What is otitis media?

Definitions

Otitis media is an infection or inflation (inflation: Inflammation) the middle ear. The middle ear is the area bounded by the outside world by the ear drum. This area connects the sound with a hearing in the inner ear. Also in this area there is a line "eustachian" that connects the middle ear to the back of the nasal cavity and upper throat.

Use of this channel are:

1. Maintain the balance of air pressure in the ear and adjust air pressure in the outside world

2. Drain the mucus produced fewer cells lining the middle ear to the back of the nose.

Cause

The cause of acute otitis media may be a virus or bacteri1. In 25% of cases and sometimes infect the middle ear with the bacteri1. Virus / bacteria that commonly cause otitis media are Streptococcus pneumoniae. Followed by Haemophilus influenzae and Moraxella caltarhalis. To remember the otits media, although most cases are caused by bacteria, only a few cases requiring antibiotics. This is possible because no antibiotic was eustachius channel will be open again so that the bacteria will be eliminated with the flow of mucus.

Why are children more susceptible to otitis media?

Children more susceptible to otitis media as compared to adults:

1. Child's immune system is still in development

2. Eustachius tract in children is more straight and shorter horizontally so that the ARI is more easily spread ketelinga middle.

3. Adenoids (adenoids salahs atu ditenggorokkan upper organ that plays a role in the immune system) is relatively larger in children than adults. Adenoid position adjacent to the mouth of the eustachian channel. In addition adenoid itself can be infected when the infection then spreads to the middle ear through the channel uestachius.

Diagnosis

OMA diagnosis must meet three of the following:

1. Disease appear suddenly (acute)

2. The discovery marks lefusi elasi: sector in body cavity fluid collection) the middle ear. Effusion demonstrated the presence of either one of the following signs:

- Mengembungkan eardrum

- Limited / absence of movement of the eardrum

- The shadow of fluid behind the eardrum

- Fluid out of the ear.

3. Signs / symptoms of middle ear inflammation, as evidenced by the presence of either one of the following signs:

- Redness of the eardrum

- Ear pain that interferes with sleep and normal activity

Symptoms and signs of Otitis media

1. Ear pain, fever, irritability

2. Middle ear effusion

3. Eardrum bleak

4. Mengembung eardrum

5. Reduced drum movement

6. Decreased hearing

Symptoms and signs of otitis media with effusion:

1. Middle ear effusion

2. Eardrum bleak

3. Reduced drum movement

4. Decreased hearing

Handling

1. Antibiotics

OMA is a disease that will usually heal by itself. Approximately 80% of OMA cured in 3 days without antibiotics. The use of antibiotics does not reduce the complications that can occur, including decreased hearing.

Observations can be done in most cases. If symptoms do not improve within 48-72 hours or no change in symptoms, antibiotics are given

The definition of mild symptoms are mild ear pain and fever <39oC in 24 hours. While the symptoms are severe ear pain is severe or fever-39 oC.

Antibiotics on the OMA will result in improvement of symptoms within 48-72 hours. In the first 24 hours occurred within 24 hours of stabilization are both taking place improvements. If the patient does not improve within 48-72 hours, there may be other diseases or treatment provided is not adequate.

In this case such as this, antibiotics are considered:

- In patients with severe symptoms or OMA is probably caused by Haemophilus influenzae in moraxalle catarrhalis, which are then selected antibiotic is amecixillin clavumate. Another source states granting clavulanate amoxixillin do if symptoms do not improve in 7 days re-emerged in 14 days.

- If the patient's allergies can be mild to amocixillin caphalosphorin such as cefdinir, loracarbef, or cefuroxime.

- In the severe allergy to amocixillin, the money given is azithormycin or clarithornycin.

2. Analgesia / pain reliever

Besides antibiotics, treatment should be accompanied OMA pain (analgesia). Analgesia is generally used on simple analgesia such as paracetamol or ibuprofen can aggravate the digestive tract irritation.

Other:

1. Provision of other drugs: as anthihistamin (allergy) or dekongestyan not provide benefits for children.

2. Corticosteroids is not recommended

3. Myrongitomy

4. Giving antibiotics as prophylaxis to prevent recurrence of the OMA does not have sufficient evidence

Prevention

Some of this seems to reduce the risk of OMA

1. And prevention of ARI in children bayui

2. Breastfeeding for at least 6 months

3. Prevention of child-feeding while lying down dibotol

4. And avoidance of tobacco smoke exposure

Complications

Chronic otitis media is characterized circuitry in a history of chronic discharge from one or two ears. If the eardrum has been ruptured for more than 2 weeks, the risk of infection has become very common. Generally, the handling is done is wash and dry ears for several weeks until the liquid is no longer out.

Otitis media is not treated it can spread to tissues surrounding the middle ear, including the brain. But these complications are generally rare. One is mastoiditis in 1 in 1000 children who were not treated OMA circuitry.

