PENDOKUMENTASIAN ASUHAN KEBIDANAN

PENDOKUMENTASIAN ASUHAN KEBIDANAN

PENDOKUMENTASIAN ASUHAN KEBIDANAN

PADA IBU HAMIL NORMAL

S (subject)

I. Pengkajian Data

Tanggal : 13 April 2008

Tempat : BPS Bidan Asti

Waktu : JAM BERAPA?

DATA SUBJEKTIF

1. Biodata Istri

Nama : Ny. Rita

Umur : 23 Tahun

Pendidikan : SMA

Pekerjaan : Ibu Rumah Tangga

Agama : Islam

Alamat : Jln. Ki Ageng Selo No.15 Purwokerto

Suku Bangsa : Jawa

Biodata Suami

Nama : Tn. Zainal

Umur : 25 Tahun

Pendidikan : S1

Pekerjaan : Pegawai Swasta

Agama : Islam

Alamat : Jln. Ki Ageng Selo No.15 Purwokerto

Suku Bangsa : Jawa

2. Alasan datang ingin memeriksakan kehamilan

3. Riwayat perkawinan : kawin 1x selama 1 tahun

4. Riwayat Medis :

A. Masa lalu : belum pernah dirawat di rumah sakit, belum pernah menderita penyakit menular/menahun seperti kencing manis, tekanan darah tinggi, asma, dll.

B. Sekarang : tidak sedang menderita sakit tertentu

C. Keluarga : Tidak ada yang menderita penyakit

5. Riwayat Obstetri :

a. Menarche umur 14 tahun

b. Lama haid 7 hari ( volume normal ), ganti pembalut 2x sehari ( teratur tiap bulan, tidak ada keluhan ).

c. HPHT : 11 Desember 2007

HPL : 18 Desember 2008

6. Riwayat kehamilan dan persalinan yang lalu : ibu belum pernah hamil ( - )

7. Riwayat kehamilan sekarang :

Ibu umur 23 tahun G1PoAo hamil………..ANC 1 x TTo

Hcg ( + ) 11 Januari 2008 keluhan mual muntah setiap pagi tidak lebih dari 5x. tidak mengkonsumsi jamu.

8. Riwayat kontrasepsi : belum pernah menggunakan alat kontrasepsi ( - )

9. Pola kebiasaan

a. Nutrisi : tidak ada gangguan

Makan : selama 1 minggu kurang nafsu

Makan 1-2 2x sehari porsi kecil

Minum : 9 gelas/hari

b. Eliminasi : BAB 1 X/hari, BAK 4-5X/hari

c. Aktivitas : pekerjaan rumah tangga biasa

d. Istirahat : Ibu tidur malam 8 jam/hari

e. Kebersihan : mandi 2x/hari, gosok gigi 2x/hari, keramas 2x/minggu

10. Persepsi dan Konsep Diri

- Suami dan keluarga sangat mengharapkan kehamilan ini

- Aadat istiadat tidak ada yang menentang kehamilan

- Ibu tidak mengetahui tentang kehamilan dan perawatan kehamilan

11. Psikologi : Ibu merasa nyaman dengan kehamilannya

O ( object )

Data Objektif

1. Keadaa umum : baik, sadar

TB : 160 cm

BB sebelum : 48 kg BB sesudah : 48 kg

Lingkar lengan :

Tekanan darah : 120/70 mmHg

Nadi : 80 x/menit

Suhu : 37 oC

2. Status present

Kepala : normal, simetris

Rambut : hitam, lurus, bersih

Mata : Konjungtiva tidak anemis, sclera tidak ikhterik

Hidung : bersih,……………..

Telinga : …………………

Mulut : bibir lembab,

Leher : tidak ada pembesaran kelenjar limfe / vena jugularis

Dada : tidak ada retraksi dinding dada

Abdomen : pinggang tidak ada nyeri lepas ………..

Genetalia : bersih, keputihan, darah, varises

Kaki : ……………

Reaksi patella :

3. Status Obstetri

Inspeksi :

Palpasi :

A ( Assasement )

II. Intepretasi Data

 Diagnosis :

 Dasar :

a) Anamesa

Ny. Rita menyatakan umur 23 tahun, primigravida, belum pernah abortus, HPHT 11 Januari 2007.

b) Tes Urine

Hasil tes urine positif ( + )

c) Palpasi

LI : TFU ½ dari simphisis phubis ke pusat, teraba bokong

LII : Punggung kanan

LIII : Teraba kepala

LIV : Belum masuk PAP

d) Auskultasi

DJJ ( + ) dengan stetoskop laennec

e) Masalah

Mual, muntah tiap pagi tidak lebih dari 5X

f) Kebutuhan

III. Merencanakan Asuhan

- Kaji keadaan umum dan tanda-tanda vital ibu

- Kaji nutrisi ibu

- Anjurkan ibu banyak istirahat

- Anjurkan chek up 2 minggu lagi

IV. Pelaksanaan Asuhan

- Mengkaji keadaan umum dan tanda-tanda vital ibu

- Kaji nutrisi ibu

- Anjurkan ibu banyak istirahat

- Anjurkan chek up 2 minggu lagi

V. Evaluasi

- Keadaan umum dan tanda-tanda vital ibu baik

- Nutrisi ibu cukup baik

- Ibu memahami anjuran bidan

Sumber : Mahasiswa Poltekes Semarang Kebidanan D3 Purwokerto

BACA SELENGKAPNYA - PENDOKUMENTASIAN ASUHAN KEBIDANAN

Tali Pusat Menumbung

Tali Pusat Menumbung: "

A. Pengertian

Menurut Prof. Dr. Roestam Mochtar, MPH, 1998. Tali pusat menumbung adalah bila teraba tali pusat keluar dan biasanya ketuban sudah pecah.

B. Klasifikasi Tali Pusat Menumbung Menurut Harry Oxorn, 1996

Tali pusat menumbung, ketuban pecah. Tali pusat menempati salah satu dari 3 kedudukan, yaitu :

1. Tali pusat menumbung di PAP, terletak di samping bagian terbawah janin di PAP

2. Tali pusat menumbung ke dalam vagina, turun ke vagina

3. Tali pusat menumbung melalui introitus dan keluar dari vagina

C. Etiologi Tali Pusat Menumbung Menurut Harry Oxorn, 1996

1. Etiologi Fetal

a. Presentasi abnormal

Sebagian besar dari tali pusat menumbung terjadi pada presentasi kepala namun bisa juga karena letak lintang dan letak sungsang/presentasi bokong, terutama bokong kaki.

b. Prematuritas

Seringnya kedudukan abnormal pada persalinan premature, yang salah satunya disebabkan karena bayi yang kecil tidak tahan terhadap trauma dan anoksia.

c. Kehamilan ganda

Faktor-faktor yang mempengaruhi meliputi gangguan adaptasi, frekuensi presentasi abnormal yang lebih besar, insidensi hydramnion yang tinggi dan pecahnya ketuban anak kedua.

d. Hydramnion

Ketika ketuban pecah, sejumlah besar cairan mengalir ke luar dan tali pusat hanyut ke bawah.

2. Etiologi Maternal

a. Disproporsi kepala panggul

Disproporsi antara panggul dan bayi menyebabkan kepala tidak dapat turun dan pecahnya ketuban dapat diikuti tali pusat menumbung.

b. Bagian terendah yang tinggi

Tertundanya penurunan kepala untuk sementara dapat terjadi meskipun panggul normal, terutama pada multipara.

3. Etiologi Dari Tali pusat dan Plasenta

a. Tali pusat yang panjang

Semakin panjang tali pusat maka semakin mudah menumbung

b. Plasenta letak rendah

Jika plasenta dekat serviks maka ia akan menghalangi penurunan bagian terendah. Di samping itu insersi tali pusat lebih dekat serviks.

D. Diagnosis Tali Pusat Menumbung Menurut Harry Oxon, 1996

Diagnosa tali pusat menumbung dibuat dengan 2 cara :

1. Melihat tali pusat di luar vulva

2. Meraba tali pusat pada pemeriksaan vaginal (periksa dalam)

Pemeriksaan vaginal harus dilakukan :

a. Bila terjadi gawat janin yang tidak diketahui sebabnya dan trauma jika bagian terbawah belum turun.

b. Bila ketuban pecah dengan bagian terendah yang masih tinggi.

c. Bila semua kasus malpresentasi pada waktu ketuban pecah

d. Bila bayinya jelas prematur

e. Pada kasus-kasus kembar

E. Prognosis Tali Pusat Menumbung Menurut Harry Oxorn, 1996

Tali pusat menumbung tidak membahayakan si ibu dan tidak menyulitkan dalam persalinan, namun mengancam bagi janin. Harapan untuk bayi tergantung pada derajat dan lamanya kompresi tali pusat dan interval antara diagnosis dan kelahiran bayi.

Faktor-faktor yang mempengaruhi nasib janin :

1. Semakin baik keadaan janin pada waktu diagnosis dibuat, semakin besar harapan hidupnya. Tali pusat yang berdenyut keras menurunkan gejala yang baik dan sebaliknya tali pusat yang berdenyut lemah berarti tidak baik.

2. Semakin cepat bayi dilahirkan setelah tali pusat turun ke bawah, semakin baik hasilnya. Penurunan lebih dari 30 menit memperbesar kematian janin 4 x.

