Hargo Basuki, Hj.Zulfianidar. Dinas Kesehatan Kab.Simalungun, Pamatang Raya.
PENDAHULUAN
Kecamatan Tapian Dolok
Jumlah Penduduk : 33.731 jiwa
Jumlah Desa : 1 Kelurahan dan 9 Desa
Jumlah Kelompok Usila
Penyakit Terbanyak Lansia
Kunjungan Lansia ke Puskesmas / Pustu Tahun 2009
ISPA = 1.232 kunjungan
Penyakit Sendi dan reumatik = 829 kunjungan
Hipertensi = 687 kunjungan
Penyakit Saluran Pencernaan = 512 kunjungan
Penyakit Gigi dan Mulut = 497 kunjungan
Penyakit Sistemik, DM = 217 kunjungan
Penyakit Kulit = 179 kunjungan
Kelainan Mata = 112 kujungan
Infeksi Saluran Kemih = 87 kunjungan
Dll = 75 kunjungan
Masalah Kesehatan dalam Pelayanan Kesehatan Usila dan Kelompok Lansia
Pengetahuan lansia yang rendah tentang manfaat posyandu / puskesmas
Jarak rumah dengan lokasi posyandu / puskesmas yang jauh atau sulit dijangkau.
Kurangnya dukungan keluarga untuk mengantar maupun mengingatkan lansia untuk datang ke posyandu / puskesmas.
Sikap yang kurang baik terhadap petugas.
TUJUAN PEMBINAAN DAN PELAYAN KESEHATAN USILA
1. Meningkatkan jangkauan pelayanan kesehatan lansia di masyarakat, sehingga terbentuk pelayanan kesehatan yang sesuai dengan kebutuhan lansia.
2. Mendekatkan pelayanan dan meningkatkan peran serta masyarakat dan swasta dalam pelayanan kesehatan disamping meningkatkan komunikasi antara masyarakat usia lanjut.
LANGKAH-LANGKAH YANG TELAH DILAKSANAKAN DALAM PEMBINAAN DAN PELAYANAN KESEHATAN USILA
Jenis Pelayanan Kesehatan yang diberikan kepada usia lanjut di Posyandu Lansia :
1. Pemeriksaan aktivitas kegiatan sehari-hari meliputi kegiatan dasar dalam kehidupan, seperti makan/minum, berjalan, mandi, berpakaian, naik turun tempat tidur, buang air besar/kecil dan sebagainya.
2. Pemeriksaan status mental.
3. Pemeriksaan status gizi melalui penimbangan berat badan dan pengukuran tinggi badan dan dicatat pada grafik indeks masa tubuh (IMT).
4. Pengukuran tekanan darah menggunakan tensimeter dan stetoskop serta penghitungan denyut nadi selama satu menit.
5. Pelaksanaan rujukan ke Puskesmas bilamana ada keluhan dan atau ditemukan kelainan.
6. Penyuluhan Kesehatan.
Gambar Kegiatan Pelayanan Usila
HASIL PERENCANAAN DAN PELAKSANAAN PEMBINAAN PELAYANAN KESEHATAN USILA
Jumlah Desa yang mendapat Program Lansia terdapat 10 kelompok. Satu Desa = 1 kelompok.
Selama ini upaya kesehatan lansia masih terbatas Posyandu Lansia
Koordinasi dengan Lintas Sektoral
Melalui pertemuan Desa dan rapat kecamatan tentang pentingnya kunjungan lansia ke Posyandu Lansia
HAMBATAN DALAM PERENCANAAN DAN PELAKSANAAN KOORDINASI KESEHATAN USILA
Masalah Internal
Banyaknya permasalahan yang lebih penting sesuai dengan tren yang ada di Puskesmas sehingga perencanaan kesehatan lansia terabaikan.
Masalah Eksternal
Kurangnya dukungan dana dalam pelaksanaan pembinaan kesehatan usila.
Kurangnya dukungan dari Lintas sektoral dalam hal pembinaan kesehatan usila.
Kesimpulan
Tujuan bahwa program Lansia adalah untuk meningkatkan derajat kesehatan lanjut usia agar tetap sehat, mandiri dan berdaya guna sehingga tidak menjadi beban bagi dirinya sendiri, keluarga maupun masyarakat. Aspek-aspek yang dikembangkan adalah dengan memperlambat proses menua (degeneratif). Bagi yang merasa sudah tua perlu dipulihkan (rehabilitatif) agar tetap mampu mengerjakan kehidupan sehari-hari secara mandiri. Ini dimungkinkan dengan makin berkembangnya ilmu pengetahuan tentang manusia berusia lanjut (Geriatri).
Bunga Harum
Catatan Hargo Basuki yang ditujukan kepada Ainiya Kusuma Wardhanie
Kamis, 01 Juli 2010
Kegiatan Pembinaan dan Pelayanan Usila di PUSKESMAS SATRIA, Kota Tebing Tinggi
PENDAHULUAN
Pembangunan dibidang kesehatan akan meningkatkan kualitas kesehatan keluarga dalam rangka mensejahterakan masyarakat yang memberikan dampak meningkatnya UHH,sejalan dgn hal tersebut jumlah usia lanjut(5,6%) juga meningkat pula.Untuk itu Puskesmas berperan dalam membina kelompok usila yang rentan terhadap masalah kesehatan.
Puskesmas Satria salah satu Puskesmas yang melaksanakan program Pembinaan dan pelayanan kesehatan usila di wilayah kerjanya yang mempunyai:
Jumlah Penduduk :27.744 Jiwa
Jumlah Kelurahan : 7 Kelurahan
Jumlah Kelp Usila : 5 Kelompok
Jumlah Usila : 1560 jiwa
Penyakit terbanyak pada usila sbb:
1.Gangguan Pencernaan
2.Tekanan darah tinggi
3.Gangguan Pernapasan
4.Gangguan Penglihatan
5.Gangguan Pendengaran
6.Penyakit kencing Manis(DM)
7.Penyakit Otot dan sendi(RA)
8.Gangguan Kejiwaan(tidur,cemas,depre
9.Gangguan hati,ginjal
10.Gangguan keseimbangan .dll
MASALAH PELAYANAN KESEHATAN USILA
DI PUSKESMAS:
a.Kurangnya fasilitas dan kemudahan bagi usila
b.Kurangnya Pengetahuan Petugas
c.Kurangnya peran keluarga dan masyarakat
d.Perhatian petugas terhadap usila kurang
e.Belum optimal pencatatan dan pelaporan
DI KELOMPOK LANSIA
a.Kurangnya peran keluarga dan masyarakat
b.Sarana dan prasarana masih kurang memadai
c.Peran kader masih kurang
d.Kurangnya kerjasama LS/LP
TUJUAN PEMBINAAN DAN PELAYANAN KESEHATAN USILA
Tujuan Umum:
Terlaksananya Pembinaan dan Pelayanan Kesehatan Usila di Puskesmas dan Kelompok usila di wilayah kerja Puskesmas
Tujuan khusus:
1.Meningkatnya Jumlah dan mutu kelompok usila
2.Meningkatnya cakupan pelayanan usila (65%)
3.Meningkatnya kemandirian usila dalam mengatasi masalah sendiri sesuai potensi yg dimiliki
4.Dilaksnakanya pembinaan dan pelayanan usila setiap bulannya
PROSES DAN PERENCANAAN YANG TELAH DILAKSANAKAN
1.Pemeriksaan aktivitas,mental,gizi
2.Pengukuran Tekanan darah,denyut nadi
3.Pemeriksaan Hb di Puskesmas
4.Pemeriksaan Kadar Gula Darah
5.Pengobatan di Pusk dan kelompok usila
6.Pemberian makanan Tambahan di kelompok
7.Pembinaan kader usila
8.Pelaksanaan rujukan ke Puskesmas
9.Memberikan Penyuluhan,yankes(prom,pre
10.Pembinaan kelompok usila dgn LS-LP
11. Memberikan kemudahan pada usila dlm mengakses pelayanan
PERENCANAAN DAN PELAKSANAAN KESEHATAN USILA (2007-2009)
-Upaya sosialisasai program usila
-Memfasilitasi pembentukan kelompak usila
-Penyuluhan kesehatan di kelompok usila
-Melaksanakan Pelayanan kesehatan usila
-Melaksanakan pembinaan kelompok usila
-Mengusulkan pelatihan kader usila ke Dinkes
-Mengikut sertakan Pelatihan Petugas usila
-Mengusulkan pengadaan usila Kit ke Dinkes
-Melaksanakan koordinasi dgn LS-LP dalam pembentukan/pembinaan kelompok usila
-Mengusulkan intensif kader ke dinkes
-Pencatatan dan pelaporan program usila
HAMBATAN DALAM PERENCANAAN DAN PELAKSANAAN PELAYANAN KESEHATAN USILA
Masalah
Internal:
>Kurangnya perhatian dan tanggung jawab petugas terhadap prog usila.