Diagnosis appears:

1. Acute pain related to the agent bioloti

2. Sleep disorders associated with pain agent

3. Hyperthermia associated with disease or trauma

4. Anxiety related to health status.

NOC (Purpose)

DX :1

1.      Lomfosit level (2100)

-          Reported physical mell-being (210001)

-          Reproted statisfaction with symptom contril (210002)

-          Reported psyehclogikal well-beining (210003)

-          Expressed contentetement with physical remanding (210004)

-          Expressed contentement with social relationship (210005)

2.      Pain control (1605)

-          Recognize causal factor (160501)

-          Recognize pain anset (160502)

-          Use preventive inpasures (160503)

-          Use non-analgesik reliet measures (160504)

-          Use analgesic apporiatelery (160505)

3.      Pain level (2102)

-          Reported pain (210201)

-          Percent of body affectzd (210202)

-          Freluency of pain episodes (210204)

-          Oral expresnous of pain (210205)

DX : 2

1.      Anxiety control (1402)

-          Monitors of anxipty (140201)

-          Himimales proasure of anxiety (140202)

-          Decrease envirotment stimuli when anxious (140203)

-          Use effective coping strategis (140206)

-          Use relaction techniques toreduce anxiety (140207)

2.      Rest (0003)

-          Amount of rest (000301)

-          Rest pattern (000302)

-          Rest quality (000303)

-          Physically rested (000304)

-          Mentally rested (000305)

3.      Sleep (0004)

Hours of sleep (000401)

Sleep pattern (000403)

Sleep quality (000404)

Sleep effiaphcy (000405)

Sleep routnice (000407)

DX : 3

1.      Thermoregulation (0800)

-          Skin temperature IER (080001)

-          Body temperature WNL (080002)

-          Headache nol present (080003)

-          Respiratory rate IER (080014

-          Hydration adecute (080014)

2.      Thermoregulation : Neonate (080101)

-          Body temperature WNL (080101)

-          Respiratory distress not present (080102)

-          Restlesrness not present (080103)

-          Skin coles change IER (080105)

-          Weight gain IER (080106)

DX : 4

1.      Anxiety control (1402)

-          Monitors intensity of anxiety (140201)

-          Elminates precursor of anxiety (140202)

-          Decrearsus envirobmental stimulasi when anxioor (140203)

-          Plans coping strategis for stesiful situation (140205)

-          Use effective coping strategis (140206)

2.      Coping (1302)

-          Identities effective coping pattern (130201)

-          Identities ineffective coping pattern (130202)

-          Modities life style as needed (130207)

-          Employs behaviors to reduce stress (130211)

-          Use effective coping stragnes (130212)

3.      Impuls control (1405)

-          Identifies harmful implusive behaviors (140501)

-          Identities feelings that lead folmpulsive actions (140502)

-          Recognizes rinc in environtment (140505)

-          Verbaliset control of impulses (14050705)

-          Accepts rofernalis for treatment (140510)

INTERVENTION (NIC)

DX: 1

Pain Management

1.      The review comprehensively about pain, including the location, characteristics and oaset, duration, frequency, quality, intensity / severity of pain and the participation factors

2.      OPbservasi non-verbal terms of inconvenience, especially in the inability to communicate effectively

3.      Use therapeutic communication so that patients can express pain

4.      Evaluation of the effectiveness of the actions that have been used to control pain

5.      Control factor-environmental factor that can affect the patient's response to discomfort

6.      Provide information about the pain such as: causes, some of the old place and precautions

7.      Give analgesics according to the recommended circuitry

8.      Increase / adequate rest

9.      Monitor patient comfort for pain management

10.  Perform technical variations to reduce the pain

DX : 2 Sleep Enhancement

1.      Determine patients sleep /activity pattern

2.      Approximate patient regular sleep/make cycle in planning care

3.      Explain the importance of educate sleep

4.      Determine the effect of the patients mediation on sleep pattern

5.      Monitor/recorded patients sleep pattern and number of sleep hours

6.      Instruct comfort measure of message, positioning and affective touch

7.      Implement comfort measure of message, posiolioning in effective touch

8.      Promot an increase in number of hours of sleep if needed

9.      Provide for naps during the day, if in diated to meet sleep requirement.

DX: 3

Fever treatment

1.      Monitor the temperature as often as possible

2.      Monitor skin color and temperature

3.      Monitor blood pressure, pulse, and RR

4.      Monitor intake and output

5.      Give antipelink

6.      Monitor decreased level of consciousness

7.      Provide treatment to have the cause of fever

8.      selimuti patients

9.      Provide treatment to prevent shivering.

DX: 4 Anxiety Reducation

1.      Reassure the client

2.      Provide information about diagnosis, prognosis and action

3.      Assess the level of anxiety and physical reactions at the level of anxiety (toachycardia, tachppnea, non-verbal expression of dismay)

4.      Accompany the patient to support the safety and reduce fear

5.      Provide activities to reduce tension

6.      Bantul patients to identify situations that create anxiety

7.      Support the use of defensive mechanisms in the right way

8.      Instruct patient to use relaxation techniques

9.      Give medication to reduce anxiety in a proper way trying to understand the state of the client.

PHYSICAL EXAMINATION EAR

a. Assist the patient in a sitting position of patients who were children can be arranged to sit on the lap of others

b. Adjust your sitting position facing the patient's ear to be reviewed.

c. For lighting, use auroskop, past the head or other light source so that your hands will be free to work

d. Begin to observe external ear, check the state of the pinna of the size, shape, color, and the presence of mass lesions on the pinna

e. Continue assessment of palpation by holding the ear with the thumb and finger tenunjuk

f. Palpation of the outer ear cartilage, namely the systematic network of luna, then the hard tissue and note if there is pain

g. Press the tragus to the ear bones and the press are below the ear leaf. When there is inflammation amka patient will feel pain

h. Compare the left ear and right ear

i. If necessary, continue the assessment of the inner ear

j. Grasp the edge of the auricle / helix and slowly pull the ear upward and backward so that the ear canal becomes straight and easily observable. In children, the ear is pulled down.

