></o:p></span></i></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54pt;">
<i><span style="font-style: normal;">Kurang tidur, perasaan
nyeri, imobilisasi dan tidak mengontrol diri<o:p></o:p></span></i></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54pt; text-indent: -18pt;">
<i><span style="font-style: normal;">3. Lingkungan
asing<o:p></o:p></span></i></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54pt;">
<i><span style="font-style: normal;">Kebiasaan sehari-hari
berubah<o:p></o:p></span></i></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54pt; text-indent: -18pt;">
<i><span style="font-style: normal;">4. Pemberian
obat kimia<o:p></o:p></span></i></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36pt;">
<i><span style="font-style: normal;">Reaksi anak saat dirawat
di Rumah sakit usia sekolah (6-12 tahun)<o:p></o:p></span></i></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54pt; text-indent: -18pt;">
<i><span style="font-style: normal;">1. Merasa
khawatir akan perpisahan dengan sekolah dan teman sebayanya<o:p></o:p></span></i></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54pt; text-indent: -18pt;">
<i><span style="font-style: normal;">2. Dapat
mengekpresikan perasaan dan mampu bertoleransi terhadap rasa nyeri<o:p></o:p></span></i></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54pt; text-indent: -18pt;">
<i><span style="font-style: normal;">3. Selalu
ingin tahu alasan tindakan<o:p></o:p></span></i></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54pt; text-indent: -18pt;">
<i><span style="font-style: normal;">4. Berusaha
independen dan produktif<o:p></o:p></span></i></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36pt;">
<i><span style="font-style: normal;">Reaksi orang tua<o:p></o:p></span></i></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54pt; text-indent: -18pt;">
<i><span style="font-style: normal;">1. Kecemasan
dan ketakutan akibat dari seriusnya penyakit, prosedur, pengobatan dan
dampaknya terhadap masa depan anak<o:p></o:p></span></i></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54pt; text-indent: -18pt;">
<i><span style="font-style: normal;">2. Frustasi
karena kurang informasi terhadap prosedur dan pengobatan serta tidak
familiernya peraturan Rumah sakit</span></i><br />
<br />
<i><span style="font-style: normal;">Selengkapnya download <a href="http://www.ziddu.com/download/17980858/AsuhanKeperawatanpadaAnakdenganBronchopneumoni.docx.html" target="_blank">disini </a></span></i><br />
<i><span style="font-style: normal;"></span></i></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;">
<i><span style="font-style: normal;"></span></i></div>Anonymoushttp://www.blogger.com/profile/10554290151381141431noreply@blogger.com0tag:blogger.com,1999:blog-1998883467064803373.post-55488621143638488182012-01-11T22:24:00.000+07:002012-09-19T13:56:03.002+07:00Anemia Hemolitik<link href="file:///C:%5CDOCUME%7E1%5CAdmin%5CLOCALS%7E1%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_filelist.xml" rel="File-List"></link><link href="file:///C:%5CDOCUME%7E1%5CAdmin%5CLOCALS%7E1%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_themedata.thmx" rel="themeData"></link><link href="file:///C:%5CDOCUME%7E1%5CAdmin%5CLOCALS%7E1%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_colorschememapping.xml" rel="colorSchemeMapping"></link><m:smallfrac m:val="off"><m:dispdef><m:lmargin m:val="0"><m:rmargin m:val="0"><m:defjc m:val="centerGroup"><m:wrapindent m:val="1440"><m:intlim m:val="subSup"><m:narylim m:val="undOvr"></m:narylim></m:intlim></m:wrapindent></m:defjc></m:rmargin></m:lmargin></m:dispdef></m:smallfrac>
<br />
<div class="MsoNormal" style="font-family: Times,"Times New Roman",serif;">
<span style="font-size: small;"><b><span style="line-height: 115%;"><i>Definisi
</i><o:p></o:p></span></b></span></div>
<div class="MsoNormal" style="font-family: Times,"Times New Roman",serif;">
<span style="font-size: small;"><span style="line-height: 115%;">Anemia Hemolitik adalah penyakit kurang darah atau
anemia yang terjadi karena meningkatnya penghancuran sel darah merah. Pada
keadaan normal, sel darah merah mempunyai waktu hidup 120 hari.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="font-family: Times,"Times New Roman",serif;">
<span style="font-size: small;"><span style="line-height: 115%;">Pada anemia hemolitik ini terjadi penurunan usia sel
darah merah, baik sementara atau terus-menerus. Anemia ini terjadi apabila
sumsum tulang telah tidak mampu mengatasinya karena usia sel darah merah sangat
pendek, atau bila kemampuannya terganggu oleh sebab lain. Salah satunya jika
suatu penyakit menghancurkan sel darah merah sebelum waktunya (hemolisis),
sumsum tulang berusaha menggantinya dengan mempercepat pembentukan sel darah
merah yang baru, sampai 10 kali kecepatan normal. Jika penghancuran sel darah
merah melebihi pembentukannya, maka akan terjadi anemia hemolitik. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="font-family: Times,"Times New Roman",serif;">
<span style="font-size: small;"><b><span style="line-height: 115%;"><i>Etiologi</i><o:p></o:p></span></b></span></div>
<div class="MsoNormal" style="font-family: Times,"Times New Roman",serif;">
<span style="font-size: small;"><span style="line-height: 115%;">Etiologi anemia hemolitik dibedakan kedalam 2 bagian
sebagai berikut :</span><span style="line-height: 115%;"> </span></span></div>
<span style="font-size: small;"><span style="font-family: Times,"Times New Roman",serif; line-height: 115%;">Intrinsik</span><br style="font-family: Times,"Times New Roman",serif;" /><span style="font-family: Times,"Times New Roman",serif; line-height: 115%;"></span></span><br />
<ul style="font-family: Times,"Times New Roman",serif;">
<li><span style="font-size: small;"><span style="line-height: 115%;">Kelainan
membran, <u1:smallfrac u1:val="off"><u1:dispdef><u1:lmargin u1:val="0"><u1:rmargin u1:val="0"><u1:defjc u1:val="centerGroup"><u1:wrapindent u1:val="1440"><u1:intlim u1:val="subSup"><u1:narylim u1:val="undOvr"></u1:narylim></u1:intlim></u1:wrapindent>seperti
sferositosis herediter, hemoglobinuria nokturnal paroksismal.</u1:defjc></u1:rmargin></u1:lmargin></u1:dispdef></u1:smallfrac></span></span></li>
