viva news-Sejak dahulu hipnotis memang fenomenal dan mengundang perhatian dan rasa penasaran orang. Apa dan bagaimana cara mempraktikkan hipnotis, Willy Wong dan Andi Hakim coba membongkar rahasia hipnosis dalam bukunya Dahsyatnya Hipnotis terbitan Visimedia.
Berikut hasil mewawancara dengan Willy Wong, seorang praktisi hipnotis bersertifikat. Ia akan menjelaskan aneka fenomena hipnotis dalam tangkapan orang awam dan bagaimana hipnotis bisa memotivasi orang dan membuat orang berprestasi di segala bidang.
1.Mengapa orang yang terhipnotis terlihat nampak seperti orang bodoh?
Sebenarnya bukan terlihat bodoh, namun menurut pendapat saya beberapa jawaban sebagai berikut:
Jika diasumsikan berdasarkan apa yang dilihat di layar televisi atau dalam materi Video CD kami, subjek (orang yang dihipnotis) adalah orang-orang pilihan yang sugestif, bahkan beberapa di antaranya pernah dihipnotis sebelumnya, sehingga lebih cenderung berekspresi diam daripada menunjukkan ketidakwajaran.
Jika subjek tersebut memang belum pernah dihipnotis sebelumnya,
Pertama, karena sang subjek merasa bingung kondisi tidak masuk akal yang pertama kali dialaminya (namun ini tidak berbahaya, asal diperlakukan dengan santun dan penuh kehati-hatian)
Kedua, dilihat dari sudut pandang penonton, akan menjadi sebuah kejadian yang menggelikan dan terkesan bodoh saat subjek melakukan sesuatu yang tidak masuk akal, sehinggga menjadi sebuah persepsi bahwa subjek tersebut "terlihat bodoh".
Padahal yang sebenarnya terjadi adalah subjek tersebut merupakan orang-orang bersugestivitas baik yang mempunyai kemampuan untuk memusatkan perhatiannya (fokus) pada satu hal saja, dimana realita sudah tidak dibedakan lagi dengan imajinasi.
2. Orang yang sering melamun betulkah lebih mudah dihipnotis?
Tidak ada korelasinya secara langsung, namun bisa dikatakan bahwa orang yang melamun berada dalam kondisi hipnotis. Sehingga orang yang sering melamun terbiasa berada dalam kondisi hipnosis, namun untuk dikategorikan sebagai "mudah" atau bersugestivitas baik, masih banyak faktor-faktor lain yang mempengaruhi.
Untuk membuktikan apakah orang tersebut termasuk bersugestivitas baik, satu-satunya cara adalah keharusan untuk melakukan "tes sugestivitas" terlebih dahulu.
Senin, 26 Oktober 2009
Sabtu, 17 Oktober 2009
Obesity
Obesity is a term used to describe body weight that is much greater than what is considered healthy. If you are obese, you have a much higher amount of body fat than lean muscle mass.
Adults with a body mass index (BMI) greater than 25 but less than 30 are considered overweight.
Adults with a BMI greater than 30 are considered obese.
Anyone more than 100 pounds overweight or with a BMI greater than 40 is considered morbidly obese.
Causes
Rates of obesity are climbing. The percentage of children who are overweight has doubled in the last 20 years. The percentage of adolescents who are obese has tripled in the last 20 years.
Consuming more calories than you burn leads to being overweight and, eventually, obesity. The body stores unused calories as fat. Obesity can be the result of:
Eating more food than the body can use
Drinking too much alcohol
Not getting enough exercise
Certain thyroid problems may also lead to signficant weight gain. Genetic factors play some part in the development of obesity -- children of obese parents are 10 times more likely to be obese than children with parents of normal weight.
Obesity is a significant health threat. The extra weight puts unusual stress on all parts of the body. It raises your risk of diabetes, stroke, heart disease, kidney disease, and gallbladder disease. Conditions such as high blood pressure and high cholesterol, which were once thought to mainly affect adults, are often seen in children who are obese. Obesity may also increase the risk for some types of cancer. Persons who are obese are more likely to develop osteoarthritis and sleep apnea.
Exams and Tests
The health care provider will perform a physical exam and ask questions about your medical history, eating habits, and exercise routine.
Skin fold measurements may be taken to check your body composition.
Blood tests may be done to look for thyroid or endocrine problems, which could lead to weight gain.
Treatment
DIET AND EXERCISE
A combination of dieting and exercise (when you stick to it) appears to work better than either one alone. Sticking to a weight reduction program is difficult and requires a lot of support from family and friends.
When dieting, your main goal should be to learn new, healthy ways of eating and make them a part of your everyday routine. Work with your doctor and nutritionist to set realistic, safe daily calorie counts that assure both weight loss and good nutrition. Remember that if you drop pounds slowly and steadily, you are more likely to keep them off. Your nutritionist can teach you about healthy food choices, appropriate portion sizes, and new ways to prepare food.
Even modest weight loss can improve your health. For most people, weight can be lost by eating a healthier diet, exercising more, and adopting new behaviors such as keeping a food diary, avoiding food triggers, and thinking positively.
The decision to keep fit requires a lifelong commitment of time and effort. Patience is essential. You should always check with your health care provider before you begin any new form of exercise.
Several simple behavioral changes can have an impact on your weight loss success:
Eat only at the table. No snacking in front of the TV, in bed, while driving, or while standing in front of the open refrigerator.
Learn about appropriate portion sizes.
Consider learning meditation or yoga as a way of managing stress, rather snacking.
Find ways to socialize and enjoy your friends and family that don't involve a meal or dessert.
Consider keeping a diet and exercise journal. This may help you identify overeating triggers in your life.
Find a support group or consider psychotherapy to help support you in the difficult but worthy goal of weight loss.
Exercise can also help control some of the diseases associated with obesity, including high blood pressure, heart disease, diabetes, osteoporosis, and certain cancers. Exercise is also a major mood lifter, a great way to increase energy, and will help strengthen your bones.
MEDICATIONS AND HERBAL REMEDIES
There are many over-the-counter diet products. Most do not work and some can be dangerous. Before using one, talk to your health care provider.
Several prescription weight loss drugs are available. Such medicines include subutramine (Meridia) and orlistat (Xenical). Ask your health care provider if these are right for you.
While weight loss drugs in general have shown some benefit, the overall weight loss achieved is generally limited. In addition, people will usually regain the weight when they discontinue the medication, unless they have made lasting lifestyle changes.
SURGERY
Surgery may be an option for persons who are morbidly obese and who cannot lose weight using other methods. Weight loss surgery, such as placing adjustable bands around the stomach and gastric bypass surgery, can significantly improve weight and health in the right candidate. Talk to your doctor to learn if this is a good option for you.
Support Groups
Many people find it easier to follow a diet and exercise program if they join a group of people with similar problems.
See: Eating disorders - support group
Possible Complications
Medical problems commonly resulting from untreated obesity and morbid obesity include:
Diabetes
Hypertension
Heart disease
Stroke
Certain cancers, including breast and colon
Depression
Osteoarthritis
Obesity can lead to a gradual decrease in the level of oxygen in your blood, a condition called hypoxemia. Persons who are obese may temporarily stop breathing while asleep (sleep apnea). Decreased blood oxygen levels and sleep apnea may cause a person to feel sleepy during the day. The conditions may also lead to high blood pressure and pulmonary hypertension. In extreme cases, especially when left untreated, this can lead to right-sided heart failure and ultimately death.
When to Contact a Medical Professional
Schedule an appointment with your health care provider if you or your child are obese or gaining weight at an extremely rapid rate. Remember that catching the problem early is much simpler than trying to fix it after the person has gained an excessive amount of weight.
Prevention
A healthy diet and regular exercise can help prevent weight gain. Increase your daily activity. Take the stairs rather than the elevator, or walk instead of driving (when possible).
See also:
Exercise and weight loss
Losing weight
Weight management
Alternative Names
Morbid obesity; Fat - obese
Adults with a body mass index (BMI) greater than 25 but less than 30 are considered overweight.
Adults with a BMI greater than 30 are considered obese.
Anyone more than 100 pounds overweight or with a BMI greater than 40 is considered morbidly obese.
Causes
Rates of obesity are climbing. The percentage of children who are overweight has doubled in the last 20 years. The percentage of adolescents who are obese has tripled in the last 20 years.
Consuming more calories than you burn leads to being overweight and, eventually, obesity. The body stores unused calories as fat. Obesity can be the result of:
Eating more food than the body can use
Drinking too much alcohol
Not getting enough exercise
Certain thyroid problems may also lead to signficant weight gain. Genetic factors play some part in the development of obesity -- children of obese parents are 10 times more likely to be obese than children with parents of normal weight.
Obesity is a significant health threat. The extra weight puts unusual stress on all parts of the body. It raises your risk of diabetes, stroke, heart disease, kidney disease, and gallbladder disease. Conditions such as high blood pressure and high cholesterol, which were once thought to mainly affect adults, are often seen in children who are obese. Obesity may also increase the risk for some types of cancer. Persons who are obese are more likely to develop osteoarthritis and sleep apnea.
Exams and Tests
The health care provider will perform a physical exam and ask questions about your medical history, eating habits, and exercise routine.
Skin fold measurements may be taken to check your body composition.