k. Observe the entrance hole of the ear and note the presence or absence of inflammation, bleeding or dirt

l. Carefully insert the lit otoskop into the ear hole

m. If the location is right otoskop, put your eyes on eye-piece

n. Observe the presence of dirt, wax, inflammation or foreign bodies in the ear hole.

o. Observe the shape, color, transparency, luster, or perforation of a blood / fluid

EXAMINATION HEARING

Way of hearing a whisper

1. Adjust your back to the patient standing at a distance of about 4.5 to 6 meters

2. Instruct the patient to cover one ear that does not dipemeriksaan

3. Whisper of a number (eg seven six).

4. Tell the patient to repeat numbers at the hearing

5. Examination of the other ear the same way

6. Compare the ability to hear the right ear and left the patient

Ways to watch hearing

1. Hold a watch on the patient's ear

2. Have the patient states whether to hear the watch ticking

3. Move slowly watch the position of the ear and send the patient away from the states if they are not able to hear again. Normally the clock rate can still be heard at distances up to about 30 cm

4. Compare the right and left ear

Way of hearing with tuning fork

1. The first examination (Rinne)

a. Vibrasikan garputala

b. Put a fork in the left mastoid patients

c. Instruct patient to tell when no longer feel the vibrations

d. Lift and hold the tuning fork in front of the patient's left ear with a tuning fork position parallel to the external ear canal of patients.

e. Instruct patient to tell whether still hear the sound vibration or not.

2. Second examination (Weber)

a. Fibrasikan garputala

b. Put a fork in the middle of the forehead of patients

c. Ask the patient about the ears hear the sound balanced, so that the vibrations felt in the middle of the head.

d. Record the results of the hearing.

3. Determinasikan whether the patients had impaired bone conduction, air or both

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Prognosis, investigation and treatment of sarcoidosis

Prognosis of sarcoidosis

Many penderit ayang not experience a serious illness and disease can disappear without treatment.

30-50% of the cases had spontaneous pemulihyan within 3 years of more than 60% of patients are asymptomatic after 9 years. Even the enlarged lymph nodes in the chest and the lung inflammation that can be

lost wide in a few months or years. More than 75% of people who greet swollen lymph nodes and more than 50% of patients lungs are involved, recovered within 5 years. Patients with sarcoidosis are still limited in the chest, better than those who also have sarcoidosis elsewhere.

Patients with enlarged lymph nodes in the chest but do not indicate a disease begins with erythema nosodom have the best prognosis.

Examination support

- Calculate blood type

- Pulmonary function tests (lung biladi formed scar tissue, then the result will show the amount of air the lungs can hold is below normal).

- ACE enzyme levels (in many patients, the levels of enzymes convert angiotensin in the blood is high)

- Rotgen chest to look for enlarged lymph nodes

- Biopsy of skin wounds in

- Bronchoscopy

- An open lung biopsy

- Liver biopsy

- Biopsy of kidney

- EKG to look for heart abnormalities

- The skin test tuiberkulin

- Skening gallum

- Liver enzymes.

Treatment

Because the cause is known and there is no penyakitinibelum drug treatment option shown untukmencegah progesivitas, improve or relieve symptoms of regression of disease with minimum side effects.

To suppress severe symptoms such as shortness of breath, joint pain and fever, administered corticosteroid.

Costicosteroid also be given if:

- Test results show that high blood calcium levels

- Regarding the heart, liver or nervous system.

- Sarcoidosis causes skin lesions or diseases of the eye that is not cured with corticosteroid eye drops

- Lung disease to get worse

The use of corticosteroid followed 1-2 years. Other drugs are sometimes used as an adjunct to corticosteroids are immunosuppressant drugs. Such as azathioprine and cyclophosphamide methostrexat.

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Symptoms and signs sarcoidosis.

Many sufferers have no symptoms and the disease is found during inspection menjelani chest images for other purposes jarnag until serious symptoms occur.

Sakoidosis symptoms vary depending on the location and extent of disease:

- Feeling unwell

- Fever

- Shortness of breath

- Cough

- The wound on the skin

- Skin rash

- Headache

- Impaired vision

- Changes in neurologic

- Enlarged lymph nodes (lumps in the armpit)

- Enlargement of the liver

- Enlargement of the spleen

- Dry mouth

- Tired

- Weight loss

Other symptoms that may be found:

- Formation of reduced tear

- Seizures

- Bleeding joints

- Hair loss

- The eyes sting, itch and belekan

- Taste not selesa

Sarcoidosis produces inflammation in the lungs that eventually would develop into scar tissue and ksita, which will cause coughing and shortness of breath

In 15% of patients, the disease attacks the eyes.

Uveritis (inflammation of certain eye structures) causing pain and redness of the eye affecting vision.

Inflammation that persists to the nature of time, will clog the flow of fluid to matadan cause glaucoma, which can cause blindness.

Bias granulomas formed in the conjunctiva (the lining of the eyeball and eyelid) granuloma often causes no symptoms.

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What is sarcoidosis?

Definition of sarcoidosis

Sarcoidosis (Sarcoidosis) is an inflammatory disease characterized by granuloma formation in lymph nodes, lungs, liver, eyes, skin and other tissues. Granuloma is a collection of macrophages, lymphocytes and giant cells many-core.

These granulomas will eventually disappear or evolve into a network total paurt. Granuloma is a core action involving the immune countered the impression due to toxic substances released by macrophages and white blood cells (lymphocytes).

Lungs are frequently involved organ and sarcoidosis also cause damage as well as a thorough alveolan mengalamisejumlah imunologikdan abnormality is becoming a disease that infiltrated restrictive.

