HELLP syndrome is a group of symptoms that occur in pregnant women who have:
* H -- hemolysis
* EL -- elevated liver enzymes
* LP -- low platelet count
Causes
HELLP syndrome occurs in approximately 10% of pregnant women with preeclampsia or eclampsia. HELLP syndrome is associated with more serious cases.
Many women have high blood pressure and are diagnosed with preeclampsia before they develop HELLP syndrome. However, in some cases, HELLP symptoms are the first warning of preeclampsia and the condition is misdiagnosed as hepatitis, gallbladder disease, idiopathic thrombocytopenic purpura, or thrombotic thrombocytopenic purpura.
Symptoms
* Headache
* Nausea and vomiting that continues to get worse
* Upper abdominal pain
* Vision problems
Exams and Tests
During a physical examination, the doctor may discover upper abdominal tenderness, especially in the right upper side. The liver may be enlarged.
Liver function tests (liver enzymes) may be elevated. Red blood cell and platelet counts may be low.
Treatment
The main treatment is to deliver the baby as soon as possible, even if premature, since liver function in the mother gets worse very quickly. Problems with the liver can be harmful to both mother and child.
Outlook (Prognosis)
When the disease is not treated early, up to 25% of women develop serious complications. Without treatment, a small number of women die. The death rate among babies born to mothers with HELLP syndrome varies and depends on birth weight and the development of the baby's organs, especially the lungs. (See also: Prematurity)
Possible Complications
The mother's liver may bleed (hemorrhage). Permanent liver damage may occur if delivery is delayed. Such damage can lead to death.
When to Contact a Medical Professional
See your obstetrician immediately, call the local emergency number (such as 911), or get to the emergency room if the symptoms above occur during pregnancy.
Although there is no known way to prevent HELLP syndrome, it is important for all pregnant women to start prenatal care early and continue it through the pregnancy. This allows the health care provider to find and treat conditions such as HELLP syndrome early.
References
Sibai BM. Hypertension. In: Gabbe SG, Niebyl JR, Simpson JL, eds. Obstetrics - Normal and Problem Pregnancies. 5th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2007:chap 33.
Martin JN, Rose CH, Briery CM. Understanding and managing HELLP syndrome: The integral role of aggressive glucocorticoids for mother and child. American Journal of Obstetrics and Gynecology. 2006; 195(914-34).
Update Date: 10/28/2008
Updated by: Linda Vorvick, MD, Seattle Site Coordinator, Lecturer, Pathophysiology, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine; and Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Redmond, Washington ; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
Minggu, 09 Januari 2011
Kamis, 17 Juni 2010
Studies Suggest New Treatment Paradigms for Ovarian, Prostate Cancers
Monday, June 7, 2010
HealthDay news imageSUNDAY, June 6 (HealthDay News) -- New research points toward novel ways to treat ovarian and prostate cancer, while producing a disappointment for those with a certain form of colon cancer.
Both the ovarian and prostate cancer trials could change clinical practice, with more women taking the drug bevacizumab (Avastin) to combat the disease in its advanced stages and more men getting radiation therapy for locally advanced prostate cancer, according to researchers who presented the findings Sunday at the American Society of Clinical Oncology (ASCO) annual meeting in Chicago.
A third trial, looking at the effectiveness of cetuximab (Erbitux) in treating certain colon cancer patients, found the drug made little difference to their survival.
The first study found that adding Avastin to standard chemotherapy (carboplatin and paclitaxel) and continuing with "maintenance" Avastin after chemo actually slowed the time-to-disease recurrence in women with advanced ovarian cancer.
Avastin is an anti-angiogenic drug, meaning it interferes with a tumor's blood supply.
"This is the first molecular-targeted and first anti-angiogenesis therapy to demonstrate benefit in this population and, combined with chemotherapy followed by [Avastin] maintenance, should be considered as one standard option for women with this disease," said lead researcher Dr. Robert A. Burger, director of the Women's Cancer Center at Fox Chase Cancer Center in Philadelphia.
"This is a new potential treatment paradigm for stage 3 and 4 ovarian cancer," added Dr. Jennifer Obel, an attending physician at Northshore University Health System and moderator of a Sunday news conference at which these results were presented.
The phase 3 study involved almost 1,900 women with stage 3 and stage 4 ovarian cancer.
Those who received standard chemotherapy plus Avastin, and then maintenance Avastin, for up to 10 months lived just over 14 months without their disease progressing compared with about 10 months for those receiving standard chemotherapy alone.
Those who received chemo plus Avastin but no maintenance drug lived without a recurrence for 11.2 months, a difference not considered statistically significant.
"I'm cautiously optimistic about this data. It clearly shows that those who had maintenance [Avastin] had improved profession-free survival," said Dr. Robert Morgan, co-director of the gynecologic oncology program at City of Hope Cancer Center in Duarte, Calif. "I think we have to wait for longer term outcomes before we make definite conclusions. It's too early for overall survival benefit data."