Blood tests may be done to look for thyroid or endocrine problems, which could lead to weight gain.
Treatment
DIET AND EXERCISE
A combination of dieting and exercise (when you stick to it) appears to work better than either one alone. Sticking to a weight reduction program is difficult and requires a lot of support from family and friends.
When dieting, your main goal should be to learn new, healthy ways of eating and make them a part of your everyday routine. Work with your doctor and nutritionist to set realistic, safe daily calorie counts that assure both weight loss and good nutrition. Remember that if you drop pounds slowly and steadily, you are more likely to keep them off. Your nutritionist can teach you about healthy food choices, appropriate portion sizes, and new ways to prepare food.
Even modest weight loss can improve your health. For most people, weight can be lost by eating a healthier diet, exercising more, and adopting new behaviors such as keeping a food diary, avoiding food triggers, and thinking positively.
The decision to keep fit requires a lifelong commitment of time and effort. Patience is essential. You should always check with your health care provider before you begin any new form of exercise.
Several simple behavioral changes can have an impact on your weight loss success:
Eat only at the table. No snacking in front of the TV, in bed, while driving, or while standing in front of the open refrigerator.
Learn about appropriate portion sizes.
Consider learning meditation or yoga as a way of managing stress, rather snacking.
Find ways to socialize and enjoy your friends and family that don't involve a meal or dessert.
Consider keeping a diet and exercise journal. This may help you identify overeating triggers in your life.
Find a support group or consider psychotherapy to help support you in the difficult but worthy goal of weight loss.
Exercise can also help control some of the diseases associated with obesity, including high blood pressure, heart disease, diabetes, osteoporosis, and certain cancers. Exercise is also a major mood lifter, a great way to increase energy, and will help strengthen your bones.
MEDICATIONS AND HERBAL REMEDIES
There are many over-the-counter diet products. Most do not work and some can be dangerous. Before using one, talk to your health care provider.
Several prescription weight loss drugs are available. Such medicines include subutramine (Meridia) and orlistat (Xenical). Ask your health care provider if these are right for you.
While weight loss drugs in general have shown some benefit, the overall weight loss achieved is generally limited. In addition, people will usually regain the weight when they discontinue the medication, unless they have made lasting lifestyle changes.
SURGERY
Surgery may be an option for persons who are morbidly obese and who cannot lose weight using other methods. Weight loss surgery, such as placing adjustable bands around the stomach and gastric bypass surgery, can significantly improve weight and health in the right candidate. Talk to your doctor to learn if this is a good option for you.
Support Groups
Many people find it easier to follow a diet and exercise program if they join a group of people with similar problems.
See: Eating disorders - support group
Possible Complications
Medical problems commonly resulting from untreated obesity and morbid obesity include:
Diabetes
Hypertension
Heart disease
Stroke
Certain cancers, including breast and colon
Depression
Osteoarthritis
Obesity can lead to a gradual decrease in the level of oxygen in your blood, a condition called hypoxemia. Persons who are obese may temporarily stop breathing while asleep (sleep apnea). Decreased blood oxygen levels and sleep apnea may cause a person to feel sleepy during the day. The conditions may also lead to high blood pressure and pulmonary hypertension. In extreme cases, especially when left untreated, this can lead to right-sided heart failure and ultimately death.
When to Contact a Medical Professional
Schedule an appointment with your health care provider if you or your child are obese or gaining weight at an extremely rapid rate. Remember that catching the problem early is much simpler than trying to fix it after the person has gained an excessive amount of weight.
Prevention
A healthy diet and regular exercise can help prevent weight gain. Increase your daily activity. Take the stairs rather than the elevator, or walk instead of driving (when possible).
See also:
Exercise and weight loss
Losing weight
Weight management
Alternative Names
Morbid obesity; Fat - obese
stroke
A stroke is an interruption of the blood supply to any part of the brain. A stroke is sometimes called a "brain attack."
Causes
A stroke happens when blood flow to a part of the brain is interrupted because a blood vessel in the brain is blocked or bursts open.
If blood flow is stopped for longer than a few seconds, the brain cannot get blood and oxygen. Brain cells can die, causing permanent damage.
There are two major types of stroke: ischemic stroke and hemorrhagic stroke.
ISCHEMIC STROKE
Ischemic stroke occurs when a blood vessel that supplies blood to the brain is blocked by a blood clot. This may happen in two ways:
A clot may form in an artery that is already very narrow. This is called a thrombus. If it completely blocks the artery, it is called a thrombotic stroke.
A clot may break off from somewhere in the body and travel up to the brain to block a smaller artery. This is called an embolism. It causes an embolic stroke.
Ischemic strokes may result from clogged arteries, a condition called atherosclerosis. (See: Stroke secondary to atherosclerosis) This may affect the arteries within the brain or the arteries in the neck that carry blood to the brain. Fat, cholesterol, and other substances collect on the wall of the arteries, forming a sticky substance called plaque. Over time, the plaque builds up. This often makes it hard for blood to flow properly, which can cause the blood to clot.
Ischemic strokes may also be caused by blood clots that form in the heart. These clots travel through the blood and can get stuck in the small arteries of the brain. This is known as a cerebral embolism.
Certain drugs and medical conditions can make your blood more likely to clot and raise your risk for ischemic stroke. A common cause of ischemic stroke in people under age 40 is carotid dissection, or a tear in the lining of the carotid artery. The tear lets blood flow between the layers of the carotid artery. This causes narrowing of the carotid artery that is not due to plaque buildup.
HEMORRHAGIC STROKE
Hemorrhagic stroke occurs when a blood vessel in part of the brain becomes weak and bursts open, causing blood to leak into the brain. Some people have defects in the blood vessels of the brain that make this more likely. The flow of blood that occurs after the blood vessel ruptures damages brain cells.
For more information on this type of stroke, see: Hemorrhagic stroke
STROKE RISKS
High blood pressure is the number one risk factor for strokes. The following also increase your risk for stroke:
Diabetes
Family history of stroke
Heart disease
High cholesterol
Increasing age
Certain medications make blood clots more likely, and therefore your chances for a stroke. Birth control pills can increase the chances blood clots, especially in woman who smoke and who are older than 35.
Men have more strokes than women. But, women have a risk of stroke during pregnancy and the weeks immediately after pregnancy.
The following can increase the risk of bleeding into the brain, which makes you more likely to have a stroke:
Alcohol use
Bleeding disorders
Cocaine use
Head injury
For more information see: Stroke risk factors and prevention
Symptoms
The symptoms of stroke depend on what part of the brain is damaged. In some cases, a person may not even be aware that he or she has had a stroke.
Symptoms usually develop suddenly and without warning, or they may occur on and off for the first day or two. Symptoms are usually most severe when the stroke first happens, but they may slowly get worse.
A headache may occur, especially if the stroke is caused by bleeding in the brain. The headache:
Starts suddenly and may be severe
Occurs when lying flat
Wakes you up from sleep
Gets worse when you change positions or when you bend, strain, or cough
Other symptoms depend on the severity of the stroke and what part of the brain is affected. Symptoms may include:
Muscle weakness in the face, arm, or leg (usually just one side)
Numbness or tingling on one side of the body
Trouble speaking or understanding others who are speaking
Problems with eyesight, including decreased vision, double vision, or total loss of vision
Sensation changes that affect touch and the ability to feel pain, pressure, different temperatures, or other stimuli
Changes in hearing
Change in alertness (including sleepiness, unconsciousness, and coma)
Personality, mood, or emotional changes
Confusion or loss of memory
Difficulty swallowing
Changes in taste
Difficulty writing or reading
Loss of coordination
Loss of balance
Clumsiness
Trouble walking
Dizziness or abnormal sensation of movement (vertigo)
Lack of control over the bladder or bowels
Exams and Tests
A complete physical and neurological exam should be performed. Your doctor will:
Check for problems with vision, movement, sensation, reflexes, understanding, and speaking. Your doctor and nurses will repeat this exam over time to see if your stroke is getting worse or is improving.
Listen for an abnormal sound, called a "bruit," when using a stethoscope to listen to the carotid arteries in the neck. A bruit is caused by turbulent blood flow.
Check and assess your blood pressure, which may be high.
Tests can help your doctor determine the type, location, and cause of the stroke and to rule out other disorders that may be responsible for the symptoms.
A CT scan of the brain is often done soon after symptoms of a stroke begin. An MRI scan of the brain may be done instead or afterwards.
Magnetic resonance angiography (MRA) or CT angiography may be done to check for abnormal blood vessels in the brain that may have caused the stroke.
Echocardiogram may be done if the stroke could have been caused by a blood clot from the heart.
Carotid duplex (a type of ultrasound exam) can show if narrowing of the neck arteries (carotid stenosis) led to the stroke.
An angiogram of the head can reveal which blood vessel is blocked or bleeding, and help your doctor decide if the artery can be reopened using a thin tube.
Laboratory tests will include acomplete blood count (CBC), bleeding time, and blood clotting tests (prothrombin time or partial thromboplastin time).
Electrocardiogram (ECG) and heart rhythm monitoring can help determine if an irregular heart beat (such as atrial fibrillation) caused the stroke.
A spinal tap (cerebrospinal fluid exam) may also be done.
Treatment
A stroke is a medical emergency. Immediate treatment can save lives and reduce disability. Call 911 or your local emergency number or seek immediate medical care at the first signs of a stroke.