Sarcoidosis has been known for sure with different densities of almost all the countries. Example: it is often found in various regions of the United scanadinavia southeastern city of New York patients and approximately 70% under the age of 40 years.

Etiology and pathogenesis

Etiology and pathogenesis of sarcoidosis is not known with certainty whether an infectious disease, genetic disease, if a foreign object or if the disease causes of illness due to one or many causes. Many infectious agents are suspected as the cause. Changes ipatologik sarcoidosis is an infection or an infection mikrobakterian mikrosistemik, but the organism can not be found either from any lesions or culture.

Inhalation of chemicals such as beryllium zikronlum and can also cause granulomas, but these materials are rarely evident in patients sarkoidosisi, genetic factors, may also play a role because of cases of anal and in the case of monozygotic twins and azigot.

Factor antigenic or immune complexes may cause a reaction system to form the mononuclear fagostosis graftulomatosa leaf, where the T lymphocyte cell

Clinical manifestations

There are two different types of diseases yhaitu acute type and chronic type. Both are different in the aluitan. Course of the disease, prognosis and Ream to the treatment.

Padasarkoidosis usually seen in acute organ muls eksplasif marked the onset of mass and the minis so that it looks as eriterna nodosum, menopati hilut, fever, polyarthritis and acute aritis. Biasnaya patient experienced no symptoms sponta resolution in some Hitan sm.

And associated with good prage3nosis.

In this type there are more chronic in patients aged over 40 years marked by the onset of the less obvious, and involved, the disease is associated with laboratory abnormalities and immunological disorders. Sarcoidosis is a multisystem disease of various organs of the incident as follows:

1. 87% of the chest cavity

2. Peripheral lymph nodes 27%

3. Skin and mucosa of 20% - 35%

4. Eyes 25% - 50%

5. Spleen 10% - 25%

6. Liver 20%

7. 2% of heart

8. 15% -20% of bone

9. Nervous system 5%

10. 6% of the salivary glands

11. Lachrymal glands of 6%

12. Parotid gland 6%

Cause sakoidosis

The cause of the disease is not known but there is the opinion expressed sarcoidosis is caused by:

- Follow imunasi back to factors beyond its natural surroundings

- Factor descent

- Follow-back system inunasi extreme

- Infection or chemical Ahan

- Hypersensitivity

Usually appears at age 30-50 years and very rarely found in children

Granuloma tissue injury and fibrosis caused alveolitas internsis in perantarakan by the enzyme lysozyme and publications makrofak radikul terbita free oxygen and subsequent fibrosis may be a bit mostly by growth factors that act ketas makrojaf issue firboplast.

These granulomas produce enzymes penkar angiotensis, which causes increased flow of serum. Kuterneas energy is poorly understood but may be caused by a serum factor that merencet penghasiulan T cells or more likely, merencet "sowing the original" T4 helper cells that will gather in places involved, and with that amount will be reduced in peredarah. This may explain the increase in T8 cells and thus produce cutaneous energy.

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Prevention of Disease (prophylaxis)

Basically the prevention of a disease much easier than treatment of disease. Process we will make dete'51 prevention and intervention on the causes and risk factors of disease. Meaning itself is to make prevention of inhibition on the development of a disease before the disease occurs.

Level of disease prevention are:

Primary prevention (primary prevention): Levels of prevention can be done on the phase sensitivity of the natural history of a disease.

Secondary prevention (secondary prevention): Levels of prevention can be done in phases and clinical perklinik

Tertiary prevention (tertiary prevention): Levels of prevention can be done at an advanced stage of disease or disability.

Primary prevention

Primary prevention consists of two categories, namely:

a. Improvement of health (Health Promotion)

Included here are:

- Improved nutrition community

- Improved housing conditions and recreation

- Health education including sex education and sanitation

b. Specific prevention (specific protection)

Included here are:

- Immunizations

- Purification of drinking water

- Prevention of accidents

- Setting the (diet) and exercise.

In the implementation of primary prevention is influenced by the attitudes of individuals and the environment.

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Prevalence of a disease

Disease is a complex phenomenon that adversely affect human life. Human behavior and way of life can be a cause of various diseases, both in primitive times and in the community who are very advanced civilization and kebudayannya. In terms of biological disease is a disorder of various organs of the human body, while the community in terms of sickness behavior is considered as a deviation from the normative social circumstances. Discrepancy could be due to abnormalities of biomedical olehj ataiu organs of the human environment, but also can be caused by abnormalities prsikososial emosiuonal and individuals concerned. Emotional factors and psikosial is basically a result of environmental or human ecosystems and human or cultural customs.

The concept of disease incidence according to type of disease depends the health sciences. In general, this conception is determined by many factors including parasites, vektorm humans and the environment. Anthropologists kesehatna which by definition can be stated to the ecology-oriented, concerned with the interrelationship between human and natural environment, the behavior of the disease and the ways the disease affects the behavior of cultural evolution through the feedback process (foster, anderson, 1978) (12_.

Disease can be seen as an element in the human environment, as seen in sickle-cell trait (sickle cell) among West African populations, an adaptive evolutionary change, which gives the relative immunity against malaria. Sickle cell trait was not a threat, even a characteristic of cool because it gives high protection against the bite of Anopheles mosquitoes.

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And the impact of behavior on the sick

Impact of Pain

Impact of pain can occur in individuals who have experienced good pain that has been experiencing pain who were treated either at home or be hospitalized. These impacts may occur in individual families or communities. These impacts include:

First, there is a change in family roles. During the sick role in the family will have the disorder given a change of role from one of the ill family member.

