By Midwivery Academy of MH Thamrin 2009
Ade Amalia, Dewi Apriliyanti A, Komalasari, Mumuy Muyasaroh
Immunization is an effective protection to prevent from many diseases. Immunization can build baby's immune system and protect children from dangerous diseases.
There are five basic immunizations given based on schedule for baby under one year old. They are Hepatitis B, BCG, Polio, DPT and Measles.
Hepatitis B Vaccination
A baby is given Hepatitis B vaccination intramuscularly once within 12 hours after birth. It must be repeated one month and six months later. Dosage per injection is 0,5 ml. It is for prevention of Hepatitis B infection to liver .
BCG Vaccination
A baby is given BCG Vaccination intradermally (15 degrees) at proximal upper arm once before 3 months old. Dosage pe injection is 0,1 ml. It is for prevention of Tuberculosis infection. Pus may occur at the location of injection but it is a common side effect.
DPT-Hepatitis B Vaccination
A baby is given BCG Vaccination intramuscularly at proximal anterolateral upper leg at the age of two, four and six months old. Dosage per injection is 0,5 ml. It is for prevention of Diphteria, Tetanus and Hepatitis B infection. Fever may occurs afterwards.
Polio Vaccination
A baby is given BCG Vaccination orally four times at the age of zero (before going home from hospital, two, four and six months old. Dosage administered is 2 drops (1 ml ). It is for prevention of polio infection-paralyzing agent.
Measles Vaccination
A baby is given measles vaccination deep subcutaneously (45 degrees) at proximal anterolateral upper leg. once at the age of nine months old. It is for prevention of measles which can cause inflamation in lungs. brain, and can cause blindness.
Sabtu, 21 November 2009
Selasa, 22 September 2009
Safety Pregnancy
Being safe in pregnancy means being safe for the pregnant woman and the fetus beared. To ensure safety pregnancy, there are some steps to do before conception, during pregnancy and after delivery. In other words, woman who want to be pregnant should undergo preconceptional care, antenatal care and postnatal care.
The principal for preconceptional care is assesing medical and psychosocial condition of a woman before pregnancy because health during pregnancy depends on it. Then a plan can be initiated for continuing obstetrical care.
The same thing happens for antenatal care and postnatal care. Except that additonal health assesment is needed for the fetus or baby. All the care provided by medical health team is important to prevent complication in pregnancy. Thus, morbidity and mortality related to pregnancy can be reduced.
Dwi Notosusanto, September 2009
The principal for preconceptional care is assesing medical and psychosocial condition of a woman before pregnancy because health during pregnancy depends on it. Then a plan can be initiated for continuing obstetrical care.
The same thing happens for antenatal care and postnatal care. Except that additonal health assesment is needed for the fetus or baby. All the care provided by medical health team is important to prevent complication in pregnancy. Thus, morbidity and mortality related to pregnancy can be reduced.
Dwi Notosusanto, September 2009
Sabtu, 04 Juli 2009
Kangaroo Care
By Elora Yushi, Dwi Yulita, Rena Novrin, Ruth Caroline
Nursing Academy of Jakarta Hospital
Kangaroo care is a way of holding a preterm or full term infant so that there is skin to skin contact between the infant and the person holding it.
Originally babies who were eligible for kangaroo care were pre term infants, less then 1500 grams and breathing on their own.
The method of managing kangaroo care is
Nursing Academy of Jakarta Hospital
Kangaroo care is a way of holding a preterm or full term infant so that there is skin to skin contact between the infant and the person holding it.
Originally babies who were eligible for kangaroo care were pre term infants, less then 1500 grams and breathing on their own.
The method of managing kangaroo care is
- The baby wears only a diaper and tied in a head u position to the mother's bare chest with a strip of cloth in a wanner that extends the baby's head and neck to revent apnea
- The tight bundling is enough for mother's breathing and chest movement to stimulate the baby's breathing. Because of the close confines being attached to his or her mother's chest, the baby is enclosed in a high carbondioxide environment which also stimulates breathing. Fathers can also use the skin to skin contact method
Beginning kangaroo care withing the first 2 hours after birth seems to be the most effective time period for succesful breastfeeding. Babies must be kept warm and dry.
Sabtu, 27 Juni 2009
Breast Care
By: Eka Reski S, Hernita Safitri, Marissa, Nadia Fauzi
Nursing Academy of Jakarta
Breast care is caring the breast regularly.
The advantages are:
Nursing Academy of Jakarta
Breast care is caring the breast regularly.
The advantages are:
- To take care and clean the breast
- To ease the breast milk out from the mother
- To keep the healthy body
The equipments needed are:
- Baby oil or coconut oil
- Two flanels
- Small towel
- Two palm of hands
- Warm water and cold water
- Cotton
There are 7 steps to do:
- Compress the nipple with the cotton and baby oil/coconut oil during 5 minutes
- Make the rotation movement in the nipple. Do this movement 30 times
- Pour the baby oil/coconut oil to the palm of hand
- Put one of the two palm of hands between two breasts and make a circle movement. Do this movement fifteen times
- Support the left breast with the left hands three fingers of the right hand, make rotation movement by giving pressure to the breast until the nipple
- Support the breast with one hand. While the other hand massage the breast with little fingers side up down nipple. Do this movement 30 times
- Compress the two breast with warm flannel during 2 minutes and then change one minute. Do this activity 3 times and finally compress with flannel.
Remember, while taking care of breast don't use alcohol and soap because the materials can make skin dry and irritated.