3. Janin yang lebih tua umur kehamilannya lebih besar pula kemampuannya bertahan terhadap proses-proses traumatic.

4. Semakin kurang trauma pada kelahiran bayi, semakin baik prognosis untuk ibu dan anak.

5. Pembukaan serviks mungkin merupakan faktor yang terpenting. Jika pembukaan sudah lengkap pada waktu diagnosis dibuat maka akan banyak bayi yang dapat diselamatkan. Semakin kecil pembukaan prognosisnya semakin jelek. Perkecualian untuk ini adalah jika dapat dilakukan section caesarea dengan segera, dalam hal mana prognosisnya sama baik atau lebih baik pada pembukaan serviks yang masih kecil.

6. Kematian janin bertambah dengan semakin panjangnya interval antara pecahnya ketuban dan kelahiran bayi.

F. Penanganan Tali Pusat Menumbang Menurut Harry Oxorn, 1996

Tali pusat menumbung dibiarkan dan persalinan diteruskan pada keadaan-keadaan sebagai berikut :

1. Bila janin sudah meninggal

2. Bila janin diketahui abnormal

3. Bila janin masih sangat premature sehingga tidak ada harapan untuk dapat hidup

Usaha-usaha untuk mengurangi kompresi tali pusat dan memperbaiki keadaan janin adalah sebagai berikut :

1. Penolong memasukkan satu tangan ke dalam vagina dan mendorong bagian terendah ke atas menjauhi tali pusat. Pada waktu yang bersamaan dilakukan persiapan untuk menolong persalinan.

2. Pasien diletakkan dalam sikap lutut-dada (knee chost) atau trendelenburg dengan pinggul diatas dan kepala di bawah.

3. Diberikan oksigen dengan masker kepada ibu

4. Denyut jantung janin sering diperiksa dengan teliti

5. Dilakukan pemeriksaan vaginal untuk menentukan presentasi, pembukaan serviks, turunnya bagian terendah dan keadaan tali pusat.

Jika pembukaan sudah lengkap dilakukan usaha-usaha untuk berbagai presentasi sebagai berikut :

1. Presentasi kepala, kepala rendah di dalam panggul : ekstraksi dengan forceps

2. Presentasi kepala, kepala tinggi : Versi ekstraksi cara ini mengandung bahaya terjadinya rupture uteri tetapi oleh karena ini merupakan usaha dalam keadaan putus asa untuk menyelamatkan anak maka resiko tersebut harus diambil

3. Presentasi bokong. Kedua kaki diturunkan dan bayi dilahirkan sebagai presentasi bokong kaki secepat mungkin.

4. Letak lintang. Versi dalam menjadi presentasi kaki dan segera dilakukan ekstraksi.

Jika pembukaan belum lengkap, dilakukan usaha-usaha sebagai berikut :

1. Sectio caesaria, merupakan pilihan selama bayinya cukup bulan dan dalam keadaan baik. Nasib bayi pada section caesaria jauh lebih baik dibanding kelahiran dengan cara lain. Bahaya untuk ibu juga sangat kurang dibanding dengan melahirkan bayi secara paksa pada pembukaan yang belum lengkap. Sementara dilakukan persiapan operasi diadakan usaha-usaha untuk mengurangi kompresi tali pusat seperti tersebut diatas.
2. Reposisi tali pusat dapat dicoba jika tidak dapat dikerjakan section caesarea. Tali pusat dibawah ke atas kedalam uterus, sedangkan bagian terendah janin di dorong ke bawah masuk panggul kemudian di tahan kadang-kadang reposisi tali pusat berhasil tetapi umumnya kita kehilangan banyak waktu yang berharga pada waktu melakukan.
3. Jika usaha ini tidak berhasil, pasien di pertahankan dalam posisi trendelenburg dengan harapan tali pusat tidak tertekan sehingga bayi tetap dapat hidup sampai pembukaan menjadi cukup lebar untuk memungkinkan lahirnya bayi.
4. Dilatasi serviks secara manual, insisi serviks dan cara-cara lain untuk memaksakan pembukaan serviks tidak akan pernah diterima. Keberhasilannya kecil sedangkan resiko untuk ibu besar.

BACA SELENGKAPNYA - Tali Pusat Menumbung

Perubahan Fisiologis Masa Nifas Pada Sistem Kardiovaskuler

Perubahan Fisiologis Masa Nifas Pada Sistem Kardiovaskuler

Volume darah normal yang diperlukan plasenta dan pembuluh darah uterin, meningkat selama kehamilan. Diuresis terjadi akibat adanya penurunan hormon estrogen, yang dengan cepat mengurangi volume plasma menjadi normal kembali. Meskipun kadar estrogen menurun selama nifas, namun kadarnya masih tetap tinggi daripada normal. Plasma darah tidak banyak mengandung cairan sehingga daya koagulasi meningkat.

Aliran ini terjadi dalam 2-4 jam pertama setelah kelahiran bayi. Selama masa ini ibu mengeluarkan banyak sekali jumlah urin. Hilangnya progesteron membantu mengurangi retensi cairan yang melekat dengan meningkatnya vaskuler pada jaringan tersebut selama kehamilan bersama-sama dengan trauma selama persalinan.

Kehilangan darah pada persalinan per vaginam sekitar 300-400 cc, sedangkan kehilangan darah dengan persalinan seksio sesarea menjadi dua kali lipat. Perubahan yang terjadi terdiri dari volume darah dan hemokonsentrasi. Pada persalinan per vaginam, hemokonsentrasi akan naik dan pada persalinan seksio sesarea, hemokonsentrasi cenderung stabil dan kembali normal setelah 4-6 minggu.

Pasca melahirkan, shunt akan hilang dengan tiba-tiba. Volume darah ibu relatif akan bertambah. Keadaan ini akan menimbulkan dekompensasi kordis pada penderita vitum cordia. Hal ini dapat diatasi dengan mekanisme kompensasi dengan timbulnya hemokonsentrasi sehingga volume darah kembali seperti sediakala. Pada umumnya, hal ini terjadi pada hari ketiga sampai kelima post patum.

Referensi

Ambarwati, 2008. Asuhan Kebidanan Nifas. Yogyakarta: Mitra Cendikia. (hlm: 85-86).

Kuliahbidan. 2008. Perubahan dalam Masa Nifas. kuliahbidan.wordpress.com/2008/09/19/perubahan-dalam-masa-nifas/ diunduh 6 Feb 2010, 02:25 PM.

scribd.com/doc/16287636/ASUHAN-KEPERAWATAN-MATERNITAS

diunduh 12 Feb 2010, 04:30 PM.

scribd.com/doc/17226035/Post-Partum-Oke diunduh 8 Feb 2010, 11:46 PM.

scribd.com/doc/24817163/Postpartum-Normal diunduh 12 Feb 2010, 04:46 PM.

http://askep-askeb.cz.cc/

BACA SELENGKAPNYA - Perubahan Fisiologis Masa Nifas Pada Sistem Kardiovaskuler

Pain Management in Childbirth

Pain Management in Childbirth: "

Pain in childbirth is normal, healthy, and productive -- and ends with the ecstasy of your baby's birth. Although management of labor pain plays less important role in a mother’s satisfaction with childbirth, compared with the quality of the relationship with her labor support and her ability to take part in decision making, it is an important topic.

Pain in labor is a nearly universal experience for childbearing women. It is, however, experienced differently by birthing mothers. The majority of women, though, need some sort of pain relief during childbirth. Methods vary from drugs to natural methods, and it is worth considering the various options available to you well in advance.

Non-pharmacologic methods of labor pain relief are becoming more common as mothers, as well as pregnancy and labor caregivers, become more aware of the effectiveness of these methods. Changing positions and movement, warm water baths, massage and acupressure are gaining more popularity, in addition to relaxation and hypnobirthing, in management of labor pain.

A vast study by Childbirth Connection in 2005 revealed that 69% of birthing mothers used at least one non-pharmacologic method to relieve pain and increase comfort during their labor. Most frequently used were breathing techniques and position changes and movement, followed by relaxation, visualization or hypnosis. As many as one in five birthing mothers used hands-on techniques such as massage and labor acupressure. These two hands-on techniques were rated very helpful by vast majority of 91% of the mothers. The popularity of these pain relieving methods is based on the simplicity and easiness to use them anywhere without any special and expensive tools. This is in addition to highly satisfactory level of relief from labor pains.

Less frequently used labor pain relieving methods include use of birthing balls, birthing tub or pool, and aromatherapy. Mothers who use these pain relieving methods, also, generally rate them helpful. Unfortunately, their use is limited by the need of special equipments or space.

By far, the most common forms of medication in both vaginal and cesarean births among the pharmacologic labor pain relieving methods are the epidural or spinal analgesia. Epidural or spinal analgesia mostly give excellent labor pain relief. However, studies revealed a scattered satisfaction with epidurals. Many interviewed mothers described their experiences of not having access to this type of pain relief when they wanted it, getting uneven pain relief on different sides, and experiencing headaches, and other adverse effects.

Labor is an exciting event and involves many new sensations, especially if you are having your first baby. These sensations are part of giving life to your baby. However, no one needs to suffer during childbirth. By understanding what you can do, and how others can help you in order to prevent and relieve labor pains, you are most likely to have a satisfying birth experience.