>Pembiayaan masih kurang
>Pengetahuan,ketrampilan Nakes masih kurang
External:
>Pembinaan secara terpadu LS/LP blm terlaksana scr optimal
>Belum adanya komitmen LS LP dalam Pembinaan pelayanan usila
>Perhatian,peran keluarga/masya masih kurang
Intervensi
-Pembinaan petugas,Membuat komitmen bersama
-Mengusulkan anggaran melalui dinkes
-Mengikutkan Pelatihan ke Dinkes
-Melaksanakan pertemuan scr berkala dgn LS-LP, Pembentukan tim pembina usila.
-Melaksanakan hasil kesepakatan yang sudah ada
-Memberikan informasi di setiap kesempatan yang ada
STRATEGI DAN PELUANG
1.Upaya sosialisasi,oprasionalisas
2.Menggerakan dan memberdayakan masyarakat dlm prog usila.
3.Memantapkan kerjasama & partisipasi LS-LP
4.Melaksanakan Pembinaan oleh LP-LS
5.Meningkatkan pembiayaan Program usila
6.Memantapkan kemampuan pengelolaan program melalui pendidikan dan pelatihan
7.Meningkatkan koodinasi secara berkala
KESIMPULAN
1.Cakupan pelayanan usila masih kurang(60%)
2.Belum Optimalnya tim pembinaan usila
3.Perlu Penambahan kelompok Usila
4.Masih kurangnya peran keluarga dan masyarakat terhadap usila
5.Kegiatan program usila di Puskesmas dan kelompok blm optimal
6.Sarana dan Prasarana untuk usila masih kurang
7.Pendanaan terhadap program usila kurang
Program Kesehatan Usila di PUSKESMAS TOMUAN, Pematang Siantar
drg.Erika, Kepala Puskesmas Tomuan, Kota Pematang Siantar
Jumlah Penduduk :
Kelurahan Tomuan : 1496 KK ; 9355 jiwa
Kelurahan Kebun Sayur : 998 KK ; 7322 jiwa
Kelurahan Pahlawan : 663 KK ; 2715 jiwa
Total : 3157 KK; 19392jiwa
DATA USIA LANJUT
Jumlah usia lanjut
adalah 897 orang yang terdata
Dari jumlah tersebut hanya sekitar 42% yang mendapat pelayanan kesehatan di puskesmas dan
hny sekitar 20% dari jumlah kunjungan pusk
10 Penyakit terbesar Lansia
Rematik dan peny jar otot lainnya
Hypertensi
ISPA
DM
Kelainan Refraksi
Gastritis
Peny kulit
Asma
Bronchitis
Ggn jantung
TUJUAN PEMBINAAN DAN PELAYANAN KESEHATAN USILA
TUJUAN UMUM
Meningkatnya derajat kesehatan para lansia dengan pelayanan kesehatan baik promotif, preventif, kuratif maupun rehabilitatif sehingga dapat mempertahankan kemandirian para lansia
TUJUAN KHUSUS
Puskesmas mempunyai SDM, sarana dan pra sarana untuk promotif, preventif, kuratif dan rehabilitatif yg mendukung utk mengoptimalkan pelayanan kesehatan pd lansia
Terbentuk kelompok usila baru yang dibina di tiap kelurahan
Kelompok usila yang mandiri
Pelayanan Usila
DALAM GEDUNG
- Promotif, preventif, kuratif, rehabilitatif?
LUAR GEDUNG
- Posyandu Lansia
Pemeriksaan kesehatan
- Penimbangan BB
- Pengukuran tekanan darah
- Pemeriksaan Kadar Gula Darah
(sesuai dgn anjuran dokter)
Pemberian obat2an/vitamin
Posyandu Lansia
JUMLAH : 1 skrg 2
TEMPAT : GEREJA HKBP TOMUAN JL. PATTIMURA
JUMLAH PESERTA : 34 ORG (33 WANITA; 1 PRIA)
HAMBATAN
MASALAH INTERNAL
- SDM
- Sarana dan Prasarana
- Sumber dana
MASALAH EKSTERNAL
- Koordinasi Lintas Sektor
- Kesadaran dan kemauan para lansia untuk
mendapat pelayanan kesehatan bukan
hanya kuratif dan rehabilitatif
- Kesehatan usila belum menjadi prioritas
KESIMPULAN
Meningkatkan derajat kesehatan para lansia melalui usaha promotif, preventif, kuratif dan rehabilitatif yang dilakukan oleh puskesmas sangat membutuhkan dukungan dari berbagai pihak sehingga dapat dijalankan secara optimal dan mendapatkan hasil yg optimal pula.
Jumlah Penduduk :
Kelurahan Tomuan : 1496 KK ; 9355 jiwa
Kelurahan Kebun Sayur : 998 KK ; 7322 jiwa
Kelurahan Pahlawan : 663 KK ; 2715 jiwa
Total : 3157 KK; 19392jiwa
DATA USIA LANJUT
Jumlah usia lanjut
adalah 897 orang yang terdata
Dari jumlah tersebut hanya sekitar 42% yang mendapat pelayanan kesehatan di puskesmas dan
hny sekitar 20% dari jumlah kunjungan pusk
10 Penyakit terbesar Lansia
Rematik dan peny jar otot lainnya
Hypertensi
ISPA
DM
Kelainan Refraksi
Gastritis
Peny kulit
Asma
Bronchitis
Ggn jantung
TUJUAN PEMBINAAN DAN PELAYANAN KESEHATAN USILA
TUJUAN UMUM
Meningkatnya derajat kesehatan para lansia dengan pelayanan kesehatan baik promotif, preventif, kuratif maupun rehabilitatif sehingga dapat mempertahankan kemandirian para lansia
TUJUAN KHUSUS
Puskesmas mempunyai SDM, sarana dan pra sarana untuk promotif, preventif, kuratif dan rehabilitatif yg mendukung utk mengoptimalkan pelayanan kesehatan pd lansia
Terbentuk kelompok usila baru yang dibina di tiap kelurahan
Kelompok usila yang mandiri
Pelayanan Usila
DALAM GEDUNG
- Promotif, preventif, kuratif, rehabilitatif?
LUAR GEDUNG
- Posyandu Lansia
Pemeriksaan kesehatan
- Penimbangan BB
- Pengukuran tekanan darah
- Pemeriksaan Kadar Gula Darah
(sesuai dgn anjuran dokter)
Pemberian obat2an/vitamin
Posyandu Lansia
JUMLAH : 1 skrg 2
TEMPAT : GEREJA HKBP TOMUAN JL. PATTIMURA
JUMLAH PESERTA : 34 ORG (33 WANITA; 1 PRIA)
HAMBATAN
MASALAH INTERNAL
- SDM
- Sarana dan Prasarana
- Sumber dana
MASALAH EKSTERNAL
- Koordinasi Lintas Sektor
- Kesadaran dan kemauan para lansia untuk
mendapat pelayanan kesehatan bukan
hanya kuratif dan rehabilitatif
- Kesehatan usila belum menjadi prioritas
KESIMPULAN
Meningkatkan derajat kesehatan para lansia melalui usaha promotif, preventif, kuratif dan rehabilitatif yang dilakukan oleh puskesmas sangat membutuhkan dukungan dari berbagai pihak sehingga dapat dijalankan secara optimal dan mendapatkan hasil yg optimal pula.
Peranan Petugas Puskesmas dan Tatalaksana Perawatan Penyakit Degeneratif pada Usila di Puskesmas
dr.Hartono Taslim,M.Med Klinik Usia Lanjut RS Gleni International Medan
Peningkatan jumlah usia lanjut ini berpotensi menimbulkan beberapa masalah pokok seperti meningkatnya beban keluarga, masyarakat, dan pemerintah, khususnya berhubungan dengan kebutuhan layanan khusus, penyediaan dan perluasan lapangan kerja, pelayanan konsultatif sosial psikologis, bantuan sosial ekonomi, upaya pelestarian sosial budaya, dan pelayanan rekreatif.