Selasa, 19 Mei 2009
Filosofi Motivasi
Motivasi itu sangat penting bagaikan bahan bakar untuk kendaraan. Setiap orang pada awalnya pasti punya motivasi untuk hidup lebih baik. Motivasi itu bisa digunakan bila ada yang mulai menggunakannya. Jadi langkah pertama adalah membuat diri sendiri mulai melangkah menuju hidup yang lebih baik dengan berbekal motivasi. Dalam perjalanan kita harus mengisi ulang motivasi. Kita dapat melakukannya dalam perjalanan. Tempat pengisian ulang bahan bakar itu bisa berupa tempat kita mencurahkan hati (pada Allah, pada keluarga, atau pada sahabat dikala sulit) dan mendapatkan kembali motivasi berupa nasehat (tulisan, lisan atau perbuatan) yang baik. Kemudian lanjutkanlah perjalanan yang sempat tertunda.
Menggapai Efisiensi dan Efektivitas Tinggi
Saya berfikir yang paling penting itu efisiensi dan efektivitas. Tiap orang punya aktivitas tiap hari. Tapi apakah aktivitas yang dilakukannya efektif dan efisien bagi kepentingan orang terkait? Untuk itu perlu adanya identifikasi faktor-faktor yang berperan. Katakanlah bahwa faktor-faktor itu sudah didapat. Langkah berikutnya adalah mencari tahu apakah ada irisan dengan faktor-faktor dari kepentingan pihak luar. Maka kemungkinannya ada 2. Irisan itu merugikan atau irisan itu menguntungkan. Di sini hal yang lebih penting adalah berfokus ada kemungkinan yang merugikan, Seperti kata pepatah lebih baik sedia payung sebelum hujan maka kita dapat melakukan pencegahan dini. Hal ini bisa dilakukan dengan berfikir dini. Selalu pikirkan hal-hal yang akan dapat merugikan bagi efektifitas dan efisiensi kita. Yakinkan bahwa pasti ada hal yang merugikan lalu cari tahu. Kita juga bisa menggunakan informasi valid dari sumber luar. Lalu kumpulkan info yang didapat dan buatlah kombinasi sekuel yang mungkin. Buatlah hubungan + dan – antara sekuel-sekuel yang seakan-akan terpisah. Lalu identifikasi pangkal dari sekuel - terumit dan segera usahakan pangkal itu tidak terjadi. Kalaupun terjadi usahakan agar tidak terus berlanjut. Percayalah usaha kita ini akan membuahkan hasil yang baik berupa efisiensi dan efektivitas yang tinggi. Insya Allah.
By D & J
By D & J
Sabtu, 25 April 2009
Critical Thinking on Ponari's Phenomenon
Generally while feeling sick, people consult a doctor. As we know that doctor is one who studied for a certain period of time in a university to be able to cure sick people. Then, the doctor decides whether they are really sick or not. By interviewing and examining patient’s body, the doctor will be able to determine any part of patient’s body which is getting wrong. Finally, the doctor will prescribe some medication for improving patient’s health status.
In fact, surprising event happened. I read the newspaper and saw on TV thousands of people are willing to queue and even send the night in front of a 10 years-old boy’s house, named Ponari in Jombang, East Java, in whom they believe has an almighty power to cure disease by only dipping his hand holding a stone, he admitted given by the sky above through lightning, to a glass of water. And the question, what is the story behind this fact?
A few months ago Ponari was hit by lightning, according to his story. When he regained consciousness there was a stone on top of his head. He threw it away but the stone came back so he took it home. There he discovered the healing effect of the stone: a neighbor was healed of fever after he had touched it, the villager’s head got rid of a bad pain in his arm and the local police officer swears he has seen with his own eyes how Ponari healed a boy who had not spoken even a single word for five years.
The news about the miraculous healings spread quickly and people started to flood to the small village of Balongsari, a few hours drive from Surabaya. First dozens, then hundreds, and now there are thousands. They bring cups, bottles and buckets of water in which the boy wonder plunges his stone. This supposedly turns the water into powerful universal remedy.
Seeing that many people with a hope that their disease will go away only as simply as drinking water from Ponari’s stone made me sad. Not only it’s ridiculous, but it shows us how bad our medical service is in the country. If only the government was able to provide free health facilities especially to the poor people, none of these would happen. I’m talking about 5 people who died while waiting for their turn meeting Ponari, the elders who could not get enough air to breathe with so many crowds around.
People tend to act based on their belief and knowledge. Those are made of previous information from other people and their own educational background. If this information is wrong and unfiltered by educational background, thing happening next is the appearance of wrong belief and knowledge. This will cause bigger impact on society if spread widely because people tend to take wrong action. This can explain Ponari phenomenon in our society.
The curing of disease by dipping stone, like what’s done by Ponari, is categorized as alternative therapy, which doesn’t involve medical knowledge. However, people who go to Ponari to cure their various diseases feel better that is perceived as being recovered. Unfortunately, there is no objective parameter used to measure. Rationally, that curing is impossible. However if we see this phenomenon from psychological aspect, suggestive effect may alleviate the symptoms of disease related to emotional factor.
In general, Ponari’s phenomenon is supported by people belief on his magical story and psychological aspect. However, there is no objective proof of the healing effect. Therefore, it is suggested that local government, especially from the field of health, should contribute to overcome Ponari’s phenomenon by facilitating more accessible health facilities, and giving correct information on health.
In fact, surprising event happened. I read the newspaper and saw on TV thousands of people are willing to queue and even send the night in front of a 10 years-old boy’s house, named Ponari in Jombang, East Java, in whom they believe has an almighty power to cure disease by only dipping his hand holding a stone, he admitted given by the sky above through lightning, to a glass of water. And the question, what is the story behind this fact?