<li><span style="font-size: small;"><span style="line-height: 115%;"><u1:smallfrac u1:val="off"><u1:dispdef><u1:lmargin u1:val="0"><u1:rmargin u1:val="0"><u1:defjc u1:val="centerGroup"><o:p></o:p></u1:defjc></u1:rmargin></u1:lmargin></u1:dispdef></u1:smallfrac></span><span style="line-height: 115%;">Kelainan
glikolisis, <u1:smallfrac u1:val="off"><u1:dispdef><u1:lmargin u1:val="0"><u1:rmargin u1:val="0"><u1:defjc u1:val="centerGroup"><u1:wrapindent u1:val="1440"><u1:intlim u1:val="subSup"><u1:narylim u1:val="undOvr"></u1:narylim></u1:intlim></u1:wrapindent>seperti
defisiensi piruvat kinase.</u1:defjc></u1:rmargin></u1:lmargin></u1:dispdef></u1:smallfrac></span></span></li>
<li><span style="font-size: small;"><span style="line-height: 115%;"><u1:smallfrac u1:val="off"><u1:dispdef><u1:lmargin u1:val="0"><u1:rmargin u1:val="0"><u1:defjc u1:val="centerGroup"><o:p></o:p></u1:defjc></u1:rmargin></u1:lmargin></u1:dispdef></u1:smallfrac></span><span style="line-height: 115%;">Kelainan
enzim, <u1:smallfrac u1:val="off"><u1:dispdef><u1:lmargin u1:val="0"><u1:rmargin u1:val="0"><u1:defjc u1:val="centerGroup"><u1:wrapindent u1:val="1440"><u1:intlim u1:val="subSup"><u1:narylim u1:val="undOvr"></u1:narylim></u1:intlim></u1:wrapindent>seperti
defisiensi glukosa-6-fosfat dehidrogenase (G6PD).</u1:defjc></u1:rmargin></u1:lmargin></u1:dispdef></u1:smallfrac></span></span></li>
<li><span style="font-size: small;"><span style="line-height: 115%;"><u1:smallfrac u1:val="off"><u1:dispdef><u1:lmargin u1:val="0"><u1:rmargin u1:val="0"><u1:defjc u1:val="centerGroup"><o:p></o:p></u1:defjc></u1:rmargin></u1:lmargin></u1:dispdef></u1:smallfrac></span><span style="line-height: 115%;">Hemoglobinopati,
<u1:smallfrac u1:val="off"><u1:dispdef><u1:lmargin u1:val="0"><u1:rmargin u1:val="0"><u1:defjc u1:val="centerGroup"><u1:wrapindent u1:val="1440"><u1:intlim u1:val="subSup"><u1:narylim u1:val="undOvr"></u1:narylim></u1:intlim></u1:wrapindent>seperti
anemia sel sabit, methemoglobinemia.<o:p></o:p></u1:defjc></u1:rmargin></u1:lmargin></u1:dispdef></u1:smallfrac></span></span></li>
</ul>
<div class="MsoNormal" style="font-family: Times,"Times New Roman",serif;">
<span style="font-size: small;"><span style="line-height: 115%;">Ekstinsik</span></span></div>
<ul style="font-family: Times,"Times New Roman",serif;">
<li><span style="font-size: small;"><span style="line-height: 115%;"></span><span style="line-height: 115%;">Gangguan
sistem imun, seperti pada penyakit autoimun, penyakit limfoproliferatif,
keracunan obat.</span></span></li>
<li><span style="font-size: small;"><span style="line-height: 115%;"><o:p></o:p></span><span style="line-height: 115%;">Mikroangiopati,
seperti pada purpura trombotik trombositopenik, koagulasi intravaskular
diseminata (KID).</span></span></li>
<li><span style="font-size: small;"><span style="line-height: 115%;"><o:p></o:p></span><span style="line-height: 115%;">Infeksi,
seperti akibat plasmodium, klostridium, borrelia.</span></span></li>
<li><span style="font-size: small;"><span style="line-height: 115%;"><o:p></o:p></span><span style="line-height: 115%;">Hipersplenisme</span></span></li>
<li><span style="font-size: small;"><span style="line-height: 115%;"><o:p></o:p></span><span style="line-height: 115%;">Luka bakar<o:p></o:p></span></span></li>
</ul>
<div class="MsoNormal" style="font-family: Times,"Times New Roman",serif;">
<span style="font-size: small;"><u1:smallfrac u1:val="off"><u1:dispdef><u1:lmargin u1:val="0"><u1:rmargin u1:val="0"><u1:defjc u1:val="centerGroup"><u1:wrapindent u1:val="1440"><u1:intlim u1:val="subSup"><u1:narylim u1:val="undOvr"></u1:narylim></u1:intlim></u1:wrapindent></u1:defjc></u1:rmargin></u1:lmargin></u1:dispdef></u1:smallfrac><i><b>Manifestasi
Klinis</b></i><span style="line-height: 115%;"><o:p></o:p></span></span></div>
<div class="MsoNormal" style="font-family: Times,"Times New Roman",serif;">
<span style="font-size: small;"><span style="line-height: 115%;">Tanda-tanda hemolisis antara lain ikterus dan
splenomegali.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="font-family: Times,"Times New Roman",serif;">
<span style="font-size: small;"><span style="line-height: 115%;">Gejala dari anemia hemolitik mirip dengan anemia
yang lainnya. Kadang-kadang hemolisis terjadi secara tiba-tiba dan berat,
menyebabkan krisis hemolitik, yang ditandai dengan: <br />
- demam <br />
- menggigil <br />
- nyeri punggung dan nyeri lambung <br />
- perasaan melayang <br />
- penurunan tekanan darah yang berarti. <br />
<br />
Sakit kuning (jaundice) dan air kemih yang berwarna gelap bisa terjadi karena
bagian dari sel darah merah yang hancur masuk ke dalam darah. Limpa membesar
karena menyaring sejumlah besar sel darah merah yang hancur, kadang menyebabkan
nyeri perut. Hemolisis yang berkelanjutan bisa menyebabkan batu empedu yang
berpigmen, dimana batu empedu berwarna gelap yang berasal dari pecahan sel
darah merah. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="font-family: Times,"Times New Roman",serif;">
<span style="font-size: small;"><span style="line-height: 115%;"><i><b>Pemeriksaan Penunjang</b></i><o:p></o:p></span></span></div>
<div class="MsoNormal" style="font-family: Times,"Times New Roman",serif;">
<span style="font-size: small;"><span style="line-height: 115%;">Terjadi penurunan kadar Ht, retikulositosis,
peninggian bilirubin indirek dalam darah dan peningkatan bilirubin total sampai
dengan 4 mg/dl, peninggian urobilinogen urin.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="font-family: Times,"Times New Roman",serif;">
<span style="font-size: small;"><u1:smallfrac u1:val="off"><u1:dispdef><u1:lmargin u1:val="0"><u1:rmargin u1:val="0"><u1:defjc u1:val="centerGroup"><u1:wrapindent u1:val="1440"><u1:intlim u1:val="subSup"><u1:narylim u1:val="undOvr"></u1:narylim></u1:intlim></u1:wrapindent></u1:defjc></u1:rmargin></u1:lmargin></u1:dispdef></u1:smallfrac><i><b>Penatalaksanaan</b></i><o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"><span style="font-size: small;"><span style="font-family: Times,"Times New Roman",serif;">Penatalaksanaan anemia hemolitik disesuaikan dengan
penyebabnya. Bila karena reaksi toksik-imunologik yang dapat diberikan adalah
kortikosteroid (prednison, prednisolon), kalau perlu dilakukan splenektomi.
