A. Definisi
Kanker ovarium adalah tumor ganas pada ovarium (indung telur) yang paling sering ditemukan pada wanita berusia 50 - 70 tahun. Kanker ovarium bisa menyebar ke bagian lain, panggul, dan perut melalui sistem getah bening dan melalui sistem pembuluh darah menyebar ke hati dan paru-paru.
Kanker ovarium sangat sulit didiagnosa dan kemungkinan kanker ovarium ini merupakan awal dari banyak kanker primer. (Wingo, 1995)
B. Etiologi
Penyebab kanker ovarium belum diketahui secara pasti. Akan tetapi banyak teori yang menjelaskan tentang etiologi kanker ovarium, diantaranya:
1. Hipotesis incessant ovulation
Teori menyatakan bahwa terjadi kerusakan pada sel-sel epitel ovarium untuk penyembuhan luka pada saat terjadi ovulasi. Proses penyembuhan sel-sel epitel yang terganggu dapat menimbulkan proses transformasi menjadi sel-sel tumor.
2. Hipotesis androgen
Androgen mempunyai peran penting dalam terbentuknya kanker ovarium. Hal ini didasarkan pada hasil percobaan bahwa epitel ovarium mengandung reseptor androgen. Dalam percobaan in-vitro, androgen dapat menstimulasi pertumbuhan epitel ovarium normal dan sel-sel kanker ovarium.
C. Faktor Risiko
• Diet tinggi lemak
• merokok
• alkohol
• penggunaan bedak talk perineal
• riwayat kanker payudara, kolon, atau endometrium
• riwayat keluarga dengan kanker payudara atau ovarium
• nulipara
• infertilitas
• menstruasi dini
• tidak pernah melahirkan
D. Tanda & Gejala
Gejala umum bervariasi dan tidak spesifik. Pada stadium awal berupa :
• haid tidak teratur
• ketegangan menstrual yang terus meningkat
• menoragia
• nyeri tekan pada payudara
• menopause dini
• rasa tidak nyaman pada abdomen
• dispepsia
• tekanan pada pelvis
• sering berkemih
• flatulenes
• rasa begah setelah makan makanan kecil
• lingkar abdomen yang terus meningkat
E. Stadium
Stadium kanker ovarium primer menurut FIGO (Federation International of Ginecologies and Obstetricians ) 1987, adalah :
STADIUM I –> pertumbuhan terbatas pada ovarium
1. Stadium 1A : pertumbuhan terbatas pada suatu ovarium, tidak ada asietas yang berisi sel ganas, tidak ada pertumbuhan di permukaan luar, kapsul utuh.
2. Stadium 1B : pertumbuhan terbatas pada kedua ovarium, tidak asietas, berisi sel ganas, tidak ada tumor di permukaan luar, kapsul intak.
3. Stadium 1C : tumor dengan stadium 1a dan 1b tetapi ada tumor dipermukaan luar atau kedua ovarium atau kapsul pecah atau dengan asietas berisi sel ganas atau dengan bilasan peritoneum positif.
STADIUM II –> Pertumbuhan pada satu atau dua ovarium dengan perluasan ke panggul
1. Stadium 2A : perluasan atau metastasis ke uterus dan atau tuba
2. Stadium 2B : perluasan jaringan pelvis lainnya
3. Stadium 2C : tumor stadium 2a dan 2b tetapi pada tumor dengan permukaan satu atau kedua ovarium, kapsul pecah atau dengan asitas yang mengandung sel ganas dengan bilasan peritoneum positif.
STADIUM III –> tomor mengenai satu atau kedua ovarium dengan implant di peritoneum di luar pelvis dan atau retroperitoneal positif. Tumor terbatas dalam pelvis kecil tetapi sel histologi terbukti meluas ke usus besar atau omentum.
1. Stadium 3A : tumor terbatas di pelvis kecil dengan kelenjar getah bening negatif tetapi secara histologi dan dikonfirmasi secara mikroskopis terdapat adanya pertumbuhan (seeding) dipermukaan peritoneum abdominal.
2. Stadium 3B : tumor mengenai satu atau kedua ovarium dengan implant dipermukaan peritoneum dan terbukti secara mikroskopis, diameter melebihi 2 cm, dan kelenjar getah bening negativ.
3. Stadium 3C : implant di abdoment dengan diameter > 2 cm dan atau kelenjar getah bening retroperitoneal atau inguinal positif.
STADIUM IV –> pertumbuhan mengenai satu atau kedua ovarium dengan metastasis jauh. Bila efusi pleura dan hasil sitologinya positif dalam stadium 4, begitu juga metastasis ke permukaan liver.
F. Penegakan Diagnosa Medis
Sebagian besar kanker ovarium bermula dari suatu kista. Oleh karena itu, apabila pada seorang wanita ditemukan suatu kista ovarium harus dilakukan pemeriksaan lebih lanjut untuk menentukan apakah kista tersebut bersifat jinak atau ganas (kanker ovarium).
Ciri2 kista yang bersifat ganas yaitu pada keadaan :
1. Kista cepat membesar
2. Kista pada usia remaja atau pascamenopause
3. Kista dengan dinding yang tebal dan tidak berurutan
4. Kista dengan bagian padat
5. Tumor pada ovarium
Pemeriksaan lanjutan untuk memperkuat dugaan ke arah kanker ovarium seperti :
• USG dengan Doppler untuk menentukan arus darah
• Jika diperlukan, pemeriksaan CT-Scan/ MRI
• Pemeriksaan tumor marker seperti Ca-125 dan Ca-724, beta - HCG dan alfafetoprotein
Semua pemeriksaan diatas belum bisa memastikan diagnosis kanker ovarium, akan tetapi hanya sebagai pegangan untuk melakukan tindakan operasi.
G. PENATALAKSANAAN
Sebagian besar kanker ovarium memerlukan pengobatan dengan kemoterapi. Hanya kanker ovarium stadium awal saja (stadium 1a dan 1b dengan derajat diferensiasi sel yang baik/sedang) yang tidak memerlukan kombinasi pengobatan. Kemoterapi diberikan sebanyak 6 seri dengan interval 3 - 4 minggu sekali dengan melakukan pemantauan terhadap efeh samping kemoterapi secara berkala terhadap sumsum tulang, fungsi hati, fungsi ginjal, sistem saluran cerna, sistem saluran cerna, sistem saraf dan sistem kardiovaskuler.
Penatalaksanaan yang sesuai dengan stadium yaitu :
• Operasi (stadium awal)
• Kemoterapi (tambahan terapi pada stadium awal)
• Radiasi (tambahan terapi untuk stadium lanjut)
H. Asuhan Keperawatan
1. Pengkajian
• Data diri klien
• Data biologis/fisiologis –> keluhan utama, riwayat keluhan utama
• Riwayat kesehatan masa lalu
• Riwayat kesehatan keluarga
• Riwayat reproduksi –> siklus haid, durasi haid
• Riwayat obstetric –> kehamilan, persalinan, nifas, hamil
• Pemeriksaan fisik
• Data psikologis/sosiologis–> reaksi emosional setelah penyakit diketahui
2. Diagnosa Keperawatan
1. Nyeri akut b.d agen cidera biologi
2. Perubahan citra tubuh dan harga diri b.d perubahan dalam penampilan fungsi dan peran
3. Resiko tinggi terhadap disfungsi seksual b.d perubahan struktur atau fungsi tubuh, perubahan kadar hormon
Diagnosa 1 : Nyeri akut b.d agen cidera biologi
Tujuan : Klien merasa reda dari nyeri dan ketidaknyamanan yang ditimbulkan
Intervensi :
• Kaji karakteristik nyeri : lokasi, kualitas, frekuensi
• Kaji faktor lain yang menunjang nyeri, keletihan, marah pasien
• Kolaborasi dengan tim medis dalam memberi obat analgesic
• Jelaskan kegunaan analgesic dan cara-cara untuk mengurangi efek samping
• Ajarkan klien strategi baru untuk meredakan nyeri dan ketidaknyamanan: imajinasi, relaksasi, stimulasi kutan
Diagnosa 2 : Perubahan citra tubuh dan harga diri b.d perubahan dalam penampilan fungsi dan peran
Tujuan : Klien dapat memperbaiki persepsi citra tubuh dan harga dirinya.
