Recognize the Signs of Labor

Although the birth process is different on every woman but the signs of labor are the same. By knowing the signs of labor you will understand when it is appropriate to go to the hospital and what can be done if the signs are there in your labor.



Signs of labor:

Mucus mixed with blood

Expenditure mucus mixed with blood. Occurs due to blockage of the thick cervical mucus despite causing a reddish color because of mixed blood.

What to do:
Expenditure of blood and mucus may occur several days before delivery, so wait until you get regular contractions or rupture of amniotic fluid, before you go to the hospital.
You should contact your doctor if there is severe bleeding.

Rupture of amniotic sac Water

The amniotic sac that surrounds the baby breaks so that the amniotic fluid out (Normal amniotic fluid is a liquid that is clean, clear and odorless.)

What to do:
Contact your doctor immediately to the hospital, even if you do not feel the contractions, because it becomes the risk of infection. While the journey can use a sanitary napkin to absorb your amniotic fluid.


Contraction of the Organized

Unlike Braxton Hick contractions, contractions occur regularly, at first contraction for a short while and then grow old and growing stronger, and contraction occurs symmetrically on both sides starting from the upper stomach near the oviduct throughout the uterus, and the pain does not disappear / less with rest or persuasion.

What to do:
When the contraction appears regularly, begin to calculate the time.
Record the length of time between a contraction with contraction follows, and duration of the contraction lasts. Delivery only occurs when contractions become closer another 40 seconds between contractions. First deliveries will take place 12-14 hours so you better wait at home while at rest to collect energy for labor. So if your contractions are every 5 minutes once or very sick you can go to the hospital. Do not forget to bring a bag that you have prepared.

Read More

Definition Epidemiology

1. Origin said:
Epi: on, above, superficial, overwrite
Demo: population, human, people
Ology: the science of learning
2. Epidemiology is the science which studies the things that befall humans.
3. Epidemiology is the science that studies the distribution and frequency of disease in populations and faktor-
Faktor/determinan that affect the distribution and frequency.
4. The study is the frequency and distribution of the determinants of disease in populations.
5. Epidemiology is the science that studies the frequency and distribution as well as deteminan of health status or the events associated with health status in a population and the application of this science is used to control health problems.

MAIN OBJECTIVES Epidemiology

Identifying groups at a population that have a high risk of a disease (High risk group). Can identify factors or characteristics of the group.

EPIDEMIOLGI APPROACH

is a way how an epidemiological identify movement or the cause of a disease.

SPECIFIC PURPOSE OF Epidemiology

1. To identify the etiology or movement of a disease and risk factors, ie factors that increase the risk of something to get the disease.
2. To determine the effect of disease on society:
- As a burden on the community
- Input for planning the provision of health care facilities
3. To study the natural history of disease and prognosis of a disease, certain diseases more serious than other diseases. Some quick legih disease cause death than other diseases
4. To evaluate preventive measures and treatment and the ways health services are offered.
5. To control health problems.


THE CONCEPT OF DISEASE PREVENTION

• If the risk groups have been identified, then prevention efforts can be made directly at risk groups, eg by screening.
• If risk factors have been identified, it can be done modifications to these risk factors, thus preventing the occurrence of disease, eg diet with high fat diet was changed to a diet with fiber foods.

Focus of observation:

• Medical clinic patients, people, individual
• Epidemiology Group of individuals

Field of science that requires epidemiological

1. Medical clinics: info about the diagnosis of disease.
2. Biology: info about the nature, characteristics, sources, modes of transmission of disease agents.
3. Chemistry and Physics: info about the hazardous substances or conditions that are hazardous to health.
4. Demographics: info about the composition and characteristics of community
5. Anthropology and Sociology: info about the habits, customs and social character of the community.
6. Genetics and Psychology: info about the nature of genetic and psychological conditions.
7. Statitik and biostatistics: info about the birth, morbidity and mortality in populations and individuals
8. Meteorology: info on air and climate of a region

NATURE OF SCIENCE Epidemiology

1. Descriptive: frequency, distribution
2. Analytical: hypotheses to be tested
3. Constructive: combining some results of research into a concept or a new theory.

Read More

Medical Anthropology

Medical anthropology is a discipline that gives attention to aspects of biological and socio-culture of human behavior, especially about the ways of interaction between the two throughout the history of human life, which affect health and disease in humans.


Anthropology of health assist the socio-cultural study of all the people associated with the sick and healthy as a center of culture, including:
1. Diseases associated with trust (misfortunes)
2. In some societies the misfortunes caused by supernatural forces and the supernatural, or witches
3. Group 'healers' are found with different forms in each community group
4. Healers have a role as a healer
5. The attention to an existence of 'sick' or 'disease' is not an individual, especially the "illness and sickness" in the family or community.

There are a number of science related to anthropology and contribute to each other contribute to the development of other sciences. For example in the fields of biology, medical anthropology describes the techniques and discoveries of medical sciences and its variations, including microbiology, biochemistry, genetics, parasitology, pathology, nutrition, and epidemiology.

This makes it possible to link the biological changes that obtained using the technique of social factors and culture in a particular society. Examples: albinism hereditary disease in an area in East Nusa Tenggara is transmitted through a recessive gene for marriage between family members.

In general, medical anthropology continues to contribute to other health sciences as follows:
1. Provide a way to look at society as a whole, including individual. Where is the proper perspective will be able to contribute right in improving the welfare of a society with still relies on the roots of personality that builds community. Examples of systems approach, holistic, emic, relativism, which became the rationale for anthropology can be used to help solve community problems and develop the situation for the better.
2. Provide a model that is operationally useful to describe the process of socio-cultural field of health.
3. Donations towards research and research methods. Both in formulating an appropriate approach as well as assist the analysis and interpretation of the results of a condition in the community.

Culture

In the context of a school or class-cultural theory that major effects in the study of anthropology, or known as "Ideasionalisme" (ideationalism) (Keesing, 1981; Sathe, 1985) in the study of health in particular.

Goodenough argued that culture is a cognitive system-a system that consists of knowledge, beliefs, and values that are in the minds of individual members of society. This means that the culture was in "the ideational order of reality." Or culture is a mental equipment by members of the community used in the processes of orientation, deals, meetings, formulation of ideas, classification, and interpretation of social behavior evident in the community. Thus the guidelines for community members to behave in socially good / decent and as interpretation for the behavior of others.

The same is also suggested by Sathe (1985:10) that culture is the ideas and important assumptions owned a society that determines or affects communication, justification, and the behavior of its members (Kalangie ,1994:1-2).

Public Health Nursing

Community Health Care is a nursing service which is an integral part of health care performed by nurses, by involving other health care team and the community to obtain a higher level of health of individuals, families and communities. (MOH, 1986).

According to the WHO in 1974, public health care is a unique unity of prakyek nursing and public health aimed at the development and improvement of the health of both themselves as individuals collectively as keliuarga maupus, a special group of people, this service memcakup spectrum of health services to the community.

Read More

Parasitic Worms Reduce Child Intelligence

Worms is a contagious disease and is often considered a disease or illness grubby lower socioeconomic groups. Disease caused by a humid tropical climate, high population density, poor sanitation, excreta used as fertilizer in the garden, soil conditions, and lack of public knowledge was found to reduce children's intelligence.


Intelligence of children of this decline occurred because the worms damage the mucosa (wall) intestine and takes nutrients from food so that children can have food absorption problems and even malnutrition. Due to the lack of nutritional intake in children would interfere with the development of body cells including brain cells. And in the end result does not develop children's intelligence, even declining.