Apabila keduanya tidak berhasil, dapat diberikan obat-obat sitostatik, seperti
klorambusil dan siklofosfamid. </span></span></span><br />
<br />
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lengkapnya teman-teman download aja Askep Anemia <a href="http://adf.ly/CyPsz" target="_blank">disini</a> </span></span></span></span></div>
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Anonymoushttp://www.blogger.com/profile/10554290151381141431noreply@blogger.com1tag:blogger.com,1999:blog-1998883467064803373.post-27986791308422507362012-01-11T11:38:00.000+07:002012-01-23T22:33:22.839+07:00Dilated Cardiomyopathy<link href="file:///C:%5CDOCUME%7E1%5CAdmin%5CLOCALS%7E1%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_filelist.xml" rel="File-List"></link><link href="file:///C:%5CDOCUME%7E1%5CAdmin%5CLOCALS%7E1%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_themedata.thmx" rel="themeData"></link><link href="file:///C:%5CDOCUME%7E1%5CAdmin%5CLOCALS%7E1%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_colorschememapping.xml" rel="colorSchemeMapping"></link>
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Dilated cardiomyopathy is a progressive disease of heart muscle that is
characterized by ventricular chamber enlargement and contractile dysfunction
with normal left ventricular (LV) wall thickness. The right ventricle may also
be dilated and dysfunctional. Dilated cardiomyopathy is the third most common
cause of heart failure and the most frequent reason for heart transplantation. <br />
Dilated cardiomyopathy is 1 of the 3 traditional classes of cardiomyopathy,
along with hypertrophic and restrictive cardiomyopathy. However, the
classification of cardiomyopathies continues to evolve, based on the rapid
evolution of molecular genetics as well as the introduction of recently
described diseases. <br />
Multiple causes of dilated cardiomyopathy exist, one or more of which may be
responsible for an individual case of the disease (see Etiology). All alter the
normal muscular function of the myocardium, which prompts varying degrees of
physiologic compensation for that malfunction. <br />
The degree and time course of malfunction are variable and do not always
coincide with a linear expression of symptoms. Persons with cardiomyopathy may
have asymptomatic LV systolic dysfunction, LV diastolic dysfunction, or both.
When compensatory mechanisms can no longer maintain cardiac output at normal LV
filling pressures, the disease process is expressed with symptoms that
collectively compose the disease state known as chronic
heart failure (CHF). <br />
Continuing ventricular enlargement and dysfunction generally leads to
progressive heart failure with further decline in LV contractile function.
Sequelae include ventricular and supraventricular arrhythmias, conduction
system abnormalities, thromboembolism, and sudden death or heart
failure–related death. <br />
Cardiomyopathy is a complex disease process that can affect the heart of a
person of any age, but it is especially important as a cause of morbidity and
mortality among the world's aging population. It is the most common diagnosis
in persons receiving supplemental medical financial assistance via the US
Medicare program. <br />
Nonpharmacologic interventions are the basis of heart failure therapy.
Instruction on a sodium diet restricted to 2 g/day is very important and can
often eliminate the need for diuretics or permit the use of reduced dosages.
Fluid restriction is complementary to a low-sodium diet. Patients should be
enrolled in cardiac rehabilitation involving aerobic exercise. <br />
For patient education information, see the Heart
Center, as well as Congestive
Heart Failure.<br />
</m:defjc></m:rmargin></m:lmargin></m:dispdef></m:smallfrac></m:defjc></m:rmargin></m:lmargin></m:dispdef></m:smallfrac><br />
<div class="MsoNormal" style="line-height: normal;">
</div>
<div class="MsoNormal" style="line-height: normal;">
<b><span style="font-family: "Times New Roman","serif"; font-size: 13.5pt;"><i>Pathophysiology</i><o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Dilated cardiomyopathy is
characterized by ventricular chamber enlargement and systolic dysfunction with
greater LV cavity size with little or no wall hypertrophy. Hypertrophy is
judged as the ratio of LV mass to cavity size; this ratio is decreased in
persons with dilated cardiomyopathies. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">The enlargement of the remaining
heart chambers is primarily due to LV failure, but it may be secondary to the
primary cardiomyopathic process. Dilated cardiomyopathies are associated with
both systolic and diastolic dysfunction. The decrease in systolic function is
by far the primary abnormality. This leads to an increase in the end-diastolic
and end-systolic volumes. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Progressive dilation can lead to
significant mitral and tricuspid regurgitation, which may further diminish the
cardiac output and increase end-systolic volumes and ventricular wall stress.