Intervensi :
• Kaji perasaan klien tentang citra tubuh dan tingkat harga diri
• Berikan dorongan untuk keikutsertaan kontinyu dalam aktifitas dan pembuatan keputusan
• Berikan dorongan pada klien dan pasangannya untuk saling berbagi kekhawatiran tentang perubahan fungsi seksual dan menggali alternatif untuk ekspresi seksual yang lazim
Diagnosa 3 : Resiko tinggi terhadap disfungsi seksual b.d perubahan struktur atau fungsi tubuh, perubahan kadar hormon
Tujuan :
• Klien menyatakan paham tentang perubahan struktur dan fungsi seksual.
• Mengidentifikasi kepuasan/ praktik seksual yang diterima dan beberapa alternatif cara mengekspresikan keinginan seksual
Intervensi:
• Mendengarkan pernyataan klien dan pasangan
• Diskusikan sensasi atau ketidaknyamanan fisik, perubahan pada respons individu
• Kaji informasi klien dan pasangan tentang anatomi/ fungsi seksual dan pengaruh prosedur pembedahan
• Identifikasi faktor budaya/nilai budaya
• Bantu klien untuk menyadari atau menerima tahap berduka
• Dorong klien untuk menyadari atau menerima tahap berduka
• Dorong klien untuk berbagi pikiran/masalah dengan orang terdekatnya
• Berikan solusi masalah terhadap masalah potensial. ex : menunda koitus seksual saat kelelahan
4. Evaluasi
1. Klien merasa reda dari nyeri dan ketidaknyamanan yang ditimbulkan
2. Klien dapat memperbaiki persepsi citra tubuh dan harga dirinya.
3. Tidak adanya tanda-tanda disfungsi seksual
a. Klien menyatakan paham tentang perubahan struktur dan fungsi seksual.
b. Mengidentifikasi kepuasan/ praktik seksual yang diterima dan beberapa alternatif cara mengekspresikan keinginan seksual
DAFTAR PUSTAKA
Brunner & Suddarth. 2001. Buku Ajar Keperawatan Medikal Bedah. EGC: Jakarta
Donges, Marilynn E. 1999.Rencana Asuhan Keperawatan. EGC: Jakarta
Wednesday, June 24, 2009
Ca OVARIUM / KANKER OVARIUM
A.Definisi
Kanker ovarium adalah tumor ganas pada ovarium (indung telur) yang paling sering
ditemukan pada wanita berusia 50 - 70 tahun. Kanker ovarium bisa menyebar ke
bagian lain, panggul, dan perut melalui sistem getah bening dan melalui sistem
pembuluh darah menyebar ke hati dan paru-paru.
Kanker ovarium sangat sulit didiagnosa dan kemungkinan kanker ovarium ini
merupakan awal dari banyak kanker primer. (Wingo, 1995)
B.Etiologi
Penyebab kanker ovarium belum diketahui secara pasti. Akan tetapi banyak teori
yang menjelaskan tentang etiologi kanker ovarium, diantaranya:
1.Hipotesis incessant ovulation
Teori menyatakan bahwa terjadi kerusakan pada sel-sel epitel ovarium untuk
penyembuhan luka pada saat terjadi ovulasi. Proses penyembuhan sel-sel epitel
yang terganggu dapat menimbulkan proses transformasi menjadi sel-sel tumor.
2.Hipotesis androgen
Androgen mempunyai peran penting dalam terbentuknya kanker ovarium. Hal ini
didasarkan pada hasil percobaan bahwa epitel ovarium mengandung reseptor
androgen. Dalam percobaan in-vitro, androgen dapat menstimulasi pertumbuhan
epitel ovarium normal dan sel-sel kanker ovarium.
C.Faktor Risiko
•Diet tinggi lemak
•merokok
•alkohol
•penggunaan bedak talk perineal
•riwayat kanker payudara, kolon, atau endometrium
•riwayat keluarga dengan kanker payudara atau ovarium
•nulipara
•infertilitas
•menstruasi dini
•tidak pernah melahirkan
D.Tanda & Gejala
Gejala umum bervariasi dan tidak spesifik. Pada stadium awal berupa :
•haid tidak teratur
•ketegangan menstrual yang terus meningkat
•menoragia
•nyeri tekan pada payudara
•menopause dini
•rasa tidak nyaman pada abdomen
•dispepsia
•tekanan pada pelvis
•sering berkemih
•flatulenes
•rasa begah setelah makan makanan kecil
•lingkar abdomen yang terus meningkat
E.Stadium
Stadium kanker ovarium primer menurut FIGO (Federation International of
Ginecologies and Obstetricians ) 1987, adalah :
STADIUM I –> pertumbuhan terbatas pada ovarium
1.Stadium 1A : pertumbuhan terbatas pada suatu ovarium, tidak ada asietas yang
berisi sel ganas, tidak ada pertumbuhan di permukaan luar, kapsul utuh.
2.Stadium 1B : pertumbuhan terbatas pada kedua ovarium, tidak asietas, berisi sel
ganas, tidak ada tumor di permukaan luar, kapsul intak.
3.Stadium 1C : tumor dengan stadium 1a dan 1b tetapi ada tumor dipermukaan luar
atau kedua ovarium atau kapsul pecah atau dengan asietas berisi sel ganas atau
dengan bilasan peritoneum positif.
STADIUM II –> Pertumbuhan pada satu atau dua ovarium dengan perluasan ke panggul
1.Stadium 2A : perluasan atau metastasis ke uterus dan atau tuba
2.Stadium 2B : perluasan jaringan pelvis lainnya
3.Stadium 2C : tumor stadium 2a dan 2b tetapi pada tumor dengan permukaan satu
atau kedua ovarium, kapsul pecah atau dengan asitas yang mengandung
sel ganas dengan bilasan peritoneum positif.
STADIUM III –> tomor mengenai satu atau kedua ovarium dengan implant di peritoneum
di luar pelvis dan atau retroperitoneal positif. Tumor terbatas dalam pelvis kecil
tetapi sel histologi terbukti meluas ke usus besar atau omentum.
1.Stadium 3A : tumor terbatas di pelvis kecil dengan kelenjar getah bening negatif
tetapi secara histologi dan dikonfirmasi secara mikroskopis terdapat adanya
pertumbuhan (seeding) dipermukaan peritoneum abdominal.
2.Stadium 3B : tumor mengenai satu atau kedua ovarium dengan implant dipermukaan
peritoneum dan terbukti secara mikroskopis, diameter melebihi 2 cm, dan kelenjar
getah bening negativ.
3.Stadium 3C : implant di abdoment dengan diameter > 2 cm dan atau kelenjar getah
bening retroperitoneal atau inguinal positif.