"

BACA SELENGKAPNYA - Pain Management in Childbirth

How Low Libido Affects Women versus Men

Most women and men experience low female libido at some time in their lives. Although the causes and treatments are not the same, many studies and much research is still needed to distinguish the subtle differences between how the two genders experience low libido. Believe it or not, about twice as many women than men experience low libido and it has a profound affect on their intimate relationships. We will identify some of the causes and symptoms specific to women who suffer from lack of libido. Some women don’t even realize that there are several medications that women frequently take which affect female libido. Many oral contraceptives suppress female libido so gradually that a woman may not even realize it is happening. Oral contraceptives prevent ovulation by changing the amount of hormones that are released in a woman’s body, so imagine how potent these medications actually need to be and how easily these hormonal changes could affect women’s libido. Women who have undergone a hysterectomy, for any reason, may also experience low sexual desire because the female hormones are suddenly depleted. Many women take medications (hormone replacement therapy or female libido pills) to replace the loss of hormones, which will usually increase libido, sexual desire, and sexual response. Many women increase libido by taking libido enhancer pills. These are usually made with a special blend of herbs used to treat female or women’s libido. Menopause is another cause of low libido and lack of sexual desire. This is again, due to the depletion and imbalance of hormones. Sometimes the loss of sexual desire that occurs naturally with age, can be aggravated by less moisture and lubrication in the vagina. This can make sexual intercourse uncomfortable or even painful and it may cause frustration and stress that a woman begins to associate with sex. Obviously birth control pills, hysterectomies, and menopause are all reasons specific to the loss of female libido. The causes of low libido in men are more commonly caused from lower testosterone levels as men age, depression, stress, medical conditions, and substance abuse. There are medications such as Viagra that are very effective for men who would like to increase libido. If the problem is psychological, individual or couples therapy can help a great deal. It is important for a man with low libido to eat a healthy diet, exercise regularly, and get plenty of sleep. It is also extremely beneficial for a man with low libido to not smoke and moderate his alcohol intake. If you are a male or female who suffers from low libido, you should consult a physician to make sure this problem is not a result of a more serious medical condition that requires attention. In relationships, open communication is a great help and goes a long way in overcoming low male or to increase female libido.

BACA SELENGKAPNYA - How Low Libido Affects Women versus Men

Breast Enhancement Therapy For Each Individual

A lady finds herself to be a complete woman only after she has experienced the divine joy of motherhood. This can be expressed only after going through the stages of pregnancy, childbirth and lactation or breast-feeding.
These stages bring many emotional, mental and physical changes in every woman. The breast enlargement is a major part of this change, which takes place naturally. The enlarged breasts are firm during the period of lactation as the supply of hormones to produce mother’s milk is continuously maintained. The fullness of female anatomy during such a period is for everyone to appreciate in a divine way. Even a skinny woman finds herself to be large breasted during this period.
However, after this phase is over and lactation stops, the breasts start shrinking and sagging as well. It is the desire of every woman to remain firm breasted with rounded large beasts, always. The absence of these features certainly brings confidence problems in some women. The confidence problems can be severe enough to result in anxiety or depression in certain cases. Therefore, the thought of breast enhancement therapy comes instantly to the female mind.
The same can be said for woman going through menopause. They may have large breasts, but the breasts are neither shaped well nor firm. However many ladies would like to retain their firmness particularly in the breasts, during that age as well. There are a few surgeries available, which cause breast enlargement. But, these have to be observed with the passage of time for their effectiveness and side effects, if any.
The major draw backs for the types of therapy involving surgery is that they are costly and every woman may not be able to afford it. Hence, we have breast enhancement pills, which are safe to use and these produce the desired result over a period of time. A woman, using breast pills regularly feels more confident after developing firm and well-shaped breasts large enough to attract the others’ attention. These pills can also be used by women who have lost the shape and size of their breasts due to a prolonged illness.
These breast enlargement pills supplement the estrogen and other feminine hormones that are responsible for the development and growth of female breasts during puberty or pregnancy, thereby strengthening the breast tissues and enlarging the mammary glands. The herbal pills have certain advantages over other therapies as they contain certain herbal ingredients that open up the tissues and then expand them to make the female breasts rounded and firm. It is important to keep in mind that the process of shaping and enlarging the breasts, which is limited somewhat to genetics, is different for each particular female when taking herbal breast pills.

BACA SELENGKAPNYA - Breast Enhancement Therapy For Each Individual

Ten Myth About Childbirth

Ten Myth About Childbirth: "

1. My water will break if I am truly in labor.
Amniotic fluid surrounds your baby during pregnancy. If you are in your last weeks of pregnancy you may be expecting a gush of water prior to the onset of labor. For most women their water does not break before labor begins and often does not break until you are in active labor if it breaks on it's own at all. In fact, quite often your doctor or midwife will break the bag of waters at some point during labor.

2. You will know when you are in labor.
Early labor can last hours and even days. Braxton Hicks contractions can feel very real and be difficult to tell apart from true labor contractions. While most women will know once they have reached the active phase of labor, early labor can be more subtle. It is not uncommon for women to be dilated four or even five centimeters and not be aware of the fact that they are in labor .False labor contractions are irregular and usually do not increase in intensity, frequency, or duration. Moms who have given birth before may actually have a more difficult time distinguishing true labor contractions from false labor. The only way to be sure whether you are indeed in labor is to have a vaginal exam to check for cervical dilation.

3. Labor induction always works.
Labor induction does not always work. Your doctor will perform a vaginal exam to check for cervical dilation and effacement and position of your cervix. Labor induction works best when the cervix has already begun to soften and dilate. You may go in for your 39 or 40 week appointment hoping for an induction only to be told that your cervix is not favorable to be induced. It is also possible to have a failed induction. If baby is not in distress you may be sent home to try labor induction again in another day or two.

4. Contractions feel like menstrual cramps.
You may have heard that contractions feel like menstrual cramps. While for some women early labor contractions may feel like menstrual cramps, this is not a very realistic description of labor contractions. Natural childbirth is definitely doable and many women have an unmedicated birth. However, we feel describing contractions as menstrual cramps is a disservice to first time moms. There are more honest and accurate descriptions of labor contractions that will better prepare you for childbirth. Contractions do resemble menstrual cramps in their location and general achiness, but they also have a powerful tightening more closely resembling a charlie horse. Generally speaking contractions in the active phase of labor will be tightening, painful, and increase in intensity until you reach the peak of the contraction and then the pain will begin to subside.

5. Unmedicated childbirth is always best.
Because labor is not one long sustained contraction but rather a series of contractions increasing in intensity, natural childbirth is quite possible. Natural childbirth, utilizing relaxation exercises, breathing, and resting between contractions, offers one option for pain management. Natural childbirth offers women the ability to be in complete control of their birth and there is a very empowered feeling after having a successful unmedicated birth. Benefits of an unmedicated birth include faster recovery time and shorter labor for mom, more alert and active baby (and mom too), and of course it's cheaper. However, there are occasions, where an unmedicated birth would not be best and certainly many reasons why women would prefer a medicated birth over an unmedicated one. Conditions such as an abrupted placenta, a baby in a breach position, or signs of fetal distress are all very good reasons to need a caesarian section. An unmedicated birth is ideal, but a happy, healthy birth can be attained regardless of your childbirth choice.

6. If you are really in labor you will not be sent home.
Women may assume if they are truly in labor that they will be admitted to the hospital. You can be in labor and still be sent home. If you are in the early phases of labor, you may be sent home until your contractions increase in frequency or your cervix is more dilated. Many hospitals will not admit you until you are at least four centimeters dilated. Do not get discouraged if the labor and delivery nurse tells you that you have to go home. You may indeed be in labor!

7. Once a caesarian birth always a caesarian birth.
This may or may not be true depending on the type of caesarian section you had along with the reasons for having a caesarian birth to begin with. VBACs or vaginal birth after caesarian are becoming increasingly more common. You will need to discuss with your doctor whether a VBAC will be possible for you.

8. Each labor gets easier.
This may or may not be true for you. Generally speaking, second labors are shorter in duration, but that is not always the case. Shorter does not always mean easier. Baby could be bigger than your first or positioned differently. Also, if you have a very rapids labor, you may find you do not have as many choices for pain medication or you may simply choose different pain options. There are any number of factors that could affect your birth.

9. You will feel an urge to push.
Feeling the urge to push is instinctive and natural right? If baby is ready to come you will certainly feel an urge to push! Well, believe it or not this is not always true. Many women do feel an urge to push, but not always. Sometimes pushing is painful and women will avoid pushing at all costs. Other times medications such as an epidural will interfere with the sensation of needing to push. Your doctor or midwife will help you to understand what is happening during labor and help you determine when you are ready to push.

10. Epidurals lead to caesarian sections.
This belief is still held by some, but recent studies have shown that epidurals do not cause an increase in caesarian sections.

"

BACA SELENGKAPNYA - Ten Myth About Childbirth

Myth During Pregnancy Period

Myth During Pregnancy Period: "

Pregnancy is a time for joy. It is a time when the parents-to-be look forward to the hold their bundle of joy in their arms. Unfortunately, not every mother-to-be is as knowledgeable about pregnancy as she should be. To add the confusion they are often misled by half truths and old wives tales when it comes to their pregnancy week by week. In order to have a healthy pregnancy, women must educate themselves on the early pregnancy symptoms and other pregnancy related issues.

Myth 1 Miscarriages

Many women worry about health issues during their pregnancy. One of the biggest concerns about pregnancy is miscarriages. Miscarriages happen, however, all spotting and bleeding are not signs of miscarriage. Still you must see a doctor immediately in case you have some.

