Archive for » Mei, 2009 «

29
Mei
DIAGNOSIS NANDA
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Askep adalah singkatan dari Asuhan Keperawatan, istilah ini sangat familier sekali di kalangan mahasiswa keperawatan dan perawat, karena dalam ilmu keperawatan setiap akan, sedang dan setelah melakukan tindakan keperawatan kepada klien tidak lepas dengan askep, yang menjadi pedoman dalam memberikan pelayan kepada pasien/klien, baik di rumah sakit, di keluarga/ komunitas maupun di rumah.

Dibawah ini adalah DIAGNOSA NANDA (2005), yang dipakai dalam acuan membuat diagnosa keperawatan yang merupakan bagian dari asuhan keperawatan / ASKEP.

Taxonomy II : Domains, Kelas dan Diagnosis

A. Domain I : Promosi Kesehatan
Kelas 1 : Kesadaran akan Kesehatan : Rekognisi dari fungsi normal dan kesehatan
Kelas 2 : Managemen kesehatan : identifikasi, controlling, performing dan aktifitas yang terintegrasi untuk
memelihara sehat dan kesehatan

Diagnosa yang berhubungan
1. Manajemen regimen terapi efektif
2. Manajemen regimen terapi tak efektif
3. Manajemen regimen terapi keluarga tak efektif
4. Manajemen regimen terapi komuniti tak efektif
5. Perilaku mencari bantuan kesehatan
6. Pemeliharan kesehatan tak efektif
7. kerusakan pemeliharaan rumah
8. Kesiapan untuk meningkatkan Manajemen regimen terapi
9. Kesiapan untuk meningkatkan nutrisi
B. Domain 2 : Nutrisi
Aktifitas untuk mengambil, asimilasi dan menggunakan nutrient untuk keseimbangan jaringan, perbaikan jaringan dan memproduksi energi

Kelas 1 : Ingesti : mengambil makanan atau nutrient kedalam tubuh
Diagnosa yang berhubungan
1. Pola makan infant tak efektif
2. Kerusakan menelan
3. Ketidakseimbangan nutrisi : kurang dari kebutuhan tubuh
4. Ketidakseimbangan nutrisi : lebih dari kebutuhan tubuh
5. Risiko terhadap ketidakseimbangan nutrisi : lebih dari kebutuhan tubuh
Kelas 2 : Digesti : aktifitas fisik dan kimia yang mengubah bahan makanan menjadi substansi yang memungkinkan diabsorpsi dan dicerna

Kelas 3 : Absorpsi: kegiatan mengambil nutrisi menuju jaringan tubuh

Kelas 4 : Metabolisme :

Kelas 5 : Hidrasi : pengambilan dan absorpsi cairan dan elektrolit
Diagnosa yang berhubungan
1. Kurang volume cairan
2. Risiko untuk kurang volume cairan
3. Kelebihan volume cairan
4. Risiko untuk ketidakseimbangan volume cairan
5. Kesiapan untuk meningkatkan keseimbangan cairan
C. Domain 3: Eliminasi
Sekresi dan ekskresi terhadap produk akhir dari tubuh

Untuk lebih lengkapnya Silahkan Download  Diagnosis NANDA  DISINI

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22
Mei
TYROID DISEASE
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What is thyroid disease?

The thyroid gland is located in the base of the neck on both sides of the lower part of the voice box and upper part of the wind pipe. A hormone from the pituitary gland stimulates the thyroid, causing it to make thyroid hormone. A thyroid that is working as it should will maintain the right amount of hormones needed to keep the body’s metabolism working at a rate that is not too fast or too slow.

Thyroid disease occurs when the thyroid gland makes too much or too little thyroid hormone. Thyroid disease is divided into two catagories (Note: These are not the only forms of thyroid disease–there is also thyroid enlargement which can accompany either of these or be associated with normal thyroid function):

* Hyperthyroidism – Overproduction of thyroid hormone
* Hypothyroidism – Underproduction of thyroid hormone

What causes Hyperthyroidism and Hypothyroidism?

Hyperthyroidism occurs when the thyroid makes too much thryoid over a short or long period of time. Many diseases and conditions can cause this problem, including:

* Graves’ disease
* Noncancerous growths of the thyroid gland or pituitary gland
* Irritation and swelling of the thyroid due to inflammation or infection (thyroiditis)

Graves’ disease accounts for 85 percent of all cases of hyperthyroidism.