A few months ago Ponari was hit by lightning, according to his story. When he regained consciousness there was a stone on top of his head. He threw it away but the stone came back so he took it home. There he discovered the healing effect of the stone: a neighbor was healed of fever after he had touched it, the villager’s head got rid of a bad pain in his arm and the local police officer swears he has seen with his own eyes how Ponari healed a boy who had not spoken even a single word for five years.
The news about the miraculous healings spread quickly and people started to flood to the small village of Balongsari, a few hours drive from Surabaya. First dozens, then hundreds, and now there are thousands. They bring cups, bottles and buckets of water in which the boy wonder plunges his stone. This supposedly turns the water into powerful universal remedy.
Seeing that many people with a hope that their disease will go away only as simply as drinking water from Ponari’s stone made me sad. Not only it’s ridiculous, but it shows us how bad our medical service is in the country. If only the government was able to provide free health facilities especially to the poor people, none of these would happen. I’m talking about 5 people who died while waiting for their turn meeting Ponari, the elders who could not get enough air to breathe with so many crowds around.
People tend to act based on their belief and knowledge. Those are made of previous information from other people and their own educational background. If this information is wrong and unfiltered by educational background, thing happening next is the appearance of wrong belief and knowledge. This will cause bigger impact on society if spread widely because people tend to take wrong action. This can explain Ponari phenomenon in our society.
The curing of disease by dipping stone, like what’s done by Ponari, is categorized as alternative therapy, which doesn’t involve medical knowledge. However, people who go to Ponari to cure their various diseases feel better that is perceived as being recovered. Unfortunately, there is no objective parameter used to measure. Rationally, that curing is impossible. However if we see this phenomenon from psychological aspect, suggestive effect may alleviate the symptoms of disease related to emotional factor.
In general, Ponari’s phenomenon is supported by people belief on his magical story and psychological aspect. However, there is no objective proof of the healing effect. Therefore, it is suggested that local government, especially from the field of health, should contribute to overcome Ponari’s phenomenon by facilitating more accessible health facilities, and giving correct information on health.
Senin, 09 Maret 2009
Nodul Tiroid
Nodul tiroid merupakan pembesaran dari kelenjar tiroid. Nodul tiroid dapat menimbulkan keluhan pasien seperti perasaan tidak nyaman karena tekanan mekanik nodul terhadap organ sekitarnya serta masalah kosmetik. Namun yang menjadi perhatian adalah kemungkinan nodul tersebut ganas. Pada beberapa kasus (jarang terjadi) nodul tiroid yang jinak (adenoma) dapat bertransfomasi menjadi ganas (tumor ganas).
Kejadian nodul tiroid meningkat sesuai dengan umur, keterpajanan terhadap radiasi pengion, defisiensi iodium, dan jenis kelamin wanita (kehamilan meningkatkan pembesaran nodul). Untuk menilai kemungkinan ganas atau jinaknya nodul perlu dilakukan penilaian melalui pemeriksaan diagnostik (pemeriksaan fisik terutama leher dan penunjang). Secara klinis, nodul dibagi menjadi nodul tunggal (soliter) dan nodul multipel. Lebih dari 95% nodul soliter bersifat jinak. Selain itu gambaran klinis yang juga dapat memberikan pertunjuk nodul jinak antara lain: riwayat penyakit keluarga (nodul jinak), besarnya tetap, biopsi jarum halus (jinak), kista simplek (hasil USG), dan mengecil dengan terapi levotiroksin.
Alur diagnosis nodul tiroid dilakukan dengan beberapa tahap. Pertama, penggalian riwayat penyakit, pemeriksaan fisik dan penunjang (kadar TSH). Bila kadar TSH normal atau tinggi dilakukan evaluasi klinik oleh dokter yang kompeten (terutama spesialis onkologi). Untuk mendapat diagnosis pasti maka perlu dilakukan biopsi jarum halus dengan tuntunan USG. Bila risiko keganasan rendah atau biopsi jarum halus hasilnya negatif maka nodul tiroid dapat diamati saja perkembangannya, atau diberikan terapi supresi hormonal (dengan I-tiroksin). Atas pertimbangan kosmetik, tindakan bedah dapat dilakukan pada suatu nodul jinak.
Nodul tiroid jinak (dibuktikan secara sitologis/pemeriksaan sel dengan mikroskop) yang diamati secara fisik dan USG selama 9 dan 11 tahun tanpa diberi pengobatan apapun: 43% nodul akan mengalami regresi (menyusut) spontan, 23% bertambah besar dan 33% menetap. Bila pasien sebelumnya diobati dengan I-tiroksin, tentu tiroksinlah yang dianggap berperan dalam mengecilkan nodul.
Terapi supresi dengan hormon tiroid (levotiroksin) merupakan pilihan yang paling sering dan mudah dilakukan. Terapi supresi dapat menghambat pertumbuhan nodul. Hanya 20 % nodul yang responsif terhadap terapi ini. Terapi supresi dilakukan dengan memberikan I-tiroksin dalam dosis supresi dengan sasaran kadar TSH sekitar 0,1 – 0,3 mIU/mL. Bisanya diberikan selama 3 -12 bulan, dan bila dalam waktu tersebut nodul tidak mengecil atau bertambah besar perlu dilakukan biopsi ulang atau disarankan operasi. Bila setelah satu tahun nodul mengecil, terapi supresi dapat dilanjutkan. Pada pasien tertentu terapi supresi hormonal dapat diberikan seumur hidup. Yang perlu diwaspadai adalah efek samping berupa osteopeni (penipisan kepadatan tulang) atau gangguan jantung. Terapi supresi hormonal tidak akan menimbulkan osteopeni pada pria atau wanita yang masih dalam usia produktif, namun dapat memicu terjadinya osteoporosis (keropos tulang) pada wanita pasca-menopause walaupun ternyata tidak selalu disertai dengan peningkatan kejadian fraktur (patah tulang).