Myth 2 weight gain

Mothers are also worried about their own health during pregnancy. Weight gain is a concern for most new mothers. With the week by week development of the baby, a mother gains about 25-35 pounds. However while eating; a mother-to-be must take care of the quality and not the quantity of food that she eats. She should not think that she has to eat for two! Instead she should follow a good diet plan. She should give up smoking, alcohol and reduce caffeine intake. Mild exercise such as walking and swimming are great ways to maintain ideal weight.

Myth 3 Labor

Many women are afraid of labor as well. They presume labor to be always painful. Labor might be painful for some women, while others may not feel much pain during childbirth. Women today can opt for natural birth or epidurals. Epidurals reduce labor pains. Breathing techniques can also help to reduce pain during natural childbirth. Keeping fit and healthy throughout pregnancy ensures an easy labor.

Myth 4 Posture

One of the biggest myths about pregnancy is that you should not sleep on your back. As long as you find it comfortable, and have no health problems, sleeping on your back is okay. Most women find it comfortable to sleep on their side.

Myth 5 Travel

Another major concern for mothers is the use of seatbelts. Seatbelts save lives, so you should not stop wearing one when traveling. However, you need to speak to your doctor about the position of the belt. If you can place the belt properly, there is no risk to your baby.

Today, women have many choices in terms of medical care and information. The mortality rate for mothers and babies has gone down considerably all over the world in the past few decades. All thanks to modern medicine and pregnancy health awareness. Hence, there is really no reason for you to worry about pregnancy. Take it easy and make sure you have proper diet and follow a well planned exercise regime.

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BACA SELENGKAPNYA - Myth During Pregnancy Period

Knowing the Signs and Symptoms of Pregnancy

Knowing the Signs and Symptoms of Pregnancy: "

Having a baby can be a joy. It signals the start of family life. The baby serves as the carrier of the bloodline and legacy of the parents. More than that, a baby is a very important individual who will someday grow up and make a difference in this world.

Creating a baby involves sexual reproduction. This can occur when a couple has sexual intercourse and both the egg cell from the woman and the sperm cell from the man unites into one fertilized cell. This cell quickly duplicates and matures within just hours and turns into a zygote. The zygote then attaches itself to the uterus lining where it further matures into a fetus. This fetus has the physical appearance of a human being as early as 6 weeks old. This developing group of cells can come to know as the woman’s baby. The period of holding this baby inside her womb and until the baby is born is called the pregnancy period.

The pregnancy period lasts for approximately 9 months or specifically 36 to 40 weeks of gestation. During this period, there are countless changes involving the baby’s growth and development inside the mother’s womb. The mother is also affected with these changes, having some changes of her own too in order to accommodate the baby’s needs. Together the mother and her baby form a bonding relationship as well as a physical connection with each other.

To know if a woman is really pregnant, there are numerous signs and symptoms which give out clues to alert the people if there is or there is no pregnancy. First, there are possible signs of pregnancy which can be felt and experienced by the woman. Next, there are probable signs of pregnancy which can be felt by the nurse or examiner. Lastly, there are positive signs of pregnancy which can be derived from running tests and examinations through which the final verdict is revealed of whether or not the woman is pregnant.

As the baby matures, there are a lot of possible signs and symptoms a mother will feel. There are nausea and vomiting episodes more commonly known as morning sickness. She will have missed monthly periods or will not menstruate in the succeeding months. The mother will have changes in libido and may feel less inclined to having sexual intercourse. She will feel her breast engorging and swelling. As the baby gets larger, the woman will have increased frequency of urination. She will also have food cravings or in some cases pica, which is the unusual consumption of usually non-edible food. The mother will be easily fatigued and experience skin changes and stretch marks. She will also feel fetal movement inside her which is termed as quickening.

Having experienced the possible signs and symptoms mentioned above, the woman will be inclined to go to a clinic to be examined. There are probable signs and symptoms which are noted by the nurse or examiner. The nurse performs a thorough assessment on the woman’s body. The nurse notes an increased abdominal girth on the mother. The nurse observes that the mother has bluish discoloration on her vagina along with the presence of a softening cervix. The nurse observes that the mother is having Braxton Hicks contraction which is a series of false labor contractions. The nurse can also note that the baby can be palpated on the mother’s abdomen.

To validate all of these signs and symptoms, there are positive signs of pregnancy to look out for. Among the three, positive signs are the most reliable indicators of pregnancy. These involve being positive in four tests, namely, the hearing of fetal heart tones through Doppler sound or stethoscope, ultrasound detection, x-ray visualization, and movement of baby as detected by the examiner.

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BACA SELENGKAPNYA - Knowing the Signs and Symptoms of Pregnancy

Eating Fish, Omega-3 Oils, Fruits And Veggies Lowers Risk Of Memory Problems

A diet rich in fish, omega-3 oils, fruits and vegetables may lower your risk of dementia and Alzheimer's disease, whereas consuming omega-6 rich oils could increase chances of developing memory problems, according to a new study.
For the study, researchers examined the diets of 8,085 men and women over the age of 65 who did not have dementia at the beginning of the study. Over four years of follow-up, 183 of the participants developed Alzheimer's disease and 98 developed another type of dementia.
The study found people who regularly consumed omega-3 rich oils, such as canola oil, flaxseed oil and walnut oil, reduced their risk of dementia by 60 percent compared to people who did not regularly consume such oils. People who ate fruits and vegetables daily also reduced their risk of dementia by 30 percent compared to those who didn't regularly eat fruits and vegetables.
The study also found people who ate fish at least once a week had a 35-percent lower risk of Alzheimer's disease and 40-percent lower risk of dementia, but only if they did not carry the gene that increases the risk of Alzheimer's, called apolipoprotein E4, or ApoE4.
"Given that most people do not carry the ApoE4 gene, these results could have considerable implications in terms of public health," said study author Pascale Barberger-Gateau, PhD, of INSERM, the French National Institute for Health and Medical Research, in Bordeaux, France. "However, more research is needed to identify the optimal quantity and combination of nutrients which could be protective before implementing nutritional recommendations."
In addition, the study found people who did not carry the ApoE4 gene and consumed an unbalanced diet characterized by regular use of omega-6 rich oils, but not omega-3 rich oils or fish were twice as likely to develop dementia compared to those who didn't eat omega-6 rich oils, which include sunflower or grape seed oil. The study did not find any association between consuming corn oil, peanut oil, lard, meat or wine and lowering risk of dementia.
"While we've identified dietary patterns associated with lowering a person's risk of dementia or Alzheimer's, more research is needed to better understand the mechanisms of these nutrients involved in these apparently protective foods," said Barberger-Gateau.Source :

source: sciencedaily.com

BACA SELENGKAPNYA - Eating Fish, Omega-3 Oils, Fruits And Veggies Lowers Risk Of Memory Problems

Screening For Breast Cancer

Breast cancer is a dangerous disease that is affecting many women today. One of the most important strategies to do to survive breast cancer, is get an early detection and treatment promptly. That means doing your monthly self exams, and getting yearly check ups at the doctors office. If you are in denial and think that it won’t happen to you, think again. It can happen to anyone, even in males.

The different techniques, used today, has advanced over the years.

Let’s take a look at some advantages we have to detect early stage of breast cancer through Medical review.

Mammography with Computer Aided Detection:

Mammograms are a great way to catch any early detection of cancer. Mammography is a an x-ray film of the breasts that is read by a Radiologist that checks to see if there is any abnormal findings. The Computer Aided Detection is a process that is computer based and it analyzes the mammogram for any abnormal tissue and shows the Radiologist where the abnormal tisse is, if there is any located.

Digital Mammography

Digital Mammography is a tool used to record an image of an x-ray of the breasts. The images are shown on a monitor and the doctors are able to enhance or manipulate the image for detection, before they print the image out on film.

Ultrasound

Ultrasounds are a high-frequency sound wave that produces pictures called sonograms. These help the Doctors to distinguish if a lump or abnormal tissue is a tumor or a cyst. Ultrasounds are not only used as a diagnostic image, but also to help guide biopsy procedures of breast tissue, like fine needle aspirations. Ultrasounds are usually done after the result of an abnormal mammogram that might show micro calcifications or other abnormal tissue.

MRI (Magnetic Resonance Imagining)

MRI’s is a procedure done that doesn’t use radiation. There is a magnet that is connected to a computer that then creates the images of what is inside the body. When a breast MRI is obtained there are a lot of images that are created from front to back, top to bottom and side to side. The patient gets on the scanning table and lie on their stomach. The breasts hang into a hollow in the table that has coils that detect any type of magnetic signal. Then the patient is moved into the tube like machine that has the magnet. This helps to improve any cancerous tumor visibility. A radiologist reads the results of MRI’s also

Fine Needle Aspirations

A fine needle aspiration distinguishes what type of tumor the patient has. There are solid tumors and liquid-filled tumors; which are cysts. How the procedure works is the doctor takes a fine needle and inserts it into the location of the tumor. The fluid in the tumor is then removed and sent to laboratory to see if the tumor has cancerous cells or not.

Surgical Biopsy

Surgical biopsies are usually done if the mass is a solid tumor. There are two different types of surgical biopsies, excisional, and incisional. Incisional biopsies are performed by removing only a small portion of the abnormal tissue to be examined by a pathologist. With excisional biopsies the whole tumor is removed with a small amount of tissue surrounding it, and then sent to a pathologist to examine.