In turn, this leads to further dilation and myocardial dysfunction. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Early compensation for systolic
dysfunction and decreased cardiac output is accomplished by increasing the stroke
volume, the heart rate, or both (cardiac output = stroke volume ´ heart rate),
which is also accompanied by an increase in peripheral vascular tone. The
increase in peripheral tone helps maintain appropriate blood pressure. Also
observed is an increased tissue oxygen extraction rate with a shift in the
hemoglobin dissociation curve. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">The basis for compensation of low
cardiac output is explained by the Frank-Starling Law, which states that
myocardial force at end-diastole compared with end-systole increases as muscle
length increases, thereby generating a greater amount of force as the muscle is
stretched. Overstretching, however, leads to failure of the myocardial
contractile unit. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">These compensatory mechanisms are
blunted in persons with dilated cardiomyopathies, as compared with persons with
normal LV systolic function. Additionally, these compensatory mechanisms lead
to further myocardial injury, dysfunction, and geometric remodeling (concentric
or eccentric). <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal;">
<b><span style="font-family: "Times New Roman","serif"; font-size: 13.5pt;">Neurohormonal
activation<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Decreased cardiac output with
resultant reductions in organ perfusion results in neurohormonal activation,
including stimulation of the adrenergic nervous system and the
renin-angiotensin-aldosterone system (RAAS). Additional factors important to
compensatory neurohormonal activation include the release of arginine
vasopressin and the secretion of natriuretic peptides. Although these responses
are initially compensatory, they ultimately lead to further disease
progression. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Alterations in the adrenergic
nervous system induce significant increases in circulating levels of dopamine
and, especially, norepinephrine. By increasing sympathetic tone and decreasing
parasympathetic activity, an increase in cardiac performance (beta-adrenergic
receptors) and peripheral tone (alpha-adrenergic receptors) is attempted. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Unfortunately, long-term exposure to
high levels of catecholamines leads to down-regulation of receptors in the
myocardium and blunting of this response. The response to exercise in reference
to circulating catecholamines is also blunted. Theoretically, the increased
catecholamine levels observed in cardiomyopathies due to compensation may in
themselves be cardiotoxic and lead to further dysfunction. In addition,
stimulation of the alpha-adrenergic receptors, which leads to increased
peripheral vascular tone, increases the myocardial workload, which can further
decrease cardiac output. Circulating norepinephrine levels have been inversely
correlated with survival. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Activation of the RAAS is a critical
aspect of neurohormonal alterations in persons with CHF. Angiotensin II
potentiates the effects of norepinephrine by increasing systemic vascular
resistance. It also increases the secretion of aldosterone, which facilitates
sodium and water retention and may contribute to myocardial fibrosis. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">The release of arginine vasopressin
from the hypothalamus is controlled by both osmotic (hyponatremia) and
nonosmotic stimuli (eg, diuresis, hypotension, angiotensin II). Arginine
vasopressin may potentiate the peripheral vascular constriction because of the
aforementioned mechanisms. Its actions in the kidneys reduce free-water
clearance. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Natriuretic peptide levels are
elevated in individuals with dilated cardiomyopathy. Natriuretic peptides in
the human body include atrial natriuretic peptide (ANP), brain natriuretic
peptide (BNP), and C-type natriuretic peptide. ANP is primarily released by the
atria (mostly the right atrium). Right atrial stretch is an important stimulus
for its release. The effects of ANP include vasodilation, possible attenuation
of cell growth, diuresis, and inhibition of aldosterone. Although BNP was
initially identified in brain tissue (hence its name), it is secreted from
cardiac ventricles in response to volume or pressure overload. As a result, BNP
levels are elevated in patients with CHF. BNP causes vasodilation and
natriuresis. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Counterregulatory responses to
neurohormonal activation involve increased release of prostaglandins and
bradykinins. These do not significantly counteract the previously described
compensatory mechanisms. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">The body's compensatory mechanisms
for a failing heart are evidently shortsighted. Compensation for decreased
cardiac output cannot be sustained without inducing further decompensation. The
rationale for the most successful medical treatment modalities for
cardiomyopathies is therefore based on altering these neurohormonal responses. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal;">
<b><span style="font-family: "Times New Roman","serif"; font-size: 13.5pt;">Circulating
cytokines as mediators of myocardial injury<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Tissue necrosis factor-alpha
(TNF-alpha) is involved in all forms of cardiac injury. In cardiomyopathies,
TNF-alpha has been implicated in the progressive worsening of ventricular
function, but the complete mechanism of its actions is poorly understood.
Progressive deterioration of LV function and cell death (TNF plays a role in
apoptosis) are implicated as some of the mechanisms of TNF-alpha. It also
directly depresses myocardial function in a synergistic manner with other
interleukins. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Elevated levels of several
interleukins have been found in patients with left ventricular dysfunction.
Interleukin (IL)–1b has been shown to depress myocardial function. One theory
is that elevated levels of IL-2R in patients with class IV CHF suggest that
T-lymphocytes play a role in advanced stages of heart failure. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">IL-6 stimulates hepatic production
of C-reactive protein, which serves as a marker of inflammation. IL-6 has also
been implicated in the development of myocyte hypertrophy, and elevated levels
have been found in patients with CHF. IL-6 has been found to correlate with
hemodynamic measures in persons with left ventricular dysfunction. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal;">
<b><span style="font-family: "Times New Roman","serif"; font-size: 13.5pt;"><i>Etiology</i><o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Cardiomyopathy has many causes,
including inherited disease, infections, and toxins. Finding a specific cause
for an individual case may be difficult, especially in patients with multiple
risk factors. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Causes of dilated cardiomyopathy
include the following:<o:p></o:p></span></div>
<ul type="disc">
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Genetics<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Secondary to other cardiovascular disease: ischemia,
hypertension, valvular disease, tachycardia induced<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Infectious: viral, rickettsial, bacterial, fungal,
metazoal, protozoal<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Probable infectious: Whipple disease, Lyme disease<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Metabolic: endocrine diseases (eg, hyperthyroidism,
hypothyroidism, acromegaly, myxedema, hypoparathyroidism,
hyperparathyroidism), diabetes mellitus, electrolyte imbalance (eg,
potassium, phosphate, magnesium) <o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Nutritional: thiamine deficiency (beriberi), protein
deficiency, starvation, carnitine deficiency<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Toxic: drugs, poisons, foods, anesthetic gases, heavy
metals, ethanol<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Collagen vascular disease<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Infiltrative: hemochromatosis, amyloidosis, glycogen
storage disease<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Granulomatous (sarcoidosis)<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Physical agents: extreme temperatures, ionizing
radiation, electric shock, nonpenetrating thoracic injury<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Neuromuscular disorders: muscular dystrophy
(limb-girdle [Erb dystrophy], Duchenne dystrophy, fascioscapulohumeral
[Landouzy-Dejerine dystrophy]), Friedreich disease, myotonic dystrophy <o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Primary cardiac tumor (myxoma)<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Senile<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Peripartum<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Immunologic: postvaccination, serum sickness,
transplant rejection<o:p></o:p></span></li>
</ul>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">The frequency of different causes of
cardiomyopathy varies with geographic location. Traditionally, ischemic
cardiomyopathy is listed as the most common cause of cardiomyopathy in North
America and Europe. In Africa, idiopathic congestive cardiomyopathy and
cardiomyopathy from endomyocardial fibrosis and from rheumatic heart disease
all are more prevalent than cardiomyopathy caused by atherosclerotic coronary
artery disease. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">In many cases of dilated
cardiomyopathy, the cause remains unexplained. However, some idiopathic cases
may result from failure to identify known causes such as infections or toxins.