It is important to get the person to the emergency room immediately to determine if the stroke is due to bleeding or a blood clot so appropriate treatment can be started within 3 hours of when the stroke began.
Treatment depends on the severity and cause of the stroke. A hospital stay is required for most strokes.
TREATMENT IN THE HOSPITAL
Clot-busting drugs (thrombolytic therapy) may be used if the stroke is caused by a blood clot. Such medicine breaks up blood clots and helps restore blood flow to the damaged area. However, not everyone can receive this type of medicine.
For these drugs to work, a person must be seen and treatment must begin within 3 hours of when the symptoms first started. A CT scan must be done to see whether the stroke is from a clot or from bleeding.
If the stroke is caused by bleeding rather than clotting, clot-busting drugs (thrombolytics) can cause more bleeding.
Other treatments depend on the cause of the stroke:
Blood thinners such as heparin or warfarin (Coumadin) are used to treat strokes due to blood clots. Aspirin of clopidogrel (Plavix) may also be used.
Other medications may be needed to control other symptoms, including high blood pressure. Painkillers may be given to control severe headache.
In some situations, a special stroke team and skilled radiologists may be able to use angiography to highlight the clogged blood vessel and open it up.
For hemorrhagic stroke, surgery is often required to remove blood from around the brain and to repair damaged blood vessels.
Surgery on the carotid artery may be needed. See also Carotid artery disease and Carotid artery surgery.
Nutrients and fluids may be necessary, especially if the person has swallowing difficulties. These may be given through a vein (intravenously) or a feeding tube in the stomach (gastrostomy tube). Swallowing difficulties may be temporary or permanent.
Physical therapy, occupational therapy, speech therapy, and swallowing therapy will all begin in the hospital.
LONG-TERM TREATMENT
The goal of long-term treatment is to help the patient recover as much function as possible and prevent future strokes. The recovery time and need for long-term treatment differs from person to person. Depending on the symptoms, rehabilitation may include:
Occupational therapy
Physical therapy
Speech therapy
Therapies such as repositioning and range-of-motion exercises can help prevent complications related to stroke, such as infection and bed sores. Those who have had a stroke should try to remain as active as physically possible.
Alternative forms of communication such as pictures, verbal cues, and other techniques may be needed in some cases.
Sometimes, urinary catheterization or bladder and bowel control programs may be needed to control incontinence.
A safe environment must be considered. Some people with stroke appear to have no awareness of their surroundings on the affected side. Others show indifference or lack of judgment, which increases the need for safety precautions.
Caregivers may need to show the person pictures, repeatedly demonstrate how to perform tasks, or use other communication strategies, depending on the type and extent of the language problems.
In-home care, boarding homes, adult day care, or convalescent homes may be required to provide a safe environment, control aggressive or agitated behavior, and meet medical needs.
Family counseling may help in coping with the changes required for home care. Visiting nurses or aides, volunteer services, homemakers, adult protective services, and other community resources may be helpful.
Legal advice may be appropriate. Advance directives, power of attorney, and other legal actions may make it easier to make ethical decisions regarding the care of a person who has had a stroke.
Causes
A stroke happens when blood flow to a part of the brain is interrupted because a blood vessel in the brain is blocked or bursts open.
If blood flow is stopped for longer than a few seconds, the brain cannot get blood and oxygen. Brain cells can die, causing permanent damage.
There are two major types of stroke: ischemic stroke and hemorrhagic stroke.
ISCHEMIC STROKE
Ischemic stroke occurs when a blood vessel that supplies blood to the brain is blocked by a blood clot. This may happen in two ways:
A clot may form in an artery that is already very narrow. This is called a thrombus. If it completely blocks the artery, it is called a thrombotic stroke.
A clot may break off from somewhere in the body and travel up to the brain to block a smaller artery. This is called an embolism. It causes an embolic stroke.
Ischemic strokes may result from clogged arteries, a condition called atherosclerosis. (See: Stroke secondary to atherosclerosis) This may affect the arteries within the brain or the arteries in the neck that carry blood to the brain. Fat, cholesterol, and other substances collect on the wall of the arteries, forming a sticky substance called plaque. Over time, the plaque builds up. This often makes it hard for blood to flow properly, which can cause the blood to clot.
Ischemic strokes may also be caused by blood clots that form in the heart. These clots travel through the blood and can get stuck in the small arteries of the brain. This is known as a cerebral embolism.
Certain drugs and medical conditions can make your blood more likely to clot and raise your risk for ischemic stroke. A common cause of ischemic stroke in people under age 40 is carotid dissection, or a tear in the lining of the carotid artery. The tear lets blood flow between the layers of the carotid artery. This causes narrowing of the carotid artery that is not due to plaque buildup.
HEMORRHAGIC STROKE
Hemorrhagic stroke occurs when a blood vessel in part of the brain becomes weak and bursts open, causing blood to leak into the brain. Some people have defects in the blood vessels of the brain that make this more likely. The flow of blood that occurs after the blood vessel ruptures damages brain cells.
For more information on this type of stroke, see: Hemorrhagic stroke
STROKE RISKS
High blood pressure is the number one risk factor for strokes. The following also increase your risk for stroke:
Diabetes
Family history of stroke
Heart disease
High cholesterol
Increasing age
Certain medications make blood clots more likely, and therefore your chances for a stroke. Birth control pills can increase the chances blood clots, especially in woman who smoke and who are older than 35.
Men have more strokes than women. But, women have a risk of stroke during pregnancy and the weeks immediately after pregnancy.
The following can increase the risk of bleeding into the brain, which makes you more likely to have a stroke:
Alcohol use
Bleeding disorders
Cocaine use
Head injury
For more information see: Stroke risk factors and prevention
Symptoms
The symptoms of stroke depend on what part of the brain is damaged. In some cases, a person may not even be aware that he or she has had a stroke.
Symptoms usually develop suddenly and without warning, or they may occur on and off for the first day or two. Symptoms are usually most severe when the stroke first happens, but they may slowly get worse.
A headache may occur, especially if the stroke is caused by bleeding in the brain. The headache:
Starts suddenly and may be severe
Occurs when lying flat
Wakes you up from sleep
Gets worse when you change positions or when you bend, strain, or cough
Other symptoms depend on the severity of the stroke and what part of the brain is affected. Symptoms may include:
Muscle weakness in the face, arm, or leg (usually just one side)
Numbness or tingling on one side of the body
Trouble speaking or understanding others who are speaking
Problems with eyesight, including decreased vision, double vision, or total loss of vision
Sensation changes that affect touch and the ability to feel pain, pressure, different temperatures, or other stimuli
Changes in hearing
Change in alertness (including sleepiness, unconsciousness, and coma)
Personality, mood, or emotional changes
Confusion or loss of memory
Difficulty swallowing
Changes in taste
Difficulty writing or reading
Loss of coordination
Loss of balance
Clumsiness
Trouble walking
Dizziness or abnormal sensation of movement (vertigo)
Lack of control over the bladder or bowels
Exams and Tests
A complete physical and neurological exam should be performed. Your doctor will:
Check for problems with vision, movement, sensation, reflexes, understanding, and speaking. Your doctor and nurses will repeat this exam over time to see if your stroke is getting worse or is improving.
Listen for an abnormal sound, called a "bruit," when using a stethoscope to listen to the carotid arteries in the neck. A bruit is caused by turbulent blood flow.
Check and assess your blood pressure, which may be high.
Tests can help your doctor determine the type, location, and cause of the stroke and to rule out other disorders that may be responsible for the symptoms.
A CT scan of the brain is often done soon after symptoms of a stroke begin. An MRI scan of the brain may be done instead or afterwards.
Magnetic resonance angiography (MRA) or CT angiography may be done to check for abnormal blood vessels in the brain that may have caused the stroke.
Echocardiogram may be done if the stroke could have been caused by a blood clot from the heart.
Carotid duplex (a type of ultrasound exam) can show if narrowing of the neck arteries (carotid stenosis) led to the stroke.
An angiogram of the head can reveal which blood vessel is blocked or bleeding, and help your doctor decide if the artery can be reopened using a thin tube.
Laboratory tests will include acomplete blood count (CBC), bleeding time, and blood clotting tests (prothrombin time or partial thromboplastin time).
Electrocardiogram (ECG) and heart rhythm monitoring can help determine if an irregular heart beat (such as atrial fibrillation) caused the stroke.
A spinal tap (cerebrospinal fluid exam) may also be done.
Treatment
A stroke is a medical emergency. Immediate treatment can save lives and reduce disability. Call 911 or your local emergency number or seek immediate medical care at the first signs of a stroke.
It is important to get the person to the emergency room immediately to determine if the stroke is due to bleeding or a blood clot so appropriate treatment can be started within 3 hours of when the stroke began.
Treatment depends on the severity and cause of the stroke. A hospital stay is required for most strokes.
TREATMENT IN THE HOSPITAL
Clot-busting drugs (thrombolytic therapy) may be used if the stroke is caused by a blood clot. Such medicine breaks up blood clots and helps restore blood flow to the damaged area. However, not everyone can receive this type of medicine.
For these drugs to work, a person must be seen and treatment must begin within 3 hours of when the symptoms first started. A CT scan must be done to see whether the stroke is from a clot or from bleeding.