Siapakah Usia Lanjut Itu?
Di Negera Berkembang, Usila bila Usia > 60 Tahun.
Di Negara Maju, Usila bila Usia > 65 Thn.
Dari Aspek Ekonomi, Usila > 60 tahun terdiri dari :
- Lansia Produktif (Sehat F,M dan S).
- Lansia Non-produktif.
Dari Aspek Kesehatan, Usila terdiri dari:
Usia 60 – 69 thn disebut Young Old.
Usia 70 – 79 thn disebut Old.
Usia 80 thn ke atas disebut Old-old.
Ada pembagian lain yaitu:
Pra-senile bila usia terletak pada 49-59 thn.
Elderly bila usia > 60 thn.
Elderly with Risk bila usia > 70 thn.
Apa Masalah pada Lanjut Usia?
Masalah paling utama adalah Kesehatan.
Penyakit yang berkaitan dengan proses usia lanjut disebut penyakit degeneratif seperti hipertensi, osteoarthritis, osteoporosis, kataraks senilis, diabetes mellitus tipe 2, penurunan fungsi luhur (demensia), dan sebagainya.
Upaya pemantapan pelayanan kesehatan bagi lansia terdiri dari :
Publikasi atau kampanye pelayanan kesehatan lanjut usia di puskesmas.
Pemaksimalan peran institusi kesehatan seperti pustu, posyandu lansia.
Peningkatan profesionalisme (SDM) di bidang lansia.
Penyediaan obat-obatan dan perawatan efektif dan terjangkau oleh lansia.
Program pokok kesehatan Lansia bertujuan untuk meningkatkan derajat kesehatan dan mutu kehidupan (Quality of Life) para lanjut usia dengan menanamkan pola hidup sehat.
Program kesehatan Usila meliputi:
Peningkatan dan pemantapan upaya kesehatan para lanjut usia di pelayanan dasar, khususnya Puskesmas melalui konsep Puskesmas Santun Usia Lanjut.
Peningkatan upaya rujukan kesehatan bagi lanjut usia.
Peningkatan penyuluhan dan penyebarluasan informasi kesehatan dan gizi bagi lanjut usia.
Peningkatan dan pemantapan upaya kesehatan para lanjut usia di pelayanan dasar, khususnya Puskesmas melalui konsep Puskesmas Santun Usia Lanjut.
Peningkatan upaya rujukan kesehatan bagi lanjut usia.
Peningkatan penyuluhan dan penyebarluasan informasi kesehatan dan gizi bagi lanjut usia.
Peningkatan mutu perawatan kesehatan bagi para usia lanjut dalam keluarga.
Peningkatan peran serta masyarakat dalam upaya kesehatan usia lanjut.
Pengembangan lembaga hospice terutama untuk perawatan usia lanjut yang menderita penyakit kronis yang berprognosis buruk dan atau penyakit terminal
Program pokok kesehatan lansia :
Upaya pencegahan penyakit (Preventif).
Upaya peningkatan kualitas kesehatan (Promotif).
Upaya pengobatan penyakit dan komplikasinya (Kuratif).
Upaya pengembalian fungsi tubuh (Rehabilitatif).
Upaya penyehatan sosial.
Peran Nakes Puskesmas pada Usila:
Upaya Preventif adalah :
Pemberian vaksinasi Influenza dan Pneumonia.
Pemberian Tablet Kalsium dan Vitamin D terutama bagi lansia di panti wreda.
Pemberian alat bantu penglihatan.
Pemberian alat bantu jalan seperti tongkat.
Upaya Promotif adalah :
Ceramah tentang kesehatan dan pola hidup sehat.
Memberdayakan lansia untuk ikut kegiatan sosial dan rekreasi.
Menyalurkan bakat dan ketrampilan dalam masyarakat.
Upaya Promotif adalah :
Ceramah tentang kesehatan dan pola hidup sehat.
Memberdayakan lansia untuk ikut kegiatan sosial dan rekreasi.
Menyalurkan bakat dan ketrampilan dalam masyarakat.
Upaya Kuratif adalah :
Mendeteksi kelainan klinis sedini mungkin.
Memberi pengobatan yang rasional dan efisien terhadap penyakit degeneratif.
Mencegah komplikasi dari penyakit degeneratif dan komplikasi pengobatan.
Mengembalikan kemampuan fungsional sedini mungkin.
Upaya Rehabilitasi adalah:
Melatih kemampuan fisik yang masih tersisa.
Melatih kemampuan hidup mandiri atau semi-mandiri.
Melatih kemampuan menjaga kesehatan diri dan lingkungan.
Melatih kemampuan dasar (ADL dan IADL).
Peran Nakes Medis dalam Pelayanan Kesehatan Usila :
Pengkajian terhadap fungsi fisik, mental dan lingkungan dari para usia lanjut.
Melakukan diagnosa keperawatan.
Perencanaan tindakan keperawatan.
Pelaksanaan tindakan keperawatan.
Evaluasi
Penkajian fungsi fisik dan mental meliputi :
Kemampuan panca indra.
Kemampuan fungsi anggota gerak.
Kemampuan fungsi organ tubuh.
Kemampuan fungsi alat pembuangan tubuh.
Kemampuan fungsi mental.
Ada atau tidak adanya nyeri kronis.
Diagnosa keperawatan harus bersifat komprehensif dan holistik:
Perubahan mobilitas fisik.
Perubahan aktifitas dasar harian.
Gangguan panca indra.
Gangguan proses pembuangan tubuh.
Gangguan proses berpikir,depresi dan gangguan tidur.
Gangguan keseimbangan cairan dan elektrolit.
Gangguan pola pernafasan.
Tidak tolerans terhadap aktivitas harian.
Perencanaan tindakan keperawatan :
Continuum of care : perencanaan tindakan keperawatan berkelanjutan yang melibatkan kerjasama antar disiplin.
Rehabilitasi.
Kemandirian : memberikan kesempatan kepada usila untuk menolong dirinya sendiri melalui program pengendalian persepsi dan motivasi.
Long term care.
Home-based care.
Pelaksanaan tindakan keperawatan :
Merupakan tindak lanjut operasional dari rencana tindakan keperawatan.
Berfokus pada masalah yang ada pada diri pasien dan lingkungan.
Contoh : pemberian oksigen, perawatan kebersihan diri, mobilisasi, orientasi terhadap waktu, tempat dan orang.
Fokus lingkungan meliputi : cahaya penerangan yang memadai, lantai yang tidak licin, anak tangga, alat genggam di kamar mandi, dan sebagainya
Evaluasi keperawatan :
Merupakan tahapan terakhir untuk menilai apakah fungsi keperawatan berhasil atau gagal yaitu dengan membandingkan situasi dan kondisi sebelum dan sesudah intervensi keperawatan.
Mengidentifikasi faktor faktor penyebab kegagalan tindakan keperawatan.
Mencari alternatif tindakan keperawatan.
Dipresentasikan di Medan tanggal 29 Juni 2010
Peningkatan jumlah usia lanjut ini berpotensi menimbulkan beberapa masalah pokok seperti meningkatnya beban keluarga, masyarakat, dan pemerintah, khususnya berhubungan dengan kebutuhan layanan khusus, penyediaan dan perluasan lapangan kerja, pelayanan konsultatif sosial psikologis, bantuan sosial ekonomi, upaya pelestarian sosial budaya, dan pelayanan rekreatif.
Siapakah Usia Lanjut Itu?
Di Negera Berkembang, Usila bila Usia > 60 Tahun.
Di Negara Maju, Usila bila Usia > 65 Thn.
Dari Aspek Ekonomi, Usila > 60 tahun terdiri dari :
- Lansia Produktif (Sehat F,M dan S).
- Lansia Non-produktif.
Dari Aspek Kesehatan, Usila terdiri dari:
Usia 60 – 69 thn disebut Young Old.
Usia 70 – 79 thn disebut Old.
Usia 80 thn ke atas disebut Old-old.
Ada pembagian lain yaitu:
Pra-senile bila usia terletak pada 49-59 thn.
Elderly bila usia > 60 thn.
Elderly with Risk bila usia > 70 thn.
Apa Masalah pada Lanjut Usia?
Masalah paling utama adalah Kesehatan.