Worms can affect anyone, but if the disease is attacking the children, then the child will experience weak, tired, lethargic, lax and loose (5L). Affected children worms will also become very vulnerable illness, hepatitis, myopic eyes, malnutrition, and decreased level of intelligence. Symptoms most often appear in young worms are digestive problems such as poor appetite, nausea, diarrhea, difficult bowel movements, weight loss and decreased intelligence of children. And anemia, tuberculosis, and malaria is a disease that could arise due to worms.

Intestinal worms in children can be caused by various types of hookworm (Ascaris lumbriocoides, Neactur smericanus, Ancylotomaduodenale), roundworms, whip worms (Truchuris trichiura), and several other types of worms. According to the survey, 60-80% of Indonesia's population affected by worms and 90% of them are elementary school children. Therefore, it is very important to teach children how to live clean, for example by requiring washing hands before eating and drinking.

Read More

Worms Disease

Do you know what percentage of children in Indonesia who became ill worms? Apparently 90% of children in Indonesia suffer from intestinal worms. Worm disease is often considered a trivial disease, however, the impact this disease can be fatal especially if the affected are children who are small and vulnerable to disease.


Worms is a typical disease of tropical regions most severe infection occurs during the rainy season. With environmental sanitation is poor or due to floods, overflowing rivers and ditches, eventually larvae - larvae of the worm spread to many places that are likely to come into contact with humans.

Worm larvae into the human body through direct contact, like children who play without the use of footwear in the regions of the former flow of flood or overflow of water channels. In addition, worms can also spread disease through food contaminated by worm larvae.

Larval worms usually will not hatch while not enter the human body. These larvae can live for weeks have not found anywhere though its host. Only after the larvae enter the human body, it will hatch in the intestine and eat foods that are digested by humans. So that the intestine can not absorb food because it was "hijacked" by the worm first. This has resulted in the human body becomes weak, thin, and lowered body resistance to other diseases began attacking. In addition, if left too long someone infected worms, it is feared may have physical and intellectual weakness. Additionally, worms can also cause nutritional problems and anemia.

So start a clean life for you and your family of worms are not attacked by the disease, because disease does not recognize adults and children alike.

Read More

Epilepsy Papers

CHAPTER I
INTRODUCTION

 A. Background

Epilepsy is defined as a syndrome characterized by impaired brain function are temporary and paroxysmal, which gives the manifestation of disorder, or loss of consciousness, impaired motor, sensory, psychological, and autonomous systems, and is episodic. Cognitive memory deficits are a problem most often occurs in pederita epilepsy.


Every person has a risk of one in 50 to get epilepsy. Drug users and alcohol drinkers had a higher risk. Narcotic users may get a first seizure due to use of narcotics, but then may continue to have seizures despite being separated from narkotik.Di UK, one person among the 131 people suffering from epilepsy.

Epilepsy can affect children, adults, parents and even newborn babies. The incidence of epilepsy is higher in men than in women, ie 1-3% of the population will suffer from epilepsy for life. In the United States, one in 100 population (1%) population susceptible to epileptic seizures, and approximately 2.5 million of whom have undergone treatment in the last five years. According to the World Health Organization (WHO), approximately 50 million people worldwide suffer from epilepsy (2004 Epilepsy.com.)

CHAPTER II
Reader Reviews

A. Definition
Epilepsy that is difficult to control medically or pharmacoresistant, because the majority of patients with epilepsy is resistant, most often attacked in advance of the head. Drugs that can soothe antiepileptik the standard. Related to biomolekular base complex. Headache attack is very difficult to be treated by pharmacological, although already in an optimal antiepileptic drug is given, about 30-40% of epilepsy patients are infected, patients usually perform surgery to relieve pain temporarily. But the symptoms of epilepsy will occur occasionally, because epilepsy is difficult to remove the head pain that attack.

B. Risk Factors
Epilepsy can affect children, adults, parents and even newborn babies. The incidence of epilepsy is higher in men than in women, ie 1-3% of the population will suffer from epilepsy for life. In the United States, one in 100 population (1%) population susceptible to epileptic seizures, and approximately 2.5 million of whom have undergone treatment in the last five years. According to the World Health Organization (WHO), approximately 50 million people worldwide suffer from epilepsy (2004 Epilepsy.com.)

C. Epidemiology
Basically everyone can have epilepsy. Every person has a brain with each generation threshold is more resistant or less resistant to the emergence of resurrection. In addition, the cause of epilepsy is quite diverse: brain injury, poisoning, stroke, infection, parasitic infestation, a brain tumor. Epilepsy can occur in males and females, any age, and race whatever. The number of people with epilepsy include 1-2% of the population. In general, shows the incidence of epilepsy showed bimodal pattern: the peak incidence in the group there are children and elderly.

D. Etiology
Etiologic factors affect the determination of prognosis. The main cause, is idopatik epilepsy, remote symptomatic epilepsy (RSE), acute symptomatic epilepsy, and epilepsy in children based on brain damage at the time of peri-or antenatal. Within these classifications there are two prominent types of epilepsy, epilepsy is idiopathic and RSE. From these two there are many different etiologies and syndromes, each with a good prognosis and bad.

Symptomatic epilepsy based on brain tissue damage was evident on CT scan or magnetic resonance imaging (MRI) and no apparent brain damage but against a background of antenatal or perinatal problems with obvious neurologic deficit. Meanwhile, the view of the possibility of re-generation of post-awitan.

The definition of neurologic in relation to the age when awitan have predictive value as follows:
• If at the time of birth, the neurologic deficit has occurred within the first 12 months the whole case will have re-generation,
• If the neurologic deficit occurs when the risk of postpartum re-generation is 75% in the first 12 months and 85% in the first 36 months. In addition, the first generation that occurs during acute brain disorder will have a risk of 40% in the first 12 months and 36 months for the occurrence of re-awakening. Overall the risk for re-generation is not constant. Most cases showed re-generation within the first 6 months.

E. Pathogenesis
The nervous system is a communication network (communication network). The brain communicates with the organs of the body through nerve cells (neurons). In normal conditions, nerve impulses from the brain electrically will be brought neurotransmitters such as GABA (gamma-aminobutiric acid) and glutamate by nerve cells (neurons) to the organs of the body. Causative factors of epilepsy in this system interfere, causing power imbalance in nerve cells and cause seizures that are characteristic of epilepsy.

Factors trigger epilepsy:
• Pressure,
• Lack of sleep or breaks,
• Sensitive to bright light (photo sensitive), and
• Drinking alcohol.

F. Diagnosis
Evaluation of patients with paroxysmal nature of symptoms, especially with an unknown factor, requires specialized knowledge and skills to explore and discover relevant data. The diagnosis of epilepsy was based on anamnesis and clinical examination combined with the results of EEG and radiologis.penderita or their parents need to be asked to testimony about the history of epilepsy the family. Then proceed with multiple checks, among others:

• Physical Examination
This examination is sifting the causes of generation by using the age and history of the disease as a handle. On auscultation elderly neck region is important to detect vascular disease. In children, judging by the slow growth, sebaceous adenoma (tuberous sclerosis), and organomegali (srorage disease).

• Electro-ensefalograf
EEG patterns in epilepsy may help to determine the type and location of generation. Epileptiform wave comes from the spark paroxysmal sourced on a group of neurons that have a synchronous depolarization. Overview of the recorded EEG epileptiform anatarcetusan appeared and stopped abruptly, often with a distinctive morphology.