Hypothyroidism occurs when the thyroid gland fails to produce enough thyroid hormone. The most common cause of hypothyroidism is Hashimoto’s thyroiditis, a disease of the thyroid gland where the body’s immune system attacks the gland. Other causes include:

* Surgical removal of the thyroid
* Radiation to the neck, chest or brain or treatment with radioactive iodine
* Birth defects
* Inflammation of the gland due to a viral infection
* Inadequate production of the pituitary hormone that stimulates the thyroid
* Too much or too little iodine in the diet
* Some medications such as lithium or amiodarone

What are the symptoms of Hyperthyroidism and Hypothyroidism?

Hyperthyroidism symptoms include:

* Weight loss
* Increased appetite
* Nervousness
* Restlessness
* Heat intolerance
* Increased sweating
* Fatigue
* Frequent bowel movements
* Menstrual irregularities
* Enlarged thyroid
* Palpitations or irregular heartbeat

Hypothyroidism symptoms include:

(Early)

* Weakness
* Fatigue
* Cold intolerance
* Constipation
* Weight gain
* Depression
* Joint or muscle pain
* Thin, brittle fingernails
* Thin and brittle hair
* Paleness

(Late)

* Slow speech
* Dry, flaky skin
* Thickening of the skin
* Puffy face, hands, and feet
* Decreased taste and smell
* Thinning of eyebrows
* Hoarseness
* Abnormal menstrual periods

In addition to symptoms people with hypothyroidism may have increased cholesterol levels.
Should I get a Thyroid test?

“Yes,” says the American Thyroid Association (ATA). It recommends thyroid testing in all adults beginning at age 35, with follow-up testing every five years. Routine thyroid testing is advised because thyroid disease is very common. If detected early, it can be treated without delay.

According to the ATA, half of the people with thyroid problems do not they have them. Women are more likely then men to have thyroid disorders. Women on thyroid hormones should check thyroid hormone levels annually and more frequently during pregnancy. Excessive use of thyroid hormone can contribute to bone loss (osteoporosis).

If you have a family history of autoimmune disease, you are also more likely to have thyroid problems. In such a case, regular checkup of the thyroid gland is highly recommended.
How is thyroid disease diagnosed?

Thyroid disease can be difficult to diagnose because symptoms are shared with other common conditions. A diagnosis is usually made by taking a medical history and a physical exam. Your doctor will check your neck and ask you to lift up your chin. You may be asked to swallow during the exam, which helps to feel the thyroid and any mass in it. Other tests your doctor may include:

1. A blood test of thyroid function
2. A radioactive thyroid scan
3. A test to measure iodine uptake by the thyroid

A simple blood test measuring thyroid stimulating hormone (TSH) test can identify thyroid disorders even before symptoms begin. TSH screening is routinely performed in the United States on newborns as part of each state’s newborn screening program. When thyroid disease is caught early, treatment can control the disorder even before symptoms begin.
What is the treatment of Hyperthyroidism and Hypothyroidism?

Treatment for Hyperthyroidism depends on the cause of the condition and the severity of symptoms. It is usually treated with antithyroid medications, radioactive iodine (which destroys the thyroid and stops the excess production of hormones), or surgery to remove the thyroid.

If the thyroid must be removed with radiation or surgery, replacement thyroid hormones are taken for the rest of your life. Beta-blockers are used to treat some of the symptoms including rapid heart rate, sweating, and anxiety.

The purpose of treatment for Hypothyroidism is to supply the body with the extra thyroid hormone it needs to function properly. Levothyroxine is the most commonly used medication. The lowest dose effective in relieving symptoms and normalizing the TSH is used. Medication must be continued even when symptoms stop. Thyroid hormone levels should be watched yearly after the correct dose of medication is determined. Life-long therapy is needed.

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22
Mei
INTERSTITIAL CYSTITIS
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What is interstitial cystitis (IC)?

IC is a chronic bladder problem that can cause pain and other symptoms. People with IC can have an inflamed and irritated bladder. This can lead to:

* scarring and stiffening of the bladder
* less bladder capacity
* bleeding in the bladder

More than 700,000 Americans have IC. IC often shows up between the ages of 30 and 40. Women are ten times more likely to have IC than men.