If the stroke is caused by bleeding rather than clotting, clot-busting drugs (thrombolytics) can cause more bleeding.
Other treatments depend on the cause of the stroke:
Blood thinners such as heparin or warfarin (Coumadin) are used to treat strokes due to blood clots. Aspirin of clopidogrel (Plavix) may also be used.
Other medications may be needed to control other symptoms, including high blood pressure. Painkillers may be given to control severe headache.
In some situations, a special stroke team and skilled radiologists may be able to use angiography to highlight the clogged blood vessel and open it up.
For hemorrhagic stroke, surgery is often required to remove blood from around the brain and to repair damaged blood vessels.
Surgery on the carotid artery may be needed. See also Carotid artery disease and Carotid artery surgery.
Nutrients and fluids may be necessary, especially if the person has swallowing difficulties. These may be given through a vein (intravenously) or a feeding tube in the stomach (gastrostomy tube). Swallowing difficulties may be temporary or permanent.
Physical therapy, occupational therapy, speech therapy, and swallowing therapy will all begin in the hospital.
LONG-TERM TREATMENT
The goal of long-term treatment is to help the patient recover as much function as possible and prevent future strokes. The recovery time and need for long-term treatment differs from person to person. Depending on the symptoms, rehabilitation may include:
Occupational therapy
Physical therapy
Speech therapy
Therapies such as repositioning and range-of-motion exercises can help prevent complications related to stroke, such as infection and bed sores. Those who have had a stroke should try to remain as active as physically possible.
Alternative forms of communication such as pictures, verbal cues, and other techniques may be needed in some cases.
Sometimes, urinary catheterization or bladder and bowel control programs may be needed to control incontinence.
A safe environment must be considered. Some people with stroke appear to have no awareness of their surroundings on the affected side. Others show indifference or lack of judgment, which increases the need for safety precautions.
Caregivers may need to show the person pictures, repeatedly demonstrate how to perform tasks, or use other communication strategies, depending on the type and extent of the language problems.
In-home care, boarding homes, adult day care, or convalescent homes may be required to provide a safe environment, control aggressive or agitated behavior, and meet medical needs.
Family counseling may help in coping with the changes required for home care. Visiting nurses or aides, volunteer services, homemakers, adult protective services, and other community resources may be helpful.
Legal advice may be appropriate. Advance directives, power of attorney, and other legal actions may make it easier to make ethical decisions regarding the care of a person who has had a stroke.
hipertention
Hypertension is the term used to describe high blood pressure.
Blood pressure readings are measured in millimeters of mercury (mmHg) and usually given as two numbers. For example, 120 over 80 (written as 120/80 mmHg).
The top number is your systolic pressure, the pressure created when your heart beats. It is considered high if it is consistently over 140.
The bottom number is your diastolic pressure, the pressure inside blood vessels when the heart is at rest. It is considered high if it is consistently over 90.
Either or both of these numbers may be too high.
Pre-hypertension is when your systolic blood pressure is between 120 and 139 or your diastolic blood pressure is between 80 and 89 on multiple readings. If you have pre-hypertension, you are more likely to develop high blood pressure.
Causes
Blood pressure measurements are the result of the force of the blood produced by the heart and the size and condition of the arteries.
Many factors can affect blood pressure, including:
How much water and salt you have in your body
The condition of your kidneys, nervous system, or blood vessels
The levels of different body hormones
High blood pressure can affect all types of people. You have a higher risk of high blood pressure if you have a family history of the disease. High blood pressure is more common in African Americans than Caucasians. Smoking, obesity, and diabetes are all risk factors for hypertension.
Most of the time, no cause is identified. This is called essential hypertension.
High blood pressure that results from a specific condition, habit, or medication is called secondary hypertension. Too much salt in your diet can lead to high blood pressure. Secondary hypertension may also be due to:
Adrenal gland tumor
Alcohol abuse
Anxiety and stress
Arteriosclerosis
Birth control pills
Coarctation of the aorta
Cocaine use
Cushing syndrome
Diabetes
Kidney disease, including:
Glomerulonephritis (inflammation of kidneys)
Kidney failure
Renal artery stenosis
Renal vascular obstruction or narrowing
Medications
Appetite suppressants
Certain cold medications
Corticosteroids
Migraine medications
Hemolytic-uremic syndrome
Henoch-Schonlein purpura
Obesity
Pain
Periarteritis nodosa
Pheochromocytoma
Pregnancy (called gestational hypertension)
Primary hyperaldosteronism
Renal artery stenosis
Retroperitoneal fibrosis
Wilms' tumor
Symptoms
Most of the time, there are no symptoms. Symptoms that may occur include:
Chest pain
Confusion
Ear noise or buzzing
Irregular heartbeat
Nosebleed
Tiredness
Vision changes
If you have a severe headache or any of the symptoms above, see your doctor right away. These may be signs of a complication or dangerously high blood pressure called malignant hypertension.
Exams and Tests
Your health care provider will perform a physical exam and check your blood pressure. If the measurement is high, your doctor may think you have high blood pressure. The measurements need to be repeated over time, so that the diagnosis can be confirmed.
If you monitor your blood pressure at home, you may be asked the following questions:
What was your most recent blood pressure reading?
What was the previous blood pressure reading?
What is the average systolic (top number) and diastolic (bottom number) reading?
Has your blood pressure increased recently?
Other tests may be done to look for blood in the urine or heart failure. Your doctor will look for signs of complications to your heart, kidneys, eyes, and other organs in your body.
These tests may include:
Chem-20
Echocardiogram
Urinalysis
Ultrasound of the kidneys
Treatment
The goal of treatment is to reduce blood pressure so that you have a lower risk of complications.
There are many different medicines that can be used to treat high blood pressure, including:
Alpha blockers
Angiotensin-converting enzyme (ACE) inhibitors
Angiotensin receptor blockers (ARBs)
Beta-blockers
Calcium channel blockers
Central alpha agonists
Diuretics
Renin inhibitors, including aliskiren (Tekturna)
Vasodilators
Your doctor may also tell you to exercise, lose weight, and follow a healthier diet. If you have pre-hypertension, your doctor will recommend the same lifestyle changes to bring your blood pressure down to a normal range.
Often, a single blood pressure drug may not be enough to control your blood pressure, and you may need to take two or more drugs. It is very important that you take the medications prescribed to you. If you have side effects, your health care provider can substitute a different medication.
Outlook (Prognosis)
Most of the time, high blood pressure can be controlled with medicine and lifestyle changes.
Possible Complications
Aortic dissection
Blood vessel damage (arteriosclerosis)
Brain damage
Congestive heart failure
Kidney damage
Kidney failure
Heart attack
Hypertensive heart disease
Stroke
Vision loss
When to Contact a Medical Professional
If you have high blood pressure, you will have regularly scheduled appointments with your doctor.
Even if you have not been diagnosed with high blood pressure, it is important to have your blood pressure checked during your yearly check-up, especially if someone in your family has or had high blood pressure.
Call your health care provider right away if home monitoring shows that your blood pressure remains high or you have any of the following symptoms:
Chest pain
Confusion
Excessive tiredness
Nausea and vomiting
Severe headache
Shortness of breath
Significant sweating
Vision changes
Prevention
Adults over 18 should have their blood pressure checked routinely.
Lifestyle changes may help control your blood pressure:
Lose weight if you are overweight. Excess weight adds to strain on the heart. In some cases, weight loss may be the only treatment needed.
Exercise regularly. If possible, exercise for 30 minutes on most days.
Eat a diet rich in fruits, vegetables, and low-fat dairy products while reducing total and saturated fat intake (the DASH diet is one way of achieving this kind of dietary plan). (See: Heart disease and diet)
Avoid smoking. (See: Nicotine withdrawal)
If you have diabetes, keep your blood sugar under control.
Do not consume more than 1 or 2 alcoholic drinks per day.
Try to manage your stress.
Follow your health care provider's recommendations to modify, treat, or control possible causes of secondary hypertension.
Alternative Names
High blood pressure; HBP; Blood pressure - high
by erzha s1'07
Blood pressure readings are measured in millimeters of mercury (mmHg) and usually given as two numbers. For example, 120 over 80 (written as 120/80 mmHg).
The top number is your systolic pressure, the pressure created when your heart beats. It is considered high if it is consistently over 140.
The bottom number is your diastolic pressure, the pressure inside blood vessels when the heart is at rest. It is considered high if it is consistently over 90.
Either or both of these numbers may be too high.
Pre-hypertension is when your systolic blood pressure is between 120 and 139 or your diastolic blood pressure is between 80 and 89 on multiple readings. If you have pre-hypertension, you are more likely to develop high blood pressure.
Causes
Blood pressure measurements are the result of the force of the blood produced by the heart and the size and condition of the arteries.
Many factors can affect blood pressure, including:
How much water and salt you have in your body
The condition of your kidneys, nervous system, or blood vessels
The levels of different body hormones
High blood pressure can affect all types of people. You have a higher risk of high blood pressure if you have a family history of the disease. High blood pressure is more common in African Americans than Caucasians. Smoking, obesity, and diabetes are all risk factors for hypertension.
Most of the time, no cause is identified. This is called essential hypertension.