The idiopathic category should continue to diminish as more information
explaining pathophysiologic mechanisms, specifically genetic-environmental
interactions, becomes available. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Toxins are a significant cause.
Almost a third of cases may result from severe ethanol abuse.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal;">
<b><span style="font-family: "Times New Roman","serif"; font-size: 13.5pt;">Viral
myocarditis<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Viral myocarditis is an important
entity within the category of infectious cardiomyopathy. Viruses have been
implicated in cardiomyopathies as early as the 1950s, when coxsackievirus B was
isolated from the myocardium of a newborn baby with a fatal infection. Advances
in genetic analysis, such as polymerase chain reaction testing, have aided in
the discovery of several viruses that are believed to have roles in viral cardiomyopathies.
<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Viral infections and viruses
associated with myocardial disease may be caused by the following:<o:p></o:p></span></div>
<ul type="disc">
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Coxsackievirus (A and B)<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Influenza virus (A and B)<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Adenovirus<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Echovirus<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Rabies<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Hepatitis<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Yellow fever<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Lymphocytic choriomeningitis<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Epidemic hemorrhagic fever<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Chikungunya fever<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Dengue fever<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Cytomegalovirus<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Epstein-Barr virus<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Rubeola<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Rubella<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Mumps<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Respiratory syncytial virus<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Varicella-zoster virus<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Human immunodeficiency virus<o:p></o:p></span></li>
</ul>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Viral myocarditis can produce
variable degrees of illness, ranging from focal disease to diffuse pancarditis
involving myocardium, pericardium, and valve structures. Viral myocarditis is
usually a self-limited, acute-to-subacute disease of the heart muscle. Symptoms
are similar to those of CHF and often are subclinical. Many patients experience
a flulike prodrome. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Confirming the diagnosis can be
difficult because symptoms of heart failure can occur several months after the
initial infection. Patients with viral myocarditis (median age, 42 years) are
generally healthy and have no systemic disease. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Acute viral myocarditis can mimic
acute myocardial infarction, with patients sometimes presenting in the
emergency department with chest pain; nonspecific electrocardiographic (ECG)
changes; and abnormal, often highly elevated serum markers such as troponin,
creatine kinase, and creatine kinase-MB.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">The diagnosis of viral myocarditis
is mainly indicated by a compatible history and the absence of other potential
etiologies, particularly if it can be confirmed with acute or convalescent
sera. An ECG demonstrates varying degrees of ST-T wave changes reflecting
myocarditis and, sometimes, varying degrees of conduction disturbances.
Echocardiography is a crucial aid in classifying this disease process, which
manifests mostly as a dilated type of cardiomyopathy. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Myocarditis is almost always a
clinically presumed diagnosis because it is not associated with any
pathognomonic sign or specific, acute diagnostic laboratory test result. In the
past, percutaneous transvenous right ventricular endomyocardial biopsy has been
used, but the Myocarditis Treatment Trial revealed no advantage for
immunosuppressive therapy in biopsy-proven myocarditis, so biopsy is not
routinely performed in most cases.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">If a patient is thought to have
viral myocarditis, the initial diagnostic strategies should be to evaluate
cardiac troponin I or T levels and to perform antimyosin scintigraphy. Positive
troponin I or T findings in the absence of myocardial infarction and the proper
clinical setting confirm acute myocarditis. Negative antimyosin scintigraphy
findings exclude active myocarditis. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">The exact mechanism for myocardial
injury in viral cardiomyopathy is controversial. Several mechanisms have been
proposed based on animal models. Viruses affect myocardiocytes by direct
cytotoxic effects and by cell-mediated (T-helper cells) destruction of
myofibers. Other mechanisms include disturbances in cellular metabolism,
vascular supply of myocytes, and other immunologic mechanisms.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Viral myocarditis may resolve over
several months during the treatment of left ventricular systolic dysfunction.
However, it can progress to a chronic cardiomyopathy. The main issue in
recovery is ventricular size. Reduction of ventricular size is associated with
long-term improvement; otherwise, the course of the disease is characterized by
progressive dilation. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Because of an immunologic mechanism
of myocyte destruction, several trials have investigated the use of
immunomodulatory medications. (Other trials are currently being conducted.)
According to Mason et al in 1995, the Myocarditis Treatment Trial demonstrated
no survival benefit with prednisone plus cyclosporine or azathioprine in
patients with viral (lymphocytic) myocarditis.<u><sup><span style="color: blue;">
</span></sup></u> Randomized trials are
under way to evaluate intravenous immunoglobulin as treatment for viral
myocarditis. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal;">
<b><span style="font-family: "Times New Roman","serif"; font-size: 13.5pt;">Familial
cardiomyopathy<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Familial cardiomyopathy is a term
that collectively describes several different inherited forms of heart failure.