Second, the occurrence of psychological disorders. This situation may result in atres (tension) to experience severe anxiety, psychological if not prepared properly. Psychological disruption process begins with the conflict against him such as anxiety, fear and others.

The third financial problems, the impact is obviously going to happen because adnaya some financial expenditure during illness was not previously suspected given the cost of care and medicines are quite expensive.

Fourth, the readiness due to separation. These impacts can occur in someone who had always brkumpul with family, but when the sick person should be treated and separated from his family.

Fifth, the change in social habits. This is definitely going to remember for the home society interaction circuitry will always happen but when someone is sick all the social activities will be amended.

Sixth, the disruption of a person's privacy. A person's privacy can be directed to the pleasant feeling that reflects a person's level of appreciation. This unpleasant feeling will be impaired because of their activities at home skait terbtas dnegan life and needs to be interrupted so as to make the unpleasant feelings that lead to social rewards difficult to achieve.

Seventh, autonomy. Have supplied all the needs of patients in the hospital resulted in a decreased ability of patient activity for the state to set up their own independent and difficult to achieve so that patients will always have the dependency.

Eighth, lifestyle changes, the rules and regulations of the hospital particularly healthy behaviors and rules in the food, medication and activities that a person will experience a change in lifestyle that is always cautious and avoid things that are forbidden according to the provisions of the treatment process dnegan and treatment.

Conduct on the sick

In addition to the impact caused by sickness or be hospitalized, even during the ill person will experience a change in the act which have an impact on him. The behavioral changes that occur during illness include:

1. Feelings of fear

These behavioral changes can occur in all the circuitry characterized by feelings of fear as a result of the illness. If the acceptance of his illness and its impact can not be received in full to someone who gets ill, the person will terhantuio this feeling of fear and if left unchecked will disrupt a person's mental status.

2. Withdraw

In people who are sick will always have the anxiety. Level of anxiety experienced by a person would be different. To reduce anxiety, then a person will behave like the silent pull out if not given the question. It is a form of the attempt to avoid anxiety.

3. Egocentric

This behavior can occur in a sick person who has always shown a lot of mempersoialkan himself and not listen to others' feelings or memilikirkan others. This behavior is also shown dnegan always want to talk about his illness.

4. Sensitive to small problems

On the sick behavior change is usually always caused by always questioning little things such as the impact of psychological disturbance are always complaining if things do not fit with him.

5. High emotional reaction

This behavior can be shown from someone who mengalamis akit circuitry weepy, irritable, angry, and demands more attention from people sakitar.

6. Changes in perception

Persepsio changes during this illness DAPT indicated by the onset of the perception that doctors and nurses are the people who can help to heal it so great hopes on the doctors and nurses.

7. Lack of interest

Changes in behavior that is shown to someone who is experiencing this pain tends to be a lack of interest occurred carneae stress (tension) caused by the perceived illness and decreased ability to perform daily activities.

Efforts that can be done by nurses within the nursing paradigm for a range of ill-health is to conduct preventive measures either primary, secondary and tertian. Primary prevention efforts may include special perilindungan and protection of health in order to avoid the various diseases, the action is performed on healthy ranges. Secondary and tertiary preventive measures carried out by early diagnosis and appropriate treatment and prevent complications arising from a variety of diseases and rehabilitation over the range of illness.

Healthy Behavior

Healthy behaviors exhibited by individuals who feel themselves healthy although they are not necessarily nmedis really healthy. Appropriate circuitry ntentang pain perception and pain behavior of the disease and health behavior were subjective in nature. Public perception of ill-health is very influenced by elements of past experience in addition to social nunsur culture. Conversely health care workers strive to implement the objective medical criteria based on symptoms that seem to diagnose the physical condition of individuals.

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Process Stages of Pain

Symptomatic stage

This stage is the initial stage of a person experiencing the pain with a marked presence of uncomfortable feelings towards him because of the onset of the symptoms that can include physical symptoms such as feelings of pain, heat and others as a manifestation of imbalance in the body. Any symptoms arise as a physical manifestation.

Assumptions to disease stage

At this stage a person will do the interpretation of the pain they experienced and will experience keraguraguian the disorder or disturbance that is felt in her body. After interpreting symptoms, the MKA someone will respond in the form of emotions for symptoms such as feeling of fear and anxiety. To overcome the fear or gold, and then conducted the consultation process surrounding circuitry or people considered to be more aware or came to the place of treatment. This stage can be found gejal end up with a definite and there is a change of surroundings. This process can be influenced by several factors, including past knowledge or experience.

In these conditions one can perform the role of pain circuitry for the purpose of obtaining health care, according to Parson tersbeut role can include: First, the client does not hold responsibility for the condition during the illness; Second: The client was released from duty and social functioning; third: the client is required to try to obtain healthy condition as quickly as possible; Fourth, klein and families seeking help competent person.

Stages of contact with health services.

This stage one has to make contact with health services dnegan seek advice from health professionals such as doctors, or other treatments are carried out on his own initiative. Information search process is performed to justify the state of his illness, and to know the symptoms that are not understood by the client and the belief that he would be better. If after consultation found no more symptoms exist, then the client considers himself cured. However, if symptoms recur, then he will come back to health.

Phase Dependence

This stage occurs after a person is considered mengamali a disease that will certainly get medical help so that the condition of a person already in pengobtan ketergangungan but not all people have the same level of dependence, but differ based on the level kebutuhanya. This condition can also be affected by the disease. This stage can be done with the assessment of the need for dependence and can be given support to someone experiencing independence.