STADIUM IV –> pertumbuhan mengenai satu atau kedua ovarium dengan metastasis jauh.
Bila efusi pleura dan hasil sitologinya positif dalam stadium 4, begitu juga
metastasis ke permukaan liver.
F.Penegakan Diagnosa Medis
Sebagian besar kanker ovarium bermula dari suatu kista. Oleh karena itu, apabila
pada seorang wanita ditemukan suatu kista ovarium harus dilakukan pemeriksaan
lebih lanjut untuk menentukan apakah kista tersebut bersifat jinak atau ganas
(kanker ovarium).
Ciri2 kista yang bersifat ganas yaitu pada keadaan :
1.Kista cepat membesar
2.Kista pada usia remaja atau pascamenopause
3.Kista dengan dinding yang tebal dan tidak berurutan
4.Kista dengan bagian padat
5.Tumor pada ovarium
Pemeriksaan lanjutan untuk memperkuat dugaan ke arah kanker ovarium seperti :
•USG dengan Doppler untuk menentukan arus darah
•Jika diperlukan, pemeriksaan CT-Scan/ MRI
•Pemeriksaan tumor marker seperti Ca-125 dan Ca-724, beta - HCG dan alfafetoprotein
Semua pemeriksaan diatas belum bisa memastikan diagnosis kanker ovarium, akan
tetapi hanya sebagai pegangan untuk melakukan tindakan operasi.
G.PENATALAKSANAAN
Sebagian besar kanker ovarium memerlukan pengobatan dengan kemoterapi. Hanya
kanker ovarium stadium awal saja (stadium 1a dan 1b dengan derajat diferensiasi
sel yang baik/sedang) yang tidak memerlukan kombinasi pengobatan. Kemoterapi
diberikan sebanyak 6 seri dengan interval 3 - 4 minggu sekali dengan melakukan
pemantauan terhadap efeh samping kemoterapi secara berkala terhadap sumsum tulang,
fungsi hati, fungsi ginjal, sistem saluran cerna, sistem saluran cerna, sistem
saraf dan sistem kardiovaskuler.
Penatalaksanaan yang sesuai dengan stadium yaitu :
•Operasi (stadium awal)
•Kemoterapi (tambahan terapi pada stadium awal)
•Radiasi (tambahan terapi untuk stadium lanjut)
H.Asuhan Keperawatan
1.Pengkajian
•Data diri klien
•Data biologis/fisiologis –> keluhan utama, riwayat keluhan utama
•Riwayat kesehatan masa lalu
•Riwayat kesehatan keluarga
•Riwayat reproduksi –> siklus haid, durasi haid
•Riwayat obstetric –> kehamilan, persalinan, nifas, hamil
•Pemeriksaan fisik
•Data psikologis/sosiologis–> reaksi emosional setelah penyakit diketahui
2.Diagnosa Keperawatan
1. Nyeri akut b.d agen cidera biologi
2. Perubahan citra tubuh dan harga diri b.d perubahan dalam penampilan fungsi
dan peran
3. Resiko tinggi terhadap disfungsi seksual b.d perubahan struktur atau fungsi
tubuh, perubahan kadar hormon
Diagnosa 1 : Nyeri akut b.d agen cidera biologi
Tujuan : Klien merasa reda dari nyeri dan ketidaknyamanan yang ditimbulkan
Intervensi :
•Kaji karakteristik nyeri : lokasi, kualitas, frekuensi
•Kaji faktor lain yang menunjang nyeri, keletihan, marah pasien
•Kolaborasi dengan tim medis dalam memberi obat analgesic
•Jelaskan kegunaan analgesic dan cara-cara untuk mengurangi efek samping
•Ajarkan klien strategi baru untuk meredakan nyeri dan ketidaknyamanan:
imajinasi, relaksasi, stimulasi kutan
Diagnosa 2 : Perubahan citra tubuh dan harga diri b.d perubahan dalam penampilan
fungsi dan peran
Tujuan : Klien dapat memperbaiki persepsi citra tubuh dan harga dirinya.
Intervensi :
•Kaji perasaan klien tentang citra tubuh dan tingkat harga diri
•Berikan dorongan untuk keikutsertaan kontinyu dalam aktifitas dan pembuatan
keputusan
•Berikan dorongan pada klien dan pasangannya untuk saling berbagi kekhawatiran
tentang perubahan fungsi seksual dan menggali alternatif untuk ekspresi seksual
yang lazim
Diagnosa 3 : Resiko tinggi terhadap disfungsi seksual b.d perubahan struktur
atau fungsi tubuh, perubahan kadar hormon
Tujuan :
•Klien menyatakan paham tentang perubahan struktur dan fungsi seksual.
•Mengidentifikasi kepuasan/ praktik seksual yang diterima dan beberapa
alternatif cara mengekspresikan keinginan seksual
Intervensi:
•Mendengarkan pernyataan klien dan pasangan
•Diskusikan sensasi atau ketidaknyamanan fisik, perubahan pada respons individu
•Kaji informasi klien dan pasangan tentang anatomi/ fungsi seksual dan pengaruh
prosedur pembedahan
•Identifikasi faktor budaya/nilai budaya
•Bantu klien untuk menyadari atau menerima tahap berduka
•Dorong klien untuk menyadari atau menerima tahap berduka
•Dorong klien untuk berbagi pikiran/masalah dengan orang terdekatnya
•Berikan solusi masalah terhadap masalah potensial. ex : menunda koitus seksual
saat kelelahan
4.Evaluasi
1.Klien merasa reda dari nyeri dan ketidaknyamanan yang ditimbulkan
2.Klien dapat memperbaiki persepsi citra tubuh dan harga dirinya.
3.Tidak adanya tanda-tanda disfungsi seksual
a. Klien menyatakan paham tentang perubahan struktur dan fungsi seksual.
b. Mengidentifikasi kepuasan/ praktik seksual yang diterima dan beberapa
alternatif cara mengekspresikan keinginan seksual
DAFTAR PUSTAKA
Brunner & Suddarth. 2001. Buku Ajar Keperawatan Medikal Bedah. EGC: Jakarta
Donges, Marilynn E. 1999.Rencana Asuhan Keperawatan. EGC: Jakarta
Kanker ovarium adalah tumor ganas pada ovarium (indung telur) yang paling sering
ditemukan pada wanita berusia 50 - 70 tahun. Kanker ovarium bisa menyebar ke
bagian lain, panggul, dan perut melalui sistem getah bening dan melalui sistem
pembuluh darah menyebar ke hati dan paru-paru.
Kanker ovarium sangat sulit didiagnosa dan kemungkinan kanker ovarium ini
merupakan awal dari banyak kanker primer. (Wingo, 1995)
B.Etiologi
Penyebab kanker ovarium belum diketahui secara pasti. Akan tetapi banyak teori
yang menjelaskan tentang etiologi kanker ovarium, diantaranya:
1.Hipotesis incessant ovulation
Teori menyatakan bahwa terjadi kerusakan pada sel-sel epitel ovarium untuk
penyembuhan luka pada saat terjadi ovulasi. Proses penyembuhan sel-sel epitel
yang terganggu dapat menimbulkan proses transformasi menjadi sel-sel tumor.
2.Hipotesis androgen
Androgen mempunyai peran penting dalam terbentuknya kanker ovarium. Hal ini
didasarkan pada hasil percobaan bahwa epitel ovarium mengandung reseptor
androgen. Dalam percobaan in-vitro, androgen dapat menstimulasi pertumbuhan
epitel ovarium normal dan sel-sel kanker ovarium.