Penyakit yang berkaitan dengan proses usia lanjut disebut penyakit degeneratif seperti hipertensi, osteoarthritis, osteoporosis, kataraks senilis, diabetes mellitus tipe 2, penurunan fungsi luhur (demensia), dan sebagainya.
Upaya pemantapan pelayanan kesehatan bagi lansia terdiri dari :
Publikasi atau kampanye pelayanan kesehatan lanjut usia di puskesmas.
Pemaksimalan peran institusi kesehatan seperti pustu, posyandu lansia.
Peningkatan profesionalisme (SDM) di bidang lansia.
Penyediaan obat-obatan dan perawatan efektif dan terjangkau oleh lansia.
Program pokok kesehatan Lansia bertujuan untuk meningkatkan derajat kesehatan dan mutu kehidupan (Quality of Life) para lanjut usia dengan menanamkan pola hidup sehat.
Program kesehatan Usila meliputi:
Peningkatan dan pemantapan upaya kesehatan para lanjut usia di pelayanan dasar, khususnya Puskesmas melalui konsep Puskesmas Santun Usia Lanjut.
Peningkatan upaya rujukan kesehatan bagi lanjut usia.
Peningkatan penyuluhan dan penyebarluasan informasi kesehatan dan gizi bagi lanjut usia.
Peningkatan dan pemantapan upaya kesehatan para lanjut usia di pelayanan dasar, khususnya Puskesmas melalui konsep Puskesmas Santun Usia Lanjut.
Peningkatan upaya rujukan kesehatan bagi lanjut usia.
Peningkatan penyuluhan dan penyebarluasan informasi kesehatan dan gizi bagi lanjut usia.
Peningkatan mutu perawatan kesehatan bagi para usia lanjut dalam keluarga.
Peningkatan peran serta masyarakat dalam upaya kesehatan usia lanjut.
Pengembangan lembaga hospice terutama untuk perawatan usia lanjut yang menderita penyakit kronis yang berprognosis buruk dan atau penyakit terminal
Program pokok kesehatan lansia :
Upaya pencegahan penyakit (Preventif).
Upaya peningkatan kualitas kesehatan (Promotif).
Upaya pengobatan penyakit dan komplikasinya (Kuratif).
Upaya pengembalian fungsi tubuh (Rehabilitatif).
Upaya penyehatan sosial.
Peran Nakes Puskesmas pada Usila:
Upaya Preventif adalah :
Pemberian vaksinasi Influenza dan Pneumonia.
Pemberian Tablet Kalsium dan Vitamin D terutama bagi lansia di panti wreda.
Pemberian alat bantu penglihatan.
Pemberian alat bantu jalan seperti tongkat.
Upaya Promotif adalah :
Ceramah tentang kesehatan dan pola hidup sehat.
Memberdayakan lansia untuk ikut kegiatan sosial dan rekreasi.
Menyalurkan bakat dan ketrampilan dalam masyarakat.
Upaya Promotif adalah :
Ceramah tentang kesehatan dan pola hidup sehat.
Memberdayakan lansia untuk ikut kegiatan sosial dan rekreasi.
Menyalurkan bakat dan ketrampilan dalam masyarakat.
Upaya Kuratif adalah :
Mendeteksi kelainan klinis sedini mungkin.
Memberi pengobatan yang rasional dan efisien terhadap penyakit degeneratif.
Mencegah komplikasi dari penyakit degeneratif dan komplikasi pengobatan.
Mengembalikan kemampuan fungsional sedini mungkin.
Upaya Rehabilitasi adalah:
Melatih kemampuan fisik yang masih tersisa.
Melatih kemampuan hidup mandiri atau semi-mandiri.
Melatih kemampuan menjaga kesehatan diri dan lingkungan.
Melatih kemampuan dasar (ADL dan IADL).
Peran Nakes Medis dalam Pelayanan Kesehatan Usila :
Pengkajian terhadap fungsi fisik, mental dan lingkungan dari para usia lanjut.
Melakukan diagnosa keperawatan.
Perencanaan tindakan keperawatan.
Pelaksanaan tindakan keperawatan.
Evaluasi
Penkajian fungsi fisik dan mental meliputi :
Kemampuan panca indra.
Kemampuan fungsi anggota gerak.
Kemampuan fungsi organ tubuh.
Kemampuan fungsi alat pembuangan tubuh.
Kemampuan fungsi mental.
Ada atau tidak adanya nyeri kronis.
Diagnosa keperawatan harus bersifat komprehensif dan holistik:
Perubahan mobilitas fisik.
Perubahan aktifitas dasar harian.
Gangguan panca indra.
Gangguan proses pembuangan tubuh.
Gangguan proses berpikir,depresi dan gangguan tidur.
Gangguan keseimbangan cairan dan elektrolit.
Gangguan pola pernafasan.
Tidak tolerans terhadap aktivitas harian.
Perencanaan tindakan keperawatan :
Continuum of care : perencanaan tindakan keperawatan berkelanjutan yang melibatkan kerjasama antar disiplin.
Rehabilitasi.
Kemandirian : memberikan kesempatan kepada usila untuk menolong dirinya sendiri melalui program pengendalian persepsi dan motivasi.
Long term care.
Home-based care.
Pelaksanaan tindakan keperawatan :
Merupakan tindak lanjut operasional dari rencana tindakan keperawatan.
Berfokus pada masalah yang ada pada diri pasien dan lingkungan.
Contoh : pemberian oksigen, perawatan kebersihan diri, mobilisasi, orientasi terhadap waktu, tempat dan orang.
Fokus lingkungan meliputi : cahaya penerangan yang memadai, lantai yang tidak licin, anak tangga, alat genggam di kamar mandi, dan sebagainya
Evaluasi keperawatan :
Merupakan tahapan terakhir untuk menilai apakah fungsi keperawatan berhasil atau gagal yaitu dengan membandingkan situasi dan kondisi sebelum dan sesudah intervensi keperawatan.
Mengidentifikasi faktor faktor penyebab kegagalan tindakan keperawatan.
Mencari alternatif tindakan keperawatan.
Kamis, 24 Juni 2010
Scientific research on the fast
medical benefits of fasting
Allah will say: O people who believe, a must for you to fast as well have been obligated to the people before you, that ye may fear Allah (Surah Al-Baqarah: 183). Allah says: And if you select the sooner the better for you if you know (Surah Al-Baqarah: 184). Does contemporary science can reveal the secret of the Word of God "And if you fast is better for you"?
Indeed contemporary medical science has not revealed the nature mempu fasting, but only stated that fasting is not desire for man to do it or not. That's it.
Indeed fasting, after various scientific research and detail of human body organs and physiological activity found that fasting is clearly something that should be done by the human body so that he could continue to perform their activities properly. And fasting is really very important and necessary for human health as humans need to eat, breathe, move, and sleep. So people who really need these things. If people can not sleep, eat during the long span of time it would hurt. Thus, the human body will experience a bad thing if he was not fasting.
In a hadith narrated by Imam Abu Umamah Nasaa'i from friends: "O Prophet, enjoin me a practice that God will give him the benefit for me to practice it". So he said, "Hurry up, because no one was equal to fasting practices".
And because of the importance of fasting for the body is that fasting helps rid the body where cells are damaged, and the cells or hormones or any substance that exceeds the amount the body needs. And fasting, as guided by Islam is an average of 14 hours, then just eat for the duration of time several hours.
This is a good method for disposal systems or damaged cells and rebuild hotmon body with new cells. And this is very different from what is understood by most people that fasting causes people to become weak and lethargic. Fasting is good for the body on condition that it was done for a month in a row in one year, and can be added 3 days every month. this right in accordance with the recommendations from Prophet in his hadith: Who fasted three days each month, then it is equal to fasting Dahr (fasting throughout the year).
And God confirmed this by saying the Prophet said: Those who work with a good deed, and God gave him the exercise 10 times. One day 10-day valued by God, then the 3-day 30-day appreciated, and if the 3rd day of each month will be 36 days. And it was worth the 360 days or one year in appreciation of God.
Tom Branch of columbia press says :
I think fasting is a spiritual experience that is extraordinary, larger than a biological experience / body alone. So because of that desire, I began to fast to cleanse themselves of excess weight. However, it turns out I found that fasting is very beneficial for mental clarity. Fasting is very helpful so that it becomes clear eyes. Also very helpful in analyzing ideas or new perceptions. However myfasting activity for several days, but I found a great psychological effect like that.