Stages of healing

This stage is the last step towards the return of the ability to adapt, where someone will make the process of learning to let go of his role during the illness and regained its pre-hospital as well as the preparation to function in social life. Role of health professionals here to help clients to increase independence and provide harpan and life to prosperity.

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The range of healthy and sick

Healthy Range

This range starts from healthy normal health status, healthy and prosperous one. Said to be healthy is not only free of disease but also covers all aspects of human life that includes physical, emotional, social and spiritual. Healthy limits itself mean that a state of perfect physical, mental and social development and not only free of disease or infirmity (WHO, 1947), based on such understanding, it is known is actually healthy characteristics: First, have the ability to reflect concern on the individual as a human being; both have a healthy outlook in the context of the environment, both internally and externally; the third has a creative and productive life.

Past experience

Past experience can affect change in health status. It can be terminated if there is an undesirable medical experience or the experience of ill health that have a major impact in subsequent health status. For example a person who never prevent a diarrhea, because of past experience in dealing with the one that causes diarrhea in the hospital itself, then in an everyday life that will always try to not repeat past experiences circuitry to prevent the things that can cause diarrhea.

An expectation about him

Expectations is one important part in improving the health status changes in the optimal direction. Hope of producing the level of health status better physically and psychologically. Because there will be motivated by the hope of a healthy lifestyle and always avoid the things that can affect her health status.

Descent

Offspring to be responsible for one's health status given the potential perubahn health status has been owned by genetic factors, although not very big but it will affect the response to various diseases.

Environment

Environment in question is the physical environment such as environmental sanitation kebrsihan yourself, or proper disposal of waste water and sewage house does not meet health requirements that may influence health behavior that can change health status.

Service

Health care can be a place of service or service system that can affect health status. It can be found if the place is too far or the health service in membverikan service quality is not good, then it can affect a person's life in a healthy behavior.

Range of Pain

Range is a series of ill health in the concept of pain. This range starts from the state after the illness, pain, chronic pain and death. Pain is basically a state of disruption of a person in the process of growth and development functions of the body as a whole or in part, as well as disruption of the process of human adjustment, pain also can be regarded as interference in the normal function of the individual as a totality in which the state of the organism as a system of biological and social adaptation (Parsons , 1972). Pain can be determined from a symptom that is felt adnaya srta disruption of an individual's ability to perform daily aktivaitas.

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The Concept Of Culture And Health Community Hospital

Mutant contains a lot of healthy term kulturan, social and professional understanding of the diverse. First from the point of view of medicine, health is closely associated with pain and disease. In fact it is not that simple, healthy should be viewed from various aspects. WHO (1981): Health is a state of complete physical, mental and social well being, and not merely the absence of disease or infirmity. 

WHO defines a healthy sense as a perfectly good physical condition, rohami, as well as one's social welfare. What extent one can be considered complete physical? By health experts, medical anthropology is seen as a discipline biobudaya pays attention to those aspects of biological and social culture of human behavior, especially about the ways of interaction between the two throughout the history of human life that affect health and disease. Disease itself is determined by culture: this is because the disease is the social recognition that the person can not afford to run its normal role of natural causes. Way of life and human life style is a phenomenon that can be associated circuitry emergence of various diseases, in addition to the results of different cultures can also cause disease.

Community and traditional healers are two concepts embrace the cause of pain is: Naturalistic and personalistic. Naturalistic is the cause of a person suffering from pain due to environmental influences, the food (one meal), living habits, imbalance in the body, including the trust as a cold chills and congenital diseases. Embraced the concept of healthy pain medicine tradisiolan (Battra) similar to that adopted by the local community, which is a condition associated with a state agency or state body disorders and symptoms are healthy for a person means a state of normal Yuang, face, comfortable and can perform daily activities with passion. While the illness is considered as a state agency that is less fun, even perceived as a punishment that causes a person can not afford to run their daily activities as well as healthy individuals (7). While the personalistic concept considers the emergence of disease (illness) is caused by the intervention of an active agent which can be either non-human creatures (ghosts, spirits, ancestors or evil spirits), or human beings (witches, fortune-teller). Tracing the cultural values, such as the introduction of leprosy and treatment. Leprosy has been known by the ethnic Makasar long time. The existence of the term kaddala sikuyu (leprosy crab) and kaddala massolong (leprosy is melted) is an expression of support that leprosy is endemic have been in a long time in the midst of the community. 

The results of qualitative research and nkuantitatif on cultural values ​​in the District Soppeng, in relation to leprosy (kaddala, BGS) in Bugis society shows that arise and are strictly diamalkanya leprophobia because according to one cultural figures, in marriage counsel older people there , said kaddala come covered in it. Mentioned that in the event of a violation to have sex when she is menstruating, they (the bride) will be cursed and suffer from leprosy / kaddala. The idea of ​​aiming for a great moral being created in the new family, growing comply with the communication process in society and became a leper as a stage concept of sin. Understanding the patient as a result of the sins of the mother-father is suffering from early leprophobia. Low self-esteem of people with low self-esteem begins to feel tainted family when one family member suffering from leprosy. Accused of sin to have sex when she is menstruating for a fanatical Islam is perceived as psychosomatic traumna burden is very heavy. (8). 