C.Faktor Risiko
•Diet tinggi lemak
•merokok
•alkohol
•penggunaan bedak talk perineal
•riwayat kanker payudara, kolon, atau endometrium
•riwayat keluarga dengan kanker payudara atau ovarium
•nulipara
•infertilitas
•menstruasi dini
•tidak pernah melahirkan
D.Tanda & Gejala
Gejala umum bervariasi dan tidak spesifik. Pada stadium awal berupa :
•haid tidak teratur
•ketegangan menstrual yang terus meningkat
•menoragia
•nyeri tekan pada payudara
•menopause dini
•rasa tidak nyaman pada abdomen
•dispepsia
•tekanan pada pelvis
•sering berkemih
•flatulenes
•rasa begah setelah makan makanan kecil
•lingkar abdomen yang terus meningkat
E.Stadium
Stadium kanker ovarium primer menurut FIGO (Federation International of
Ginecologies and Obstetricians ) 1987, adalah :
STADIUM I –> pertumbuhan terbatas pada ovarium
1.Stadium 1A : pertumbuhan terbatas pada suatu ovarium, tidak ada asietas yang
berisi sel ganas, tidak ada pertumbuhan di permukaan luar, kapsul utuh.
2.Stadium 1B : pertumbuhan terbatas pada kedua ovarium, tidak asietas, berisi sel
ganas, tidak ada tumor di permukaan luar, kapsul intak.
3.Stadium 1C : tumor dengan stadium 1a dan 1b tetapi ada tumor dipermukaan luar
atau kedua ovarium atau kapsul pecah atau dengan asietas berisi sel ganas atau
dengan bilasan peritoneum positif.
STADIUM II –> Pertumbuhan pada satu atau dua ovarium dengan perluasan ke panggul
1.Stadium 2A : perluasan atau metastasis ke uterus dan atau tuba
2.Stadium 2B : perluasan jaringan pelvis lainnya
3.Stadium 2C : tumor stadium 2a dan 2b tetapi pada tumor dengan permukaan satu
atau kedua ovarium, kapsul pecah atau dengan asitas yang mengandung
sel ganas dengan bilasan peritoneum positif.
STADIUM III –> tomor mengenai satu atau kedua ovarium dengan implant di peritoneum
di luar pelvis dan atau retroperitoneal positif. Tumor terbatas dalam pelvis kecil
tetapi sel histologi terbukti meluas ke usus besar atau omentum.
1.Stadium 3A : tumor terbatas di pelvis kecil dengan kelenjar getah bening negatif
tetapi secara histologi dan dikonfirmasi secara mikroskopis terdapat adanya
pertumbuhan (seeding) dipermukaan peritoneum abdominal.
2.Stadium 3B : tumor mengenai satu atau kedua ovarium dengan implant dipermukaan
peritoneum dan terbukti secara mikroskopis, diameter melebihi 2 cm, dan kelenjar
getah bening negativ.
3.Stadium 3C : implant di abdoment dengan diameter > 2 cm dan atau kelenjar getah
bening retroperitoneal atau inguinal positif.
STADIUM IV –> pertumbuhan mengenai satu atau kedua ovarium dengan metastasis jauh.
Bila efusi pleura dan hasil sitologinya positif dalam stadium 4, begitu juga
metastasis ke permukaan liver.
F.Penegakan Diagnosa Medis
Sebagian besar kanker ovarium bermula dari suatu kista. Oleh karena itu, apabila
pada seorang wanita ditemukan suatu kista ovarium harus dilakukan pemeriksaan
lebih lanjut untuk menentukan apakah kista tersebut bersifat jinak atau ganas
(kanker ovarium).
Ciri2 kista yang bersifat ganas yaitu pada keadaan :
1.Kista cepat membesar
2.Kista pada usia remaja atau pascamenopause
3.Kista dengan dinding yang tebal dan tidak berurutan
4.Kista dengan bagian padat
5.Tumor pada ovarium
Pemeriksaan lanjutan untuk memperkuat dugaan ke arah kanker ovarium seperti :
•USG dengan Doppler untuk menentukan arus darah
•Jika diperlukan, pemeriksaan CT-Scan/ MRI
•Pemeriksaan tumor marker seperti Ca-125 dan Ca-724, beta - HCG dan alfafetoprotein
Semua pemeriksaan diatas belum bisa memastikan diagnosis kanker ovarium, akan
tetapi hanya sebagai pegangan untuk melakukan tindakan operasi.
G.PENATALAKSANAAN
Sebagian besar kanker ovarium memerlukan pengobatan dengan kemoterapi. Hanya
kanker ovarium stadium awal saja (stadium 1a dan 1b dengan derajat diferensiasi
sel yang baik/sedang) yang tidak memerlukan kombinasi pengobatan. Kemoterapi
diberikan sebanyak 6 seri dengan interval 3 - 4 minggu sekali dengan melakukan
pemantauan terhadap efeh samping kemoterapi secara berkala terhadap sumsum tulang,
fungsi hati, fungsi ginjal, sistem saluran cerna, sistem saluran cerna, sistem
saraf dan sistem kardiovaskuler.
Penatalaksanaan yang sesuai dengan stadium yaitu :
•Operasi (stadium awal)
•Kemoterapi (tambahan terapi pada stadium awal)
•Radiasi (tambahan terapi untuk stadium lanjut)
H.Asuhan Keperawatan
1.Pengkajian
•Data diri klien
•Data biologis/fisiologis –> keluhan utama, riwayat keluhan utama
•Riwayat kesehatan masa lalu
•Riwayat kesehatan keluarga
•Riwayat reproduksi –> siklus haid, durasi haid
•Riwayat obstetric –> kehamilan, persalinan, nifas, hamil
•Pemeriksaan fisik
•Data psikologis/sosiologis–> reaksi emosional setelah penyakit diketahui
2.Diagnosa Keperawatan
1. Nyeri akut b.d agen cidera biologi
2. Perubahan citra tubuh dan harga diri b.d perubahan dalam penampilan fungsi
dan peran
3. Resiko tinggi terhadap disfungsi seksual b.d perubahan struktur atau fungsi
tubuh, perubahan kadar hormon
Diagnosa 1 : Nyeri akut b.d agen cidera biologi
Tujuan : Klien merasa reda dari nyeri dan ketidaknyamanan yang ditimbulkan
Intervensi :
•Kaji karakteristik nyeri : lokasi, kualitas, frekuensi
•Kaji faktor lain yang menunjang nyeri, keletihan, marah pasien
•Kolaborasi dengan tim medis dalam memberi obat analgesic
•Jelaskan kegunaan analgesic dan cara-cara untuk mengurangi efek samping
•Ajarkan klien strategi baru untuk meredakan nyeri dan ketidaknyamanan:
imajinasi, relaksasi, stimulasi kutan
Diagnosa 2 : Perubahan citra tubuh dan harga diri b.d perubahan dalam penampilan
fungsi dan peran
Tujuan : Klien dapat memperbaiki persepsi citra tubuh dan harga dirinya.
Intervensi :
•Kaji perasaan klien tentang citra tubuh dan tingkat harga diri
•Berikan dorongan untuk keikutsertaan kontinyu dalam aktifitas dan pembuatan
keputusan
•Berikan dorongan pada klien dan pasangannya untuk saling berbagi kekhawatiran
tentang perubahan fungsi seksual dan menggali alternatif untuk ekspresi seksual
yang lazim
Diagnosa 3 : Resiko tinggi terhadap disfungsi seksual b.d perubahan struktur
atau fungsi tubuh, perubahan kadar hormon
Tujuan :
•Klien menyatakan paham tentang perubahan struktur dan fungsi seksual.