I have fasted several times until now. And I usually choose the time between 1 to 6 days. And in the beginning my goal was to eliminate the negative effects of the foods I eat, also to clean up my soul from the things that I experienced throughout my life, especially after watching the world in recent months, and I saw many tyrannical and brutality that humans live in it . Really, I feel responsible for their situation, so I'm fasting to eliminate those thoughts. "
"I feel fast every time interest in food really missing, and I feel my body is very relaxed and comfortable. And I feel myself turning away from fantasy, negative emotions like envy, jealousy, love girl talk, also lost feeling of fear, unpleasant feelings , and boredom. All of these feelings disappear by itself when I was fasting. And indeed, I felt the experience was so impressed with a lot of people when fasting. And may I say all this because what makes Muslims-as I see them in Turkey, Syria, and the Quds-1 with fasting during the full moon make their lives so impressive that I could not find anywhere in the world ".
Prevent tumor
Fasting also serves as a "surgeon" to remove damaged cells and weak in the body. So, the hunger that people who fasted will be able to move the internal organs in the body to destroy or take the cells rusah or weak to cover their hunger. So it is a good time for the body to replace cells with new cells that can return to work and play. With it also can eliminate or eat the organs of sick and renew. And fasting also serve to keep the body from the addition of harmful substances, such as excess calcium, excess meat and fat. Can also prevent the initial formation of tumors.
Keep blood sugar levels
Fasting is very good for lowering blood sugar levels to achieve balance. Based on this, really gave quick pancreas glands good opportunity to rest. Thus, insulin is released pancreas to neutralize starch sugar and fat collected in the pancreas. If the food contains excess insulin, the pancreas will experience pressure and weakened. It is up to the end of the pancreas can not function. Similarly, blood levels will rise and continue to increase until finally emerged with diabetes. And has done a lot of effort this diabetes treatment around the world by following the "fast system" for more than 10 hours and less than 20 hours. Each group gained influence, according to the situation. Then, the patient to consume snacks during a sequence of less than 3 weeks. And this method has achieved remarkable results in the treatment without the use diabetes and chemical drugs as well.
Fasting is the most expensive doctor
Indeed fasting, without exaggeration, is the "doctor" is really the most expensive. Because fasting can lose weight significantly, when the record breaking fast by eating a balanced diet and do not consume foods and beverages immediately when broken. Apostle when starting ifthar of fasting is to eat a few seeds of dates and not others, or a sip of water and prayer. This is a clue.
And this is the best guide for people who fasted from food and drink for a long time. Thus, there is sugar in the dates and people will feel full when eating dates, because he is very easily digested and sent to the blood, and at the same time he gives the energy or strength to the body.
As if we live to eat meat after a hunger for fast, vegetables, and bread, the body takes a long time to digest and absorb the essence of food and then we feel full. And at a time like this, then people will break when the initial still hungry. And finally, those who fasted were less able to benefit directly from the fasting, the health gain, be fitter, and vitality, even he will remain mostly fat and obesity. And this is certainly not valid for the purpose of God from the servants of His to fast.
God said: The month of Ramadan that the Qur'an descended as a guide for mankind, an explanation for the guidance and differentiation. So who will fill this Ramadan fast. And who is sick or in the street so fast that he was replacing another month. God wants to comfort you and do not want to trouble you "(Al-Baqarah: 175).
Diseases of skin disease
It's fast useful for treating various skin diseases. This is because the water content rapidly decreased in the blood, it also reduces the water content in the skin. This in turn will impact upon:
1. Adding the power of the skin against microbes and microbial diseases of the stomach.
2. Minimize the possibility of skin disease that spread throughout her body like a sick psoriasis (chronic skin disease).
3. Minimizing skin allergies and skin problems limit the fat.
Mrs.Ilham Hussein, an Egyptian princess, tell :
When I was 10 years old, I suffered from chronic skin diseases. This disease appears in red, and I do not see a single drug. And after the famous skin specialist in Egypt said to my father, "You better get used to it and you live with this disease. This is disease to other guests take a long time".
And when I reached the end of 20 years, and close to the time my wedding, I was more sad and isolate themselves from society, I really narrow (small chest). And finally, one friend of my father who always used to make quick to give advice to me, "Try, O daughter, you fast a day later you break (eat) a day, because that is what is the reason for my husband's recovery from a disease that until now unknown medicine by a doctor. However, if the drug is God and we are the real cause of all the drugs in his hand. So, ask him to heal before you suffer from the disease, and quickly ".
So, I fasted, and I began to research the things that get me out of the surrounding jahim. And I used when breaking the fast consumption of vegetables and fruits, and then after 3 hours I'd just eaten a heavy meal. And I eat (not fast) on the second day, and the third day of fasting, and so on. And things began to happen to everyone's surprise, the pain that I had started to recover after 2 months of time passed since I was fasting. I do not believe in myself, and I started as usual, and I saw the pain slowly began to disappear, and until completely recovered. Finally, I would never be affected by skin disease until the end of my days. "
Fasting prevent diseases of the rich
The disease is often referred to as "nacreous disease" caused by excess food and often eat meat. And finally the body can not break down proteins contained in meat. Where it will lead to piles of excess urine in the joints, especially in the joints of the toes. And when the nacreous joint pain, it will be red and swollen and painful that is. And sometimes in the urine levels of excess salt in the blood, then he settles in the kidneys and finally crystallized in the kidneys. And reduce the amount of food is the main cause for the cure of this disease is very dangerous.
Freezing the heart and brain
The professors who conduct scientific medical research - the majority are non-Muslims - will confirm the truth of fasting, because fasting can be reduced because the oil in the body and in turn will lead to reduced cholesterol. Do you know what "mal-cholesterol" that? Mal-Cholesterol is a substance that accumulates on therefore it is no exaggeration if we want to hear the word of Allah Ta `ala, which reads:
"And if you want the course faster is better for you if ye but knew." So how many thousands of people who overcome the habit of eating and drinking constantly, without the knowledge or not because of desire. And if they follow the method of God and the Sunnah of the Prophet of God Blessing will wasallam not excessive in terms of food and drink, fasting three times a month, they would know that many diseases that they have experienced will end and will reduce their weight several hundred pounds.
Joint pain
Joint pain is a disease caused by a long passage of time. With the body's organs began to hurt and pain will be with, and both hands and feet will experience a lot of pain. The disease is sometimes upon men in the final phases of his age, but more specifically at the age between 30 to 50 years. And the real problem is the modern medicine have not been able to find a cure for this disease until now.
However, scientific experiments conducted in Russia confirmed that fasting can be a cure for this disease. And fasting can restore or clean the body from things that harm. Fasting is done for three consecutive weeks. in these conditions the microbes or bacteria that cause this disease into a substance that cleanses the body during fasting. This experiment is performed on the number of people with the disease and get great results.
Rogerz Sulaiman of New York said, "I have a disease of chronic joint dysfunction for three years ago, when the disease is not too heavy at that time unless I can not walk far, and was unable to sit for more than half an hour. I've found a cure of various kinds but they all failed qodarullah then I met a friend named Zanji Irfani on a road to the mosque and he invited me to Islam, and we were then in the month of Ramadan, and I was surprised with the fast method itself, but I continue to follow Islamic rules this because I felt it was more relaxing rules, where rules can prevent the emergence of dangerous substances and to balance the things that are not stable in the body.
Two things are the most difficult problems that I experienced in New York. And so I try to fast a day before the conversion to Islam, I only eat vegetables, fruits and dates only when fasting. And I do not eat anything after that except when the dawn, and now I can walk long and Alhamdulillah I could walk faster. And finally even lost all the pain that I've experienced. Fasting is the only way that I met who could cure this disease. So I give thanks to God for His blessings overflow to convert me when I really steady with him.
Finally, Sulaiman says actually has the virtue of fasting for me, if you see how I greet the month of Ramadan every year, surely you would say, "Ah, like a child just does not like people age 40 or 50 years".
Indeed contemporary medical science has not revealed the nature mempu fasting, but only stated that fasting is not desire for man to do it or not. That's it.
Indeed fasting, after various scientific research and detail of human body organs and physiological activity found that fasting is clearly something that should be done by the human body so that he could continue to perform their activities properly. And fasting is really very important and necessary for human health as humans need to eat, breathe, move, and sleep. So people who really need these things. If people can not sleep, eat during the long span of time it would hurt. Thus, the human body will experience a bad thing if he was not fasting.