Daftar Pustaka
W.Sudoyo,Aru. dkk. Buku Ajar Ilmu Penyakit Dalam-Jild III edisi IV. Pusat penerbitan Ilmu eyakit Dalam FKUI: Jakarta, 2006.
Sabtu, 31 Januari 2009
FIRST AID FOR SUDDEN UNCONSCIOUS PATIENT
Unexpected situation that calls for medical help can happen anywhere at any time. In this situation first responder who sees the casualty must take action by giving first aid. It is very important that first aid is given as soon as possible with appropriate first aid procedure. Responder has to do steps of screening emergency sign including consciousness, breathing and circulation of blood. Each sign reflects function of vital organ system. Consciousness is the higher function of central nervous system. Breathing reflects the function of respiratory system. Circulation of blood reflects the function of cardiovascular system.
Checking consciousness can be done by giving stimulus to casualty then checking respons. The stimulus can be sound, palpation or painful stimulus. If the casualty wakes up then we should ask about what he or she feels at that time and plan for immediate transportation to the nearest medical fascilitation. If he or she doesn’t wake up, we need to give painful stimulus. Pain can be created by pinching the tip of casualty’s finger nail or pressing eye brow area near the middle body line or pressing in the middle of the chest right to the sternum. If the casulty doesn’t respond to all the steps then we have to activate emergency medical system by calling 118-team and move to next steps of evaluating patient’s breath.
Breath can be evaluated by checking airway and chest movement. Airway is the channel for air flow to get inside and outside lungs. Checking airway means checking air flow. It can be done by listening to sound of breathing or feeling movement of air flow near the casualty’s nose or mouth. If there is no sound or stridor (snooring sound), airway may be obstructed. We should help the casualty by removing foreign object that is in the way of air way following triple airway maneuver as head tilt, chin lift or jaw thrust and open mouth. After securing airway, we must check chest movement to make sure whether the casualty breathes adequately. Breating frequency must be more than 11 times per minute and deep enough. If breathing is not adequate, give respiratory resucitation by mouth-to-mouth or mouth-to-nose rescucitation. Give at least enough two breathes then check the casualty’s circulation of blood.
Circulation of blood can be evaluated by checking carotid artery pulse. Carotid artery pulsation must be palpated by putting our three finger tips to casualty’s Adam’s apple and move 2 cm to left or right side. If there is no carotid artery pulsation felt then chest compression must be started. The first responder or helper must make the casualty lay down in prone position on flat and hard material. Then from the left or right side of casualty put hands palm to back on the middle body line in chest area, on the lower middle part of sternum. Then stright our upper and lower arm, do not hunch. Start chest compression by moving our body weight to stright arm. The depth of compression is between 3 centimetres to 5 centimetres. Make sure that helper hands always touch the chest during the compression up and down. The compression must be rhytmical. To do so, the helper must count ‘and one, and two and three and four and five’. One chest compression cycle consists of 6 times one to five count. After each cycle, two breathes rescutitation mut be given. Do it until six cycles. After that check for carotid pulse again. Redo chest compression until carotid pulsation is palpable or the casualty shows respons or until the medical emergency team comes. If it will take long time until medical emergency team comes, consider transporting the casualty to the nearest medical service fascilitation especially which provides defibrilation devices.
In general, we should keep in mind that the casualty is dying if proper first aid is not given as soon as possible. For unconscious breathing and circulatory arrest casualty, every one minute without help means possibility of survival is decreasing 10 precent. Properly check emergency sign including consciousness, breathing and circulation of blood! Activate emergency medical system by calling 118-team and do necessary first aid as soon as possible. Hopefully God will give her or him a chance to be revived through the first responder action.
By. James (Dwi Notosusanto)
Checking consciousness can be done by giving stimulus to casualty then checking respons. The stimulus can be sound, palpation or painful stimulus. If the casualty wakes up then we should ask about what he or she feels at that time and plan for immediate transportation to the nearest medical fascilitation. If he or she doesn’t wake up, we need to give painful stimulus. Pain can be created by pinching the tip of casualty’s finger nail or pressing eye brow area near the middle body line or pressing in the middle of the chest right to the sternum. If the casulty doesn’t respond to all the steps then we have to activate emergency medical system by calling 118-team and move to next steps of evaluating patient’s breath.
Breath can be evaluated by checking airway and chest movement. Airway is the channel for air flow to get inside and outside lungs. Checking airway means checking air flow. It can be done by listening to sound of breathing or feeling movement of air flow near the casualty’s nose or mouth. If there is no sound or stridor (snooring sound), airway may be obstructed. We should help the casualty by removing foreign object that is in the way of air way following triple airway maneuver as head tilt, chin lift or jaw thrust and open mouth. After securing airway, we must check chest movement to make sure whether the casualty breathes adequately. Breating frequency must be more than 11 times per minute and deep enough. If breathing is not adequate, give respiratory resucitation by mouth-to-mouth or mouth-to-nose rescucitation. Give at least enough two breathes then check the casualty’s circulation of blood.
Circulation of blood can be evaluated by checking carotid artery pulse. Carotid artery pulsation must be palpated by putting our three finger tips to casualty’s Adam’s apple and move 2 cm to left or right side. If there is no carotid artery pulsation felt then chest compression must be started. The first responder or helper must make the casualty lay down in prone position on flat and hard material. Then from the left or right side of casualty put hands palm to back on the middle body line in chest area, on the lower middle part of sternum. Then stright our upper and lower arm, do not hunch. Start chest compression by moving our body weight to stright arm. The depth of compression is between 3 centimetres to 5 centimetres. Make sure that helper hands always touch the chest during the compression up and down. The compression must be rhytmical. To do so, the helper must count ‘and one, and two and three and four and five’. One chest compression cycle consists of 6 times one to five count. After each cycle, two breathes rescutitation mut be given. Do it until six cycles. After that check for carotid pulse again. Redo chest compression until carotid pulsation is palpable or the casualty shows respons or until the medical emergency team comes. If it will take long time until medical emergency team comes, consider transporting the casualty to the nearest medical service fascilitation especially which provides defibrilation devices.