Some people with IC feel only mild discomfort and some have severe pain. Severe cases of IC can keep people from doing their daily tasks, such as going to work or school.

What are the causes of IC?

No one knows what causes IC. Researchers are working to learn more about it and find treatments that will ease symptoms. Right now, there is no cure for IC.

Current research shows that a substance found in the urine of some people with IC may block the normal growth of the cells that line the inside wall of the bladder. Learning more about this substance may lead to a better understanding of the causes of IC.

It is thought that genes may play a role in some forms of IC. In a few cases, IC has affected a mother and daughter or two sisters. Still, it does not commonly run in families.

What are some symptoms and signs of IC?

Diagram of the urinary systemThe symptoms of IC vary from person to person. Also, one person can have symptoms of IC that change over time. People with IC may have an inflamed and irritated bladder. They may have mild discomfort, pressure, tenderness, or intense pain in the bladder and pelvic area. The pelvic area is between your navel (belly button) and your thigh. Symptoms also may include feeling like you need to urinate right away, often, or both.

Pain may get better or worse as the bladder fills with urine or as it empties. Women’s symptoms often get worse during their periods. Pain during sex is common.
How can I tell if I have IC?

Your doctor can tell if you have IC if you have the symptoms above and by ruling out other diseases with similar symptoms.

The first step in diagnosing IC is to rule out other health problems that may be causing the symptoms. Symptoms of urinary tract infections, bladder cancer, endometriosis, sexually transmitted diseases (STDs), and kidney stones can be the same as those caused by IC. Tests on your urine, bladder, and urinary tract may be done. These can include:

* Urine culture. Looking at urine under a microscope can show if you have germs that show you have a urinary tract infection or an STD. Your doctor will insert a catheter, which is a thin tube to drain urine. Or you may be asked to give a urine sample using the “clean catch” method. For a clean catch, you will wash the genital area before collecting urine midstream in a sterile container.
* Cystoscopy with or without bladder distention. Your doctor may use a device called a Cystoscope to see inside the bladder and rule out cancer. Further testing may include slowly stretching the bladder, called bladder distention, by filling it with liquid. This helps the doctor get a better look inside the bladder. This test can find bladder wall inflammation; bleeding or ulcers; a thick, stiff bladder wall; and total bladder capacity. This test is often done as an outpatient surgery.
* biopsy. A biopsy is a tissue sample that your doctor looks at under a microscope. Samples of the bladder and urethra may be removed during a cystoscopy. A biopsy helps your doctor rule out bladder cancer.

Is there a cure for IC?

Doctors have not yet found a cure for IC. They cannot predict who will respond best to the different treatment options. Sometimes, symptoms may go away for no reason or after a change in diet or treatment plan. Even when symptoms do go away, they may return after days, weeks, months, or years.

How is IC treated?

There are treatments available to help ease symptoms. Although many of these options are still being studied, they have shown to help some women feel better. Some of these include:

* Bladder distention. The doctor slowly stretches the bladder by filling it with liquid. Doctors are not sure why, but this test eases pain for some patients.
* Bladder instillation (a bladder wash or bath). The bladder is filled with a liquid that is held for different periods of time before being emptied. The only drug approved to date by the U.S. Food and Drug Administration (FDA) for use in bladder instillation is dimethyl sulfoxide. Other drugs for this use are being studied.
* Oral medicines. These medicines include a prescription medicine called pentosan polysulfate sodium (Elmiron®), which can help ease symptoms in some patients. Because Elmiron has not been tested in pregnant women, it is not recommended for use during pregnancy, except in severe cases. Other oral medicines used include aspirin and ibuprofen, other stronger painkillers, antidepressants, and antihistamines.
* Transcutaneous electrical nerve stimulation (TENS). Wires send mild electric pulses to the bladder area. Scientists do not know exactly how TENS works, but it helps ease pain and urinary frequency in some people. Sacral nerve stimulation implants are being studied as another way to relieve IC symptoms.
* Self-help strategies. Bladder training, dietary changes, quitting smoking, reducing stress, and low-impact exercise have been shown to help some people.
* Surgery. If other treatments have failed and the pain is disabling, surgery may be an option. Surgery may or may not ease symptoms.