• Examination of the brain imaging
MRI aims to look at brain structure and complete EEG data. Useful to compare the right and left hippocampus. One also can identify abnormalities of brain growth, the tumors are small, certain vascular malformations, and diseases of demyelination.
Differential Diagnosis

• Genesis paroxysmal
Differential diagnosis for paroxysmal events that are included sinkrop, migraine, TIA (TransientIschaemic Attack), periodic paralysis, gastrointestinal disorders, disorders of movement and breath holding spells. This diagnosis is fundamental.

• simple partial epilepsy
Diagnosis includes TIA, migraine, hyperventilation, tics, mioklonus, and spasmus hemifasialis. TIAs can occur with sensory symptoms are distinguished from simple partial epilepsy. Both paroksimal, generation may be losing sight for a moment, and experience of elderly patients.

• complex partial epilepsy
Differential diagnosis is related to the level of loss of consciousness, ranging from drop attacks through behavior patterns that rumit.secara common diagnoses include sinkrop, migraine, sleep disorders, non-epileptic attack, narcolepsy, metabolic disorders and transient global amnesia.

G. Management
Once the diagnosis is established, the therapeutic actions are maintained. All people who suffer from epilepsy, both idiopathic and non-idiopathic, but the underlying pathological process is progressive not active as cerebral tumor, should receive medicinal therapy. Drug choice for eradication of epileptic attacks of any kind, other than petit mal, is luminal or phenytoin. To determine the dose must be known luminal patients' age, type epilepsinya, frequency of attacks and when the doctors treated another. Doses of drugs being used. For children luminal dose is 3-5 mg / kg / BW / day, while adults do not need a dose of it. Adults need 60 to 120 mg / day. Dose of phenytoin (Dilatin, Parke Davis) for children is 5 mg / kg / BW / day for adults and 5-15 mg / kg / BW / day. Effects phenytoin 5 mg / kg / BW / day (approximately 300 mg daily) had seen in five days. So if the direct effect to be achieved at doses of 15 mg / kg / BW / day (approximately 800 mg / day) should be used.

Anticonvulsant effect can be assessed on the 'follow up'. Patients with common assault frequency of 3 times a week is much easier to treat compared with patients who have a frequency of 3 times a year. On the visit of 'follow up' to be reported good results, bad or that can not be judged good or bad because of the frequency of attacks before and during the new therapy is still about the same. When the frequency is reduced by appeal, the doses being used needs to be increased slightly. When frekuensinay fixed, but the attack epileptic patients assessed by their parents or people with epileptic Jackson motor / sensory / 'march' as 'light' or 'much lighter', then the doses used may be continued or increased slightly. If the result is bad, the dose should be increased or added to other anticonvulsants.
Therapy Treatment of Epilepsy:

The first drug most commonly used:
(Such as: sodium valporat, phenobarbital and phenytoin)
• It is recommended for people with epilepsy new
• These medications will give side effects such as gum swelling, dizziness, acne and body fur (Hirsutisma), swollen seed kelenjardan osteomalakia.

The second drug commonly used: (such as lamotrigine, tiagabin, and gabapetin)
• If there is no change in the patient's head after the first drug use, the drug will be added with the second drug.
• Lamotrigine has been released as the first drug in Malaysia.
• New drugs are introduced do not have side effects, especially in terms of disability during birth.

CHAPTER III
CLOSING

A. Conclusion

Epilepsy is a disorder of the central nervous system (CNS) characterized by the occurrence of resurrection (seizure, fit, attact, spell) a spontaneous (unprovoked) and periodic. Generation can be interpreted as a modification of brain function that are sudden and quick, which is derived from a large group of brain cells, is singkron and rhythmic. The rise of epilepsy occurs when the excitation processes in the brain is more dominant than the inhibition process.

Every person has a risk of one in 50 to get epilepsy. Drug users and alcohol drinkers had a higher risk. Narcotic users may get a first seizure due to use of narcotics, but then may continue to have seizures despite being separated from the narcotic. Generally epilepsy may be caused by brain damage in the process of birth, head injury, stroke, brain tumors, alcohol. Sometimes epilepsy may also be due to genetic, hereditary disease but not epilepsy. But the exact cause remains unknown.

References

- Harsono.2007.Epilepsi, Gadjah Mada University Press, Yogyakarta
- Sidhartha, Priguna M.D., Ph. D.1999. Clinical Neurology in general practice, Dian Rakyat, Jakarta.
- Http / / epilepsi.web. / / Www.google.co.id//2009

Read More

How to Cope with Epilepsy Disease Symptoms

What is epilepsy? What causes epilepsy? definition of epilepsy? and how to overcome the symptoms of epilepsy itself.

Epilepsy, derived from the Greek (Epilepsia), which means 'attack'. Please note, epilepsy is not contagious, not a hereditary disease, and not identical with the people who experience mental ketebelakangan. In fact, many people with epilepsy who suffer from epilepsy without a known cause.


Causes of Epilepsy

Our brain consists of millions of nerve cells (neurons), in charge of coordinating all activities of our body including feeling, seeing, thinking, moving the (muscle).

In people with epilepsy, sometimes these signals, do not move properly. This can be caused by various factors, among others; head trauma (head region had experienced an injury), brain tumors, and so forth.

Generally epilepsy may be caused by brain damage in the process of birth, head injury, stroke, brain tumors, alcohol. Sometimes epilepsy may also be due to genetic, hereditary disease but not epilepsy. But the exact cause remains unknown.

Diagnosis

Hippocrates was the first to successfully identify the symptoms of epilepsy as a problem in the brain, evil spirits, and so forth. A person may otherwise suffer from epilepsy if that person has at least had seizures that are not caused by alcohol and blood pressure is very low. The tools that are used normally are:
- MRI (Magnetic Resonance Imaging) Using a powerful magnet to earn a picture of the body / brain someone. Not using X-Ray. MRI is more sensitive dripada CT-Scan.
- EEG (Electro Encephalo Graphy) tool to check the brain waves.

How to overcome the symptoms of epilepsy

Up to now unknown drug that truly efficacious to cure epilepsy. The most important effort is to eliminate first the causes which can lead to epileptic attacks, such as the remnants of syphilis, hardened arteries, brain diseases, alcohol poisoning, the worms in the stomach and others. To attempt to reduce epileptic attacks occur and minimize the dangers to people with epilepsy are among others:

1. The patient should keep in daily life, body and thoughts do not be too heavy in the work so as not to become tired. Do not allowed the patient to drink alcohol, coffee or tea is dense and not too much to eat meat. The patient should have a lot to eat vegetables and get enough rest and try to defecate regularly.

2. The patients do not in allowed to perform acts that if something can be dangerous to himself like climbing trees or ladders, climbing the narrow bridge, standing alongside a river or pond or a fire, swimming, cycling, walking alone in a big way and was standing near the machine that was spinning and other forth. Because it all, endanger the patient if the seizure was a relapse.

3. If looking for signs that the patient will be stricken with apoplexy, the command that he swallows 1 or 2 teaspoons of salt and inhaling the smell of garlic that have been finely ground. And also feet and hands may also be tied tightly, may wear a cloth or a large rope. In that way, usually epileptic attack can be avoided.

4. If the patient has fallen unconscious, let laid back and his clothes slightly loosened, if necessary on the sidelines of the upper and lower teeth to enter a clean cloth that has been folded or spoon, to avoid being bitten tongue and allow it until he regained consciousness.