High blood pressure that results from a specific condition, habit, or medication is called secondary hypertension. Too much salt in your diet can lead to high blood pressure. Secondary hypertension may also be due to:
Adrenal gland tumor
Alcohol abuse
Anxiety and stress
Arteriosclerosis
Birth control pills
Coarctation of the aorta
Cocaine use
Cushing syndrome
Diabetes
Kidney disease, including:
Glomerulonephritis (inflammation of kidneys)
Kidney failure
Renal artery stenosis
Renal vascular obstruction or narrowing
Medications
Appetite suppressants
Certain cold medications
Corticosteroids
Migraine medications
Hemolytic-uremic syndrome
Henoch-Schonlein purpura
Obesity
Pain
Periarteritis nodosa
Pheochromocytoma
Pregnancy (called gestational hypertension)
Primary hyperaldosteronism
Renal artery stenosis
Retroperitoneal fibrosis
Wilms' tumor
Symptoms
Most of the time, there are no symptoms. Symptoms that may occur include:
Chest pain
Confusion
Ear noise or buzzing
Irregular heartbeat
Nosebleed
Tiredness
Vision changes
If you have a severe headache or any of the symptoms above, see your doctor right away. These may be signs of a complication or dangerously high blood pressure called malignant hypertension.
Exams and Tests
Your health care provider will perform a physical exam and check your blood pressure. If the measurement is high, your doctor may think you have high blood pressure. The measurements need to be repeated over time, so that the diagnosis can be confirmed.
If you monitor your blood pressure at home, you may be asked the following questions:
What was your most recent blood pressure reading?
What was the previous blood pressure reading?
What is the average systolic (top number) and diastolic (bottom number) reading?
Has your blood pressure increased recently?
Other tests may be done to look for blood in the urine or heart failure. Your doctor will look for signs of complications to your heart, kidneys, eyes, and other organs in your body.
These tests may include:
Chem-20
Echocardiogram
Urinalysis
Ultrasound of the kidneys
Treatment
The goal of treatment is to reduce blood pressure so that you have a lower risk of complications.
There are many different medicines that can be used to treat high blood pressure, including:
Alpha blockers
Angiotensin-converting enzyme (ACE) inhibitors
Angiotensin receptor blockers (ARBs)
Beta-blockers
Calcium channel blockers
Central alpha agonists
Diuretics
Renin inhibitors, including aliskiren (Tekturna)
Vasodilators
Your doctor may also tell you to exercise, lose weight, and follow a healthier diet. If you have pre-hypertension, your doctor will recommend the same lifestyle changes to bring your blood pressure down to a normal range.
Often, a single blood pressure drug may not be enough to control your blood pressure, and you may need to take two or more drugs. It is very important that you take the medications prescribed to you. If you have side effects, your health care provider can substitute a different medication.
Outlook (Prognosis)
Most of the time, high blood pressure can be controlled with medicine and lifestyle changes.
Possible Complications
Aortic dissection
Blood vessel damage (arteriosclerosis)
Brain damage
Congestive heart failure
Kidney damage
Kidney failure
Heart attack
Hypertensive heart disease
Stroke
Vision loss
When to Contact a Medical Professional
If you have high blood pressure, you will have regularly scheduled appointments with your doctor.
Even if you have not been diagnosed with high blood pressure, it is important to have your blood pressure checked during your yearly check-up, especially if someone in your family has or had high blood pressure.
Call your health care provider right away if home monitoring shows that your blood pressure remains high or you have any of the following symptoms:
Chest pain
Confusion
Excessive tiredness
Nausea and vomiting
Severe headache
Shortness of breath
Significant sweating
Vision changes
Prevention
Adults over 18 should have their blood pressure checked routinely.
Lifestyle changes may help control your blood pressure:
Lose weight if you are overweight. Excess weight adds to strain on the heart. In some cases, weight loss may be the only treatment needed.
Exercise regularly. If possible, exercise for 30 minutes on most days.
Eat a diet rich in fruits, vegetables, and low-fat dairy products while reducing total and saturated fat intake (the DASH diet is one way of achieving this kind of dietary plan). (See: Heart disease and diet)
Avoid smoking. (See: Nicotine withdrawal)
If you have diabetes, keep your blood sugar under control.
Do not consume more than 1 or 2 alcoholic drinks per day.
Try to manage your stress.
Follow your health care provider's recommendations to modify, treat, or control possible causes of secondary hypertension.
Alternative Names
High blood pressure; HBP; Blood pressure - high
by erzha s1'07
influenzha
Influenza, commonly referred to as the flu, is an infectious disease caused by RNA viruses of the family Orthomyxoviridae (the influenza viruses), that affects birds and mammals. The name influenza comes from the Italian influenza, meaning "influence" (Latin: influentia). The most common symptoms of the disease are chills, fever, sore throat, muscle pains, severe headache, coughing, weakness and general discomfort.[1] Fever and coughs are the most frequent symptoms. In more serious cases, influenza causes pneumonia, which can be fatal, particularly for the young and the elderly. Although it is often confused with other influenza-like illnesses, especially the common cold, influenza is a much more severe disease than the common cold and is caused by a different type of virus.[2] Influenza may produce nausea and vomiting, particularly in children,[1] but these symptoms are more common in the unrelated gastroenteritis, which is sometimes called "stomach flu" or "24-hour flu".[3]
Typically, influenza is transmitted through the air by coughs or sneezes, creating aerosols containing the virus. Influenza can also be transmitted by bird droppings, saliva, nasal secretions, faeces and blood. Infection can also occur through contact with these body fluids or through contact with contaminated surfaces. Airborne aerosols have been thought to cause most infections, although which means of transmission is most important is not absolutely clear. Influenza viruses can be inactivated by sunlight, disinfectants and detergents.[4][5] As the virus can be inactivated by soap, frequent hand washing reduces the risk of infection.
Influenza spreads around the world in seasonal epidemics, resulting in the deaths of hundreds of thousands annually — millions in pandemic years. Three influenza pandemics occurred in the 20th century and killed tens of millions of people, with each of these pandemics being caused by the appearance of a new strain of the virus in humans. Often, these new strains appear when an existing flu virus spreads to humans from other animal species, or when an existing human strain picks up new genes from a virus that usually infects birds or pigs. An avian strain named H5N1 raised the concern of a new influenza pandemic, after it emerged in Asia in the 1990s, but it has not evolved to a form that spreads easily between people.[6] In April 2009 a novel flu strain evolved that combined genes from human, pig, and bird flu, initially dubbed "swine flu" and also known as influenza A(H1N1), emerged in Mexico, the United States, and several other nations. The World Health Organization officially declared the outbreak to be a "pandemic" on June 11, 2009. The WHO's declaration of a pandemic level 6 was an indication of spread, not severity.[7]
Vaccinations against influenza are usually given to people in developed countries[8] and to farmed poultry.[9] The most common human vaccine is the trivalent influenza vaccine (TIV) that contains purified and inactivated material from three viral strains. Typically, this vaccine includes material from two influenza A virus subtypes and one influenza B virus strain.[10] The TIV carries no risk of transmitting the disease, and it has very low reactivity. A vaccine formulated for one year may be ineffective in the following year, since the influenza virus evolves rapidly, and new strains quickly replace the older ones. Antiviral drugs can be used to treat influenza, with neuraminidase inhibitors being particularly effective.by rzha from wikipedia
Typically, influenza is transmitted through the air by coughs or sneezes, creating aerosols containing the virus. Influenza can also be transmitted by bird droppings, saliva, nasal secretions, faeces and blood. Infection can also occur through contact with these body fluids or through contact with contaminated surfaces. Airborne aerosols have been thought to cause most infections, although which means of transmission is most important is not absolutely clear. Influenza viruses can be inactivated by sunlight, disinfectants and detergents.[4][5] As the virus can be inactivated by soap, frequent hand washing reduces the risk of infection.
Influenza spreads around the world in seasonal epidemics, resulting in the deaths of hundreds of thousands annually — millions in pandemic years. Three influenza pandemics occurred in the 20th century and killed tens of millions of people, with each of these pandemics being caused by the appearance of a new strain of the virus in humans. Often, these new strains appear when an existing flu virus spreads to humans from other animal species, or when an existing human strain picks up new genes from a virus that usually infects birds or pigs. An avian strain named H5N1 raised the concern of a new influenza pandemic, after it emerged in Asia in the 1990s, but it has not evolved to a form that spreads easily between people.[6] In April 2009 a novel flu strain evolved that combined genes from human, pig, and bird flu, initially dubbed "swine flu" and also known as influenza A(H1N1), emerged in Mexico, the United States, and several other nations. The World Health Organization officially declared the outbreak to be a "pandemic" on June 11, 2009. The WHO's declaration of a pandemic level 6 was an indication of spread, not severity.[7]
Vaccinations against influenza are usually given to people in developed countries[8] and to farmed poultry.[9] The most common human vaccine is the trivalent influenza vaccine (TIV) that contains purified and inactivated material from three viral strains. Typically, this vaccine includes material from two influenza A virus subtypes and one influenza B virus strain.[10] The TIV carries no risk of transmitting the disease, and it has very low reactivity. A vaccine formulated for one year may be ineffective in the following year, since the influenza virus evolves rapidly, and new strains quickly replace the older ones. Antiviral drugs can be used to treat influenza, with neuraminidase inhibitors being particularly effective.by rzha from wikipedia
Rabu, 14 Oktober 2009
perawatan luka
catatan materi perkuliahan tentang perawatan luka ....by erzha
a. Proses Penyembuhan Luka
luka adalah terputusnya kontinuitas suatu jaringan oleh karena adanya cedera atau pembedahan. Luka ini bisa diklasifikasikan berdasarkan struktur anatomis, sifat, proses penyembuhan dan lama penyembuhan. Adapun berdasarkan sifat yaitu : abrasi, kontusio, insisi, laserasi, terbuka, penetrasi, puncture, sepsis, dll. Sedangkan klasifikasi berdasarkan struktur lapisan kulit meliputi: superfisial, yang melibatkan lapisan epidermis; partial thickness, yang melibatkan lapisan epidermis dan dermis; dan full thickness yang melibatkan epidermis, dermis, lapisan lemak, fascia dan bahkan sampai ke tulang.