In a hadith narrated by Imam Abu Umamah Nasaa'i from friends: "O Prophet, enjoin me a practice that God will give him the benefit for me to practice it". So he said, "Hurry up, because no one was equal to fasting practices".
And because of the importance of fasting for the body is that fasting helps rid the body where cells are damaged, and the cells or hormones or any substance that exceeds the amount the body needs. And fasting, as guided by Islam is an average of 14 hours, then just eat for the duration of time several hours.
This is a good method for disposal systems or damaged cells and rebuild hotmon body with new cells. And this is very different from what is understood by most people that fasting causes people to become weak and lethargic. Fasting is good for the body on condition that it was done for a month in a row in one year, and can be added 3 days every month. this right in accordance with the recommendations from Prophet in his hadith: Who fasted three days each month, then it is equal to fasting Dahr (fasting throughout the year).
And God confirmed this by saying the Prophet said: Those who work with a good deed, and God gave him the exercise 10 times. One day 10-day valued by God, then the 3-day 30-day appreciated, and if the 3rd day of each month will be 36 days. And it was worth the 360 days or one year in appreciation of God.
Tom Branch of columbia press says :
I think fasting is a spiritual experience that is extraordinary, larger than a biological experience / body alone. So because of that desire, I began to fast to cleanse themselves of excess weight. However, it turns out I found that fasting is very beneficial for mental clarity. Fasting is very helpful so that it becomes clear eyes. Also very helpful in analyzing ideas or new perceptions. However myfasting activity for several days, but I found a great psychological effect like that.
I have fasted several times until now. And I usually choose the time between 1 to 6 days. And in the beginning my goal was to eliminate the negative effects of the foods I eat, also to clean up my soul from the things that I experienced throughout my life, especially after watching the world in recent months, and I saw many tyrannical and brutality that humans live in it . Really, I feel responsible for their situation, so I'm fasting to eliminate those thoughts. "
"I feel fast every time interest in food really missing, and I feel my body is very relaxed and comfortable. And I feel myself turning away from fantasy, negative emotions like envy, jealousy, love girl talk, also lost feeling of fear, unpleasant feelings , and boredom. All of these feelings disappear by itself when I was fasting. And indeed, I felt the experience was so impressed with a lot of people when fasting. And may I say all this because what makes Muslims-as I see them in Turkey, Syria, and the Quds-1 with fasting during the full moon make their lives so impressive that I could not find anywhere in the world ".
Prevent tumor
Fasting also serves as a "surgeon" to remove damaged cells and weak in the body. So, the hunger that people who fasted will be able to move the internal organs in the body to destroy or take the cells rusah or weak to cover their hunger. So it is a good time for the body to replace cells with new cells that can return to work and play. With it also can eliminate or eat the organs of sick and renew. And fasting also serve to keep the body from the addition of harmful substances, such as excess calcium, excess meat and fat. Can also prevent the initial formation of tumors.
Keep blood sugar levels
Fasting is very good for lowering blood sugar levels to achieve balance. Based on this, really gave quick pancreas glands good opportunity to rest. Thus, insulin is released pancreas to neutralize starch sugar and fat collected in the pancreas. If the food contains excess insulin, the pancreas will experience pressure and weakened. It is up to the end of the pancreas can not function. Similarly, blood levels will rise and continue to increase until finally emerged with diabetes. And has done a lot of effort this diabetes treatment around the world by following the "fast system" for more than 10 hours and less than 20 hours. Each group gained influence, according to the situation. Then, the patient to consume snacks during a sequence of less than 3 weeks. And this method has achieved remarkable results in the treatment without the use diabetes and chemical drugs as well.
Fasting is the most expensive doctor
Indeed fasting, without exaggeration, is the "doctor" is really the most expensive. Because fasting can lose weight significantly, when the record breaking fast by eating a balanced diet and do not consume foods and beverages immediately when broken. Apostle when starting ifthar of fasting is to eat a few seeds of dates and not others, or a sip of water and prayer. This is a clue.
And this is the best guide for people who fasted from food and drink for a long time. Thus, there is sugar in the dates and people will feel full when eating dates, because he is very easily digested and sent to the blood, and at the same time he gives the energy or strength to the body.
As if we live to eat meat after a hunger for fast, vegetables, and bread, the body takes a long time to digest and absorb the essence of food and then we feel full. And at a time like this, then people will break when the initial still hungry. And finally, those who fasted were less able to benefit directly from the fasting, the health gain, be fitter, and vitality, even he will remain mostly fat and obesity. And this is certainly not valid for the purpose of God from the servants of His to fast.
God said: The month of Ramadan that the Qur'an descended as a guide for mankind, an explanation for the guidance and differentiation. So who will fill this Ramadan fast. And who is sick or in the street so fast that he was replacing another month. God wants to comfort you and do not want to trouble you "(Al-Baqarah: 175).
Diseases of skin disease
It's fast useful for treating various skin diseases. This is because the water content rapidly decreased in the blood, it also reduces the water content in the skin. This in turn will impact upon:
1. Adding the power of the skin against microbes and microbial diseases of the stomach.
2. Minimize the possibility of skin disease that spread throughout her body like a sick psoriasis (chronic skin disease).
3. Minimizing skin allergies and skin problems limit the fat.
Mrs.Ilham Hussein, an Egyptian princess, tell :
When I was 10 years old, I suffered from chronic skin diseases. This disease appears in red, and I do not see a single drug. And after the famous skin specialist in Egypt said to my father, "You better get used to it and you live with this disease. This is disease to other guests take a long time".
And when I reached the end of 20 years, and close to the time my wedding, I was more sad and isolate themselves from society, I really narrow (small chest). And finally, one friend of my father who always used to make quick to give advice to me, "Try, O daughter, you fast a day later you break (eat) a day, because that is what is the reason for my husband's recovery from a disease that until now unknown medicine by a doctor. However, if the drug is God and we are the real cause of all the drugs in his hand. So, ask him to heal before you suffer from the disease, and quickly ".
So, I fasted, and I began to research the things that get me out of the surrounding jahim. And I used when breaking the fast consumption of vegetables and fruits, and then after 3 hours I'd just eaten a heavy meal. And I eat (not fast) on the second day, and the third day of fasting, and so on. And things began to happen to everyone's surprise, the pain that I had started to recover after 2 months of time passed since I was fasting. I do not believe in myself, and I started as usual, and I saw the pain slowly began to disappear, and until completely recovered. Finally, I would never be affected by skin disease until the end of my days. "
Fasting prevent diseases of the rich
The disease is often referred to as "nacreous disease" caused by excess food and often eat meat. And finally the body can not break down proteins contained in meat. Where it will lead to piles of excess urine in the joints, especially in the joints of the toes. And when the nacreous joint pain, it will be red and swollen and painful that is. And sometimes in the urine levels of excess salt in the blood, then he settles in the kidneys and finally crystallized in the kidneys. And reduce the amount of food is the main cause for the cure of this disease is very dangerous.
Freezing the heart and brain
The professors who conduct scientific medical research - the majority are non-Muslims - will confirm the truth of fasting, because fasting can be reduced because the oil in the body and in turn will lead to reduced cholesterol. Do you know what "mal-cholesterol" that? Mal-Cholesterol is a substance that accumulates on therefore it is no exaggeration if we want to hear the word of Allah Ta `ala, which reads:
"And if you want the course faster is better for you if ye but knew." So how many thousands of people who overcome the habit of eating and drinking constantly, without the knowledge or not because of desire. And if they follow the method of God and the Sunnah of the Prophet of God Blessing will wasallam not excessive in terms of food and drink, fasting three times a month, they would know that many diseases that they have experienced will end and will reduce their weight several hundred pounds.
Joint pain
Joint pain is a disease caused by a long passage of time. With the body's organs began to hurt and pain will be with, and both hands and feet will experience a lot of pain. The disease is sometimes upon men in the final phases of his age, but more specifically at the age between 30 to 50 years. And the real problem is the modern medicine have not been able to find a cure for this disease until now.
However, scientific experiments conducted in Russia confirmed that fasting can be a cure for this disease. And fasting can restore or clean the body from things that harm. Fasting is done for three consecutive weeks. in these conditions the microbes or bacteria that cause this disease into a substance that cleanses the body during fasting. This experiment is performed on the number of people with the disease and get great results.