Read More

Definition of Allergy

Allergy refers to the exaggerated reaction by our immune system in response to body contact with certain foreign substances. Exaggerated because these foreign substances are generally regarded by the body as sessuatu that does not harm and does not occur in response to people who are not allergic. The bodies of people who are allergic to recognize foreign material and part of the immune system is activated. Allergy ingredients called "allergens." Examples of allergens include pollen, dust mites, molds, and foods. To understand the language of allergy is very important to remember that allergens are substances foreign to the body and can cause allergic reactions in certain people.


When the allergen in contact with the body, he causes the immune system to develop allergic reactions in people who are allergic to it. When you do not react according to the allergens that are generally not dangerous to other people, you have an allergic reaction and can be referred to as allergic or atopic. By karananya, people who tend to have the allergy is called allergic or atopic.

Austria pediatrician named Clemens Pirquet (1874-1929) first used the term allergy. He referred to both immunity is beneficial and harmful as an allergic hypersensitivity. The word allergy comes from the Greek words "allos," meaning different or changed and "ergos" meaning work or action. Allergies in general are referred to as "the reaction has changed". The word allergy was first used in 1905 to describe the adverse reactions of the children given repeated injections of horse serum to fight infection. The following year, the term allergy is proposed to explain the reactivity of these unexpected changes.

Allergy Facts

* It is estimated that some 50 million Americans affected by allergic conditions.
* The cost of allergies in America is more than $ 10 billion each year.
* Allergic rhinitis (nasal allergies) affects about 35 million Americans, 6 million of whom are children.
* Asthma affects 15 million Americans, 5 million of whom are children.
* Figures from asthma cases doubled over the past 20 years.

Read More

Allergy Causes

To help answer this question, let us look at some examples of common household. A few months after the arrival of a cat in the house, the father started getting the itchy eyes and sneezing episodes of. One in three children developed a cough and wheezing, especially when the cat into the bedroom. Mother and two other children did not experience any reaction to the presence of cats. How do we explain this?


The immune system is a defense mechanism which was organized by the body against foreign invaders, particularly infections. His job is to recognize and react against foreign substances, called antigens. Antigens are the ingredients that can cause the production of antibodies. Antigens may or may not lead to allergic reactions. Allergens are certain antigens that cause allergic reactions and the production of IgE.

The purpose of the immune system is to mobilize its power to assault and destroy the enemy. One way to do this is to create protective proteins called antibodies that specifically targeted against particular foreign substances. These antibodies, or immunoglobulins (IgG, IgM, IgA, IgD), are protective and help destroy a foreign particle by attaching itself to the surface, thus making easier the other immune cells to destroy it. However people who are allergic, develop a specific type of antibody called immunoglobulin E, or IgE, in response to specific foreign substances that are generally harmless, such as cat dander. Summarized, immunoglobulins are a group of protein molecules that work as antibodies. There are 5 kinds of different types: IgA, IgM, IgG, IgD, and IgE. IgE is the allergy antibody.

In the example animal cat, father and youngest daughter developed IgE antibodies directed in large numbers against cat allergens, cat dander. Father and daughter now become sensitive or likely to develop allergic reactions on subsequent exposure and repeated on cat allergen. Typically, there are periods of "sensitivity" that range from monthly to yearly before an allergic reaction. While it may occasionally occur an allergic reaction on first exposure to the allergen, certainly before there is contact so that the immune system to react in this way.

IgE is the antibody which is owned by all of us in small quantities. People who are allergic, however, produce IgE in large amounts. Normally, antibodies are important in protecting us from parasites, but not from cat dander or allergens. During the period of sensitivity, over-produced IgE cat dander and certain cells lining the potentially explosive-containing chemicals. These cells are capable of causing an allergic reaction on subsequent exposure to the dander. This is caused by a reaction from dander cat dander IgE irritates the cells and lead to the release of various chemicals, including histamine. These chemicals, in turn, causes inflammation and allergy symptoms are typical. This is how the immune system becomes excessive and disiapakn to cause an allergic reaction when stimulated by allergens.

Time of exposure to cat dander, mother and two other children generate classes other antibodies, none of them cause allergic reactions. The family members who are not allergic, dander particles are eliminated by the immune system and the cat has no effect on them.

Read More

allergy

Allergic Eczema
Allergic eczema (atopic dermatitis) is generally not an allergic rash caused by skin contact with allergens. This condition is commonly associated with allergic rhinitis or asthma and highlight the following symptoms:

* Itching, redness, and or dryness of skin
* Rash (Rash) in advance, especially children
* A rash around the eyes, in the folds of elbows, and behind the knees, especially in children and older adults


Hives
Hives (urticaria) are skin reactions that occur as swelling, itching and swelling that can occur on any body part. Hives can be caused by allergic reactions, such as in food or drugs, but they also can occur in people who are not allergic. The symptoms of hives, a typical:

* Raised red welts
* Itching great

Allergic Shock
Allergic shock (anaphylaxis or anaphylactic shock) is a life-threatening allergic reaction that can affect several organs at the same time. This response typically occurs when the allergen is eaten (eg, food) or disuntikakan (eg bee stings). Some or all of the following symptoms may occur:

* Hives or reddish discoloration of the skin
* Nose clogged

Swelling of the throat
Abdominal pain, nausea and vomiting
* Short breath, wheezing (wheezing)
Low blood pressure or shock

Shock refers to inadequate blood circulation to the body tissues. The most common shock caused by blood loss or infection. Allergic shock caused by enlarged blood vessels and "leaky", which resulted in the decline of blood pressure.

Read More

High Blood Disease or Hypertension

"Beware of High Blood Diseases In The you without your awareness, recognize the symptoms and causes as early as possible!". High Blood disease or hypertension, is one of the most devastating killer disease in the world today.



Age is one risk factor for hypertension. More often found that people with high blood pressure or hypertension in old age. Blood pressure is showing the state where the pressure imposed by blood in the arteries when blood is pumped by the heart to all members of the body. Blood pressure can be seen by taking two sizes and are usually indicated by numbers such as 120/80 mmHg. Figures 120 shows the pressure in the arteries when the heart contracts. Called systolic pressure. Figures 80 shows the pressure when the heart is relaxing. Called diastolic pressure. The best attitude to measure blood pressure is in a state of sitting or lying down.


High blood pressure (hypertension) causes an increased risk for stroke, heart failure, heart attack and kidney damage. Without looking at age or gender, everyone can get heart disease and usually without any previous symptoms. Blood pressure in one's life varies naturally infants and children normally have a blood pressure is much lower than the adult. Blood pressure is also influenced by physical activity, which will be higher at the time and activity is lower when resting. Blood pressure also differs in one day, the highest in the morning and lowest during sleep at night.


Symptoms of High Blood Diseases (Hypertension)

Hypertension is difficult to recognize by someone because hypertension has no specific symptoms. The symptoms are easily observed, among others, namely:

1. Mild symptoms such as dizziness or headaches

2. Often agitated

3. Red face

4. Sore neck

5. Irritable

6. Ear buzzing

7. It is hard to sleep

8. Blown

9. Sense of weight in the nape

10. Easily tired

11. The eyes see stars

12. Nosebleed (nosebleed)


Hypertension can be identified by measuring blood pressure regularly. Patients with hypertension, if not handled properly, will have a big risk to die from cardiovascular complications like stroke, heart attack, heart failure, and kidney failure, the target of damage caused by hypertension, among others:


- Brain: causes stroke

- Eyes: causes hypertension and retinopathy can cause blindness

- Heart: cause of coronary heart disease (including myocardial sac), heart failure

- Kidney: cause of chronic kidney disease, terminal renal failure


Causes of High Blood Disease or Hypertension.