Familial dilated cardiomyopathy is diagnosed in patients with idiopathic
cardiomyopathy who have 2 or more first- or second-degree relatives with the
same disease (without defined etiology). Establishing a diagnosis with more-distant
affected relatives (third degree and greater) simply requires identifying more
family members with the same disease. Genetic screening has been recommended
for patients fulfilling the above criteria. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">A study by van Spaendonck-Zwarts et
al suggested that a subset of peripartum cardiomyopathy is an initial
manifestation of familial dilated cardiomyopathy. This may have important
implications for cardiologic screening in such families.<u><sup><span style="color: blue;"> </span></sup></u><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Several forms of familial
cardiomyopathy have been described, and theories postulate its association with
other causes of cardiomyopathy. Inheritance is autosomal dominant; however,
autosomal recessive and sex-linked inheritance have been reported. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Several different genes and
chromosomal aberrations have been described in studied families. One example is
the gene that codes for actin, a cardiac muscle fiber component. Other forms of
familial cardiomyopathy involve a strong association with conduction system
disease. As research continues, the knowledge database regarding familial
cardiomyopathies is likely to expand. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal;">
<b><span style="font-family: "Times New Roman","serif"; font-size: 13.5pt;">Doxorubicin-induced
cardiomyopathy<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Anthracyclines, which are widely
used as antineoplastic agents, have a high degree of cardiotoxicity and cause a
characteristic form of dose-dependent toxic cardiomyopathy. Both early acute
cardiotoxicity and chronic cardiomyopathy have been described with these
agents. Anthracyclines can also be associated with acute coronary spasm. The
acute toxicity can occur at any point from the onset of exposure to several
weeks after drug infusion. Radiation and other agents may potentiate the
cardiotoxic effects of anthracyclines. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Cardiac injury occurs even at doses
below the empiric limitation of 550 mg/m<sup>2</sup>. However, whether injury
results in clinical CHF varies. The development of heart failure is very rare
at total doses less than 450 mg/m<sup>2</sup> but is dose dependent. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">The history of these patients, in
addition to having classic heart failure symptoms or symptoms of acute
myocarditis, involves a previous history of malignancy and treatment with
doxorubicin.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Anatomically, these patients' hearts
vary from having bilaterally dilated ventricles to being of normal size. The
mechanism of myocardial injury is related to degeneration and atrophy of
myocardial cells, with loss of myofibrils and cytoplasmic vacuolization. The
generation of free radicals by doxorubicin has also been implicated.
Progressive deterioration is the norm for this toxic cardiomyopathy.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Prevention is based on limiting
dosing after 450 mg/m<sup>2</sup> and on serial functional assessments (ie,
resting and exercise evaluation of ejection fraction). The drug should be
discontinued if the ejection fraction is less than 0.45, if it falls by more
than 0.05 from baseline, or if it fails to increase by more than 0.05 with
exercise. Dexrazoxane is an iron-chelating agent approved by the FDA to reduce
toxicity; however, it increases the risk of severe myelosuppression. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal;">
<b><span style="font-family: "Times New Roman","serif"; font-size: 13.5pt;">Cardiomyopathy
associated with collagen-vascular disease<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Several collagen-vascular diseases
have been implicated in the development of cardiomyopathies. These include the
following: <o:p></o:p></span></div>
<ul type="disc">
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Rheumatoid arthritis<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Systemic lupus erythematosus<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Progressive systemic sclerosis<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Polymyositis<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">HLA-B12–associated cardiac disease<o:p></o:p></span></li>
</ul>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Diagnosis is based on identification
of the underlying disease in conjunction with appropriate clinical findings of
heart failure. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal;">
<b><span style="font-family: "Times New Roman","serif"; font-size: 13.5pt;">Granulomatous
cardiomyopathy (sarcoidosis)<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Endomyocardial biopsy may be helpful
in establishing the diagnosis, especially in sarcoidosis in which the
myocardium may be involved. Involvement may be patchy, resulting in a negative
biopsy finding. The diagnosis can also be made if some other tissue diagnosis
is possible or available in conjunction with the appropriate clinical picture
for heart failure. Cardiac involvement in sarcoidosis reportedly occurs in
approximately 20% of cases.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Patients have signs and symptoms of
sarcoidosis and CHF. Patients rarely present with CHF without evidence of
systemic sarcoid. Bilateral mediastinal, paratracheal, and/or hilar
lymphadenopathy may be evident.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Noncaseating granulomatous
infiltration of the myocardium occurs as with other organs affected by this
disease. Sarcoid granulomas can show a localized distribution within the
myocardium. The granulomas particularly affect the conduction system of the
heart, left ventricular free wall, septum, papillary muscles, and,
infrequently, heart valves. Fibrosis and thinning of the myocardium occurs as a
result of the infiltrative process affecting the normal function of the
myocardium.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Diagnosis involves finding
noncaseating granulomas from cardiac biopsy or other tissues. Often, patients
present with conduction disturbances or ventricular arrhythmias. In fact, in
patients with normal left ventricular function, these conduction disturbances
may be the primary clinical feature.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Treatment of cardiac sarcoidosis
with low-dose steroids may be beneficial, especially in patients with
progressive disease, conduction defects, or ventricular arrhythmias. The true
benefit is unknown because of the lack of placebo-controlled studies. This also
holds true for the use of other immunosuppressive agents (eg, chloroquine,
hydroxychloroquine, methotrexate) in the treatment of cardiac sarcoidosis. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal;">
<b><span style="font-family: "Times New Roman","serif"; font-size: 13.5pt;">Carnitine
deficiency<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">A carnitine transporter defect is
characterized by severely reduced transport of carnitine into skeletal muscle,
fibroblasts, and renal tubules. All children with dilated cardiomyopathy or
hypoglycemia and coma should be evaluated for this transporter defect because
it is readily amenable to therapy, which results in prolonged prevention of
cardiac failure. The prognosis for long-term survival in pediatric dilated
cardiomyopathy is poor. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal;">
<b><span style="font-family: "Times New Roman","serif"; font-size: 13.5pt;">Tachycardia-induced
cardiomyopathy<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Generally, this type of
cardiomyopathy is reversible once treatment of the tachycardia is successful.