Keep in mind, these treatments do not cure IC. For some people, these treatments have helped ease their IC symptoms.
How does diet affect IC?

There is no proof of a link between diet and IC. Still, some people think alcohol, tomatoes, spices, chocolate, caffeinated and citrus drinks, and high-acid foods may irritate the bladder. Others notice that their symptoms get worse after eating or drinking products made with artificial sweeteners. If you think certain foods or drinks may be making your symptoms worse, try avoiding them. You can start eating or drinking these products again one at a time to see if any affect your symptoms.

I have IC and just found out I’m pregnant. Will it affect my baby?

Doctors do not have much information about pregnancy and IC. IC is not thought to affect fertility or the health of a fetus. Some women find that their IC symptoms get better during pregnancy. Others find their symptoms get worse.

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20
Mei
SINUSITIS
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Apakah sinusitis itu?

Sinusitis adalah peradangan yang terjadi pada rongga sinus. Sinusitis banyak ditemukan pada penderita hay fever yang mana pada penderita ini terjadi pilek menahun akibat dari alergi terhadap debu dan sari bunga. Sinusitis juga dapat disebabkan oleh bahan bahan iritan seperti bahan kimia yang terdapat pada semprotan hidung serta bahan bahan kimia lainnya yang masuk melalui hidung. Jangan dilupakan kalau sinusitis juga bisa disebabkan oleh infeksi virus atau bakteri. Tulisan kali ini lebih menitikberatkan pembahasan pada sinusitis yang disebabkan oleh infeksi.

Apakah sinus itu?

Sinus atau sering pula disebut dengan sinus paranasalis adalah rongga udara yang terdapat pada bagian padat dari tulang tenggkorak di sekitar wajah, yang berfungsi untuk memperingan tulang tenggkorak. Rongga ini berjumlah empat pasang kiri dan kanan. Sinus frontalis terletak di bagian dahi, sedangkan sinus maksilaris terletak di belakang pipi. Sementara itu, sinus sphenoid dan sinus ethmoid terletak agak lebih dalam di belakang rongga mata dan di belakang sinus maksilaris. Dinding sinus terutama dibentuk oleh sel sel penghasil cairan mukus. Udara masuk ke dalam sinus melalui sebuah lubang kecil yang menghubungkan antara rongga sinus dengan rongga hidung yang disebut dengan ostia. Jika oleh karena suatu sebab lubang ini buntu maka udara tidak akan bisa keluar masuk dan cairan mukus yang diproduksi di dalam sinus tidak akan bisa dikeluarkan.

Apa yang menyebabkan sinusitis?

Sinusitis dapat terjadi bila terdapat gangguan pengaliran udara dari dan ke rongga sinus serta adanya gangguan pengeluaran cairan mukus. Adanya demam, flu, alergi dan bahan bahan iritan dapat menyebabkan terjadinya pembengkakan pada ostia sehingga lubang drainase ini menjadi buntu dan mengganggu aliran udara sinus serta pengeluaran cairan mukus. Penyebab lain dari buntunya ostia adalah tumor dan trauma. Drainase cairan mukus keluar dari rongga sinus juga bisa terhambat oleh pengentalan cairan mukus itu sendiri. Pengentalan ini terjadi akibat pemberiaan obat antihistamin, penyakit fibro kistik dan lain lain. Sel penghasil mukus memiliki rambut halus (silia) yang selalu bergerak untuk mendorong cairan mukus keluar dari rongga sinus. Asap rokok merupakan biang kerok dari rusaknya rambut halus ini sehingga pengeluaran cairan mukus menjadi terganggu. Cairan mukus yang terakumulasi di rongga sinus dalam jangka waktu yang lama merupakan tempat yang nyaman bagi hidupnya bakteri, virus dan jamur.

Apa saja tipe sinusitis?