The cause of hypertension is often referred to as one of the degenerative disease. Generally, people with hypertension do not know him before his blood pressure checked. This disease is also known to affect anyone of various age groups and socio-economic groups. However, more common in the elderly which is one risk factor.


Risk factor for hypertension, are among others:

* Stress.

* Factors Heredity (Genetics).

* Age.

* Intake of Salt.

* A less healthy lifestyle.


With increasing age, the likelihood of someone suffering from hypertension are also getting bigger. Influence of age on the occurrence of stress often occur as well. Many found the retirees who've never worked longer face extreme environmental changes. Faced with conditions at home that no activity and is positioned as being no longer able to perform some job stress raises.


There is an increasing body fluid volume and blood pressure which will be followed by increased spending excess salt substance that back in normal circumstances. In essential hypertension, this condition is disturbed. Diet and activity in an unbalanced also have contributed a great cause of hypertension. Smoking, drinking alcoholic beverages and lack of exercise can also affect blood pressure elevation.


Overweight let alone obese patients will experience higher blood pressure compared with those with normal weight. Increased blood pressure is found throughout the day, including at night. Moreover, added, blood pressure during the night as high as in the daytime in those who have excess weight to overweight. Supposedly, at night, decreased blood pressure, blood bilatekanan remain high, this condition can cause interference with the heart.


Hypertension can be classified into two broad categories, namely primary and secondary. Primary Hypertension Hypertension means that the cause is not known clearly. The second class is the cause of hypertension semunder be said to have been uncertain, for example, kidneys are not functioning, use of oral contraceptives, and disruption of hormonal balance which is a factor regulating blood pressure.

Combating High Blood Diseases

The dominant factors that cause hypertension are diet and body activity. As a result of two things with age increase the risk of disease emergence. Control of hypertension, among others, namely:


1. Diets low in salt, cholesterol, and saturated fat. Reduce intake of salt into the body. Should pay attention to the eating habits of people with hypertension. Reducing salt intake will dramatically difficult to implement, so it should be gradual and not used as a single treatment.

2. Behenti smoking and alcohol

3. Regular physical exercise

4. Avoid stress. Create an atmosphere of calm and relaxation-relaxation routine to do every day. It is important to give the effect of tranquility that can control the nervous system so it can lower blood pressure.

5. Fix a less healthy lifestyle. It is important to do sports such as aerobics or brisk walking about 30 minutes several times a week.


Diet Prevent High Blood Diseases

One of the main causes of hypertension is asteroklerosis. This condition is caused by excess fat consumption. Therefore, to prevent the onset of hypertension is to reduce the consumption of excess fat in addition to the provision of medicines when necessary. Restriction of fat intake should be started early before hypertension appeared, especially in people who have a history of hypertension and on the descent towards the elderly. We recommend starting at the age of 40 years in women to be more cautious in consuming fats because of approaching menopause.


The main principle in making a healthy diet is a balanced nutrition, which consume a balanced variety of foods, namely:


* Sources of carbohydrates: whole grains.

* Sources of protein: fish, poultry, white meat, egg whites, milk / low fat-free.

* The source of vegetable protein: beans and legumes as well as processed products.

* Source of vitamins and minerals: vegetables and fresh fruits.


Healthy diet aims to reduce and maintain ideal weight, so it is recommended to balance calorie intake with total energy needs by limiting consumption of foods containing high calories and / or foods that contain high sugar and fat. In addition, for physical activity sufficient to achieve good physical fitness.


Kesahatan article is taken from a book by Sutanto (Book Title: Beware seven Degenerative Diseases) HOW TO PREVENT AND OVERCOME 7 DAHSYAT MOST KILLER DISEASE: Parkinson CANCER HEART STROKE DIABETES HYPERTENSION OSTEOARTHRITIS


Preventing Always Better than cure ...

Read More

Huknah Low

A. Definition
Insert a warm liquid through the anus to the colon using a cannula rekti desenden.

B. Goal
1. Stimulates intestinal peristalsis, so the patient can defecate
2. Emptying the colon in preparation for surgery
3. As measures of treatment


C. Indication
1. Patients who obstipasi
2. patients who will be in operation
3. Preparation of diagnostic measures such as (radiological examination)
4. Patients with melena

D. Preparation

1. Preparation of patients
a. Therapeutic greetings
b. Introduce yourself
c. Explain to the client and family about the procedure and purpose of the actions to be implemented.
d. Explanations are given to understand the client / family
e. During the communication language used is clear, systematic and non-threatening.
f. Clients / families are given the opportunity to ask for clarification
g. Privacy respected client during the communication.
h. Show patience, empathy, politeness, and attention and respect for communicating and taking action
i. Making the contract (time, place and actions to be taken)
j. Patients put in a position to sleep on your left (the position of the sim)

2. Preparation tool
a. Clean gloves
b. Bath blanket or cloth cover
c. Perlak and buttocks pengalas
d. Irigator complete with canule recti, hoses and klemnya
e. Warm fluids as needed (eg fluid Nacl, soapy water, plain water)
f. Crooked
g. Lubricant (Vaseline, sylokain, Jelly 2% / water-soluble lubricant
h. Hanger pole irigator
i. If necessary provide a chamber pot, water purifier and cotton cebok / toilet tissue

E. Procedure
1. Door closed / pair sampiran
2. Washing hands
3. Nurses standing on the right clients and pairs of gloves
4. Put Perlak and pengalas
5. Put a blanket bath while the bottom of the client's clothing discarded
6. Set the client's position left sim
7. Connect the rubber hose and clamp (closed) with irigator
8. Contents irigator with a liquid that has been provided
9. Hanging irigator with a height of 40-50 cm from the client's buttocks
10. Remove air from the hose to drain fluid into the twisted
11. Put kanule rekti and spread with jelly
12. Enter kanule into the anus, the clamp is opened, enter the liquid slowly
13. If fluid runs out, hose clamps and pull the cannula and insert into the bent
14. Set back the position of the client and ask the client to hold a minute
15. Help the client to the toilet if able, if not fixed in a slanting position and replace the chamber pot dibokong clients.
16. Client dirapihkan
17. Tools trimmed back
18. Washing hands
19. Implement documentation:

a. Record actions taken and results and client response to the client record sheet
b. Record the date and hour of taking action and the name of the nurse who did and signature / initials on the client record sheet

Read More

Cell Biology, Cell Structure and Function

CELL BIOLOGY

Tues fundamental for the biological sciences. All organisms consist of cells. Cells are the unit structure and unit functions in biological systems. Cell as a unit structure, as all systems were prepared by cell biology. While the cell as a functional unit, because all life events that show the characteristic of life going on inside the cell. The living cell is a miniature chemical industry, where thousands of reactions going on inside a room that is microscopic cells.


In the hierarchy of biological organization, this cell is a simple collection of materials that can live. In addition, there are various forms of life intangible as single-celled organisms. More complex organisms, including plants and animals, are multicellular; its body is a collaboration of various types of specialized cells that will not survive long if each stood alone. However, when the cell is organized into a higher level of organization, such as tissues and organs, cells can be separated as the basic unit of structure and function of organisms.