•Mengidentifikasi kepuasan/ praktik seksual yang diterima dan beberapa
alternatif cara mengekspresikan keinginan seksual
Intervensi:
•Mendengarkan pernyataan klien dan pasangan
•Diskusikan sensasi atau ketidaknyamanan fisik, perubahan pada respons individu
•Kaji informasi klien dan pasangan tentang anatomi/ fungsi seksual dan pengaruh
prosedur pembedahan
•Identifikasi faktor budaya/nilai budaya
•Bantu klien untuk menyadari atau menerima tahap berduka
•Dorong klien untuk menyadari atau menerima tahap berduka
•Dorong klien untuk berbagi pikiran/masalah dengan orang terdekatnya
•Berikan solusi masalah terhadap masalah potensial. ex : menunda koitus seksual
saat kelelahan
4.Evaluasi
1.Klien merasa reda dari nyeri dan ketidaknyamanan yang ditimbulkan
2.Klien dapat memperbaiki persepsi citra tubuh dan harga dirinya.
3.Tidak adanya tanda-tanda disfungsi seksual
a. Klien menyatakan paham tentang perubahan struktur dan fungsi seksual.
b. Mengidentifikasi kepuasan/ praktik seksual yang diterima dan beberapa
alternatif cara mengekspresikan keinginan seksual
DAFTAR PUSTAKA
Brunner & Suddarth. 2001. Buku Ajar Keperawatan Medikal Bedah. EGC: Jakarta
Donges, Marilynn E. 1999.Rencana Asuhan Keperawatan. EGC: Jakarta
Wednesday, June 17, 2009
penyebaran HIV
HIV SANGAT BAHAYA
perkembangan penyebaran virus HIV sangat cepat, tidak hanya menyerang orang dewasa maupun golongan tertentu, namun bisa juga terjadi pada anak-anak, orang tua maupun siapa saja, tanpa melihat jenis kelamin atau golongan.
tercatat perkembangan virus HIV ini juga terjadi melalui pemakaian jarum suntik narkoba atau obat terlarang lainya. disamping melalui hubungan sexual tanpa kondom, dan tranfusi darah yang tercemar virus HIV. bahkan penyebaran melalui jarum suntik menepati urutan paling atas.
jadi jangan pernah menganggap kita tidak akan ter infeksi HIV hanya karena kita selalu setia pada pasangan kita, atau selalu menggunakan kondom setiap berhubungan sexs.pernahkah kita membayangkan diri kita terinfeksi karena keteledoran kita menggunakan pisau cukur secara bersama tanpa di sterilkan, atau menggunakan alat suntik bersama-sama? karena itu sadarilah status HIV sebelum segalanya terlambat.
perkembangan penyebaran virus HIV sangat cepat, tidak hanya menyerang orang dewasa maupun golongan tertentu, namun bisa juga terjadi pada anak-anak, orang tua maupun siapa saja, tanpa melihat jenis kelamin atau golongan.
tercatat perkembangan virus HIV ini juga terjadi melalui pemakaian jarum suntik narkoba atau obat terlarang lainya. disamping melalui hubungan sexual tanpa kondom, dan tranfusi darah yang tercemar virus HIV. bahkan penyebaran melalui jarum suntik menepati urutan paling atas.
jadi jangan pernah menganggap kita tidak akan ter infeksi HIV hanya karena kita selalu setia pada pasangan kita, atau selalu menggunakan kondom setiap berhubungan sexs.pernahkah kita membayangkan diri kita terinfeksi karena keteledoran kita menggunakan pisau cukur secara bersama tanpa di sterilkan, atau menggunakan alat suntik bersama-sama? karena itu sadarilah status HIV sebelum segalanya terlambat.
Sunday, June 14, 2009
UROLITHIASIS
A. DEFINITION
Urolithiasis is an emergency of a cumulation oksalat, calculi (kidney stones) in the ureter or the kidney area. Symptoms of excessive pain in the waist, Nausea, vomiting, fever, hematuria. More occurred in men dibanging women 3:1 in comparison with the age of 30-60 years. Urine color, such as snoring or red tea.
Vesikolithiasis (bladder stones) there is a stone in the bladder. Vesikolithiasis refers to the stone / kalkuli in vesika urinaria. Stone formed in the funnel urinal (vesika urinaria) when the thickness of the substance of urine, the calcium oksalat, calcium phosphate, acid strand of improvement. Stone urinal (urolithiasis) can arise at various levels of the system urination (kidney, ureter, bladder), but the most frequently found in the kidney (nephrollihiasis). Approximately one third of individuals who suffer at the channel will chew up the nomination dijangkiti the kidney.
B. Etiology
Theory of the formation of stones: 1). Theory core (nucleus): crystal and a foreign object is settling in urin crystals that have been experienced supersaturasi. 2) Theory matrik Matrik organic or derived from serum protein-protein provides the possibility urin crystal precipitation. 3) crystallization inhibitor Theory: Some substance in urin prevent the occurrence of crystallization, a concentration or occurrence of absennya allows crystallization. Almost half of the cases of stone in the urinal is idiopatik. Factors that influence the process of kalkuligenesis or the formation of stones in the vesika urinaria, among others: the flow of water ¬ Disorders urine / obstruksi static and Disturbances metabolism urin ¬ ¬ channel urine infection by microorganisms powerless to make urease (Proteus Mirabilis). Channel urine infection can cause kidney nekrosis network or other channels urine (vesika urinaria) and will be the core of the formation of stone lines urine. ¬ ¬ foreign Benda died Network (nekrosis papil) ¬ Sex Data indicate that the stone channel more urine found in the male. ¬ The descendants of a family member with a channel stone chew have more opportunity to have a stone channel urine from the other. ¬ have drinking water diuresis with how much water will reduce the possibility terbentuknya stone, while less water when the level of all substances in urin akan akan simplify and increase the formation of stones. According to the saturation water content, especially calcium mineralnya estimated influence terbentuknya ureter stones. ¬ Workers Employment-workers a lot of hard labor such as moving and farmers will reduce the likelihood of a stone channel urine when compared with many workers who are seated. ¬ Food Society consume a lot of animal protein morbiditas number decreased ureter stones, while the people with low socio-economic condition more often. Population vegetarian meals that are less white eggs often suffer stone urine channel (vesika urinaria dab uretra). ¬ Temperature is the bersuhu spent a lot of heat causing perspiration, will reduce the production of urin and easier formation of stone lines urine.