In general, we should keep in mind that the casualty is dying if proper first aid is not given as soon as possible. For unconscious breathing and circulatory arrest casualty, every one minute without help means possibility of survival is decreasing 10 precent. Properly check emergency sign including consciousness, breathing and circulation of blood! Activate emergency medical system by calling 118-team and do necessary first aid as soon as possible. Hopefully God will give her or him a chance to be revived through the first responder action.
By. James (Dwi Notosusanto)
Jumat, 30 Januari 2009
Forensic The Silence Evidence
Forensic or legal medicine is one of specialistic branch of medicine field of study that helps law enforcement related to human body condition, life or death based on scientific and factual findings-the silence evidence. To be specialist in forensic medicine one should be able to combine his medical knowledge and skill with legal jurisdiction such as by making Visum Et Repertum. More focus on evidence left on human body after violation as well as natural diseases is undoubtedly necessary for scientific factor to interpret silence evidence and proof hypotesis on possible former happenings. Moreover, determination of disease or disability-related violation depends solely on attending competent doctor. So, in case of suspected criminal action on human, role of forensic medicine absolutely exists.
Making visum et repertum is one of legal ways the forensic doctor can communicate his medical interpretation on factual evidence found from victim. Visum et Repertum is written report on human body --whole or partial-- asked by police, made by doctor based on his/her knowledge and under doctor's pledge which mainly explains victim's identification, sign and related symptom of violence, and degree of disease or violation-related disability. In the reason that suspected criminal case has not been unsolved yet, any findings that give addditional clues must be recorded well to ensure that recalling of case could be held. Comprehensive health examination have to be done to prevent skip of important findings. After that, report is written down with 5 main compositions, as opening parts (head of letter and sentence "PRO JUSTITIA", introductory data (data on requesting police institution, brief description on personal victim profile, identity of examining doctor), report on factual findings (whole body character, related sign and symptoms, causal factor identified from victim), medicolegal conclusion (interpretation of report on factoal finding in correlation with jurisdiction) and closing pledge statement.
Jumat, 23 Januari 2009
The Use of Medical Health Records
Medical Health Record is written collection of information about a patient’s health and treatment written by health care professionals. Doctor, nurses and other health care professionals write up medical/health records so that previous medical information is available when needed. A patient’s medical record should provide accurate information on: who the patient is and who provided health care; what, when, why and how services were provided; and the outcome of care and treatment. The medical record has four major sections: administrative, which includes demographic and socioeconomic data such as the name of the patient (identification), sex, date of birth, place of birth, patient’s permanent address, and medical record number; legal data including a signed consent for treatment by appointed doctors and authorization for the release of information; financial data relating to the payment of fees for medical services and hospital accommodation; and clinical data on the patient whether admitted to the hospital or treated as an outpatient or an emergency patient. Considering the composition of medical health record, there are four main uses of medical record. The main uses of the medical record are: to document the course of the patient's illness and treatment; to communicate between attending doctors and other health care professionals providing care to the patient; for the continuing care of the patient; for research of specific diseases and treatment; and the collection of health statistics.
Medical record has to be able to clearly document the course of patient’s illness and treatment reflecting that medical examination and procedure have been done. It is a must that as health care team we write what we do and we do what we write. Doing it will be good for medical health care team since evaluation of what have done to patients by looking at and redoing thinking of medical health record provides chance for improvement of health care team. Unwritten important things on medical treatment can be seen soon and prompt improvement can be done.
Medical record as means of communication between attending doctor and other medical health professionals providing care to the patient prevents misunderstanding and provides fast patient's status that will be useful for their consideration of making effective and efficient medical desicions. The doctor may need assistance from other medical health professionals such as health consultant, other health specialists, and nurses. Since they may be busy on their own tasks, spoken instruction or communication may not be enough. When cancellation is done, possibility on forgetting medical consuls or tasks may be forgotten. To overcome the forgetful situation, there should be reminder. In this case, written reminder--medical record-- will come in handy.
Medical record that is saved for several years is useful for continuing care of the patient. There may be some diseases or conditions that affect patient health condition further such as chronic diseases, potential relapse disease, allergy, and past medical treatment history. They must be considered while giving medical treatment to the patient because doing that will be considered as treating patient holistically. That is reasonable because we tend to be able to do proper, effective and efficient medical treatment to the patient if we get whole picture of patient health condition. Then, medical health team can concentrate more on continuing care of the patient without retreating uneffective past treatment.
Well documented medical records are also useful for research of disease, related treatment, and health statistics. Collecting them means collecting epidemiology data from population and this is valuable in the view of medical field of study. As ethical issues forbid medical health institutes to do intervensive procedure without evidence based medicine, data of patient continuing treatment and the result may provide basis on evidence based medicine without breaking the ethics. Then, possibility on researches of new medical intervensive procedure or method will be opened to improve the result of treatment.
In general, the use of medical health record brings good environment to development of medical health treatment. Adequate attention on proper making of medical health record ensures the optimal use of medical health record.