Persistent tachycardia is known to lead to myocyte dysfunction and
cardiomyopathy. The exact mechanisms by which tachycardia affects cell function
are poorly understood. The following are possible mechanisms by which myocyte
dysfunction arises from tachycardia: <o:p></o:p></span></div>
<ul type="disc">
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Depletion of energy stores<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Abnormal calcium channel activity<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Abnormal subendocardial oxygen delivery secondary to
abnormalities in blood flow<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Reduced responsiveness to beta-adrenergic stimulation<o:p></o:p></span></li>
</ul>
<div class="MsoNormal">
<b><span style="font-family: "Times New Roman","serif"; font-size: 13.5pt; line-height: 115%;"><i>Epidemiology</i><o:p></o:p></span></b></div>
The true incidence of cardiomyopathies is unknown. As with other diseases,
authorities depend on reported cases (at necropsy or as a part of clinical
disease coding) to define the prevalence and incidence rates. The inconsistency
in nomenclature and disease coding classifications for cardiomyopathies has led
to collected data that only partially reflect the true incidence of these
diseases. <br />
Whether secondary to improved recognition or other factors, the incidence
and prevalence of cardiomyopathy appear to be increasing. The reported
incidence is 400,000-550,000 cases per year, with a prevalence of 4-5 million
people. <br />
Cardiomyopathy is a complex disease process that can affect the heart of a
person of any age, and clinical manifestations appear most commonly in the
third or fourth decade.<br />
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b><span style="font-family: "Times New Roman","serif"; font-size: 13.5pt; line-height: 115%;"><i>Prognosis</i><o:p></o:p></span></b></div>
Although some cases of dilated cardiomyopathy reverse with treatment of the
underlying disease, many progress inexorably to heart failure. With continued
decompensation, heart transplantation may be necessary. <br />
The prognosis for patients with heart failure depends on several factors,
with the etiology of disease being the primary factor. Other factors play
important roles in determining prognosis; for example, higher mortality rates
are associated with increased age, male sex, and severe CHF. Prognostic indices
include the New York Heart Association functional classification. <br />
The Framingham Heart Study found that approximately 50% of patients
diagnosed with CHF died within 5 years.<sup> </sup>Patients with severe heart
failure have more than a 50% yearly mortality rate. Patients with mild heart
failure have significantly better prognoses, especially with optimal medical
therapy.<br />
<br />
sources : http://emedicine.medscape.comAnonymoushttp://www.blogger.com/profile/10554290151381141431noreply@blogger.com0tag:blogger.com,1999:blog-1998883467064803373.post-43015713430864275102012-01-11T10:55:00.000+07:002012-01-23T22:34:42.434+07:00Cervical Cancer<link href="file:///C:%5CDOCUME%7E1%5CAdmin%5CLOCALS%7E1%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_filelist.xml" rel="File-List"></link><link href="file:///C:%5CDOCUME%7E1%5CAdmin%5CLOCALS%7E1%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_themedata.thmx" rel="themeData"></link><link href="file:///C:%5CDOCUME%7E1%5CAdmin%5CLOCALS%7E1%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_colorschememapping.xml" rel="colorSchemeMapping"></link>
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Cervical cancer is the second most common malignancy in women worldwide, and
it remains a leading cause of cancer-related death for women in developing
countries. In the United States, cervical cancer is relatively uncommon. (See
Epidemiology.) <br />
The incidence of invasive cervical cancer has declined steadily in the
United States over the past few decades; however, it continues to rise in many
developing countries. The change in the epidemiological trend in the United
States has been attributed to mass screening with Papanicolaou tests.
Furthermore, cervical cancer is a preventable disease, primarily with newly
approved human papillomavirus (HPV) vaccines and secondarily through treatment
of preinvasive disease. <br />
Papanicolaou test screening is recommended in women who meet screening
criteria, regardless of symptoms. However, symptoms, abnormal Papanicolaou test
results, or women with a gross lesion of the cervix are best evaluated with
colposcopy and biopsy. For further recommendations concerning cervical cancer
screening, evaluation and management of abnormal Papanicolaou test results, and
treatment of cervicalintraepithelial neoplasia (CIN) grade 1, see the American Society for Colposcopy and Cervical Pathology (ASCCP)
guidelines.<sup> </sup>Also
see Clinical and Workup.<br />
The treatment of cervical cancer varies with the stage of the disease. For
early invasive cancer, surgery is the treatment of choice. In more advanced
cases, radiation combined with chemotherapy is the current standard of care. In
patients with disseminated disease, chemotherapy or radiation provides symptom
palliation. (See Treatment.)<br />
<br />
<div class="MsoNormal">
<b><span style="font-family: "Times New Roman","serif"; font-size: 13.5pt; line-height: 115%;"><i>Etiology</i><o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Early epidemiological data
demonstrated a clear association between cervical cancer and sexual activity.
Major risk factors observed were sex at a young age, multiple sexual partners,
promiscuous male partners, and history of sexually transmitted diseases.
However, the search for a potential sexually transmitted carcinogen was
unsuccessful until breakthroughs in molecular biology enabled scientists to
detect viral genome in cervical cells. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Strong evidence now implicates human
papillomaviruses (HPVs) as prime suspects.<sup> </sup>HPV
viral DNA has been detected in more than 90% of premalignant and malignant
cervical lesions compared with a consistently lower percentage in controls.
Both animal data and molecular biologic evidence confirm the malignant
transformation potential of papilloma virus–induced lesions. Squamous
intraepithelial lesions (SILs) are found predominantly in younger women, while
invasive cancers are detected more often in women 10-15 years older, suggesting
slow progression of cancer. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">HPV infection occurs in a high
percentage of sexually active women. Most of these infections clear
spontaneously within months to a few years, and only a small proportion
progress to cancer. This means that other crucial factors must be involved in
the process of carcinogenesis. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Three main factors have been
postulated to influence the progression of low-grade SILs to high-grade SILs.