In plants and animals, many cells produce a chemical material which is then delivered for use on other baigan of these organisms. For example, enzymes and hormones are used for the metabolism of cells, tissues and organs. Chemical process known as cellular respiration will move the mobile economy by extracting the energy stored in sugar and other food reserves (catabolism). In contrast, cells use this energy to carry out various types of work, such as synthesis of macromolecules (anabolisme).

Since the discovery of return and recognition of the principles of Mendel, born in 1902 a new science called cytogenetics. Clearly it seems that cytogenetics is a hybrid science pengetaahuan cytology and genetics as the parent.

CELL STRUCTURE AND FUNCTION

Cell structure

The aim is to separate cells fraksionasil cell into parts, separate the major organelles so that their respective functions can be studied
Fractionation preceded by homogenization, in order to break the cell without being too damaging organelles. This activity makes the researchers to prepare specific components of cells in large numbers to study the composition and function.
The main part of the cell were: wall / cell membrane, cytoplasm, and nucleus of cells. But thanks to the discovery of electron microscopy, it has been identified in the cytoplasm of the cell organelles

Cell membrane

Type a variety of membrane is the basis for setting the cell. In general, biological membranes consist of a single phospholipid bilayer (double leyer) and other lipids. Various proteins trapped inside or attached to the surface of the lipid bilayer

With the membrane structure, the molecular organization of the membrane causes the selective permeability of cell membranes (Figure 4). Thus some of the basic functions of cell membranes are:
1. Passive transport is diffusion across a membrane
2. osmosis is the passive transport of water (solvent)
3. cell survival depends on the balance of absorption and release of water
4. Specific proteins facilitate passive transport of selected solutes
5. active transport is the pumping of solutes against gradiennya
6. some ion pumps generate voltage across the membrane
7. dalm kotranspor, mengkopel membrane protein transport of a substance dissolved with other solute
8. eksositosis and endocytosis transport large molecules

Cell organelles
The inner structure of cells and present in the cell cytoplasm called organelles, among them: endoplasmik reticulum, mitochondria, ribosomes, lysosomes, peroxisomes, Golgi apparatus, plastids, vacuoles, etc..

Reticulum Endoplasmik

It is known there are two kinds of endoplasmic reticulum (ER), namely RE-rough (rough RE) and RE-smooth (smooth RE) (Figure 5). Re-refined various cell types function in the metabolism of eg lipid synthesis, carbohydrate metabolism, and offers (detoksikasi) drugs and poisons. Re-refined essential for synthesis of lipids, including phospholipids and steroids. Among the steroid sex hormone that is in the male / male (testosterone), female / female (estrogen), and various steroid hormone produced by the adrenal glands (corticosteroids, aldosterone, cortisone, etc.). Cells that actually synthesize and secrete this hormone testosterone (testes) and estrogen (ovarian), for example, contains many fine RE, which is characteristic of structural and in accordance with the function of these cells.

Liver cells is one fine example of the role of RE in the metabolism of carbohydrates. Liver cells store carbohydrates in the form of glycogen, a polysaccharide. Glycogen hydrolysis causes the release of glucose from the liver cells, which are important in regulating blood sugar levels. Enzyme RE subtle help offered drugs and poisons (detoksikasi function), particularly in the liver. Offering of poison involves the addition of hydroxyl groups into the drug, which causes the drug more soluble and more easily removed from the body. Barbiturates phenobarbital and other sedatives are examples of drugs that are metabolized Obata this way by

RE subtle in liver cells.
Many types of specialized cells secrete a protein produced by ribosomes, which is attached to the RE rude. For example, certain cells in the pancreas to secrete the protein insulin, a hormone into the blood circulation. Most of the proteins skretoris form of glycoproteins, proteins covalently bound to the carbohydrate. In addition to making proteins skretoris, RE roughly a membrane factory that grows in place of adding proteins and phospholipids. Because of polypeptide that would be membrane proteins grow from ribosomes, the polypeptide is inserted into the membrane RE and held there by the hydrophobic proteins. RE coarse also create their own membrane phospholipids.

Golgi apparatus

After leaving the RE, many transport vesicles move to the Golgi apparatus. Organelle is considered a center of manufacturing, warehousing, sorting, and delivery of products from the cell. Here, the product RE modified, and saved, then sent to another destination. Thus, the Golgi apparatus is found in many cells that are specialized for secretion

Lysosomes

Merpakan membrane bound bags of hydrolytic enzymes used by cells to digest macromolecules (Fig. 6). There lysosomes enzymes that can hydrolyze proteins, polysaccharides, fats and nucleic acids. Enzi mini works very well in acidic pH, about pH 5. Lysosome membrane maintain a low pH in this by pumping hydrogen ions from the cytosol into the lumen of lysosomes. If the lysosomes rupture or leak its contents, aktvitas cytosol enzyme is reduced in a neutral environment.

Various hereditary disorder called lysosome storage diseases (lysosomal storage diseases) affect the metabolism of lysosomes. People with this deficiency one active hydrolytic enzymes that are normally present in lysosomes. Pompe disease, liver damaged by the accumulation of glycogen due to deficiency of enzymes that hydrolyze functioning liver glycogen (polysaccharides). In Tay-Sachs disease, lipid digestive enzymes are missing or inactive, and brain damaged because of the accumulation of lipids in the cell. Maybe one day with biotechnology to improve directly with the insert DNA (genes) for the missing enzyme.

Cytogenetics

Chromosome when viewed with electron microscope appears composed of thick fibers can range between 100-500 Angstrom. For purposes of analysis of chromosomes, then the specific cells can diguanakannya, eg T lymphocytes, which must first be cultured.

T lymphocyte cell culture

1. Approximately 2.5 cc of venous blood, cultured with TC 199 medium for 72 hours
2. Add PHA (phytohemaglutinin) as an antigen nonspecific T lymphocytes so that mitosis
3. Add veal serum to enhance / stimulate mitosis
4. Before harvest, add substance to stop colchisin remain in metaphase of mitosis
5. Add hipotonus KCl solution, thus damaging the cells and chromosomes didnding biases are removed from the cell.
6. Kmbil samples and used as drops in on an object-glass, fixation with ethanol, and color with Giemsa.
7. Chromosomes are ready to be used for analysis / karyotiping

Karyotiping (Charyotiping)

Is a group activity based on the shape and length of chromosome chromosome
Fundamental usefulness of chromosome analysis is to detect the amount and structure.

Detecting the Number of Chromosome Abnormalities

1. Turner Syndrome (45X0)
2. Klinerfilter Syndrome (47XXY)

Abnormalities of chromosome structure

1. Deletion
2. Insertion
3. Duplication
4. Inversion
5. Translocation

Sex chromatin

An activity in cytogenetics menentuan sex
1. Barr Body
Preparations for the inside of the cheek scrapings, place the object-glass, fixation with methanol and color with carbol fuchsin. Barr body positive result ()
2. Drum Stick
Smear preparations, put on the object-glass, and color fixation with phosphate buffered Giemsa
3. F-Body
Smear preparations, put on the object-glass, and color fixation with buffer quinacrine, view with fluorescence microscope. The result, F-body is male.

Read More

Anticancer

Cancer is a disease characterized by cell disruption or failure of regulatory mechanisms of multiplication and other homeostatic functions in multicellular organisms.