Parents, the family is refusing her son was diagnosed leprosy. In the present study the use of Health Services. In the province of East Nusa Kalimanta Western Landmark (1990), the results of group discussions in East Kalimantan showed that the children expressed pain when mengangis continues, the body sweats, not eating, not sleeping, cranky, skinny. For adults, a declared sick when it's not working, can not walk, malaise, chills, dizziness, weakness, anemia, cough, nausea, diarrhea. While the results of group discussions at the World Medical Nusa Tenggara No Mirror. 149, 2005 50 

West suggests that the sick child be seen from the physical state of the body and behavior yaitujika show symptoms such as fever, cough runny nose, diarrhea, vomiting, itching, sores, abscessed tooth, yellow body, leg and abdominal swelling. A traditional healers who also accept the view of modern medicine, has an interesting knowledge about ill-health problems. For him, the meaning of illness are as follows: bodily pain means no signs of disease in the body such as high fever, weak eyesight, is not strong work, it is difficult to eat, sleep disturbances, and weakness or pain, lie down or rest it wants. Inner Padapenyakit no signs on his body, but can be known by asking the supernatural. In healthy people, movements agile, strong, working, normal body temperature, and then the normal sleep, visions bright, bright eyes, do not complain of lethargy, weakness or body aches (9). 

Based on the range of healthy-sick, then the paradigm of nursing in the health-illness concept, the paradigm of nursing in the concept of healthy-looking sore that forms keperawtan services to be provided over a range of healthy and sick, will advance the health status in a healthy range, pain, whether its status in setanggah stage illness, pain or chronic pain, so it will dikethaui levels of nursing care to be provided and the objectives to be expected in improving health status. Range where it can be drawn from the hospital a half sick, skait, chronic pain and death ended circuitry, while the healthy range can dgigambarkan from normal healthy, very healthy and prosperous as the highest health status. 

This range is a measurement tool in assessing the status kesehaqtan that is dynamic and always changing in every time. Through this range can be known limitation of nurses in nursing practice clearly.

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The definition of ill health

Healthy

According to the WHO says "healthy" includes a state of complete physical, mental and social, not merely freedom from disease and disability (weakness).

Roy defines health as a concinuum of merunggal up to the highest level of health. He stressed that a healthy state and the process in an effort to make himself an integrated and overall physical, mental and social. Integrity of individual adaptation is manifested by an individual's ability to fulfill the purpose of maintaining the growth and reproduction.

Illness

Pain is a condition of an individual's inability to adapt to stimuli originating from within and outside the individual. Very healthy and diseased individuals perceived by the individual. Person's ability to adapt (coping) depending on the individual's background in interpreting and sense-perception of pain, such as educational level, occupation, age, culture and others.

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Appendicitis Assessment Advanced Level

A. Percussion to determine the position and size of hepatic

1. Perform percussion ranging from at or below the line midklavikularis uymbilikus heading up through the tympanic area until a faint sound which is the lower limit of the liver. With a pencil mark on the place began to dim the sound was found.

2. Do percussion on the line that starts from the right midklavikularis resonant area of ​​lung to dim down until it was sound that indicates the upper limit mark on the liver and found the place began to dim sound.

3. Measure the distance between two marks before (upper and lower limit of the liver) in centimeters which states the size of the liver.

Normally the liver on the line length is 6-12 cm midklavikularis to the lower limit is at or slightly below the rib cage.

B. Percussion to determine the position and size of the lien

Lien easy diperkusi if enlargement. Percussion performed along the line of the left midclavikularis up and down. Record the place where the voice sounded faint. Normally heard in the area between the ribs between the 6th to the sidelines of the 10th rib with a length of about 7 cm in adults.

C. Palpation of the liver

Palpation of the liver can be performed with the aim of bimanual primarily to determine the presence of enlarged

1. Stand beside the patient's right

2. Put your left hand on the posterior wall of the piston is approximately at the rib cage to the 11 and 12

3. Emphasize the left hand is slightly raised up so that the chest wall

4. Put your right hand on the lower limit of the right side of the ribs with an angle of about 45o to the abdominal rectus muscle or parallel to the abdominal rectus muscle with the fingers towards the rib cage.

5. While patients ekhalasi, apply pressure depth of 4 to 5 cm below the top down toward the bone

6. Keep your hands and tell patients inhaled / a deep breath

7. While the patient's inhalation, hepatic btas feel your hand moving against a normally felt with regular contours. When the liver does not feel / felt clearly, then tell the patient to breathe in while you still maintain the position of the hands or put pressure on the hands or give a little more pressure in the liver is the difficulty in feeling often experienced in obese patients.

8. When the liver is enlarged, then do dibatas palpation under the right rib. Note the enlargement occurs below the rib cage.

D. Lien palpation

Spleen was not palpable in normal adults. Spleen palpation is done by using a pattern like on palpation of the liver.

1. Instruct the patient to the right so that the lien kesisi tilted closer to the abdominal wall

2. Perform palpation at the lower limit by using the left rib-like pattern on palpation of the liver.

E. Kidney palpation

Anatomically, the upper lobe of both kidneys touches the diaphragm down during inhalation, and kidneys. Right kidney is normally more easily palpated than the left kidney, because under the right kidney is located more than the left kidney. Right kidney is located parallel to the rib cage to the left kidney-12 and parallel to the rib cage to 11 cm, a width of 4 to 7 cm and 2.5 cm thick.

Palpate the kidneys, then position the patient supine set dn nurses palpate standing here / right patient. Palpation of the kidneys is the working steps:

1. Palpation in the right kidney, place your left hand under the pelvis and kidney elevasikan anterior direction.

2. Put your right hand on the anterior abdominal wall at garias midclavikularis from the bottom edge of the costal margin

3. Emphasize your right hand straight up while the patient took a deep breath. In the normal adult, the kidney was not palpable but the people who are very thin, the bottom of the right kidney can be felt.