There are other procedures that are used for detection of breast cancer. The techniques that are listed above are the most common procedures used for patients today. Newer diagnostic imaging and techniques are being developed that are guaranteed to catch early detection and identify patients that are at a high risk of breast cancer. Infrared Thermographic Imaging is a new discovery that picks up any subtle changes that have occurred in the breast pathology. Another new advancement for early detection is Gamma imaging camera that is used with an MRI that can pick up a cancerous tumor that is within the breast. There are always new advances in technology that will help improve the techniques to find early detection of breast cancer. One of these days there will be a cure, but for now concentrate on getting early detection before it becomes too late.

BACA SELENGKAPNYA - Screening For Breast Cancer

Lybrel: Safest option to control pregnancy

ybrel is the first FDA approved birth control pill. Women globally have been opting for this birth control pill, as it is the safest option for them.

Lybrel birth control pill can also be regarded as a continuous pill, as it can be consumed 365 days. What attracts women more towards this pill is that it also suppresses the menstrual cycle.

The way Lybrel works is very simple. It delivers low dose of hormones to our body every day. Like many other birth control pills, it suppresses pregnancy through the process of ovulation suppression. While we take Lybrel, the lining of the uterus does not undergo the changes needed for menstruation and, therefore one does not have regular menstrual cycle.

While undertaking the course of Lybrel, in place of a menstrual period, the women get what is called a "pill period." Most of the traditional cyclic birth control pills have been providing hormones for 21 out of 28 days. Thus, this prevents ovulation and minimizes the build-up of your uterine lining.

While starting the course of Lybrel, one can feel unscheduled bleeding or spotting. However, the number of days, for which one gets these spotting decreases in case of majority of women. The benefit of having no regular menstrual cycle is more beneficial than the unwanted bleeding and spotting.

But one should remember that Lybrel birth control pills should be taken under the supervision of your personal doctor. Women who have blood clots; breast, uterine, or liver cancers; a history of heart attack, stroke, or breast cancer and those who are pregnant should avoid taking these pills.

The sides effects associate with Lybrel are comparatively less and limit to menstrual cramps, headaches and nausea.

Along with controlling pregnancy, the Lybrel pregnancy control pills have another benefit. They also cure problem of acne.

Thus Lybrel is a safer option for those who want to avoid unwanted pregnancy. It has really acted as a blessing for working women. You can also buy these birth control pills online. There are many online stores which can be trusted. Order one now, and see the difference.

BACA SELENGKAPNYA - Lybrel: Safest option to control pregnancy

Lybrel: Safest option to control pregnancy

ybrel is the first FDA approved birth control pill. Women globally have been opting for this birth control pill, as it is the safest option for them.

Lybrel birth control pill can also be regarded as a continuous pill, as it can be consumed 365 days. What attracts women more towards this pill is that it also suppresses the menstrual cycle.

The way Lybrel works is very simple. It delivers low dose of hormones to our body every day. Like many other birth control pills, it suppresses pregnancy through the process of ovulation suppression. While we take Lybrel, the lining of the uterus does not undergo the changes needed for menstruation and, therefore one does not have regular menstrual cycle.

While undertaking the course of Lybrel, in place of a menstrual period, the women get what is called a "pill period." Most of the traditional cyclic birth control pills have been providing hormones for 21 out of 28 days. Thus, this prevents ovulation and minimizes the build-up of your uterine lining.

While starting the course of Lybrel, one can feel unscheduled bleeding or spotting. However, the number of days, for which one gets these spotting decreases in case of majority of women. The benefit of having no regular menstrual cycle is more beneficial than the unwanted bleeding and spotting.

But one should remember that Lybrel birth control pills should be taken under the supervision of your personal doctor. Women who have blood clots; breast, uterine, or liver cancers; a history of heart attack, stroke, or breast cancer and those who are pregnant should avoid taking these pills.

The sides effects associate with Lybrel are comparatively less and limit to menstrual cramps, headaches and nausea.

Along with controlling pregnancy, the Lybrel pregnancy control pills have another benefit. They also cure problem of acne.

Thus Lybrel is a safer option for those who want to avoid unwanted pregnancy. It has really acted as a blessing for working women. You can also buy these birth control pills online. There are many online stores which can be trusted. Order one now, and see the difference.

BACA SELENGKAPNYA - Lybrel: Safest option to control pregnancy

Reasons Why 100% Effective Vaginal Odour Treatments “Don’t” Work

Why is it that every piece of information found on vaginal odour treatments or vaginal discharge is nearly always the same? Many women admit to feeling more frustrated over this than that of their actual vaginal concern. Reasons given for this happening is, if inappropriate treatments are used and still no cure then naturally you are drawn like a magnet to once again return for what seems repetitive information? Let us say you have a vaginal odour and would like rid because of embarrassment, then what do you do, you look for medication or a solution to clear the smell. You can prevent further episodes of frustration if the right vaginal odour treatments are used in the first place. Take note all frustrated women, could you be using the wrong treatment, if so then the law of average has it that you will no doubt go back and have to read the same old thing over and over again until you get it right. No treatment no matter how affective will give positive results if treating the wrong condition.

Vaginal odour treatments vary purely because of different causes. These causes can be brought about for many reasons of which need to be determined by your doctor so he/she can get to the root of the problem for why the smell is there. Vaginal odour treatments are only 100% affective if your prescription is to treat the right symptoms. The vagina is an odourless organ of the body, but if your vagina is in the process of releasing an unhealthy smell - then there has to be a perfectly simple explanation for this, and for why there maybe a vaginal itch also. Having an itch around your private parts is not only embarrassing but one that can worsen if infection sets in after the delicate skin surrounding the vagina is torn through fingernails used for relief.

The best course of action to avoid vaginal irritation is to keep the genital area dry giving the region room breathe.

1 Cotton underwear should be worn
2 Change sanitary towels and tampons at regular intervals
3 Refrain from using vaginal sprays, deodorants or other type smellies
4 Remove damp clingy clothing caused through sweating
5 Avoid tight-fitting clothes; not only to help keep vaginal smells at bay but for comfort too
6 Wearing synthetic materials next to the skin can cause irritation
7 Cleanse well after using the loo. Use the front to back motion after bowel movement
8 Hot sweaty conditions should have you wash more

There may be times that you feel the need to go that extra mile by giving the vagina a real good scrub on the inside. Douching is not recommended as it can disturb the vagina's natural acidic balance and increase risk of irritation. A vaginal douche forces water or other fluids into the vaginal cavity to clean away discharge or stubborn period blood. The vulva only needs a daily rinse with warm water. Some fem products may contain scented ingredients which can add to your problem or cause irritation.

Bacterial Vaginosis/vaginitis

Bacterial vaginosis is an inflammation which happens in the vagina and includes several germs that cause bacterial vaginosis yeast infections and trichomoniasis. Bacterial vaginosis is the most common vaginal infection affecting from 10 percent to 64 percent of the female population. If BV is left untreated it can increase risk of pelvic inflammatory disease (PID), endometritis, cervicitis, and cause complications to rise throughout pregnancy. Main causes of bacterial vaginosis include an overgrowth of anaerobic bacteria and the Gardnerella organism.

One familiar symptom of bacterial infection is an unpleasant fishy odor. Itching and/or burning sometimes come with bacterial infections, but are not necessarily a symptom of the condition. Bacterial Vaginosis treatment is relatively easy and effective. BV treatment usually consists of three days or up to a week of applying Cleocin 2% vaginal cream. Oral antibiotic treatment is sometimes given on prescription.

Vaginal Thrush

Thrush is an infection caused by yeast called Candida. Tiny numbers of Candida live on the skin and around the vaginal region. The immune system and the harmless bacteria that normally reside on the skin and in the vagina usually stop Candida from flourishing. Trailing behind bacterial vaginosis, thrush is the second most common cause of a vaginal discharge. Discharge is recognized as white and smooth, but can be loose (watery.) Aside from pain (not all patients) thrush is a female complaint of torment where the symptoms of an itch and redness come to the fore. Symptoms are normally petty and clear up them self. There are various treatments for thrush so it is important for your doctor to be the one who recommends any treatments.

Topical treatments are pessaries and creams which are inserted into the vagina with an applicator. Ingredients include anti-yeast medicines such as clotrimazole, econazole, fenticonazole, or miconazole. You can get topical treatments on prescription, or you can buy them at chemists without a doctor's prescription. Topical treatments can be used if you are expecting a baby.

Two types of tablet for treating thrush are available. Fluconazole is taken as a single dose, or itraconazole which is taken as two doses over the course of 24 hours. Side-effects are rare. Unlike topical treatments these are not to be taken if pregnant or breastfeeding. Anti-yeast cream can be rubbed onto the skin around the vagina to help relieve an itch. Tablet treatments and topical creams are equally effective. Women find the tablets more convenient, although more expensive, but hey girls what's a few extra pennies in comparison to having a healthy vagina.

BACA SELENGKAPNYA - Reasons Why 100% Effective Vaginal Odour Treatments “Don’t” Work

You KNOW you are a nurse when :

You KNOW you are a nurse when :
by Ners HarmokoYou believe that all bleeding stops ... eventually.

You find humor in other people's stupidity.

You believe that 90% of people are a poor excuse for protoplasm.

Discussing dismemberment over a gourmet meal seems perfectly normal to you.

Your idea of fine dining is anywhere you can sit down to eat.