A common trait of cancer:
1. Excessive growth, generally in the form of tumor.
2. Impaired differentiation of cells and tissues.
3. Invasive nature, able to grow in the surrounding tissue.
4. Are metastatic, spread somewhere else and cause new growth.
5. Having heriditas congenital, derived cancer cells can also cause cancer.
6. The shift of metabolism towards the formation of macromolecules of nucleosides and amino acids and carbohydrates for energy increased ketabolisme cells.
• Work anticancer mainly based on disruption at one of the essential cell process, citizens and governments because there is no difference between cancer cells and normal cells (cytotoxic).
• On the spread of cancer treatment is not cure, but is merely a palliative for symptoms, prevention of complications, psychological support and to prolong life.

Anticancer based on its cell cycle is classified into 2, namely:
1. Showed selective toxicity toward the cells were proliferated called Cell Cycle specific substance (CCS), which is effective against cancers with high proliferative characteristics, such as cell
blood. Examples of drugs: vincristine, vinblastine, cytarabine, Fluorouracil, Azositidin, Bleomisin,
Merkaptopurin, Tioguanin, Hydroxy-urea, and methotrexate.
2. Cell Cycle Non-specific substances (CCNS), which is useful in tumors that grow slowly or quickly. Example drugs: Mekloretamin, Cyclophosphamide, Melfalan, Tiotepa, Mitomisin, Daktinomisin, Daksorubisin, daunorubicin and Cisplatalin.

Based on its anticancer divided by 4, namely:
1. Substance pengalkil or Alkilator, drug samples: Cyclophosphamide, Klorambusil, Busulfan, Melfalan, ifosfamide and Lomustin.
2. Antibiotics, drug samples: Doxorubicin, Bleomisin, Mitomisin and Epirubisin.
3. Antimetabolite, drug samples: Methotrexate, Fluorouracil, cytarabine and Merkaptopurin.
4. Alkaloids Vinka, examples of drugs: vincristine, and vinblastine Vindesin.

Hormone that functions as an anticancer are:
1. Hormones Estrogen, for prostate and breast cancer therapy, drug samples: Stilbestrol, ethinylestradiol and Fosferol - Tetrasodium.
2. Progesterone for the treatment of breast and endometrial cancer, drug samples: Megestrol and Medroksi-Progesterone Acetate.
3. Androgen, for breast cancer therapy, drug samples: Testosterone propionate and Fluoksimesteron.

Read More

Hypothermia and Hyperthermia

HYPOTHERMIA
Normal temperature in neonates ranges from 360C - 37.50 C in the armpit temperature. Early symptoms of hypothermia when the temperature <360C or both legs and hands felt cold. When the baby's entire body felt cold, then the baby was already experiencing hypothermia (temperature 320C - <360C).

Called severe hypothermia when the body temperature <320C. To measure the body temperature thermometer measures needed on hypothermia low (low reading thermometer) to 250C. Besides as a symptom, hypothermia can be an early disease ended in death.

The principle difficulty as a result of hypothermia is the increased consumption of oxygen (hypoxia occurs), the occurrence of metabolic acidosis as a consequence of anaerobic glycolysis, and decreased glycogen deposits with resultant hypoglycemia. The loss of calories seems to weight loss that can be overcome by increasing the intake of calories.

Etiology and precipitation factors - Prematurity - Asphyxia - Sepsis - Neurologic conditions such as meningitis and cerebral hemorrhage - Inadequate drying after birth - Exposure to cold ambient temperatures

Treatment of hypothermia is intended to:
1) Preventing hypothermia,
2) Know the baby with hypothermia,
3) Know the risk of hypothermia,
4) Action on hypothermia.

Clinical signs of hypothermia:
a. Hypothermia are: - Cold Feet palpable - The ability to suck weak - Tears of weak - Skin color is uneven or kutis marmorata
b. Severe hypothermia - Same with hypothermia were - Respiratory slow irregular - The sound of slow heart - It may arise hypoglycemia and metabolic asidosisi
c. Advanced stages of hypothermia - Front, toe and hand bright red - The other body pale - The skin hardens, red and edema occur mainly on the back, legs and hands (sklerema) HYPERTHERMIA

Environment that is too hot too dangerous for babies. This situation occurs when a baby is placed near heat sources, indoor air is hot, too many clothes and blankets. Symptoms of hyperthermia in the newborn: - The baby's body temperature> 37.5 C
- Frequency of breath baby> 60 x / min
- Signs of dehydration are weight loss, lack of skin turgor, decreased amount of urine

Assessment of hypothermia hyperthermia &
1. History of pregnancy
- Difficulties with the trauma of infant birth
- Drug abuse
- The use of anesthesia or analgesia in the mother

2. Status of infants at birth
- Prematurity
- A low Apgar score
- Asphyxia by rescucitasi
- CNS disorders or damage
- The body temperature below 36.5 C or above 37.5 C
- Fever in the precipitate maternal neonatal sepsis

3. Cardiovascular
- Bradycardia
- Tachycardia in hyperthermia

4. Gastrointestinal
- Poor food intake
- Vomiting or abdominal distension
- Losing weight means

5. Integumentary
- CNS central or pallor (hypothermia)
- Skin redness (hyperthermia)
- Edema of the face, shoulder and arm
- Cold in the chest and extremities (hypothermia)
- Perspiration (hyperthermia)

6. Neorologic
- Tears of the weak
- Decrease in reflexes and activities
- Fluctuations in temperature above or below the normal limits according to age and body weight

7. Pulmonary
- Nasal flaring or decreased breath, iregguler
- Chest retraction
- Ekspirasi grunting
- Episodes of apnea or Tachypnoea (hyperthermia)

8. Renal
- Oliguria

9. Diagnostic Study
- Levels of serum glucose, to identify resulting decrease in energy used for the response to cold or heat
- Blood gas analysis, to determine karbondoksida increase and decrease oxygen levels, indicating the risk of acidosis
- Levels of Blood Urea Nitrogen, an increase indicates impaired kidney function and potensila oliguric
- Study of electrolytes, to identify the increase in potassium is associated with impaired kidney function
- Culture of body fluids, to identify any infection

Read More

Asphyxia

Assessment of infant at birth is to determine the degree of vitality of the body functions. The degree of vitality is the ability of a number of bodily functions that are essential and complex for infant survival, such as breathing, heart rate, blood circulation and reflexes, primitive reflexes such as sucking and looking nipple. If not handled properly, quickly and correctly the baby's general condition will deteriorate rapidly and may even die. In some infants may be able to recover spontaneously within 10-30 minutes after birth but the baby still has a high risk for disability.


Generally, the assessment used in the newborn Apgar values (Apgar Score). SAREC meeting in Sweden in 1985 advocated the use of newborn assessment parameters in a simple way the so-called value Sigtuna (Sigtuna Score) in accordance with the name of the place of consensus. The assessment in this way mainly to the level of basic health services because only assess the two essential parameters.

The degree of vitality of the newborn according to the value of Sigtuna is: (a) without asphyxia or mild asphyxia value = 4, (b) asphyxia was the value of 2-3, (c) severe asphyxia value of 1, (d) the baby is born dead or dead new " fresh still birth "value 0.

All this is generally to assess the degree of vitality of the newborn Apgar scoring is used. Implementation is quite complex because at the same time birth attendant must assess the five parameters: heart rate, respiratory effort, muscle tone, movement and skin color. the results of research in the U.S. Apgar value is very useful to know a potential high risk infants for mortality and long-term neurological disability such as cerebral palsy. Of the five variables Apgar values only breathing and heart rate are closely related to the occurrence of hypoxia and anoksia. The three other variables more an indicator of maturity of the baby's growth.