Rogerz Sulaiman of New York said, "I have a disease of chronic joint dysfunction for three years ago, when the disease is not too heavy at that time unless I can not walk far, and was unable to sit for more than half an hour. I've found a cure of various kinds but they all failed qodarullah then I met a friend named Zanji Irfani on a road to the mosque and he invited me to Islam, and we were then in the month of Ramadan, and I was surprised with the fast method itself, but I continue to follow Islamic rules this because I felt it was more relaxing rules, where rules can prevent the emergence of dangerous substances and to balance the things that are not stable in the body.
Two things are the most difficult problems that I experienced in New York. And so I try to fast a day before the conversion to Islam, I only eat vegetables, fruits and dates only when fasting. And I do not eat anything after that except when the dawn, and now I can walk long and Alhamdulillah I could walk faster. And finally even lost all the pain that I've experienced. Fasting is the only way that I met who could cure this disease. So I give thanks to God for His blessings overflow to convert me when I really steady with him.
Finally, Sulaiman says actually has the virtue of fasting for me, if you see how I greet the month of Ramadan every year, surely you would say, "Ah, like a child just does not like people age 40 or 50 years".
Abstracted from the real story that happened in Cirebon : IBU RATRI
name and not the actual display
Ibu Ratri, victualler name recently appeared happy. Soon she would give birth to her first child after three years of marriage. Ibu Ratri always diligent prenatal care to the midwife. Never once did she check the pregnancy to the shaman, even though they are neighbors. She is still actively selling as usual. Ibu Ratri half-life. Her husband, Pak Salam was a farmer and one time the city became construction workers.
On one afternoon, she felt something wet from under her skirt. Until 01.00 am, the liquid is still flowing. Ibu Ratri began to panic. She asked her husband to call the midwife. Pak Salam did not dare to interfere with the midwife for being late. He chose to call the shaman who lived near his home.
At 03.00 am. Shamans come and see the content directly Ibu Ratri. She felt Ibu Ratri stomach and said, "Still a long birth, Bu!" and then go home.
Ibu Ratri increasingly agitated and asked her husband to call the midwife. Pak Salam is only left in the morning, midwife went to health centers.
Pak Salam confusion, how to bring his wife to the health center because he only had a bicycle. He had to run helter-skelter looking for a vehicle loan.
Arriving at the health centre, the midwife said Ibu Ratri liquid amniotic is finite, while opening a new. Ibu Ratri must be taken to the hospital, because the midwife can not handle it.
Arriving at the Hospital, Ibu Ratri can not be directly addressed because they do not have enough money. She just brought Rp.80.000,- and the her father family's green card. The hospital will not receive a green card because Ibu Ratri married, must have their own green card.
Normal Birth Cost is estimated Rp.400.000,-
The hospital agreed in advance to help Ibu Ratri, while Pak Salam went to raise funds. Pak Salam around the village to seek loans for labor it, but to no avail. Finally he got a loan from his father in-law.
Hospital, Ibu Ratri undergo a series of examinations by a doctor. The doctor stated that immediate surgery should be Ibu Ratri. Ratri more nervous because not enough money.
When her husband came with a puzzled face, Ibu Ratri said if she must to operate......
Pak Salam was surprised to hear this news. He had collected money with great effort, just enough for a normal birth. Especially now, when an operation, what cost????
Pak Salam could only let go and sat listless.
Ibu Ratri, victualler name recently appeared happy. Soon she would give birth to her first child after three years of marriage. Ibu Ratri always diligent prenatal care to the midwife. Never once did she check the pregnancy to the shaman, even though they are neighbors. She is still actively selling as usual. Ibu Ratri half-life. Her husband, Pak Salam was a farmer and one time the city became construction workers.
On one afternoon, she felt something wet from under her skirt. Until 01.00 am, the liquid is still flowing. Ibu Ratri began to panic. She asked her husband to call the midwife. Pak Salam did not dare to interfere with the midwife for being late. He chose to call the shaman who lived near his home.
At 03.00 am. Shamans come and see the content directly Ibu Ratri. She felt Ibu Ratri stomach and said, "Still a long birth, Bu!" and then go home.
Ibu Ratri increasingly agitated and asked her husband to call the midwife. Pak Salam is only left in the morning, midwife went to health centers.
Pak Salam confusion, how to bring his wife to the health center because he only had a bicycle. He had to run helter-skelter looking for a vehicle loan.
Arriving at the health centre, the midwife said Ibu Ratri liquid amniotic is finite, while opening a new. Ibu Ratri must be taken to the hospital, because the midwife can not handle it.
Arriving at the Hospital, Ibu Ratri can not be directly addressed because they do not have enough money. She just brought Rp.80.000,- and the her father family's green card. The hospital will not receive a green card because Ibu Ratri married, must have their own green card.
Normal Birth Cost is estimated Rp.400.000,-
The hospital agreed in advance to help Ibu Ratri, while Pak Salam went to raise funds. Pak Salam around the village to seek loans for labor it, but to no avail. Finally he got a loan from his father in-law.
Hospital, Ibu Ratri undergo a series of examinations by a doctor. The doctor stated that immediate surgery should be Ibu Ratri. Ratri more nervous because not enough money.
When her husband came with a puzzled face, Ibu Ratri said if she must to operate......
Pak Salam was surprised to hear this news. He had collected money with great effort, just enough for a normal birth. Especially now, when an operation, what cost????
Pak Salam could only let go and sat listless.
Rabu, 23 Juni 2010
Penyakit Kawasaki
Penyakit Kawasaki adalah demam pada anak yang berkaitan dengan vaskulitis terutama pembuluh darah koronaria serta keluhan sistemik lainnya.1 Penyakit Kawasaki pada umumnya ditemukan pada anak balita, 80% ditemukan pada anak dibawah 4 tahun dan jarang pada usia dibawah 3 bulan atau lebih 8 tahun. Usia tersering adalah 1-2 tahun.4 Penyakit Kawasaki tersebar seluruh dunia yang mengenai seluruh etnik terutama ras Asia.1 Di AS pada tahun 2000 diperkirakan terdapat 4248 pasien rawat inap dengan Penyakit Kawasaki.1,2 Anak laki-laki lebih sering terkena dari perempuan. 3 Di Indonesia diperkirakan sudah ditemukan lebih dari 100 kasus terutama di daerah Jabotabek.4 Advani dkk pada tahun 2005 melaporkan seri kasus pertama Penyakit Kawasaki di Indonesia pada symposium Internasional Penyakit Kawasaki ke VIII di San Diego,Amerika serikat. Sejak itu Indonesia secara resmi masuk dalam peta penyakit Kawasaki dunia.4
PENYAKIT KAWASAKI
Definisi :
Penyakit Kawasaki adalah demam pada anak yang berkaitan dengan vaskulitis terutama pembuluh darah koronaria serta keluhan sistemik lainnya.1
Epidemiologi :
Penyakit Kawasaki tersebar seluruh dunia yang mengenai seluruh etnik terutama ras Asia.1 Di AS pada tahun 2000 diperkirakan terdapat 4248 pasien rawat inap dengan Penyakit Kawasaki.1,2 Anak laki-laki lebih sering terkena dari perempuan. 3 Di Indonesia diperkirakan sudah ditemukan lebih dari 100 kasus terutama di daerah Jabotabek.4 Advani dkk pada tahun 2005 melaporkan seri kasus pertama Penyakit Kawasaki di Indonesia pada symposium Internasional Penyakit Kawasaki ke VIII di San Diego,Amerika serikat. Sejak itu Indonesia secara resmi masuk dalam peta penyakit Kawasaki dunia.4 Penyakit Kawasaki pada umumnya ditemukan pada anak balita, 80% ditemukan pada anak dibawah 4 tahun dan jarang pada usia dibawah 3 bulan atau lebih 8 tahun. Usia tersering adalah 1-2 tahun.4
Etiologi :
Hingga saat ini penyebab pasti belum dapat diketahui, meskipun gambaran klinis, laboratorium, epidemiologi mengarah kepada penyakit infeksi. 1,2 Diduga penyakit ini dipicu oleh gangguan imun yang didahului oleh proses infeksi.4
Manifestasi klinis :
PENYAKIT KAWASAKI
Definisi :
Penyakit Kawasaki adalah demam pada anak yang berkaitan dengan vaskulitis terutama pembuluh darah koronaria serta keluhan sistemik lainnya.1
Epidemiologi :
Penyakit Kawasaki tersebar seluruh dunia yang mengenai seluruh etnik terutama ras Asia.1 Di AS pada tahun 2000 diperkirakan terdapat 4248 pasien rawat inap dengan Penyakit Kawasaki.1,2 Anak laki-laki lebih sering terkena dari perempuan. 3 Di Indonesia diperkirakan sudah ditemukan lebih dari 100 kasus terutama di daerah Jabotabek.4 Advani dkk pada tahun 2005 melaporkan seri kasus pertama Penyakit Kawasaki di Indonesia pada symposium Internasional Penyakit Kawasaki ke VIII di San Diego,Amerika serikat. Sejak itu Indonesia secara resmi masuk dalam peta penyakit Kawasaki dunia.4 Penyakit Kawasaki pada umumnya ditemukan pada anak balita, 80% ditemukan pada anak dibawah 4 tahun dan jarang pada usia dibawah 3 bulan atau lebih 8 tahun. Usia tersering adalah 1-2 tahun.4
Etiologi :
Hingga saat ini penyebab pasti belum dapat diketahui, meskipun gambaran klinis, laboratorium, epidemiologi mengarah kepada penyakit infeksi. 1,2 Diduga penyakit ini dipicu oleh gangguan imun yang didahului oleh proses infeksi.4
Manifestasi klinis :
Fase Akut (10 hari pertama )
A. Enam gelaja diagnostik
1. Demam tinggi mendadak, tidak respon dengan antibiotika, dapat berlangsung 1-2 minggu bahkan bisa 4-5 minggu. Dalam 2-5 hari demam gejala lain akan muncul.