You get an almost irresistible urge to stand and wolf your food even in the nicest restaurants.

You plan your dinner break whilst lavaging an overdose patient.

Your diet consists of food that has gone through more processing than most computers.

You believe chocolate is a food group.

You refer to vegetables and are not talking about a food group.

You have the bladder capacity of five people.

Your idea of a good time is a cardiac arrest at shift change.

You believe in aerial spraying of Prozac.

You disbelieve 90% of what you are told and 75% of what you see.

You have your weekends off planned for a year in advance.

You encourage an obnoxious patient to sign a self discharge form so you don't have to deal with them any longer.

You believe that "shallow gene pool" should be a recognized diagnosis.

You believe that the government should require a permit to reproduce.

You believe that unspeakable evils will befall anyone who utters the phrase "Wow, it's really quiet isn't it".

You threaten to strangle anyone who even starts to say the "q" word when it is even remotely calm.

You say to yourself "great veins" when looking at complete strangers at the grocery store.

You have ever referred to someone's death as a transfer to the "Eternal Care Unit".

You have ever wanted to hold a seminar entitled "Suicide ... Doing It Right".

You feel that most suicide attempts should be given a free subscription to "Guns and Ammo" magazine.

You have ever had a patient look you straight in the eye and say "I have no idea how that got stuck in there".

You have ever had to leave a patient's room before you begin to laugh uncontrollably.

Your favorite hallucinogen is exhaustion.

You think that caffeine should be available in I/V form.

You have ever restrained someone and it was not a sexual experience.

You believe the waiting room should be equipped with a Valium fountain.

You play poker by betting ectopics on ECG strips.

You want the lab to perform a "dumb shit profile".

You have been exposed to so many X-rays that you consider radiation a form of birth control.

You believe that waiting room time should be proportional to length of time from symptom onset.

Your most common assessment question is "what changed tonight to make it an emergency after 6 hours / days / weeks / months / years)?".

You have ever had a patient control his seizures when offered some food.

Your idea of gambling is an blood alcohol level pool instead of a football pool.

You shock someone with an unrecognizable rhythm ... until you get one you DO recognize.

You believe a book entitled 'Suicide: Getting it Right the First Time' will be your next project.

You have ever referred to someone's death as a 'transfer to part 3 accomodation'.

You can identify what kind of diarrhea it is just by the smell.

You will never name a daughter "Melena" or anything along those lines.. and laugh to yourself every time you hear someone by that name

You call subcutaneous emphysema "Rice Krispies".

Your immune system is so well developed that it has been known to attack squirrels in the backyard.

http://askep-askeb.cz.cc/

BACA SELENGKAPNYA - You KNOW you are a nurse when :

CPR Chest Compression Depth Guidelines in Children May Need Revision

The chest compression depth recommended in cardiopulmonary resuscitation (CPR) guidelines for pediatric patients do not appear to be optimal and may be excessive, according to studies in the July issue of Pediatrics.
The studies used computed tomography reconstruction to estimate chest compression depths that would be optimal for infants and children up to 8 years old during cardiopulmonary resuscitation. Current guidelines in that age group call for compressions of one third to one half the external anterior-posterior chest depth.
Dr. Matthew Braga at Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire, and co-authors blame low rates of survival among children who experience cardiac arrest on unproven targets for pediatric chest compressions that are based on extrapolation from adults and animal models.
To provide direct experimental data, Dr. Braga's team examined pediatric chest CT scans previously performed to measure individual chest depths in 14 age groups between birth and 8 years.
Results show that "the current recommendations of one third to one half external anterior-posterior chest depth are not ideal and may not be attainable or safe for all children."
For example, a one-half chest compression in 3- to 12-month-olds would theoretically result in 25% having no residual internal depth, causing harm to structures being compressed. The authors estimate that the same would be true for 21% of 1- to 3-year-olds, and 8% of 3- to 8-year-olds.
According to Dr. Braga and associates, "Use of a constant chest compression depth target of 38 mm would be expected to be adequate for > 98% of 1 to 8-year-old children, with > 10 mm of residual chest depth."
Dr. Matthew Huei-Ming Ma and associates at National Taiwan University Hospital, Taipei, take a similar tack, using chest CT scans of 36 infants and 38 children ages 1 to 8.
They observed that accurate depths of chest compression at the lower half of the sternum and the internipple line revealed no significant difference. Therefore, they maintain, "because guidelines should be modified and simplified for ease of use by either the layperson or health care provider, it is not necessary to provide two choices in the pediatric resuscitation guidelines in the future."
Dr. Ma's team also observed that compression depths according to current guidelines were similar to or even higher than recommended compression depths for adults.
"More scientific debate is needed on this issue for further revision of pediatric CPR guidelines," they conclude.
Pediatrics 2009;124:e69-e74.
Source : http://www.medscape.com/viewarticle/705045?sssdmh=dm1.492967&src=nldne

BACA SELENGKAPNYA - CPR Chest Compression Depth Guidelines in Children May Need Revision

Askep Hiperemesis Gravidarum

HIPEREMESIS GRAVIDARUM

A. Pengertian

Hiperemesis Gravidarum adalah mual dan muntah berlebihan pada wanita hamil sampai mengganggu pekerjaan sehari-hari karena pada umumnya menjadi buruk karena terjadi dehidrasi (Rustam Mochtar, 1998).
Hiperemesis Gravidarum (vomitus yang merusak dalam kehamilan) adalah nousea dan vomitus dalam kehamilan yang berkembang sedemikian luas sehingga menjadi efek sistemik, dehidrasi dan penurunan berat badan (Ben-Zion, MD, Hal:232).
Hiperemesis Gravidarum diartikan sebagai muntah yang terjadi secara berlebihan selama kehamilan (Hellen Farrer, 1999, hal:112).

B. Etiologi

Penyebab hiperemesis gravidarum belum diketahui secara pasti. Frekuensi kejadian adalah 2 per 1000 kehamilan. Faktor-faktor predisposisi yang dikemukakan (Rustam Mochtar, 1998).

• Umumnya terjadi pada primigravida, mola hidatidosa, diabetes dan kehamilan ganda akibat peningkatan kadar HCG
  
• Faktor organik, yaitu karena masuknya viki khoriales dalam sirkulasi maternal dan perubahan metabollik akibat kehamilan serta resitensi yang menurun dari pihak ibu terhadap perubahan–perubahan ini serta adanya alergi yaitu merupakan salah satu respon dari jaringan ibu terhadap janin.
  
• Faktor ini memegang peranan penting pada penyakit ini. Rumah tangga yang retak, kehilangan pekerjaan, takut terhadap kehamilan dan persalinan, takut terhadap tanggungan sebagai ibu dapat menyebabkan konflik mental yang dapat memperberat mual dan muntah sebagai ekspresi tidak sadar terhadap keengganan menjadi hamil atau sebagai pelarian kesukaran hidup.
  
• Faktor endokrin lainnya : hipertyroid, diabetes dan lain-lain.

C. Patofisiologi (Pathway Hiperemesis Gravidarum)
Perasaan mual adalah akibat dari meningkatnya kadar estrogen yang biasa terjadi pada trimester I. bila perasaan terjadi terus-menerus dapat mengakibatkan cadangan karbohidrat dan lemak habis terpakai untuk keperluan energi. Karena oksidasi lemak yang tak sempurna, terjadilah ketosis dengan tertimbunnya asam aseto-asetik, asam hidroksida butirik dan aseton darah. Muntah menyebabkan dehidrasi, sehingga caira ekstraseluler dan plasma berkurang. Natrium dan klorida darah turun. Selain itu dehidrasai menyebabkan hemokonsentrasi, sehingga aliran darah ke jaringan berkurang. Hal ini menyebabkan jumlah zat makanan dan oksigen ke jaringan berkuang pula tertimbunnya zat metabolik yang toksik. Disamping dehidrasi dan gangguan keseimbangan elektrolit. Disamping dehidraasi dan gangguan keseimbangan elektrolit, dapat terjadi robekan pada selaput lendir esofagus dan lambung (sindroma mollary-weiss), dengan akibat perdarahan gastrointestinal.

D. Tanda dan gejala
Batas mual dan muntah berapa banyak yang disebut hiperemesis gravidarum tidak ada kesepakatan. Ada yang mengatakan bila lebih dari sepuluh kali muntah. Akan tetapi apabila keadaan umum ibu terpengaruh dianggap sebagai hiperemesis gravidarum. Menurut berat ringannya gejala dibagi menjadi tiga tingkatan, yaitu :

1. Tingkatan I (ringan)
   
   • Mual muntah terus-menerus yang mempengaruhi keadaan umum penderita
     
   • Ibu merasa lemah
     
   • Nafsu makan tidak ada
     
   • Berat badan menurun
     
   • Merasa nyeri pada epigastrium
     
   • Nadi meningkat sekitar 100 per menit
     
   • Tekanan darah menurun
     
   • Turgor kulit berkurang
     
   • Lidah mengering
     
   • Mata cekung
     
2. Tingkatan II (sendang)
   
   • Penderita tampak lebih lemah dan apatis
     
   • Turgor kulit mulai jelek
     
   • Lidah mengering dan tampak kotor
     
   • Nadi kecil dan cepat
     
   • Suhu badan naik (dehidrasi)
     
   • Mata mulai ikterik
     
   • Berat badan turun dan mata cekung
     
   • Tensi turun, hemokonsentrasi, oliguri dan konstipasi
     
   • Aseton tercium dari hawa pernafasan dan terjadi asetonuria.
     