Sinusitis dapat dibagi menjadi dua tipe besar yaitu berdasarkan lamanya penyakit (akut, subakut, khronis) dan berdasarkan jenis peradangan yang terjadi (infeksi dan non infeksi). Disebut sinusitis akut bila lamanya penyakit kurang dari 30 hari. Sinusitis subakut bila lamanya penyakit antara 1 bulan sampai 3 bulan, sedangkan sinusitis khronis bila penyakit diderita lebih dari 3 bulan. Sinusitis infeksi biasanya disebabkan oleh virus walau pada beberapa kasus ada pula yang disebabkan oleh bakteri. Sedangkan sinusitis non infeksi sebagian besar disebabkan oleh karena alergi dan iritasi bahan bahan kimia. Sinusitis subakut dan khronis sering merupakan lanjutan dari sinusitis akut yang tidak mendapatkan pengobatan adekuat.

Apa saja gejala sinusitis?

Gejala sinusitis yang paling umum adalah sakit kepala, nyeri pada daerah wajah, serta demam. Hampir 25% dari pasien sinusitis akan mengalami demam yang berhubungan dengan sinusitis yang diderita. Gejala lainnya berupa wajah pucat, perubahan warna pada ingus, hidung tersumbat, nyeri menelan, dan batuk. Beberapa pasien akan merasakan sakit kepala bertambah hebat bila kepala ditundukan ke depan. Pada sinusitis karena alergi maka penderita juga akan mengalami gejala lain yang berhubungan dengan alerginya seperti gatal pada mata, dan bersin bersin.

Bagaimana mendiagnosa sinusitis?

Sinusitis sebagian besar sudah dapat didiagnosa hanya berdasarkan pada riwayat keluhan pasien serta pemeriksaan fisik yang dilakukan dokter. Hal ini juga disebabkan karena pemeriksaan menggunakan CT Scan dan MRI yang walaupun memberikan hasil lebih akurat namun biaya yang dikeluarkan cukup mahal. Pada pemeriksaan fisik akan ditemukan adanya kemerahan dan pembengkakan pada rongga hidung, ingus yang mirip nanah, serta pembengkakan disekitar mata dan dahi. Pemeriksaan menggunakan CT Scan dan MRI baru diperlukan bila sinusitis gagal disembuhkan dengan pengobatan awal. Rhinoskopi, sebuah cara untuk melihat langsung ke rongga hidung, diperlukan guna melihat lokasi sumbatan ostia. Terkadang diperlukan penyedotan cairan sinus dengan menggunakan jarum suntik untuk dilakukan pemeriksaan kuman. Pemeriksaan ini berguna untuk menentukan jenis infeksi yang terjadi.

Bagaimana mengobati sinusitis?

Untuk sinusitis yang disebabkan oleh karena virus maka tidak diperlukan pemberian antibiotika. Obat yang biasa diberikan untuk sinusitis virus adalah penghilang rasa nyeri seperti parasetamol dan dekongestan. Curiga telah terjadi sinusitis infeksi oleh bakteri bila terdapat gejala nyeri pada wajah, ingus yang bernanah, dan gejala yang timbul lebih dari seminggu. Sinusitis infeksi bakteri umumnya diobati dengan menggunakan antibiotika. Pemilihan antibiotika berdasarkan jenis bakteri yang paling sering menyerang sinus karena untuk mendapatkan antibiotika yang benar benar pas harus menunggu hasil dari biakan kuman yang memakan waktu lama. Lima jenis bakteri yang paling sering menginfeksi sinus adalah Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Staphylococcus aureus, dan Streptococcus pyogenes. Antibiotika yang dipilih harus dapat membunuh kelima jenis kuman ini. Beberapa pilihan antiobiotika antara lain amoxicillin, cefaclor, azithromycin, dan cotrimoxazole. Jika tidak terdapat perbaikan dalam lima hari maka perlu dipertimbangkan untuk memberikan amoxicillin plus asam klavulanat. Pemberian antibiotika dianjurkan minimal 10 sampai 14 hari. Pemberian dekongestan dan mukolitik dapat membantu untuk melancarkan drainase cairan mukus. Pada kasus kasus yang khronis, dapat dipertimbangkan melakukan drainase cairan mukus dengan cara pembedahan.

Apa komplikasi dari sinusitis?

Komplikasi yang serius jarang terjadi, namun kemungkinan yang paling gawat adalah penyebaran infeksi ke otak yang dapat membahayakan kehidupan.

Kesimpulan

Sinusitis jika diobati secara dini dengan pengobatan yang tepat akan mampu sembuh dengan baik. Segeralah ke dokter jika anda menjumpai gejala gejala sinusitis.

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