b. Klasifikasi
Berdasarkan klasifikasi berdasarkan lama penyembuhan bisa dibedakan menjadi dua yaitu:akut dan kronis. Luka dikatakan akut jika penyembuhan yang terjadi dalam jangka waktu 2-3 minggu. Sedangkan luka kronis adalah segala jenis luka yang tidak tanda-tanda untuk sembuh dalam jangka lebih dari 4-6 minggu. Luka insisi bisa dikategorikan luka akut jika proses penyembuhan berlangsung sesuai dengan kaidah penyembuhan normal tetapi bisa juga dikatakan luka kronis jika mengalami keterlambatan penyembuhan (delayed healing) atau jika menunjukkan tanda-tanda infeksi.
d. Proses Penyembuhan Luka
Proses penyembuhan luka tidak hanya terbatas pada proses regenerasi yang bersifat local, tetapi juga dapat dipengaruhi oleh faktor endogen seperti umur, nutrisi, imunologi, pemakaian obat-obatan, kondisi metabolik. Pada dasarnya proses penyembuhan luka ditandai dengan adanya proses pemecahan/ katabolik dan proses pembentukan atau anabolik. Dari penelitian diketahui bahwa proses anabolik telah dimulai saat terjadi perlukaan dan akan terus berlanjut pada keadaan dimana dominasi proses katabolisme selesai. Pada proses penyembuhan luka akan terjadi melalui tiga tahapan yang dinamis, saling terkait, dan berkesinambungan serta tergantung pada tipe/jenis dan derajat luka. Luka akan sembuh sesuai dengan tahapan yang spesifik dimana bisa terjadi tumpang tindih (overlap). Proses penyembuhan luka tergantung pada jenis jaringan yang rusak serta penyebab luka tersebut
Fase penyembuhan luka :
1) Fase inflamasi / eksudasi (Hari ke 0-5)
Fase inflamasi adalah adanya respon vaskuler dan seluler yang terjadi segera setelah injuri akibat perlukaan yang terjadi pada jaringan lunak. Tujuan yang hendak dicapai adalah menghentikan perdarahan dan membersihkan area luka dari benda asing, sel-sel mati dan bakteri untuk mempersiapkan dimulainya proses penyembuhan. Pada awal fase ini kerusakan pembuluh darah akan menyebabkan keluarnya platelet yang berfungsi sebagai hemostasis. Platelet akan menutupi vaskuler yang terbuka (clot) dan juga mengeluarkan “substansi vasokonstriksi” yang mengakibatkan pembuluh darah kapiler vasokonstriksi. Selanjutnya terjadi penempelan endotel yang akan menutup pembuluh darah. Periode ini berlangsung 5-10 menit dan setelah itu akan terjadi vasodilatasi kapiler akibat stimulasi saraf sensoris (Local sensory nerve endding), local reflex action dan adanya substansi vasodilator (histamin, bradikinin, serotonin dan sitokin). Histamin juga menyebabkan peningkatan permeabilitas vena, sehingga cairan plasma darah keluar dari pembuluh darah dan masuk ke daerah luka dan secara klinis terjadi oedema jaringan dan keadaan lingkungan tersebut menjadi asidosis. Eksudasi ini juga mengakibatkan migrasi sel leukoasit terutama neutrofil ke ekstravaskuler. Fungsi netrofil adalah melakukan fagositosis benda asing dan bakteri didaerah luka selama 3 hari dan kemudian akan digantikan oleh makrofag yang berperan lebih besar jika disbanding dengan netrofil pada proses penyembuhan luka. Fungsi sel makrofag disamping fagositosis adalah :
a) sintesa kolagen
b) pembentukan jaringan granulasi bersama-sama dengan fibroblast
c) memproduksi growth factor yang berperan dalam proses reepitelialisasi dan
d) pembentukan pembuluh kapiler baru atau angiogenesis.
Dengan hasil dicapainya keadaan luka yang bersih, tidak terdapat infeksi atau kuman serta terbentuknya makrofag dan fibroblast, maka keadaan ini dapat dipakai sebagai pedoman /parameter bahwa fase inflamasi dapat dilanjutkan ke fase berikutnya yakni fase proliferasi. Secara klinis fase inflamasi ini ditandai dengan : eritema, hangat pada kulit, oedema dan rasa sakit yang berlangsung sampai hari ke-3 atau hari ke-4.
2) Fase proliferasi / epitelisasi ( Hari 3 – 14)
Proses kegiatan seluler yang penting pada fase ini adalah memperbaiki dan menyembuhkan luka dan ditandai dengan proliferasi sel. Peran fibroblas sangat besar pada proses perbaikan yaitu bertanggung jawab pada persiapan menghasilkan produk struktur protein yang akan digunakan selama proses rekonstruksi jaringan. Pada jaringan lunak yang normal (tanpa perlukaan), pemaparan sel fibroblas sangat jarang dan biasanya bersembunyi di matriks jaringan penunjang. Sesudah terjadi luka, fibroblas akan aktif bergerak dari jaringan sekitar luka ke dalam daerah luka, kemudian akan berkembang (proliferasi) serta mengeluarkan beberapa substansi (kolagen, elastin, hyaluronic acid, fibronectin dan proteoglycans) yang berperan dalam membangun (rekontruksi) jaringan baru. Fungsi kolagen yang lebih spesifik adalah membentuk cikal bakal jaringan baru (connective tissue matrix) dan dengan dikeluarkannya substrat oleh fibroblas, memberikan pertanda bahwa makrofag, pembuluh darah baru dan juga fibroblas sebagai kesatuan unit dapat memasuki kawasan luka. Sejumlah sel dan pembuluh darah baru yang tertanam didalam jaringan baru tersebut disebut sebagai jaringan “granulasi”.sedangkan proses proliferasi fibroblast dengan aktifitas sintetiknya disebut fibroplasia. Respon yang dilakukan fibroblast terhadap proses fibroplasia adalah proliferasi, migrasi, deposit jaringan matriks, kontraksi luka. Angiogenesis adalah suatu proses pembentukan pembuluh kapiler baru di dalam luka. Angiogenesis mempunyai arti penting pada tahap proliferasi pada proses penyembuhan luka. Kegagalan pembentukan kapiler darah baru/ vaskuler akibat penyakit (diabetes), pengobatan (radiasi), atau obat (preparat Steroid) mengakibatkan terjadi lambatnya proses sembuh karena terbentuknya ulkus yang kronis. Jaringan vaskuler yang melakukan invasi kedalam luka merupakan suatu respon untuk memberikan oksigen dan nutrisi yang cukup didaerah luka karena biasanya pada daerah luka terdapat keadaan hipoksik dan turunya tekanan oksigen.
Pada fase ini fibroplasia dan angiogenesis merupakan proses yang terintegrasi dan dipengaruhi oleh substansi yang dikeluarkan oleh platelet dan makrofag (growth factors).
Proses selanjutnya adalah epitelisasi, dimana fibroblast mengeluarkan Keratinocyte Growth Factor (KGF) yang berperan dalam stimulasi mitosis sel epitel. Keretanisasi akan dimulai dari pinggir luka dan akhirnya membentuk barier yang menutupi permukaan luka. Dengan sintesa kolagen oleh fibroblast, pembentukan jaringan dermis ini akan disempurnakan kualitasnya dengan mengatur keseimbangan jaringan granulasi dan dermis.
Untuk membantu jaringan baru tersebut menutup luka, fibroblast akan merubah strukturnya menjadi myofibroblast yang mempunyai kapasitas melakukan kontraksi pada jaringan. Fungsi kontraksi akan lebih menonjol pada luka dengan defek luas dibandingkan dengan defek luka minimal. Fase proliferasi akan berakhir jika epitel dermis dan lapisan kolagen telah terbentuk, terlihat proses kontraksi dan akan dipercepat oleh berbagai growth faktor yang dibentuk oleh makrofag dan platelet.
3) Fase maturasi atau remodelling
Fase ini dimulai pada minggu ke-3 setelah perlukaan dan berakhir sampai kurang lebih 12 bulan. Tujuan dari fase maturasi adalah ; menyempurnakan terbentuknya jaringan baru menjadi jaringan penyembuhan yang kuat dan bermutu. Fibroblas sudah mulai meninggalkan jaringan granulasi, warna kemerahan dari jaringa mulai berkurang karena pembuluh mulai regresi dan serat fibrin dari kolagen bertambah banyak untuk memperkuat jaringan parut. Kekuatan dari jaringan parut akan mencapai puncaknya pada minggu ke-10 setelah perlukaan.