3. Tingkatan III (berat)
   
   • Keadaan umum lebih parah (kesadaran menurun dari somnolen sampai koma)
     
   • Dehidrasi hebat
     
   • Nadi kecil, cepat dan halus
     
   • Suhu badan meningkat dan tensi turun
     
   • Terjadi komplikasi fatal pada susunan saraf yang dikenal dengan enselopati wernicke dengan gejala nistagmus, diplopia dan penurunan mental
     
   • Timbul ikterus yang menunjukkan adanya payah hati.

E. Penatalaksanaan

1. Pencegahan
   Pencegahan terhadap hiperemesis gravidarum diperlukan dengan jalan memberikan penerapan tentang kehamilan dan persalinan sebagai suatu proses yang fisiologis. Hal itu dapat dilakukan dengan cara :
   
   • Memberikan keyakinan bahwa mual dan muntah merupakan gejala yang fisiologik pada kehamilan muda dan akan hilang setelah kehamilan berumur 4 bulan.
     
   • Ibu dianjurkan untuk mengubah pola makan sehari-hari dengan makanan dalam jumlah kecil tetapi sering.
     
   • Waktu bangun pagi jangan segera turun dari tempat tidur, tetapi dianjurkan untuk makan roti kering arau biskuit dengan teh hangat
     
   • Hindari makanan yang berminyak dan berbau lemak
     
   • Makan makanan dan minuman yang disajikan jangan terlalu panas atau terlalu dingin
     
   • Usahakan defekasi teratur.
     
2. Terapi obat-obatan
   Apabila dengan cara diatas keluhan dan gejala tidak berkurang maka diperlukan pengobatan.
   
   • Tidak memberikan obat yang terotogen
     
   • Sedativa yang sering diberikan adalah phenobarbital
     
   • Vitamin yang sering dianjurkan adalah vitamin B1 dan B6
     
   • Antihistaminika seperti dramamine, avomine
     
   • Pada keadaan berat, anti emetik seperti diklomin hidrokhoride atau khlorpromazine.

Hiperemesis gravidarum tingkatan II dan III harus dirawat inap di rumah sakit. Adapun terapi dan perawatan yang diberikan adalah sebagai berikut :

1. Isolasi
   Penderita disendirikan dalam kamar yang tenang, tetapi cerah dan peredaran udara baik. Jangan terlalu banyak tamu, kalau perlu hanya perawat dan dokter saja yang boleh masuk. Catat cairan yang keluar dan masuk. Kadang-kadang isolasi dapat mengurangi atau menghilangkan gejala ini tanpa pengobatan
   
2. Terapi psikologik
   Berikan pengertian bahwa kehamilan adalah suatu hal yang wajar,normal dan fisiologik. Jadi tidak perlu takur dan khawatir. Yakinkan penderita bahwa penyakit dapat disembuhkan dan dihilangkan masalah atu konflik yang kiranya dapat menjadi latar belakang penyakit ini.
   
3. Terapi mental
   Berikan cairan parenteral yang cukup elektrolit, karbohidrat dan protein dengan glukosa 5 %, dalam cairan gram fisiologis sebanya 2-3 liter sehari. Bila perlu dapat ditambah dengan kalium dan vitamin khususnya vitamin B kompleks dn vitamin C dan bila ada kekurangan protein, dapat diberikan pula asam amino esensial secara intravena. Buat dalam daftar kontrol cairan yang amsuk dan dikeluarkan. Berikan pula obat-obatan seperti yang telah disebutkan diatas.
   
4. Terminasi kehamilan
   Pada beberapa kasus keadaan tidak menjadi baik, bahkan mundur. Usahakan mengadakan pemeriksaan medik dan psikiatrik bila keadaan memburuk. Delirium, kebutaan, takikardia, ikterik, anuria, dan perdarahan merupakan manifestasi komplikasi organik.
   Dalam keadaan demikian perlu dipertimbangkan untuk mengakhiri kehamilan. Keputusan untuk melakukan abortus terapeutik sering sulit diambil, oleh karena disatu pihak tidak boleh dilakukan terlalu capat dan dipihal lain tidak boleh menunggu sampai terjadi irreversible pada organ vital.

F. Diagnosa Keperawatan Yang Muncul

1. Gangguan nutrisi kurang dari kebutuhan tubuh berhubungan dengan kehilangan nutrisi dan cairan yang berlebihan dan intake yang kurang.
   
2. Gangguan rasa nyaman : nyeri ulu hati berhubungan dengan frekuensi muntah yang sering.
   

G.. Intervensi

1. Gangguan nutrisi kurang dari kebutuhan tubuh berhubungan dengan kehilangan nutrisi dan cairan yang berlebihan dan intake yang kurang.
   Tujuan : Nutrisi terpenuhi
   Kriteria Hasil :
   
   1. Berat badan tidak turun.
      
   2. Pasien menghabiskan porsi makan yang di sediakan.
      
   3. Mengkonsumsi suplemen zat besi / vitamin sesuai resep.
   
   Intervensi :
   
   • Tunjukkan keadekuatan kebiasaan asupan nutrisi dulu / sekarang dengan menggunakan batasan 24 jam. Perhatikan kondisi rambut, kulit dan kuku.
     
   • Monitor tanda-tanda dehidrasi : turgor kulit, mukosa mulut dan diuresis.
     
   • Monitor intake dan output cairan.
     
   • Singkirkan sumber bau yang dapat membuat pasien mual, seperti : deodorant / parfum, pewangi ruangan, larutan pembersih mulut.
     
   • Timbang berat badan klien; pastikan berat badan pregravida biasanya. Berikan inforamasi tentang penambahan prenatal yang optimum.
     
   • Tingkatkan jumlah makanan padat dan minuman perlahan sesuai dengan kemampuan.
     
   • Anjurkan pasien untuk minum dalam jumlah sedikit tapi sering.
   
   
2. Gangguan rasa nyaman : nyeri ulu hati berhubungan dengan frekuensi muntah yang sering.
   Tujuan : Nyaman terpenuhi
   Kriteria Hasil :
   
   1. Nyeri berkurang / hilang
      
   2. Ekspresi wajah tenang / rilek, tidak menunjukan rasa sakit.
   
   Intervensi :
   
   • Kaji nyeri (skala, lokasi, durasi dan intensitas)
     
   • Atur posisi tidur senyaman mungkin sesuai dengan kondisi pasien.
     
   • Anjurkan teknik relaksasi dan distraksi.
     
   • Jelaskan penyebab nyeri pada pasien dan keluarga pasien.
     
   • Beri kompres hangat pada daerah nyeri.
     
   • Kaji tanda-tanda vital.
     
   • Kolaborasi medis untuk pemberian obat-obatan analgetika dan antiemetik.
   
   
3. Kurang pengetahuan tentang proses penyakit dan pengobatan berhubungan dengan informasi yang tidak adekuat.
   Tujuan : Pengetahuan pasien tentang penyakit dan pengobatan meningkat.
   Kriteria Hasil :
   
   1. Pasien dapat mengetahui penyakitnya.
      
   2. Dapat mendemonstrasikan perawatan diri dan mengungkapkan secara verbal, mengerti tentang instruksi yang diberikan.
      
   3. Pasien kooperatif dalam program pengobatan.
   
   Intervensi :
   
   • Kaji tingkat pengetahuan pasien tentang proses penyakitnya, gejala, dan tanda, serta yang perlu diperhatikan dalam perawatannya.
     
   • Beri penjelasan tentang proses penyakit, gejala, tanda dan hal-hal yang perlu diperhatikan dalam perawatan dan pengobatan.
     
   • Jelaskan tentang pentingnya perawatan dan pengobatan.
     
   • Jelaskan tentang pentingnya istirahat total.
     
   • Berikan informasi tertulis / verbal yang terpat tentang diet pra natal dan suplemen vitamin / zat besi setiap hari.
     
   • Evaluasi motivasi / sikap, dengan mendengar keterangan klien dan meminta umpan balik tentang informasi yang diberikan.
     
   • Tanyakan keyakinan berkenaan dengan diet sesuai dengan budaya dan hal- hal tabu selama kehamilan.

Hasil Pencarian Untuk Asuhan Keperawatan Askep Hiperemesis Gravidarum
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BACA SELENGKAPNYA - Askep Hiperemesis Gravidarum

Materi Kesehatan: Tanda - tanda Ibu Hamil yang Sehat

Tanda - tanda Ibu Hamil yang Sehat

• Cukup bertenaga dan bersemangat
  
• Nafsu makan baik
  
• Tidak pusing-pusing dan mengalami perubahan penglihatan
  
• Tidak mual dan muntah-muntah berlebihan
  
• Tidak merasa panas disaluran kemih ketika buang air kecil
  
• Tidak ada gatal-gatal di vagina
  
• Tidak ada duh/cairan vagina yang berbau
  
• Tidak kesulitan bernafas
  
• Tidak ada rasa nyeri yang berarti pada perut, punggung dan tungkai
  
• Tidak ada perdarahan dari vagina
  
• Tidak ada bengkak pada tangan dan wajah
  

Dan yang harus diperhatikan oleh ibu hamil adalah diperlukannya istirahat agar tubuh tetap sehat dan kuat, antara lain dengan tidur/berbaring paling sedikit selama 1 jam pada siang hari dan tidur 8 jam pada malam hari.