By. James (Dwi Notosusanto)
Medical record has to be able to clearly document the course of patient’s illness and treatment reflecting that medical examination and procedure have been done. It is a must that as health care team we write what we do and we do what we write. Doing it will be good for medical health care team since evaluation of what have done to patients by looking at and redoing thinking of medical health record provides chance for improvement of health care team. Unwritten important things on medical treatment can be seen soon and prompt improvement can be done.
Medical record as means of communication between attending doctor and other medical health professionals providing care to the patient prevents misunderstanding and provides fast patient's status that will be useful for their consideration of making effective and efficient medical desicions. The doctor may need assistance from other medical health professionals such as health consultant, other health specialists, and nurses. Since they may be busy on their own tasks, spoken instruction or communication may not be enough. When cancellation is done, possibility on forgetting medical consuls or tasks may be forgotten. To overcome the forgetful situation, there should be reminder. In this case, written reminder--medical record-- will come in handy.
Medical record that is saved for several years is useful for continuing care of the patient. There may be some diseases or conditions that affect patient health condition further such as chronic diseases, potential relapse disease, allergy, and past medical treatment history. They must be considered while giving medical treatment to the patient because doing that will be considered as treating patient holistically. That is reasonable because we tend to be able to do proper, effective and efficient medical treatment to the patient if we get whole picture of patient health condition. Then, medical health team can concentrate more on continuing care of the patient without retreating uneffective past treatment.
Well documented medical records are also useful for research of disease, related treatment, and health statistics. Collecting them means collecting epidemiology data from population and this is valuable in the view of medical field of study. As ethical issues forbid medical health institutes to do intervensive procedure without evidence based medicine, data of patient continuing treatment and the result may provide basis on evidence based medicine without breaking the ethics. Then, possibility on researches of new medical intervensive procedure or method will be opened to improve the result of treatment.
In general, the use of medical health record brings good environment to development of medical health treatment. Adequate attention on proper making of medical health record ensures the optimal use of medical health record.
By. James (Dwi Notosusanto)
Selasa, 20 Januari 2009
Injection Safety Procedure
Injection is one of common route drug administration that must be carefully practiced to lessen injection related side effect because of misuse or overuse of it. Health care workers should ensure themselves and patients that substance given by injection is useful for improving patients’ health condition and doesn’t cause life risky side effect. Practice related to injection before, during and after injection need to be handled based on safety procedure. While doing that, injection-related side effects must be prevented, be monitored and be treated well--if they occur--in order to prevent further complication that will worsen patient health status. Moreover, doing safe injection practice will also benefit health care workers since it prevents blood-borne pathogens transmission.
Injection is an infusion method of putting liquid into the body, usually with a hollow needle and a syringe which is pierced through the skin to a sufficient depth for the material to be forced into the body that must be used sensibly not only to promote the patient’ benefit but also to prevent injection giver injury. Since it is manual and invasive, the practice depends on health care team and needs special skill. Misuse and overuse of injection may occur. Misuse of injection occurs when injection doesn’t follow safety procedure such as sharing the same syringes with different persons or reusing syringes to inject different drugs. Injection is overused if unnecessary injection is done when oral formula may still be used.
Steps of doing safety injection procedures include preparation before the injection, execution during the injection and evaluation after the injection. First, equipments and drugs should be provided for related patient. They include syringe, needle, gloves, torniquet, alcohol swab and dry cloth. Make sure that the equipments are sterile. Tell patient about procedure that will be done and ask for patient’s approval. Second, injection techniques must suit patient’s condition and be done by right procedure. There are 4 techniques, subcutaneus injection, hypodermic injection, muscular injection and intraveinous injection and each technique mustn't subtitute other technique without competent doctor supervision. Third, all medical sewage must be disposed in appropriate place. There are containers for disposal of syringes and sharps. Then, monitoring patient’s condition is important. Look for any signs of injection related side effect and tell the patient to beware of symptoms that may occur following the injection. If necessary, laboratory check should be done to see asymptomatic effect. Consult medical health team when side effect occurs since rapid and well treatment must be held to guard against complication whether it can be devastating or fatal.
Doing these will ensure not only patients’ safety but also health workers’ safety. Since chronic diseases as hepatitis B virus, hepatitis C virus and HIV transmit by blood, safety procedure that prevent patients’ blood contact to health workers will limit the transmission. In general, injection safety procedure is a must to prevent unwanted events for patients and health worker team.
By. James (Dwi Notosusanto)
Injection is an infusion method of putting liquid into the body, usually with a hollow needle and a syringe which is pierced through the skin to a sufficient depth for the material to be forced into the body that must be used sensibly not only to promote the patient’ benefit but also to prevent injection giver injury. Since it is manual and invasive, the practice depends on health care team and needs special skill. Misuse and overuse of injection may occur. Misuse of injection occurs when injection doesn’t follow safety procedure such as sharing the same syringes with different persons or reusing syringes to inject different drugs. Injection is overused if unnecessary injection is done when oral formula may still be used.
Steps of doing safety injection procedures include preparation before the injection, execution during the injection and evaluation after the injection. First, equipments and drugs should be provided for related patient. They include syringe, needle, gloves, torniquet, alcohol swab and dry cloth. Make sure that the equipments are sterile. Tell patient about procedure that will be done and ask for patient’s approval. Second, injection techniques must suit patient’s condition and be done by right procedure. There are 4 techniques, subcutaneus injection, hypodermic injection, muscular injection and intraveinous injection and each technique mustn't subtitute other technique without competent doctor supervision. Third, all medical sewage must be disposed in appropriate place. There are containers for disposal of syringes and sharps. Then, monitoring patient’s condition is important. Look for any signs of injection related side effect and tell the patient to beware of symptoms that may occur following the injection. If necessary, laboratory check should be done to see asymptomatic effect. Consult medical health team when side effect occurs since rapid and well treatment must be held to guard against complication whether it can be devastating or fatal.