Untuk mencapai penyembuhan yang optimal diperlukan keseimbangan antara kolagen yang diproduksi dengan yang dipecahkan. Kolagen yang berlebihan akan terjadi penebalan jaringan parut atau hypertrophic scar, sebaliknya produksi yang berkurang akan menurunkan kekuatan jaringan parut dan luka akan selalu terbuka (somantri, 2007)
Luka dikatakan sembuh jika terjadi kontinuitas lapisan kulit dan kekuatan jaringan parut mampu atau tidak mengganggu untuk melakukan aktifitas normal. Meskipun proses penyembuhan luka sama bagi setiap penderita, namun outcome atau hasil yang dicapai sangat tergantung pada kondisi biologis masing-masing individu, lokasi serta luasnya luka. Penderita muda dan sehat akan mencapai proses yang cepat dibandingkan dengan kurang gizi, diserta penyakit sistemik (diabetes mielitus).
a. Proses Penyembuhan Luka
luka adalah terputusnya kontinuitas suatu jaringan oleh karena adanya cedera atau pembedahan. Luka ini bisa diklasifikasikan berdasarkan struktur anatomis, sifat, proses penyembuhan dan lama penyembuhan. Adapun berdasarkan sifat yaitu : abrasi, kontusio, insisi, laserasi, terbuka, penetrasi, puncture, sepsis, dll. Sedangkan klasifikasi berdasarkan struktur lapisan kulit meliputi: superfisial, yang melibatkan lapisan epidermis; partial thickness, yang melibatkan lapisan epidermis dan dermis; dan full thickness yang melibatkan epidermis, dermis, lapisan lemak, fascia dan bahkan sampai ke tulang.
b. Klasifikasi
Berdasarkan klasifikasi berdasarkan lama penyembuhan bisa dibedakan menjadi dua yaitu:akut dan kronis. Luka dikatakan akut jika penyembuhan yang terjadi dalam jangka waktu 2-3 minggu. Sedangkan luka kronis adalah segala jenis luka yang tidak tanda-tanda untuk sembuh dalam jangka lebih dari 4-6 minggu. Luka insisi bisa dikategorikan luka akut jika proses penyembuhan berlangsung sesuai dengan kaidah penyembuhan normal tetapi bisa juga dikatakan luka kronis jika mengalami keterlambatan penyembuhan (delayed healing) atau jika menunjukkan tanda-tanda infeksi.
d. Proses Penyembuhan Luka
Proses penyembuhan luka tidak hanya terbatas pada proses regenerasi yang bersifat local, tetapi juga dapat dipengaruhi oleh faktor endogen seperti umur, nutrisi, imunologi, pemakaian obat-obatan, kondisi metabolik. Pada dasarnya proses penyembuhan luka ditandai dengan adanya proses pemecahan/ katabolik dan proses pembentukan atau anabolik. Dari penelitian diketahui bahwa proses anabolik telah dimulai saat terjadi perlukaan dan akan terus berlanjut pada keadaan dimana dominasi proses katabolisme selesai. Pada proses penyembuhan luka akan terjadi melalui tiga tahapan yang dinamis, saling terkait, dan berkesinambungan serta tergantung pada tipe/jenis dan derajat luka. Luka akan sembuh sesuai dengan tahapan yang spesifik dimana bisa terjadi tumpang tindih (overlap). Proses penyembuhan luka tergantung pada jenis jaringan yang rusak serta penyebab luka tersebut
Fase penyembuhan luka :
1) Fase inflamasi / eksudasi (Hari ke 0-5)
Fase inflamasi adalah adanya respon vaskuler dan seluler yang terjadi segera setelah injuri akibat perlukaan yang terjadi pada jaringan lunak. Tujuan yang hendak dicapai adalah menghentikan perdarahan dan membersihkan area luka dari benda asing, sel-sel mati dan bakteri untuk mempersiapkan dimulainya proses penyembuhan. Pada awal fase ini kerusakan pembuluh darah akan menyebabkan keluarnya platelet yang berfungsi sebagai hemostasis. Platelet akan menutupi vaskuler yang terbuka (clot) dan juga mengeluarkan “substansi vasokonstriksi” yang mengakibatkan pembuluh darah kapiler vasokonstriksi. Selanjutnya terjadi penempelan endotel yang akan menutup pembuluh darah. Periode ini berlangsung 5-10 menit dan setelah itu akan terjadi vasodilatasi kapiler akibat stimulasi saraf sensoris (Local sensory nerve endding), local reflex action dan adanya substansi vasodilator (histamin, bradikinin, serotonin dan sitokin). Histamin juga menyebabkan peningkatan permeabilitas vena, sehingga cairan plasma darah keluar dari pembuluh darah dan masuk ke daerah luka dan secara klinis terjadi oedema jaringan dan keadaan lingkungan tersebut menjadi asidosis. Eksudasi ini juga mengakibatkan migrasi sel leukoasit terutama neutrofil ke ekstravaskuler. Fungsi netrofil adalah melakukan fagositosis benda asing dan bakteri didaerah luka selama 3 hari dan kemudian akan digantikan oleh makrofag yang berperan lebih besar jika disbanding dengan netrofil pada proses penyembuhan luka. Fungsi sel makrofag disamping fagositosis adalah :
a) sintesa kolagen
b) pembentukan jaringan granulasi bersama-sama dengan fibroblast
c) memproduksi growth factor yang berperan dalam proses reepitelialisasi dan
d) pembentukan pembuluh kapiler baru atau angiogenesis.
Dengan hasil dicapainya keadaan luka yang bersih, tidak terdapat infeksi atau kuman serta terbentuknya makrofag dan fibroblast, maka keadaan ini dapat dipakai sebagai pedoman /parameter bahwa fase inflamasi dapat dilanjutkan ke fase berikutnya yakni fase proliferasi. Secara klinis fase inflamasi ini ditandai dengan : eritema, hangat pada kulit, oedema dan rasa sakit yang berlangsung sampai hari ke-3 atau hari ke-4.
2) Fase proliferasi / epitelisasi ( Hari 3 – 14)
Proses kegiatan seluler yang penting pada fase ini adalah memperbaiki dan menyembuhkan luka dan ditandai dengan proliferasi sel. Peran fibroblas sangat besar pada proses perbaikan yaitu bertanggung jawab pada persiapan menghasilkan produk struktur protein yang akan digunakan selama proses rekonstruksi jaringan. Pada jaringan lunak yang normal (tanpa perlukaan), pemaparan sel fibroblas sangat jarang dan biasanya bersembunyi di matriks jaringan penunjang. Sesudah terjadi luka, fibroblas akan aktif bergerak dari jaringan sekitar luka ke dalam daerah luka, kemudian akan berkembang (proliferasi) serta mengeluarkan beberapa substansi (kolagen, elastin, hyaluronic acid, fibronectin dan proteoglycans) yang berperan dalam membangun (rekontruksi) jaringan baru. Fungsi kolagen yang lebih spesifik adalah membentuk cikal bakal jaringan baru (connective tissue matrix) dan dengan dikeluarkannya substrat oleh fibroblas, memberikan pertanda bahwa makrofag, pembuluh darah baru dan juga fibroblas sebagai kesatuan unit dapat memasuki kawasan luka. Sejumlah sel dan pembuluh darah baru yang tertanam didalam jaringan baru tersebut disebut sebagai jaringan “granulasi”.sedangkan proses proliferasi fibroblast dengan aktifitas sintetiknya disebut fibroplasia. Respon yang dilakukan fibroblast terhadap proses fibroplasia adalah proliferasi, migrasi, deposit jaringan matriks, kontraksi luka. Angiogenesis adalah suatu proses pembentukan pembuluh kapiler baru di dalam luka. Angiogenesis mempunyai arti penting pada tahap proliferasi pada proses penyembuhan luka. Kegagalan pembentukan kapiler darah baru/ vaskuler akibat penyakit (diabetes), pengobatan (radiasi), atau obat (preparat Steroid) mengakibatkan terjadi lambatnya proses sembuh karena terbentuknya ulkus yang kronis. Jaringan vaskuler yang melakukan invasi kedalam luka merupakan suatu respon untuk memberikan oksigen dan nutrisi yang cukup didaerah luka karena biasanya pada daerah luka terdapat keadaan hipoksik dan turunya tekanan oksigen.
Pada fase ini fibroplasia dan angiogenesis merupakan proses yang terintegrasi dan dipengaruhi oleh substansi yang dikeluarkan oleh platelet dan makrofag (growth factors).
Proses selanjutnya adalah epitelisasi, dimana fibroblast mengeluarkan Keratinocyte Growth Factor (KGF) yang berperan dalam stimulasi mitosis sel epitel. Keretanisasi akan dimulai dari pinggir luka dan akhirnya membentuk barier yang menutupi permukaan luka. Dengan sintesa kolagen oleh fibroblast, pembentukan jaringan dermis ini akan disempurnakan kualitasnya dengan mengatur keseimbangan jaringan granulasi dan dermis.