BACA SELENGKAPNYA - Materi Kesehatan: Tanda - tanda Ibu Hamil yang Sehat

Materi Kesehatan: Cara Menentukan Umur Kehamilan Post Partum Menurut Ballard (1997)

Cara Menentukan Umur Kehamilan Post Partum Menurut Ballard (1997)

KULIT

0 = merah seperti agar transparan

1 = merah muda licin/halus tampak vena

2 = permukaan mengelupas dengan/tanpa ruam, sedikit vena

3 = daerah pucat, retak2, vena jarang

4 = seperti kertas putih, retak lebih dalam tidak ada vena

5 = seperti kulit retak mengkerut

LANUGO

0 = tidak ada

1 = banyak

2 = menipis

3 = menghilang

4 = umumnya tidak ada

5 =……………..

LIPATAN PLANTAR

0 = hampir tidak tampak

1 = tanda merah sangat sedikit

2 = hanya lipatan anterior yang menghilang

3 = lipatan 2/3 anterior

4 = lipatan seluruh tampak

PAYUDARA

0 = hampir tidak tampak

1 = areola mendatar tidak ada tonjolan

2 = areola seperti titik tonjolan 1-2 mm

3 = areola lebih jelas dengan 3-4 mm

4 = areola penuh tonjolan 5-10 mm

DAUN TELINGA

0 = datar tetap terlihat

1 = sedikit melengkung, lunak lambat kembali

2 = bentuknya lebih baik, lunak mudah membalik

3 = bentuk sempurna, membaik seketika

4 = tulang rawan tebal, tulang telinga kaku

KELAMIN LAKI - LAKI

0 = skrotum tidak ada rugae

1 = testis belum turun

2 = testis turun, sedikit rugae

3 = testis dibawah, rugaenya bagus

4 = testis tergantung, rugaenya dalam

KELAMIN WANITA

0 = klitoris dan labia minor menonjol

1 = labia mayor dan minor sama2 menonjol

2 = labia mayor besar, minor kecil

3 = klitoris dan labia minor di tutupi labia mayor

BACA SELENGKAPNYA - Materi Kesehatan: Cara Menentukan Umur Kehamilan Post Partum Menurut Ballard (1997)

Materi Kesehatan: Anak Tunggal atau Kembar

Tanda Anak Kembar adalah :

• perut lebih besar dari pada yang sesuai dengan tuanya kehamilan.
• meraba 3 bagian besar atau lebih (yang di maksud bagian besar adalah kepala dan bokong sedangkan yang kecil adalah kaki dan tangan.
• meraba 2 bagian besar berdampingan.
• meraba banyak bagian-bagian kecil.
• mendengar bunyi jantung anak pada dua tempat dengan sama jelasnya dan memiliki perbedaan frekwensi 10 denyut atau lebih dalam 1 menit.
• pemeriksaan elektrokardiografi, ultrasound.
• pada hydramnion selalu harus diingat kemungkinan kehamilan kembar.
• pada RO foto ultrasonogram nampak 2 kerangka janin.

BACA SELENGKAPNYA - Materi Kesehatan: Anak Tunggal atau Kembar

Materi Kesehatan: Perbedaan Primigravida dan Multigravida

Perbedaan Primigravida dan Multigravida

Primigravida :

• buah dada tegang
• puting susu runcing
• perut tegang dan menonjol kedepan
• striae lividae
• perineum utuh
• vulva tertutup
hymen perforatus
• vagina sempit dan teraba rugae
• portio runcing, ost. ext. tertutup

Multigravida :

• lembek, menggantung
• puting susu tumpul
• perut lembek dan tergantug
• striae lividae dan striae albicans
• perineum berparut
• vulva mengangah
• carunculae myrtiformis
• vagina longgar, selaput lendir licin
• portio timpul dan terbagi dalam bibir depan dan bibir belakang.

BACA SELENGKAPNYA - Materi Kesehatan: Perbedaan Primigravida dan Multigravida

Materi Kesehatan: Pemeriksaan Umum Kehamilan

Apa sajakah Pemeriksaan Umum Kehamilan ?

1. Bagaimana keadaan umum penderita, keadaan gizi, kelainan bantuk badan, kesadaran.
2. Adakah anemia, cyanosis, icterus, atau dyspnoe.
3. Keadaan jantung dan paru-paru.
4. Adakah oedem :
   Oedema dalah kehamilan dapat disebabkan oleh toxemia gravidarum atau oleh tekanan rahim yang membesar pada vena-vena dalam panggul yang mengalirkan darah dari kaki, tetapi juga oleh hypovitaminose B1, hypoproteinaemia dan penyakit jantung.
5. Refleks :
   terutama refleks lutut. Refleks lutut negatif pada hypovitaminose B1 dan penyakit urat syaraf.
6. Tensi :
   Tensi pada orang hamil tidak boleh mencapai 140 systolis atau 90 diastolis.
   Juga perubahan 30 systolis dan 15 diastolis di atas tensi sebelum hamil menandakan toxemia gravidarum.
7. Berat badan :
   walaupun prognosa kehamilan dan persalinan bagi orang gemuk kurang baik di bandingkan dengan orang yang normal beratnya, dalam menimbang seseorang bukan beratnya saja yang penting, tapi lebih penting lagi perubahan berat setiap kali ibu memeriksakan diri.
   Berat badan dalam triwulan ke III tidak boleh tambah lebih dari 1 kg seminggu atau 3 kg sebulan.
   Penambahan yang lebih dari batas-batas tersebut di atas disebabkan oleh penimbunan (retensi) air dan di sebut praoedema.
8. Pemeriksaan Laboratorium
   • Air kencing :
     - terutama diperiksa atas glukose, zat putih telur dan sedimen.
     Adanya glukose dalam urine orang hamil harus dianggap sebagai gejala penyakit diabetes kecuali kalau kita dapat membuktikan bahwa hal-hal lain yang menyebabkannya.
     -Dalam akhir kehamilan dan dalam nifas reaksi reduksi dapat menjadi positif adanya laktose dalam air kencing. Zat putih telur positsf dalam air kencing pada nefritis, toxemia gravidarum dan radang dari saluran kencing.
   • Darah :
     - dari darah perlu ditentukan Hb, sekali 3 bulan karena pada orang hamil sering timbul anemia karena defisiensi Fe.
     - Selanjutnya perlu di periksa reaksi seroogis (WR) dan golongan darah. Juga pemeriksaan kadar gula darah. Reaksi Wasserman positif dan lues, tetapi juga pada fraimboesia.
     Golongan darah ditentukan supaya kita cepat dapat mencairkan darah yang cocok jika penderita memerlukannya. Kalau ibu golongan O maka mungkin timbul ABO antagonisme.
   • Faeces diperiksa atas telur-telur cacing.

BACA SELENGKAPNYA - Materi Kesehatan: Pemeriksaan Umum Kehamilan

Materi Kesehatan: Keluhan Normal Ibu Hamil

Keluhan Normal yang Biasa terjadi pada Kehamilan

• Mual-mual ringan pada 3-4 bulan pertama kehamilan
  
• Sering mengantuk pada 3-4 bulan pertama kehamilan dan pada minggu terakhir kehamilan
  
• Rasa nyeri anggota tubuh yang akan hilang bila beristirahat, dipijat,atau berolahraga
  
• Napas sedikit sesak pada kehamilan 8-9 bulan karena desakan janin.

BACA SELENGKAPNYA - Materi Kesehatan: Keluhan Normal Ibu Hamil

Materi Kesehatan: Menghitung Taksiran Persalinan

Cara Menghitung Hari Taksiran Persalinan (HTP) dan Umur Kehamilan Berdasarkan Haid Terakhir

Pemeriksaan Kehamilan

Metoda I : Metoda Kalender (untuk HTP)

Hari Pertama haid teakhir (HPHT) untuk tanggal ditambahkan 7 hari, untuk bulan dikurangi 3 bulan dan untuk tahun ditambahkan 1 tahun. Misalnya, HPHT tanggal 12 April 1980, maka untuk hari 12 + 7 = 19 jadi tanggal 19, untuk bulan April : 4 - 3 =1 jadi bulan Januari, untuk tahun ditambah 1 tahun 1980 + 1 =1981 jadi tahun 1981. Jadi HTPnya adalah 19 Januari 1981.


Metoda II : Metoda Bulan (untuk HTP)

Bila ibu hamil mempunyai siklus haid 28 hari (4 minggu), bayi akan lahir tepat 40 minggu atau setelah 10 bulan purnama, bila HPHTnya pada waktu bulan purnama.


Metoda III : Metoda "Roda Kehamilan" (untuk HTP dan Umur Kehamilan)

Perhitungan dilakukan dengan menggunakan "Roda Kehamilan" atau gestogram (bila ada).


Metoda IV (untuk Umur Kehamilan)


Hitung berapa bulan sudah berlalu sejak HPHT sampai saat pertama kali memeriksakan kehamilan. Misalnya, HPHT pada tanggal 6 April dan ibu memeriksakan diri pada tanggal 12 Juni, maka kehamilannya pada waktu itu telah berumur 2 bulan lebih sedikit.

Umur Kehamilan diperhitungkan dan dibandingkan dengan ukuran uterus, untuk melihat apakah janin tumbuh semakin besar pada setiap kunjungan ulangan.

BACA SELENGKAPNYA - Materi Kesehatan: Menghitung Taksiran Persalinan