Doing these will ensure not only patients’ safety but also health workers’ safety. Since chronic diseases as hepatitis B virus, hepatitis C virus and HIV transmit by blood, safety procedure that prevent patients’ blood contact to health workers will limit the transmission. In general, injection safety procedure is a must to prevent unwanted events for patients and health worker team.
By. James (Dwi Notosusanto)
Jumat, 16 Januari 2009
Principles of Genital Hygiene
Genital hygiene is one of modifiable factors for urinary tract infection and reproductive tract disease. It depends on how one behaves on taking care of self genital hygiene by doing self care and routinely doing medical examination. It is so personal that every one is responsible for his or her benefit. Genital hygiene includes cleanliness, genital skin acidity, odor, dryness and moist of genital and the surrounding area. These are to support the natural body defense mechanism which is the existence of beneficial bacteria (normal floras) that prevents the growth and accumulation of potential pathogens (infectious microorganisms). Since genital is part of urinary tract in human and part of reproductive tract in man and pathogens can spread, person with poor genital hygiene is prone to genital infection and disease that will lead to urinary tract infection and reproductive tract disease.
To achieve favorable state, one should make effort on keeping good genital hygiene by doing general personal hygiene care, genital hygiene care, and medical check ups on certain condition. General personal hygiene care means paying attention to general body hygiene especially part of body closely related to genital such as hands, anus and area surrounding genital. Genital hygiene care means paying attention to genital (penis and scrotum for man, external part of vagina, labia major and labia minor for woman and pubis for adults). Medical check ups on certain condition means having medical examination from competent doctor considering uncomfortable symptoms of urinary and reproductive tract.
There are also clothing factor that play role in genital hygiene care, especially clothes related to genital. They are underwear, pants, towel, toilet paper, and sanitary napkins. They are used to provide comfort for genital and they should be replaced when no longer clean nor dry. It is also advisable that sharing of personal clothes not be done.
Besides all of those factors, correct knowledge on how to clean genital is also important. Excessive procedures such as frequent use of antiseptic, deodorant, soap, hot water and perfumes can not ensure good genital hygiene. In fact, irritation may occur following the procedures. Direction of washing genital, healthy sexual behavior, hormonal state influencing genital condition, and special treatment for baby and uncircumcised man are things that should come into consideration.
By. James (Dwi Notosusanto)
To achieve favorable state, one should make effort on keeping good genital hygiene by doing general personal hygiene care, genital hygiene care, and medical check ups on certain condition. General personal hygiene care means paying attention to general body hygiene especially part of body closely related to genital such as hands, anus and area surrounding genital. Genital hygiene care means paying attention to genital (penis and scrotum for man, external part of vagina, labia major and labia minor for woman and pubis for adults). Medical check ups on certain condition means having medical examination from competent doctor considering uncomfortable symptoms of urinary and reproductive tract.
There are also clothing factor that play role in genital hygiene care, especially clothes related to genital. They are underwear, pants, towel, toilet paper, and sanitary napkins. They are used to provide comfort for genital and they should be replaced when no longer clean nor dry. It is also advisable that sharing of personal clothes not be done.
Besides all of those factors, correct knowledge on how to clean genital is also important. Excessive procedures such as frequent use of antiseptic, deodorant, soap, hot water and perfumes can not ensure good genital hygiene. In fact, irritation may occur following the procedures. Direction of washing genital, healthy sexual behavior, hormonal state influencing genital condition, and special treatment for baby and uncircumcised man are things that should come into consideration.
By. James (Dwi Notosusanto)
Selasa, 13 Januari 2009
Steps of Positioning Traffic Accident-Patient
Traffic accident-patients are at ease of getting disabilities or even death if not treated well as soon as possible. Critical injuries following the accident include bone fracture and internal injury. These can be fatal if they cause failure in cardiovascular system, respiratory system or central nervous system. Medical first responder should do steps of determining fatal cause and help positioning the patients to ensure life savings. Without knowing them, wrongly positioning the patients may further worsen the patient’s condition or even lead to sudden death.
The steps are uncovering the A B C D of patients. A is securing patient’s airway. If sign of potential obstruction is found, positioning is needed. For example: if patient is lying flat on his back and vomits, he should be positioned to sleep on his unaffected or healthy (left or right) side so that the vomit will be more easily go out of respiratory tract. B is examining patient’s breathing. Inspect chest movement, determine whether it is deep enought and withing regular normal frequency. Untight clothing without moving patient. C is examining patient’s circulation status. It can be done by looking at the color of patient’s finger nail, checking the temperature and examining skin. The color is pale, the temperature is cold and the skin is sweating, patient may be having hypovolemic shock because of external or internal bleeding. Therefore the source of bleeding should be searched and his leg should be elevated higher than head to help directing blood to vital internal organs while he is lying flat. D is examining patient’s deformities. Fracture in cervical spinal vertebrae, ribs or head may be fatal if it is not treated well. Patient’s head should be made fixated by neck collar before moving the patient because moving it unwisely will possibly paralyze all patient’s extremities and even cause paralyze of breathing muscle. Patient having rib fracture may not be left lying on stomach because it will give further burden to breathing muscle. Patient’ can die of respiratory failure. After medical first responder is sure that A B C D patient’s is safe they can consider transporting patient’s to the nearest hospital.