C. PATOFISIOLOGI
Stone in the urinal obstruksi lines derived from the urine, may occur only obstruksi partial or complete. Obstruksi can become a full hidronefrosis with the signs and symptoms. Patofisiologisnya process is mechanical. Urolithiasis is the crystallization of minerals from the surrounding matrix, such as pus, blood, a network that is not vital, tumor or blood vessel. Increasing the concentration of the solution due urin low fluid intake and also increase the organic materials due to static ISK or urin, mensajikan digs for the formation of stones. Add in the infection to increase basahan urin (Amonium by production), which result in presipitasi calcium phosphate and magnesium phosphate Amonium. Renalis calculus composition and the factors that are encouraging: No composition / type of stone supporting factors / causes of Calcium 1 (oksalat and phosphate) Hiperkalsemia Hiperkasiuri Impact of Vitamin D Hiperparatiroidisme Intoksikasi dislocated a severe disease Asidosis Tubulus Renalis Intake steroid purine Ph urin high Low urine volume and 2 acid urin (Gout) Diet and high purine ph urin low urin Volume 3 low xanthine Cystinuria and Cystine impact of genetic disruption of amino acid metabolism and mechanisms of formation of xanthineuria kidney stones or urine channel is not known exactly, but some the book is the stone could be caused by the following: a. There is presipitasi salt-soluble salt in the urine, when urine is saturated precipitation will occur. b. There is a core (nidus). For example there is infection then occurs tukak, which is the core tukak stone formation, as the place menempelnya particles on the stone's core. c. Changes in pH or any other colloid in urine will neutralize meyebabkan load and the occurrence of precipitation. Speed of growth depends on a stone to stone location, such as a stone jar on the faster growth of the disbanding of kidney stones. It also depends on the reaction of the urine, that is stone sour akan rapid growth in urin with a low pH. Urin composition will also facilitate the growth of stones, because there are substances-substances in urine that it can not be relatively late. Another thing that will accelerate the growth is due to a stone infection. Kidney stones in a certain amount to grow attached to the top of the papil and remain in kaliks, who came to pyelum which can then move to the distal area, remain or settle in a place where any time and developed into a large stone.
D. PATHWAY
Decrease in fluid intake Static urin urine infection channel Renal / kidney concentration urin solvent crystallization of mineral matrix surrounding Obstruksi sal urine prsial / total kidney stone / urolithiasis Ureter / ureterolithiasis Vesikolithiasis auaretrolithiasis Changes elimination pattern BAK Operation open Resti infection Port entrée de micro Poor information Poor knowledge conditions does it feel comfortable Ggn: painful hipotalamus stimulate nociseptor
E. Complications
If the stone is left can be a breeding bacteria that can cause urine infection channel, pylonetritis, and ultimately, kidney damage, kidney failure and then emerged with all the consequences that are far more severe.
F. Clinical manifestations
a) In addition to the severe pain attacks that occur in a sudden take a moment and then suddenly disappear and then, reappear, along with rapid pulse, pallor, cold sweat and blood pressure down or called kolik, also accompanied by pain that blurred repeatedly in the kidney and the feeling of hot or burned at the waist that can take several days to several weeks. Hematuri can also occur when there is a wound in urine due to channel shifting stones.
b) When the going can be touched hydronefrosis kidney enlargement. Urin fever and a turbid akan also experienced kidney stone sufferer. Fever indicates infection broadcaster. If a stoppage comprehensive channel urine, body temperature can suddenly high repeatedly. c. Anuria akan stones occur when there is bilateral or if there is only one kidney patients.
G. FOCUS
1) Data subjective pain Pain (kolik renal) are the main symptoms of the acute episode of renal calculus. Location of pain depends on the location of the stone. When the trophies are in a new kidney, pain is the result of more hidronefrosis that it is dull and constant, especially arising in the costovertebral angle. When you walk along stone ureter pain increase and are becoming intermiten. Caused by pressure due spasme ureter stones. Pain along anterior path of the ureter down to the supra pubis and crawling to external genetalia. Often the quiet stone and do not cause symptoms for several years, and this indeed occurred in the kidney stone is very large. Stone which is very small and can be fine unwittingly passed by the person. Nausea and vomiting often accompany the kolik renal.
2) Objective data Urin monitored blood on there. Gross hematuria / fresh bleeding happens when the stones can be edge-tapering pinggirnya and can also occur mikrohematuri. If there is a stone is suspected, all urin be filtered to determine there is a stone that can be out of time berkemih. Pattern berkemih recorded, because berkemih but often a little bit once. Asiditas or kalkalisan urin checked with PH paper / litmus paper.
H. Nursing diagnosis AND INTERVENTIONS
1. Interference feeling comfortable: there is excessive pain in the waist area of the stone bd on a narrow area in the ureter or the kidney. Data support: ¬ ¬ weary of excessive weakness, nausea, vomiting, cold sweat ¬ nervous patients Destination: Pain can be sick / lost. Criteria: • Kolik reduced / lost • Patients do not complain illness • Patients can rest quietly. Action Plan ¬ Kaji intensity, location and area and the spreading of pain ¬ Observation of abdominal pain ¬ Explain to the patient the cause of pain patients Suggest ¬ ¬ Please drink a lot of positions and a comfortable environment ¬ Teach relaxation techniques, distortion and techniques to imagine a guide eliminate pain without drugs. ¬ cooperation with the health care team: • The provision of drugs The anti-drug addict • spasmotika
2. Perubaha pattern of elimination obstruksi bd (calculi) in the renal or the uretra. Supporting Data: • Urine out put <50 cc perjam • Regional perifer pale cold blood • <100/70 mmHg • Nadi> 120 x permenit respiratory •> 28 x permenit • Charging capillary> 3 seconds Objectives: Disturbances perfusi can be overcome Criteria: • 30-50 cc urine production perjam • • Perifer warm vital signs in the limit of normal • Charging capillary <3 seconds Action Plan - Observation vital signs - Observed urine production per hour - Observed changes in the level of awareness - Cooperation with the health care team: -- laboratory examination: kadae ureum / kreatinin, Hb, HCT Urine
3. Lack of knowledge about the condition of the disease less bd Data supporting information: Patients not claim to understand about the disease in patients less cooperative treatment program Purpose: Knowledge about the disease patients increased Criteria: • Patient understanding of disease processes • Discuss the process of the Action Plan of the disease: - Kaji level knowledge patients and families - an opportunity to patients / families to express perasaannya - Discuss the importance of infusion fluids - Suggest white patients to drink 6-8 liters of water per day for no contra indications - Limit physical activity weight - Discuss the importance of low-calcium diet - Cooperation with the health team : ¬ Diet low protein, low calcium and posfat ¬ chlorida of ammonium and mandelamine
4. Resti infections associated with microorganisms entrée de port through the operation wound. Goal: No infection occurred Criteria results: ¬ Improve healing time with the right, free from drainage purulen / eritema, and no fever ¬ says the cause of the risk factors ¬ Demonstrating techniques, changes in living patterns to reduce the risk intervention: - Record the characteristics of urine, and note whether the changes relate to the pain complaint pinggul. - Test urine with pH paper Nitrazin - Report a halt the flow of urin abruptly. - Observation and record wound drainage, signs inflamasi insisi, the systemic sepsis. - Replace the bandage according indication, when wearing. - Kaji area in the thigh skin fold, perineum - Awasi vital signs
Urolithiasis is an emergency of a cumulation oksalat, calculi (kidney stones) in the ureter or the kidney area. Symptoms of excessive pain in the waist, Nausea, vomiting, fever, hematuria. More occurred in men dibanging women 3:1 in comparison with the age of 30-60 years. Urine color, such as snoring or red tea.
Vesikolithiasis (bladder stones) there is a stone in the bladder. Vesikolithiasis refers to the stone / kalkuli in vesika urinaria. Stone formed in the funnel urinal (vesika urinaria) when the thickness of the substance of urine, the calcium oksalat, calcium phosphate, acid strand of improvement. Stone urinal (urolithiasis) can arise at various levels of the system urination (kidney, ureter, bladder), but the most frequently found in the kidney (nephrollihiasis). Approximately one third of individuals who suffer at the channel will chew up the nomination dijangkiti the kidney.