4. When the kidneys palpable, feel the contour (shape), size, presence of tenderness

5. To palpate the kidneys run, do the opposite side of the patient's body and place your left hand under the pelvis and then do the action as on palpation of the right kidney.

F. Bladder palpation

Palpation of the bladder can be done dengtan use one or two hands. Palpable bladder, especially when it distends due to accumulation of urine. If found there then do distended bladder percussion in the area to find the sound / level of ruination.

G. Assessment Rectum

The rectum is the most distal part of the gastrointestinal fraktus. The general objective here is to obtain assessment data on the condition of the  rectum and rectum. In the assessment of male patients is also useful to know the state of the prostate.

Equipment that needs to be prepared, including a blanket to cover the body parts that are not checked, sterile gloves / disposable and lubricants. Working steps:

1. Help the patient to adjust the position of the dorsal rekomben. Arrange thighs rotated out, knee flexion and close the body parts that are not checked

2. Nampakkan the buttocks and instruct the patient to focus attention

3. Place the inspection of the rectum to determine presence / absence of hemorrhoids, lesions or reddish.  Rectum  appear normal intact skin, no hemorid, lesions or redness.

4. Wear gloves and put grease on the pointer finger and slowly insert a finger into the  rectum and rectum.

5. Perform palpation of the rectum wall and feel the presence or absence of nodules, masses and tenderness

6. In men, did palpation on the anterior wall to find the prostate gland.

7. In women, do seruik palpation of the uterus through the anterior rectal wall

8. When finished, drag your finger from the rectum and  rectum, observe the state of the stool on the glove. Normal stools

9. Record the results of your examination.

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Appendicitis Surgery Techniques

Surgery

Surgery is done when rehydration and businesses drop in body temperature has been reached. Body temperature does not exceed 38 ° c, the production of urine ranges from 1-2 ml / kg / hour. Pulse under 120/menit.

Surgical technique

Transverse incision on the right just below the umbilicus. Fowler Weier incision is preferred because it can quickly reach the abdominal cavity and the incision when needed and could be extended to and facilitated by cutting medial rectum muscle. Before opening the peritoneal edge incision secured with gauze. Opening the peritoneum and the first few straws were prepared such that the pus can be sucked directly without contamination to the edge of the incision. Peritoneal incision is enlarged and pus continued exploitation. Apendektomi done as usual. Peritoneal cavity Perncucian absolutely done with physiological saline until completely clean. Fluid that added look weary when smoked again. The collection of pus usually found in the appendix fossa, below the diaphragm and pelvis ronga among the intestines. Incision wound was washed with physiological NaCl solution and also after the peritoneum lining the peritoneum and the fascia that attach muscles partially sewn. Suturing the cut should not be done too strong and tight. Dren intraperitoneal installation is controversial. When washing the peritoneal cavity is completely clean Dren is not required. Better than the washed out without Dren Dren fitted washed clean less.

Note

Infiltrate the inflamed appendix can spread is limited by the omentum and the intestines and peritoneum around it to form a mass (mass apendiceal). Appendix mass is generally formed on day 4, since the inflammation begins in case of no general peritonitis. The mass of the appendix is ​​more often found in patients aged 5 tyahun or more, the immune system has progressed well and the omentum was long and thick enough to encapsulate the process of inflammation.

Therapy

Perforated appendicitis

Preparation prabedah: sonde installation and the action of gastric decompression. Rehydration, decreased body temperature. With broad spectrum antibiotics, adequate doses are given intravenously.

Appendicitis with generalized peritonitis complicating

Clients are generally in poor condition. Looks septic and hypovolemic conditions and hypertension. Hypovolemic due to long fasting, vomiting, and concentration of liquids in the process of inflammation, such as intraperitoneal organ edema, abdominal wall and the collection of fluid in the cavity of the intestine and the peritoneal cavity

Preparation Pre-Surgical:

1. Installation to decompress the stomach sonde

2. Catheters to control urine production

3. Rehydration

4. With broad spectrum antibiotics, high doses and administered intravenously

5. Drugs decrease the heat, as anti meninggigil Phenergan, largaksil to open the peripheral blood vessels is given after rehydration is achieved.

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Physical examination of appendicitis, Radiology and Laboratory

Physical Examination

1. General state of the client really looks sick
2. Mild rise in body temperature on mild appendicitis. Body temperature rises and settled around 30oC or more if perforation has occurred.
3. Dehydration mild to severe depending on the degree of pain. Severe dehydration on the client perforated appendicitis with generalized peritonitis. This is due to shortage of inputs, vomiting, rise in body temperature and fluid collection in the viscus tissues (edema) and peritoneal cavity.
4. Abdomen: The signs of the right lower quadrant peritoneal stimulation. Perforated appendicitis is more obvious, such as muscular defans, word of pain and tenderness.
5. Not rare signs of paralytic intestinal obstruction due to the local or general peritonitis

Radiological Examination

1. Perselubungan picture is more clear and not confined to the lower right quadrant
2. Bowel wall thickening around the location of the appendix, such as the cecum and ileum
3. Pre-peritoneal fat lines disappear
4. Scoliosis to kenana
5. Signs of intestinal obstruction such as lines of liquid-liquid surface due to local paralysis of the intestines in the process of interaction.

Laboratory

Blood tests: Leukocytes are generally mild in simple appendicitis over 13000/mm3 generally in perforated appendicitis. Lekositosis absence does not rule out appendicitis. Counts: there is a shift to the left. Urine examination: normal or sediment can be contained leucocytes and erythrocytes more than normal when the inflamed appendix attached to the ureter or vesicles.

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