Untuk membantu jaringan baru tersebut menutup luka, fibroblast akan merubah strukturnya menjadi myofibroblast yang mempunyai kapasitas melakukan kontraksi pada jaringan. Fungsi kontraksi akan lebih menonjol pada luka dengan defek luas dibandingkan dengan defek luka minimal. Fase proliferasi akan berakhir jika epitel dermis dan lapisan kolagen telah terbentuk, terlihat proses kontraksi dan akan dipercepat oleh berbagai growth faktor yang dibentuk oleh makrofag dan platelet.
3) Fase maturasi atau remodelling
Fase ini dimulai pada minggu ke-3 setelah perlukaan dan berakhir sampai kurang lebih 12 bulan. Tujuan dari fase maturasi adalah ; menyempurnakan terbentuknya jaringan baru menjadi jaringan penyembuhan yang kuat dan bermutu. Fibroblas sudah mulai meninggalkan jaringan granulasi, warna kemerahan dari jaringa mulai berkurang karena pembuluh mulai regresi dan serat fibrin dari kolagen bertambah banyak untuk memperkuat jaringan parut. Kekuatan dari jaringan parut akan mencapai puncaknya pada minggu ke-10 setelah perlukaan.
Untuk mencapai penyembuhan yang optimal diperlukan keseimbangan antara kolagen yang diproduksi dengan yang dipecahkan. Kolagen yang berlebihan akan terjadi penebalan jaringan parut atau hypertrophic scar, sebaliknya produksi yang berkurang akan menurunkan kekuatan jaringan parut dan luka akan selalu terbuka (somantri, 2007)
Luka dikatakan sembuh jika terjadi kontinuitas lapisan kulit dan kekuatan jaringan parut mampu atau tidak mengganggu untuk melakukan aktifitas normal. Meskipun proses penyembuhan luka sama bagi setiap penderita, namun outcome atau hasil yang dicapai sangat tergantung pada kondisi biologis masing-masing individu, lokasi serta luasnya luka. Penderita muda dan sehat akan mencapai proses yang cepat dibandingkan dengan kurang gizi, diserta penyakit sistemik (diabetes mielitus).
Selasa, 13 Oktober 2009
materi PMR sub Kesehatan Reproduksi
A.Kesehatan Reproduksi
Kesehatan reproduksi adalah suatu keadaan sehat secara utuh baik secara fisik, mental, social dan terbebas dari sakit dan kecacatan yang berhubungan dengan system, fungsi dan proses reproduksi.
Puber
Dalam kehidupan sehari-hari kita sering mendengar istilah Puber, sebenarnya apa yang dimaksud dengan puber itu ? dan bagaimana prose situ bias terjadi? Dalam masa ini kita sering kita merasa telah dewasa, pubertas akan dialami oleh semua manusia. Pubertas adalah proses dimana kita akan melewati pintu gerbang untuk masuki masa remaja dan meninggalkan masa kanak – kanak.
Namanya juga pintu gerbang, artinya sebelum remaja kita harus melalui masa pubertas, pada masa ini terjadi kematangan fisik dalam perubahan yang ada pada diri kita, tapi perubahan ini berbeda pada tiap orang dan waktunya pun tidak sama. Secara umum pubertas di mulai pada umur 8 tahun.
Pada laki – laki pubertas itu ditandai dengan perubahan fisik seperti tumbuhnya rambut di ketiak, di muka (kumis dan jenggot) serta tumbuhnya jakun yaitu adanya bagian menonjol pada leher. Selain itu suara menjadi besar, badan lebih berotot dan pada sifatnya dia akan merasa dirinya sudah gede. Dan biasanya baik pada laki – laki pernah dalam hidupnya mimpi indah atau mimpi basah.
Sedangkan pada perempuan ditandai dengan payudara membesar dan diwajibkan menggunakan BRA HOT, paha dan pinggul membesar dan tumbuh rambut di ketiak. Selain itu datangnya masa menstruasi (datang bulan). Menstruasi adalah adanya pematangan sel telur dalam waktu 28 hari dan karena tidak dibuahi oleh sperma maka sel telur tersebut akan lepas dan akhirnya dinding “luruh” karena tidak terjadi proses pembuahan.
B. Infeksi Menular Seksual (IMS)
Infeksi Menular Seksual (IMS) adalah penyakit – penyakit yang ditularkan melalui proses hubungan seksual (senggama). Proses hubungan seksual ini dikelompokkan menjadi Penyakit Hubungan Seksual (PHS).
Macam – macam Infeksi Menular Seksual (IMS)
1. Gonore (GO) atau Kencing Nanah
Penyebab kuman Gonokus
Masa tunas kuman 1 – 5 hari
Gejala :
Pada Pria timbul rasa gatal pada penis, keluar nanah, penis akan hancur.
Pada Wanita tanpa gejala awal namun bila sudah gawat akan mengalami radang kelenjar di labia mayora dan bisa menular pada bayi yang baru lahir yang mengakibatkan kebutaan.
Cara pengobatan dengan penisilin dan antibiotika lainnya.
2. Sifilis (Raja Singa)
Penyebab kuman Treponema Pallidum
Masa tunas kuman 2 – 4 minggu
Gejala :
- Luka di kemaluan dan hilang pada beberapa hari
- Demam tinggi dan sakit pada alat kelamin (kemaluan)
Timbul benjolan dikulit
Pelunakan tulang
Kerusakan sarap dan otot.
Pengobatan dengan penisilin dan antibiotik lainnya.untu pengobatan sebaiknya dilakukan lebih dini sehingga dapat sembuh dengan sempurna karena apabila terlambat maka penyakit ini akan sulit disembuhkan.
3. Ulkus Molle
Penyebab kuman Hemofilus
Gejala timbul benjolan merah dan skit di sekitar kemaluan.
Umumya penyakit ini tidak terlalu berbahaya.
4. Limfogranuloma
Penyebab Virus
Gejala timbulnya benjolan kecil diskitar kemaluan, mudah pecah dan menyebar kemana – mana.
Umumya penyakit ini tidak terlalu berbahaya
5. Herpes Genitalis
Penyebab virus Herpes
Gejala timbul berupa gelembung berair disekitar kemaluan
Umumya penyakit ini tidak terlalu berbahaya tetpi apabila ditulari penyakit lainnya akan menjadi berbahaya
6. Kondiloma Akuminata
Penyebab Virus
Gejala timbulnya banyak kutil disekitar kemaluan
Umunya penyakit ini tidak terlalu berbahaya.
7. Kandiasis Genitalis
Penyebab Jamur Candida Albicans
Tumbuh pada alat kelamin
Umumya penyakit ini tidak terlalu berbahaya
8. Trikomoniasis
Penyebab Parasit Trichomonas Vaginalis
Penyakit ini menyerang saluran kemih
Umumya tidak berbahaya
9. AIDS (Aquired Immune Deficiency Syndrome)
C. HIV AIDS
AIDS (Aquired Immune Deficiency Syndrome) adalah kumpulan gejala penurunan kekebalan tubuh sehingga tubuh rentan terhadap penyakit lain yang mematikan.
Penyebab Virus HIV (Human Immuno deficiency Virus)
Masa awal 2 – 6 bulan
Masa tenang 2 – 10 tahun (rata – rata 5 tahun )
Masa AIDS 1 – 2 tahun
Gejala masa awal pembengkakan kelenjar bening, berkurang berat badan, berkeringat, diare dan beberapa infeksi ringan.
Tanda masa tenang secara fisisk kelihatan sehat (normal), namun erjalann HIV menghancurkan system kekebalan.
Tanda masa AIDS menghancurkan sebagian atau seluruh sytem kekebalan tubuh sehingga mulai nampak infeksi Opportunistik seperti :
- Radang paru – paru
- Kanker kulit
- TBC
- Penyakit syaraf
- Penyakit saluran cerna
- Dan berbagai penyakit lainnya dan sulit disembuhkan sehingga dapat menimbulkan kematian.
Penularan HIV
1.Melakukan senggama (hubungan kelamin)
- HIV dipindahkan lewat cairan sperma atau cairan Vagina
- Adanya luka dipihak penerima akan memperbesar kemungkinan penularan
- Bersenggama tidak wajar (leawat dubur)
2.Lewat transfusi darah
- Jika darah yang akan ditransfusikan telah terkena HIV
3.Melalui jarum suntik
- Secara teoritis penggunaan Akupuntur (tusuk jarum), tatto dan tindikan
- Penggunaan alat suntik atau injeksi yang tidak steril
- Sering dipakai oleh pengguna narkoba suntikan
- Suntikan oleh petugas kesehatan liar.
4.Penularan lewat kehamilan dan menyusui
- Ibu hamil yang dalam tubuhnya terinfeksi HIV, menular ke janin melalui plasenta
- Ibu menyusi menularkan HIV lewat cairan ASI
- Resiko penularan ibu hamil dan menyusui berkisar 20% – 40%
Cara melindungi diri dari AIDS
(A) Abstinence alias Puasa
Bagi yang belum menikah jangan dekat – dekat dengan senggama
(B) Be faithful alias Setia Pasangan Hidup
Bagi yang sudah menikah hanya bersenggama dengan pasangannya
(C) Condom alias Kondom
Penggunaan kondom akan memperkecil kemungkinan tetularnya PHS dan AIDS
(D) Drugs alias Obat – obatan
Jauhkan NAFZA khususnya secara suntikan secara bersamaan
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