Handling of asphyxia in newborn infants aim to keep the airway remain free, stimulates respiration, maintain cardiac output, maintaining the temperature, and provide supporting drug resuscitation. Consequences which may arise in infants asphyxia as a whole experienced the death of 10-20%, whereas 20-45% of the live experience neurological disorders. Approximately 60% of them with severe sequelae. The remaining normal. Neurologic sequelae of cerebral palsy, mental retardation, epilepsy, mikrocefalus, hidrocefalus and others.

Nursing Diagnosis
Impaired gas exchange

Data supporting / contributing factors:
Adequate oxygenation of infants affected by many factors such as prenatal and intrapartal history, excessive mucus production, and stress due to cold. History intrapartal poor prenatal and may result in fetal distress and hypoxia adaptation time of the baby. Gas exchange can also be disrupted by excessive mucus production and airway clearance is not adequate. Stress due to cold increases oxygen demand and may lead to acidosis as the effects of anaerobic metabolism.

Objectives:
Airway free of secretions / mucus, respiratory and pulse within normal limits, cyanosis does not occur, no sign of respiratory disstres.

Intervention:
• Observe the prenatal complications that affect the status of the placenta and fetal (heart or kidney disease, or diabetes PIH)
• Review the status of intrapartal including heart rate, changes in heart rate variability rhythm, PH levels, colors and amount of amniotic fluid.
• Record the time and the treatment given to the mother such as magnesium sulfate or Demerol
• Assess respiratory rate
• Record the state of the nasal pharynx, chest retraction, grunting respiration, rales or ronchi
• Clear the airway; do nasopharyngeal suction if needed, apical pulse monitor during suction
• Place the baby on the Trendelenburg position at an angle of 10 degrees.
• Dry the baby with a soft towel and place it between the arm selimuti mother or warm with a heating unit
• Observe the intensity of crying
• Note the apical pulse
• Give a touch of tactile and sensory stimulation
• Observation of skin color, cyanosis location, assess muscle tone

Collaboration
• Give oxygen through a mask, 4-7 lt / min if indicated asphyxia
• Give medications such as Narcan through IV
• Provide resuscitation therapy

Read More

Hyperbilirubinemia

Definition:
Hyperbilirubinemia is excessive accumulation of bilirubin in the blood (normal levels of 5 mg / dl in normal babies) that cause jaundice, yellow color is clearly visible on the skin, mucosa, sclera and urine.


Etiology:
Hyperbilirubinemia can be caused by a variety of circumstances. The most common cause of hemolysis found here is caused by ABO blood group incompatibility or G6PD enzyme deficiency. Hemolysis may also arise because of the bleeding closed (sefal hematoma, bleeding subaponeoratik) or Rh blood group inkompatabilitas. The infection also plays an important role in the occurrence of hyperbilirubinemia: the situation is especially true in patients with sepsis and gastroenteritis. Several other factors are also a cause of hyperbilirubinemia is hypoxia / anoksia, dehydration and acidosis, hypoglycemia and polycythemia.

Pathophysiology
Increased bilirubin levels of the body can occur in some circumstances. Genesis is often found when there is the addition of bilirubin load on liver cells that are too excessive. It can be found when there is increased destruction of erythrocytes, polycythemia, shortened erythrocyte age fetus / infant, increased bilirubin from other sources, or the presence of increased enterohepatic circulation.

Impaired uptake of plasma bilirubin can also cause elevated levels of bilirubin body. This can happen if a Y-protein content is reduced or the state of protein-protein-Y and Z are bound by other anions, for example in infants with acidosis or to hypoxia / anoksia. Other circumstances which show elevated levels of bilirubin are found gagguan if hepatic conjugation (enszim glukoronil transferase deficiency) or infants who suffer from disorders of excretion, such as neonatal hepatitis or bile duct blockage intra / extra hepatic.

In some degree, this bilirubin will be toxic and tissue damage. Toxicity was mainly found in indirect bilirubin that are difficult to dissolve in water but soluble in fat. This property allows the occurrence of pathological effects on brain cells when bilirubin was able to penetrate the blood brain barrier. Abnormalities that occur in the brain called the nucleus jaundice or biliary encephalopathy. Generally considered that the abnormalities in the central nervous sususnan might arise if the indirect bilirubin levels over 20 mg / dl. Easy least bilirubin through the blood brain barrier was not only depends on the high levels of bilirubin, but depends also on the state of their own neonates. Indirect bilirubin will easily through the blood brain barrier in infants if there are circumstances immaturity, low birth weight, hypoxia, hypercarbia, hypoglycemia, and central nervous system disorders resulting from trauma or infection.

Assessment

1. Family history and pregnancy:
- Parents or siblings with neonatal jaundice or liver disease
- Prenatal care
- DM in the mother
- Infections such as toxoplasmosis, spilis, hepatitis, rubella, cytomegalovirus and herves which cross keplasenta transmitted during pregnancy
- Abuse of drugs in the elderly
- Mother with Rh negative and Rh positive father
- History Rh positive transfusion in Rh-negative mother
- History of abortion with the baby's Rh positive
- The drugs during pregnancy, such as sulfonamides, nitrofurantoin and anti-malaria
- Induction of oxytocin during childbirth
- The use of vacuum extraction
- The use of phenobarbital in pregnant 1-2 months before delivery

2. Status of infants at birth:
- Prematurity or small gestational
- Apgar score indicating asphyxia
- Trauma with hematoma or injury
- Neonatal Sepsis, a liquid that smells
- Hepatosplenomegaly

3. Cardiovascular
- General edema, or decreased blood volume, leading to heart failure on hydro fetalis

4. Gastrointestinal
- Oral feeding poor
- Losing weight to 5% for 24 hours caused by low calorie intake
- Hepatosplenomegaly

5. Integumentary
- Jaundice during the first 24 hours (pathological type), after 24 hours of the first (physiologic type) or after 1 month with a given breast milk
- Heat is caused by anemia due to RBC hemolysis

6. Neurologic
- Hipotoni
- Tremor, no moro reflex and sucking reflex, tendon reflexes minimal
- Irritability, elbow flexion, muscle weakness, opistotonis
- Seizures

7. Pulmonary
- Apnu, cyanosis, dyspnea after the incident nuclear jaundice
- Aspiksia, pulmonary effusion

8. Supporting Data
- Blood type and Rh factor in the mother and infant to determine the risk of Incompatibilities, Rh father also checked if Rh negative mothers (test performed during prenatal)
- Amniocentesis with amniotic fluid analysis, Coombs test with negative results indicate an increased titer of anti-D antibodies, bilirubin levels in amniotic fluid increases to more than 0.28 mg / dl had an abnormal value (indicates the need for transfusion in the fetus).
- Coombs test (direct) in cord blood after childbirth, positive when antibodies are formed in infants.
- Coombs test (indirect) in cord blood, positive if the antibody present in maternal blood.
- Serial total bilirubin level, greater than or equal to 0.5 mg / h till 20 mg / dl indicates the risk of exchange transfusion kernikterus and needs depending on the baby's weight and gestational age.
- Direct bilirubin levels, increases in the event of infection or disruption of Rh hemolytic
- Calculate the reticulocyte, an increase in hemolysis
- Hb and HCT
- Total protein, determining the decrease in binding sites
- Calculate the leukocytes, decreased to below 5000/mm3, indicating the occurrence of infection
- Urinalsis, to detect glucose and acetone, pH and urobilinogen, creatinine level

Read More