B. Etiology
Theory of the formation of stones: 1). Theory core (nucleus): crystal and a foreign object is settling in urin crystals that have been experienced supersaturasi. 2) Theory matrik Matrik organic or derived from serum protein-protein provides the possibility urin crystal precipitation. 3) crystallization inhibitor Theory: Some substance in urin prevent the occurrence of crystallization, a concentration or occurrence of absennya allows crystallization. Almost half of the cases of stone in the urinal is idiopatik. Factors that influence the process of kalkuligenesis or the formation of stones in the vesika urinaria, among others: the flow of water ¬ Disorders urine / obstruksi static and Disturbances metabolism urin ¬ ¬ channel urine infection by microorganisms powerless to make urease (Proteus Mirabilis). Channel urine infection can cause kidney nekrosis network or other channels urine (vesika urinaria) and will be the core of the formation of stone lines urine. ¬ ¬ foreign Benda died Network (nekrosis papil) ¬ Sex Data indicate that the stone channel more urine found in the male. ¬ The descendants of a family member with a channel stone chew have more opportunity to have a stone channel urine from the other. ¬ have drinking water diuresis with how much water will reduce the possibility terbentuknya stone, while less water when the level of all substances in urin akan akan simplify and increase the formation of stones. According to the saturation water content, especially calcium mineralnya estimated influence terbentuknya ureter stones. ¬ Workers Employment-workers a lot of hard labor such as moving and farmers will reduce the likelihood of a stone channel urine when compared with many workers who are seated. ¬ Food Society consume a lot of animal protein morbiditas number decreased ureter stones, while the people with low socio-economic condition more often. Population vegetarian meals that are less white eggs often suffer stone urine channel (vesika urinaria dab uretra). ¬ Temperature is the bersuhu spent a lot of heat causing perspiration, will reduce the production of urin and easier formation of stone lines urine.
C. PATOFISIOLOGI
Stone in the urinal obstruksi lines derived from the urine, may occur only obstruksi partial or complete. Obstruksi can become a full hidronefrosis with the signs and symptoms. Patofisiologisnya process is mechanical. Urolithiasis is the crystallization of minerals from the surrounding matrix, such as pus, blood, a network that is not vital, tumor or blood vessel. Increasing the concentration of the solution due urin low fluid intake and also increase the organic materials due to static ISK or urin, mensajikan digs for the formation of stones. Add in the infection to increase basahan urin (Amonium by production), which result in presipitasi calcium phosphate and magnesium phosphate Amonium. Renalis calculus composition and the factors that are encouraging: No composition / type of stone supporting factors / causes of Calcium 1 (oksalat and phosphate) Hiperkalsemia Hiperkasiuri Impact of Vitamin D Hiperparatiroidisme Intoksikasi dislocated a severe disease Asidosis Tubulus Renalis Intake steroid purine Ph urin high Low urine volume and 2 acid urin (Gout) Diet and high purine ph urin low urin Volume 3 low xanthine Cystinuria and Cystine impact of genetic disruption of amino acid metabolism and mechanisms of formation of xanthineuria kidney stones or urine channel is not known exactly, but some the book is the stone could be caused by the following: a. There is presipitasi salt-soluble salt in the urine, when urine is saturated precipitation will occur. b. There is a core (nidus). For example there is infection then occurs tukak, which is the core tukak stone formation, as the place menempelnya particles on the stone's core. c. Changes in pH or any other colloid in urine will neutralize meyebabkan load and the occurrence of precipitation. Speed of growth depends on a stone to stone location, such as a stone jar on the faster growth of the disbanding of kidney stones. It also depends on the reaction of the urine, that is stone sour akan rapid growth in urin with a low pH. Urin composition will also facilitate the growth of stones, because there are substances-substances in urine that it can not be relatively late. Another thing that will accelerate the growth is due to a stone infection. Kidney stones in a certain amount to grow attached to the top of the papil and remain in kaliks, who came to pyelum which can then move to the distal area, remain or settle in a place where any time and developed into a large stone.
D. PATHWAY
Decrease in fluid intake Static urin urine infection channel Renal / kidney concentration urin solvent crystallization of mineral matrix surrounding Obstruksi sal urine prsial / total kidney stone / urolithiasis Ureter / ureterolithiasis Vesikolithiasis auaretrolithiasis Changes elimination pattern BAK Operation open Resti infection Port entrée de micro Poor information Poor knowledge conditions does it feel comfortable Ggn: painful hipotalamus stimulate nociseptor
E. Complications
If the stone is left can be a breeding bacteria that can cause urine infection channel, pylonetritis, and ultimately, kidney damage, kidney failure and then emerged with all the consequences that are far more severe.
F. Clinical manifestations
a) In addition to the severe pain attacks that occur in a sudden take a moment and then suddenly disappear and then, reappear, along with rapid pulse, pallor, cold sweat and blood pressure down or called kolik, also accompanied by pain that blurred repeatedly in the kidney and the feeling of hot or burned at the waist that can take several days to several weeks. Hematuri can also occur when there is a wound in urine due to channel shifting stones.
b) When the going can be touched hydronefrosis kidney enlargement. Urin fever and a turbid akan also experienced kidney stone sufferer. Fever indicates infection broadcaster. If a stoppage comprehensive channel urine, body temperature can suddenly high repeatedly. c. Anuria akan stones occur when there is bilateral or if there is only one kidney patients.
G. FOCUS
1) Data subjective pain Pain (kolik renal) are the main symptoms of the acute episode of renal calculus. Location of pain depends on the location of the stone. When the trophies are in a new kidney, pain is the result of more hidronefrosis that it is dull and constant, especially arising in the costovertebral angle. When you walk along stone ureter pain increase and are becoming intermiten. Caused by pressure due spasme ureter stones. Pain along anterior path of the ureter down to the supra pubis and crawling to external genetalia. Often the quiet stone and do not cause symptoms for several years, and this indeed occurred in the kidney stone is very large. Stone which is very small and can be fine unwittingly passed by the person. Nausea and vomiting often accompany the kolik renal.
2) Objective data Urin monitored blood on there. Gross hematuria / fresh bleeding happens when the stones can be edge-tapering pinggirnya and can also occur mikrohematuri. If there is a stone is suspected, all urin be filtered to determine there is a stone that can be out of time berkemih. Pattern berkemih recorded, because berkemih but often a little bit once. Asiditas or kalkalisan urin checked with PH paper / litmus paper.