These include the type and duration of viral infection, with high-risk HPV type
and persistent infection predicting a higher risk for progression; host
conditions that compromise immunity, such as multiparity or poor nutritional
status; and environmental factors such as smoking, oral contraceptive use, or
vitamin deficiencies. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">In addition, various gynecologic
factors significantly increase the risk for cervical cancer. These include
early age of first intercourse and higher number of sexual partners. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal;">
<b><span style="font-family: "Times New Roman","serif"; font-size: 13.5pt;"><i>Human
papillomavirus</i><o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">HPV is a heterogeneous group of
viruses that contain closed circular double-stranded DNA. The viral genome
encodes 6 early open reading frame proteins (ie, E1, E2, E3, E4, E6, E7), which
function as regulatory proteins, and 2 late open reading frame proteins (ie,
L1, L2), which make up the viral capsid. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">To date, 77 different genotypes of
HPV have been identified and cloned, among which types 6, 11, 16, 18, 26, 31,
33, 35, 39, 42, 43, 44, 45, 51, 52, 53, 54, 55, 56, 58, 59, 66, and 68 have the
propensity to infect anogenital tissues. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">The HPVs that infect the human
cervix fall into 2 broad risk categories. The low-risk types, HPV 6b and 11,
are associated with low-grade SILs but are never found in invasive cancer. The
high-risk types, mostly HPV 16 and 18, are found in 50-80% of SILs and in up to
90% of invasive cancers. Although less common, types 31, 33, 35, 39, 45, 51,
52, 56, 58, 59, 68, 73, and 82 should also be considered carcinogenic. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">The major difference between the 2
types is that after infection, the low-risk HPVs are maintained as
extrachromosomal DNA episomes, while the high-risk HPV genome is found
integrated into the host cellular DNA. The recombination event often leaves E6
and E7 directly coupled to the viral promoter and enhancer sequences, allowing
their continued expression after integration. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Because E7 binds and inactivates the
Rb protein while E6 binds p53 and directs its degradation, the functional loss
of both <i>TP53</i> and the <i>RB</i> genes leads to resistance to apoptosis,
causing uncensored cell growth after DNA damage. This ultimately results in
progression to malignancy. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal;">
<b><span style="font-family: "Times New Roman","serif"; font-size: 13.5pt;"><i>Human
immunodeficiency virus</i><o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">The role of human immunodeficiency
virus (HIV) infection in the pathogenesis of cervical cancer is not fully
understood. Studies have shown a higher prevalence of HPV infection in
HIV-seropositive women than in seronegative women, and the HPV prevalence was
directly proportional to the severity of immunosuppression as measured by CD4
counts. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Impaired lymphocyte function has
been postulated to enhance latent or subclinical HPV activity, resulting in a
higher rate of persistent infection. Whether HIV has a synergistic effect on
HPV infection, either by direct molecular interaction or through an indirect
immunologic effect, remains unclear. <o:p></o:p></span></div>
<div class="MsoNormal">
<b><span style="font-family: "Times New Roman","serif"; font-size: 13.5pt; line-height: 115%;"><i>Epidemiology</i><o:p></o:p></span></b></div>
Cervical cancer is the second most common malignancy in women worldwide, and
it remains a leading cause of cancer-related death for women in developing
countries. In the United States, cervical cancer is relatively uncommon. The
incidence of invasive cervical cancer has declined steadily in the United
States over the past few decades; however, it continues to rise in many
developing countries. The change in the epidemiological trend in the United
States has been attributed to mass screening with Papanicolaou tests.<sup> </sup><br />
The American Cancer Society estimated that in the United States in 2010,
12,200 new cases of cervical cancer would be diagnosed.<sup> </sup>In addition,
more than 50,000 cases of carcinoma in situ are diagnosed each year.
Internationally, 500,000 new cases are diagnosed each year. Unlike the United
States, where the annual incidence is 6.8 cases or less per 100,000 women,
rates in parts of South America and Africa range as high as 52.8 cases per
100,000 women.<sup> </sup><br />
Forouzanfar et al performed annual age-specific assessments of cervical
cancer in 187 countries from 1980-2010. The global cervical cancer incidence
increased from 378,000 cases per year in 1980 to 454,000 cases per year in 2010
(annual rate of increase, 0.6%). Cervical cancer death rates have been decreasing,
but the disease still accounted for 200,000 deaths in 2010; 46,000 of these
women were aged 15-49 years in developing countries.<sup> </sup><br />
<h3>
<i>Race- and age-related demographics</i></h3>
In the United States, cervical cancer is more common in Hispanic, African
American, and Native American women than in white women. Additionally, women of
these races also have higher mortality from cervical cancers compared with
their white counterparts. The Center for Disease Control and Prevention’s
Surveillance of Screening-Detected Cancers (Colon and Rectum, Breast, and
Cervix)—United States, 2004–2006 reported that incidence rates of late-stage
cervical cancer were highest among women aged 50-79 years and Hispanics.<sup> </sup>However,
cervical cancer may be diagnosed in any woman of reproductive age.<br />
<br />
<div class="MsoNormal">
<b><span style="font-family: "Times New Roman","serif"; font-size: 13.5pt; line-height: 115%;"><i>Prognosis</i><o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Prognosis of cervical cancer depends
on disease stage. In general, the 5-year survival rates are as follows:<o:p></o:p></span></div>
<ul type="disc">
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Stage I - Greater than 90%<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Stage II - 60-80%<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Stage III - Approximately 50%<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Stage IV - Less than 30%<o:p></o:p></span></li>
</ul>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">The American Cancer Society
estimated that 4,210 women would die of cervical cancer in the United States in
2010.<sup> </sup>This
represents 1.3% of all cancer deaths and 6.5% of deaths from gynecologic
cancers. <o:p></o:p></span></div>
<div class="MsoNormal">
<b><span style="font-family: "Times New Roman","serif"; font-size: 13.5pt; line-height: 115%;"><i>Patien
Education</i><o:p></o:p></span></b></div>
Cervical cancer is overrepresented among underserved and minority groups in
the United States. It is imperative to increase awareness about the benefits of
Papanicolaou test screening in these groups.<br />
A Cochrane review found that the best approach to encourage women to undergo
cervical screening involved invitations, such as fixed or open appointments,
letters, telephone calls, verbal recommendations, prompts, and follow-up
letters.<sup> </sup>However,
these findings relate to screening in developed countries, and their relevance
to developing countries is unclear. Further studies are required to determine
the effectiveness of promising interventions, such as revealing in an
invitation letter the gender of the smear taker, using a health promotion
nurse, the use of lay outreach health workers, and intensive attempts at
recruitment. <br />
For patient education information, see the Cancer
and Tumors Center, Women's
Health Center, and Procedures
Center, as well as Cervical
Cancer, Pap Smear, and Colposcopy.<br />
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">sources : http://emedicine.medscape.com<o:p></o:p></span></div>Anonymoushttp://www.blogger.com/profile/10554290151381141431noreply@blogger.com1