2. Konjunctivitis bilateral tanpa eksudat.
3. Bibir merah terang kemudian pecah dan berdarah, lidah merah (strawberry tongue) dan eritema difus pada rongga mulut dan faring.
4. Edema yang induratif dan kemerahan pada telapak tangan dan telapak kaki, kadang terasa nyeri.
5. Eksantema berbagai bentuk (polimorfik), dapat di wajah , badan dan ektremitas. Sering menyerupai urtikaria dan gatal, dapat seperti makula dan papula sehingga menyerupai campak.
6. Pembesaran kelenjer getah bening leher (cervikal) dijumpai sekitar 50% penderita, hampir selalu bersifat unilateral dan berukuran > 1,5 cm.
B. Tanda dan gejala lain yang mungkin dijumpai :
· Piuria steril (pada 60% kasus)
· Gangguan fungsi hepar ( 40%)
· Artritis sendi besar (30%) dapat juga sendi kecil
· Meningitis aseptik (25%)
· Nyeri perut dengan diare (20%)
· Hidrops kandung empedu dengan ikterus (10%)
C. Kelainan kardiovaskuler yang mungkin timbul :
Takikardi, irama derap, bising jantung, kardiomegali, efusi perikardium, disfungsi ventrikel kiri, perubahan EKG, (PR interval memanjang, voltase QRS rendah, ST depresi/elevasi, QTc memanjang). Kelainan arteri Koroner mulai terjadi pada akhir minggu pertama hingga minggu kedua
Fase Subakut ( hari 11-25 )
· Deskuamasi ujung jari tangan dan kemudian diikuti jari kaki (karakteristik).
· Eksentema, demam dan limfadenophati menghilang.
· Perubahan kardiovaskuler yang nyata mungkin timbul : dapat terjadi dilatasi / aneurisma, efusi perikardium, gagal jangtung dan infark miokard. Jumlah trombosit meningkat, dan dapat mencapat lebih dari 1.000,000/ mm3
Fase Konvalesen ( 6-8 minggu dari awitan )
Pada fase ini laju endap darah dan hitung trombosit mencapai nilai normal kembali, dapat dijumpai garis tranversa yang dikenal dengan Beau’s line. Meskipun anak tampak menunjukkan perbaikan klinis, namun kelainan jantung dapat berlangsung terus.
Diagnosis :
Diagnosisi Penyakit Kawasaki didasarkan kepada gejala klinis semata. Tidak ada pemeriksaan penunjang yang dapat memastikan diagnosis. Terdapat 6 kriteria gejala diagnostik :
1. Demam remiten dapat mencapai 41O C dan berlangsung > 5 hari.
2. Infeksi konjunktiva bilateral (tanpa eksudat).
3. Kelainan di mulut dan bibir : lidah Strawberry, rongga mulut merah difus, bibir merah dan pecah.
4. Kelainan tangan dan kaki, eritema dan edema pada fase akut serta deskuamasi ujung jari tangan dan kaki pada fase subakut.
5. Eksantema yang polimorfik.
6. Limfadenopathi servikal unilateral.
Pemerikasaan penunjang :
Laboratorium :
· Lekositosis pada fase akut dengan pergeseran ke kiri pada hitung jenis.
· Anemia normositik normogrom.
· Peningkatan reaktan fase akut : CRP (C Reactive Protein), laju endap darah.
· Trombositosis di jumpai pada fase akut bisa > 1.000.000/mm3.
· Piuria.
· Peningkatan trasaminase serum (enzim hati), hiperbilirubinemia ringan, peningkatan gamma glutamyl transpeptidase.
· Hipoalbuminemia pada kasus berat.
· Peningkatan enzim miokardium seperti Creatine Phospokinase MB menunjukan
· infark miokard 1,2
Rontgen thoraks :
Biasanya tidak banyak memberi informasi, dapt ditemukan kardiomegali jika terjadi miokarditis atau kelainan arteri koroner atau regurgitasi katup yang berat, 2,4
EKG :
Harus dilakukan saat diagnosis ditegakkan. EKG dapat menunjukkan gambaran voltage QRS rendah, perubahan gelombang ST elevasi atau depresi, QTc memanjang, Gelombang Q yang abnormal.4
Ekokardiografi :
Pemeriksaan ini mutlak perlu dilakukan untuk melihat kelainan arteri koroner dan disfungsi jantung yang lain. 4
Penatalaksanaan :
Semua pasien dengan Penyakit Kawasaki fase akut harus menjalani tirah baring dan rawat inap. Selama fase akut aspirin dapat di berikan 80-100 mg/kgbb/hari dalam 4 dosis terbagi dan imunoglobulin intravena 2 gr/kgbb dosis tunggal diberikan selama 10-12 jam.2,4 Lamanya pemberian aspirin bervariasi, pengurangan dosis dilakukan 48-72 jm bebas demam, beberapa klinisi memberikan aspirin dosisi tinggi sampai 14 hari sakit dan 48-72 jam setelah demam hilang.2 Dosis rendah aspirin 3-5mg/kgbb/hari dan dipertahankan hingga pasien tidak menunjukan perubahan arteri koroner dalam 6-8 minggu onset penyakit.2 Steroid digunakan untuk Penyakit Kawasaki bila terdapat kegagalan respon dengan terapi inisial. Regimen steroid yang umum diberikan methylprednisolon intravena 30mg/kgbb selama 2-3 hari diberikan sekali sehari selama 1-3 jam. 2,4
Prognosis :
Penyembuhan biasanya sempurna pada penderita yang tidak menderita vaskulitis koroner. Serangan kedua jarang sekali terjadi. Angka kematian Penyakit Kawasaki di jepang 0,08% - 1-2%. Semua anak yang menderita Penyakit Kawasaki meninggal karena komplikasi jantung, biasanya dalam 1-2 bulan sejak timbulnya penyakit. Aneurisma koroner dapat dijumpai pada sekitar 20-49% kasus dan kurang dari 5% menjadi infark miokard. 2,4
Kepustakaan :
1. Rowley AH, Shulman ST, Kawasaki Disease in Behrman RE, Kliegman R, Arvin AR editor, nelson texbook of Pediatrics 17th edition, Philadelphia 2004: 823-4
2. Newburger JW, et al, Diagnosis, treatment and long term Managementof Kawasaki Disease. A statement for health professionals from the Committee on Rheumatic Fever, Endocarditis and Kawasaki disease. Council of cardiovascular Disease in the young. American Heart Association , 2004
3. Parillo S. Pediatrics Kawasaki Disease, Medicine 2008 diunduh dari http://www.edmedicine.com/
4. Advani N. Diagnosis dan Tatalaksana Penyakit kawasaki dalam Buku Naskah Lengkap: Hot Topics in pediatrics IDAI cabang Kalimantan Timur 2006
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