H. Nursing diagnosis AND INTERVENTIONS
1. Interference feeling comfortable: there is excessive pain in the waist area of the stone bd on a narrow area in the ureter or the kidney. Data support: ¬ ¬ weary of excessive weakness, nausea, vomiting, cold sweat ¬ nervous patients Destination: Pain can be sick / lost. Criteria: • Kolik reduced / lost • Patients do not complain illness • Patients can rest quietly. Action Plan ¬ Kaji intensity, location and area and the spreading of pain ¬ Observation of abdominal pain ¬ Explain to the patient the cause of pain patients Suggest ¬ ¬ Please drink a lot of positions and a comfortable environment ¬ Teach relaxation techniques, distortion and techniques to imagine a guide eliminate pain without drugs. ¬ cooperation with the health care team: • The provision of drugs The anti-drug addict • spasmotika
2. Perubaha pattern of elimination obstruksi bd (calculi) in the renal or the uretra. Supporting Data: • Urine out put <50 cc perjam • Regional perifer pale cold blood • <100/70 mmHg • Nadi> 120 x permenit respiratory •> 28 x permenit • Charging capillary> 3 seconds Objectives: Disturbances perfusi can be overcome Criteria: • 30-50 cc urine production perjam • • Perifer warm vital signs in the limit of normal • Charging capillary <3 seconds Action Plan - Observation vital signs - Observed urine production per hour - Observed changes in the level of awareness - Cooperation with the health care team: -- laboratory examination: kadae ureum / kreatinin, Hb, HCT Urine
3. Lack of knowledge about the condition of the disease less bd Data supporting information: Patients not claim to understand about the disease in patients less cooperative treatment program Purpose: Knowledge about the disease patients increased Criteria: • Patient understanding of disease processes • Discuss the process of the Action Plan of the disease: - Kaji level knowledge patients and families - an opportunity to patients / families to express perasaannya - Discuss the importance of infusion fluids - Suggest white patients to drink 6-8 liters of water per day for no contra indications - Limit physical activity weight - Discuss the importance of low-calcium diet - Cooperation with the health team : ¬ Diet low protein, low calcium and posfat ¬ chlorida of ammonium and mandelamine
4. Resti infections associated with microorganisms entrée de port through the operation wound. Goal: No infection occurred Criteria results: ¬ Improve healing time with the right, free from drainage purulen / eritema, and no fever ¬ says the cause of the risk factors ¬ Demonstrating techniques, changes in living patterns to reduce the risk intervention: - Record the characteristics of urine, and note whether the changes relate to the pain complaint pinggul. - Test urine with pH paper Nitrazin - Report a halt the flow of urin abruptly. - Observation and record wound drainage, signs inflamasi insisi, the systemic sepsis. - Replace the bandage according indication, when wearing. - Kaji area in the thigh skin fold, perineum - Awasi vital signs
treat cough with tradition jawa
jawa (indonesia ) people generally treat a cough with natural ingredients they use - the materials for pickup made in medicine. Any way people treat it with a cough is a herb lemon half and soya bean soybean half spoon. is the half lemon in the water to grab the spoon in the Mix soy sauce and soy, does not require additional water, then poke through the flat. then drink. but this herb should not be drinking at someone when you're in the sick stomach gastritis or inflammation. because of this herb contains vitamin c and feel glum.
Friday, June 12, 2009
Maintained the health is important
Maintained the health is important
“ the LIFE must be HEALTHY “, that was the slogan that was exact for our life, healthy was important for us, why? Because healthily so we could achieve the perfect life. How when our life was unhealthy? His answer must be the misery. Took care to live we in order to stay healthy including being by means of:
1. Avoid tobacco
2. eating health food
3. should not drink alcohol
4. sport
5. and others
it is hoped healthy your life always, and guarded your healthy.
“ the LIFE must be HEALTHY “, that was the slogan that was exact for our life, healthy was important for us, why? Because healthily so we could achieve the perfect life. How when our life was unhealthy? His answer must be the misery. Took care to live we in order to stay healthy including being by means of:
1. Avoid tobacco
2. eating health food
3. should not drink alcohol
4. sport
5. and others
it is hoped healthy your life always, and guarded your healthy.
Tuesday, June 9, 2009
Avian Influenza (BIRD FLU) Our method of avoiding this virus was..... Lately often was reported dimedia the mass about his danger avian influenza or more was known with bird flu bird flu. Moreover could be said, now bird flu could be said as the spectre of the world. This was caused did not yet have medicine that was effective for this flu recuperation. The virus that attacked this was spread by the poultry, that notabene was main food for some people but also as the source of the livelihood. So as to become the very frightening spectre, was caused the poultry personally had the high mobility (red, birds) so as his spreading also could easily, when we did not know methods of avoiding him. Everything was reported also that this virus also attacked the dog and the cat. How tips n the method of avoiding him?
1. The short Avian history influenza of – Flu Burung in fact not a new matter, this flu has been since 100 years ago, was found the first time in Italia, and in accordance with his name then, this virus only attacked was limited to the poultry not to humankind. The infection was to these birds caused by a kind of influenza virus tie A the sub-type H5 and H7. This virus was the first time found attacked humankind in Hong Kong in 1997, in 2003 spread in Vietnam but also to Indonesia. Moreover immediately already many falling casualties were caused by this virus. The influenza virus was divided into 3 types, that is the A type virus, the B type and the C type with several sub-types. The virus that now attacked to humankind was the virus that bertipe A the sub-type H5N1. This virus was easy bermutasi so as to be not yet found appropriate medicine, so as when attacking humankind could result in fatal. Could be mentioned highly pathogenic avian influenza was caused by the sufferer's mortality rate that could
2. The sign
● to Unggas
– the Poultry was sick and not appetite. The certain case was found also the poultry at once died. – Unggas that was attacked by this virus could be seen in the cock's comb changed to changed pale or coloured blue, was caused by the existence of stemming of blood vessels all over the body. – Ada also the poultry that experienced leleran or pilek.
● to Manusia
– to humankind, his sign like common flu, that is the high fever on 39 Celcius levels and was accompanied pilek. As in the case of to this virus poultry immediately will spread all through the body. So as immediately must be handled, because of could cause the outbreak of blood vessels, even the outbreak of brain blood vessels.
– Kadang we regarded the sign like above was the normal sign, dengue fever then also had the sign that almost same, that is the high fever. Immediately periksakan or konsultasikan to the Hospital or the closest doctor, particularly having the poultry that died suddenly in the house or our neighbour.
1. The short Avian history influenza of – Flu Burung in fact not a new matter, this flu has been since 100 years ago, was found the first time in Italia, and in accordance with his name then, this virus only attacked was limited to the poultry not to humankind. The infection was to these birds caused by a kind of influenza virus tie A the sub-type H5 and H7. This virus was the first time found attacked humankind in Hong Kong in 1997, in 2003 spread in Vietnam but also to Indonesia. Moreover immediately already many falling casualties were caused by this virus. The influenza virus was divided into 3 types, that is the A type virus, the B type and the C type with several sub-types. The virus that now attacked to humankind was the virus that bertipe A the sub-type H5N1. This virus was easy bermutasi so as to be not yet found appropriate medicine, so as when attacking humankind could result in fatal. Could be mentioned highly pathogenic avian influenza was caused by the sufferer's mortality rate that could
2. The sign
● to Unggas
– the Poultry was sick and not appetite. The certain case was found also the poultry at once died. – Unggas that was attacked by this virus could be seen in the cock's comb changed to changed pale or coloured blue, was caused by the existence of stemming of blood vessels all over the body. – Ada also the poultry that experienced leleran or pilek.
● to Manusia
– to humankind, his sign like common flu, that is the high fever on 39 Celcius levels and was accompanied pilek. As in the case of to this virus poultry immediately will spread all through the body. So as immediately must be handled, because of could cause the outbreak of blood vessels, even the outbreak of brain blood vessels.
– Kadang we regarded the sign like above was the normal sign, dengue fever then also had the sign that almost same, that is the high fever. Immediately periksakan or konsultasikan to the Hospital or the closest doctor, particularly having the poultry that died suddenly in the house or our neighbour.
DENGUE FEVER ONLY could IN COMBAT with YOU ACTIVE ROLE
DENGUE FEVER ONLY could IN COMBAT with the YOU ACTIVE ROLE Because of the number of places that had the high risk for the spread, then the eradication pinched must was carried out by the community comprehensively, was arranged one week very much and berkesinambungan. the role of the district head/the territory, the head of the office, the teacher, the Muslim scholar, the Manager the factory/the hotel and each leader of the community including the cadre were critical for the success of eradication efforts of the Demam Berdarah Illness. Be on the alert DENGUE FEVER!!!!!!!!
Subscribe to:
Comments (Atom)