By
James (Dwi Notosusanto)
The steps are uncovering the A B C D of patients. A is securing patient’s airway. If sign of potential obstruction is found, positioning is needed. For example: if patient is lying flat on his back and vomits, he should be positioned to sleep on his unaffected or healthy (left or right) side so that the vomit will be more easily go out of respiratory tract. B is examining patient’s breathing. Inspect chest movement, determine whether it is deep enought and withing regular normal frequency. Untight clothing without moving patient. C is examining patient’s circulation status. It can be done by looking at the color of patient’s finger nail, checking the temperature and examining skin. The color is pale, the temperature is cold and the skin is sweating, patient may be having hypovolemic shock because of external or internal bleeding. Therefore the source of bleeding should be searched and his leg should be elevated higher than head to help directing blood to vital internal organs while he is lying flat. D is examining patient’s deformities. Fracture in cervical spinal vertebrae, ribs or head may be fatal if it is not treated well. Patient’s head should be made fixated by neck collar before moving the patient because moving it unwisely will possibly paralyze all patient’s extremities and even cause paralyze of breathing muscle. Patient having rib fracture may not be left lying on stomach because it will give further burden to breathing muscle. Patient’ can die of respiratory failure. After medical first responder is sure that A B C D patient’s is safe they can consider transporting patient’s to the nearest hospital.
By
James (Dwi Notosusanto)
The Importance of Bedmaking
Bed making is one of unavoidable and important procedures in taking care of patients who are in bed rest. No body wants to take a rest in a dirty and uncomfortable condition and so do the patients. As beds are where they spend most of their time in hospital, the condition of bed will affect the physical and psychological comfort for patients who are ill. Good bedmaking promotes good sleep and good sleep promotes optimum health and healing process. Therefore, it is essential the nurse keep the bed as clean and comfortable as possible.
Bedmaking as practiced by a nurse assistant is a skilled task that must be performed precisely. The bed must be, dry, wrinkle-free to prevent bedsores, which not only cause discomfort to the patient but can cause serious health problems(such as pressure ulcers). It must be clean and the open end of the pillow case must be facing away from the door to prevent an infection control issue. It is also important to make sure that it is odorless for the patients’ comfort. There are specific bedmaking techniques for use when a bed is occupied by a patient which is different from the unoccupied one. Moreover, there is also special matress to prevent and treat decubitus ulcers.
However, bedmaking can not substitute for nursing care. Periodically turning patient, doing skin care and positioning are procedures that need nurse’s help. Doing all these things will help the patients feel comfortable and lessen the illness.
By. Dwi Notosusanto (James)
Bedmaking as practiced by a nurse assistant is a skilled task that must be performed precisely. The bed must be, dry, wrinkle-free to prevent bedsores, which not only cause discomfort to the patient but can cause serious health problems(such as pressure ulcers). It must be clean and the open end of the pillow case must be facing away from the door to prevent an infection control issue. It is also important to make sure that it is odorless for the patients’ comfort. There are specific bedmaking techniques for use when a bed is occupied by a patient which is different from the unoccupied one. Moreover, there is also special matress to prevent and treat decubitus ulcers.
However, bedmaking can not substitute for nursing care. Periodically turning patient, doing skin care and positioning are procedures that need nurse’s help. Doing all these things will help the patients feel comfortable and lessen the illness.
By. Dwi Notosusanto (James)
Minggu, 11 Januari 2009
Pentingnya Kejujuran Pasien dan Keluarganya
Bagi siapa saja yang pernah sakit atau ikut mengantarkan orang yang sakit hingga bertemu langsung dengan dokter seharusnya mengetahui bahwa hal pertama yang dilakukan dokter adalah bertanya tentang riwayat kesehatan dan penyakit pasien kepada pasien dan keluarganya. Dalam ilmu kedokteran ini disebut anamnesis.
Anamnesis merupakan 80 % modal dokter dalam melakukan diagnosis (penetapan daftar masalah) penyakit.Dalam anamnesis dibutuhkan kerjasama dari pasien dan keluarga untuk secara jujur memberikan informasi terkait data diri pasien, keluhan utama pasien, riwayat penyakit sekarang dan riwayat pengobatannya, riwayat penyakit dahulu dan pengobatannya, riwayat penyakit kelurga dan riwayat sosial ekonomi. Dalam anamnesis, dokter akan menggali gejala penyakit yang menunjukkan perjalanan penyakit sehingga didapat kemungkinan terbesar jenis penyakit pada pasien. Dalam melakukan anamnesis dokter menggunakan pengetahuan teori kondisi tubuh manusia dalam keadaan sehat dan sakit. Dokter berusaha dengan sungguh-sungguh untuk mendapatkan gambaran keadaaan kesehatan dan penyakit pasien secara penuh. Untuk itulah dokter harus mendapat informasi yang benar dari pasien dan keluarga.
Kejujuran pasien dan keluarganya merupakan awal dari kemungkinan penatalaksaan pasien dengan baik dan benar. Hal ini sangat menentukan pemeriksaan klinis maupun laboratorium lanjutan yang akan dilakukan oleh dokter. Misalnya, jika pasien dan keluarga tidak mengeluhkan keadaan sakit pada alat kelamin pasien maka dokter kemungkinan besar tidak akan memeriksa kelamin pasien. Jika pasien dan keluarga tidak mengeluhan keadaan sakit pada payudara pasien maka dokter kemingkinan besar tidak akan melakukan pemeriksaan mendetail pada dada pasien. Bila info dari pasien salah maka anamnesis akan tidak valid. Akibatnya 80% modal dokter dalam melakukan diagnosis (penetapan daftar masalah) penyakit akan terganggu. Yang terjadi kemudian ialah ketidakefektifan pengobatan karena penyakit yang mau diobati tidak terdeteksi.
Menimbang hal itu semua maka perlu disadari pentingnya Kejujuran Pasien dan Keluarganya kepada dokter. Bukankah dokter juga manusia dan dokter bukan paranormal. Jadi, bekerjasamalah dengan baik dengan cara berkata jujur.
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