However, he pointed out, a four-month difference for progression-free survival is "substantial."
Doctors are already using Avastin off-label widely to treat ovarian cancer, he said, although it is not yet approved for this use. It has been shown to be more active in this cancer than in many cancers for which it is approved, Morgan noted.
"Clinicians will need to make decisions based upon the specific subsets of patients with advanced ovarian cancer, including the stage of the cancer," added Dr. Ursula Matulonis, director of medical gynecologic oncology at Dana-Farber Cancer Institute and an associate professor of medicine at Harvard Medical School in Boston.
"Also, Avastin has a lot of side effects," she pointed out. "The physician has to balance the benefit vs. the risk."
A second phase 3 study presented Sunday found that adding radiation to hormone therapy, also known as androgen-deprivation therapy (ADT) in patients with locally advanced or high-risk prostate cancer reduced the seven-year risk of dying by 43 percent compared to treating with hormone therapy alone.
"We know that radiation is better if added to ADT, but we didn't know if we could treat patients with ADT alone," said Obel. "The message here is that radiation is an indispensable element in the treatment of high-risk prostate cancer patients."
In the Canadian study, more than 1,200 men were randomized to receive either hormone therapy alone or hormone therapy with radiation.
Over the next seven years, those in the combination group had a 43 percent lower risk of dying from prostate cancer, the team found.
"After seven years, 74 percent of patients with the combined treatment were alive as compared to 66 percent in the ADT group alone," noted study author Dr. Padraig Warde, deputy head of the radiation medicine program at the University of Toronto's Princess Margaret Hospital. "At seven years, only 10 percent of patients who received radiation and ADT had died of prostate cancer vs. 21 percent in the ADT-alone group."
"Patients treated with the combined treatment -- radiation and hormones -- live longer and are less likely to die of prostate cancer," he said. "Radiation treatments should be part of the treatment package for this group of patients."
Also, radiation doses are higher today and may be even more potent, he added.
Finally, yet another phase 3 study -- albeit one with less encouraging results -- found that the monoclonal antibody drug cetuximab (Erbitux) did not aid people with (potentially curable) early-stage colon cancer if they carried the normal form of the KRAS gene.
The finding was a blow, given that Erbitux has helped patients with more advanced cancers.
Patients in this study had the normal form of the KRAS gene, for which the drug works in more advanced cancer.
The more than 1,600 patients in the study were followed for almost 16 months and were also treated with conventional chemotherapy.
"Much to our surprise, the trial showed that patients receiving standard therapy compared to those receiving cetuximab with standard therapy had no difference in outcomes," said study author Dr. Steven Alberts, a professor of oncology at the Mayo Clinic College of Medicine in Rochester, Minn. "It also indicates that disease in earlier stages may be different than diseases in later stages."
The trial, which was supported by the U.S. National Institutes of Health, Bristol-Myers Squibb, ImClone, Sanofi-Aventis and Pfizer, was halted after researchers realized there was no added benefit.
SOURCES: June 6, 2010, news conference with: Jennifer Obel, M.D., attending physician, Northshore University Health System, Padraig Warde, MBChB, deputy head, radiation medicine program, Princess Margaret Hospital, University of Toronto, Steven Alberts, M.D., professor, oncology, Mayo Clinic College of Medicine, Rochester, Minn. and Robert A. Burger, M.D., director, Women's Cancer Center, Fox Chase Cancer Center, Philadelphia; Robert Morgan, M.D., co-director, gynecologic oncology program, City of Hope Cancer Center, Duarte, Calif.; Ursula Matulonis, M.D., director, medical gynecologic oncology, Dana-Farber Cancer Institute, and associate professor, medicine, Harvard Medical School, Boston
HealthDay
HealthDay news imageSUNDAY, June 6 (HealthDay News) -- New research points toward novel ways to treat ovarian and prostate cancer, while producing a disappointment for those with a certain form of colon cancer.
Both the ovarian and prostate cancer trials could change clinical practice, with more women taking the drug bevacizumab (Avastin) to combat the disease in its advanced stages and more men getting radiation therapy for locally advanced prostate cancer, according to researchers who presented the findings Sunday at the American Society of Clinical Oncology (ASCO) annual meeting in Chicago.
A third trial, looking at the effectiveness of cetuximab (Erbitux) in treating certain colon cancer patients, found the drug made little difference to their survival.
The first study found that adding Avastin to standard chemotherapy (carboplatin and paclitaxel) and continuing with "maintenance" Avastin after chemo actually slowed the time-to-disease recurrence in women with advanced ovarian cancer.
Avastin is an anti-angiogenic drug, meaning it interferes with a tumor's blood supply.
"This is the first molecular-targeted and first anti-angiogenesis therapy to demonstrate benefit in this population and, combined with chemotherapy followed by [Avastin] maintenance, should be considered as one standard option for women with this disease," said lead researcher Dr. Robert A. Burger, director of the Women's Cancer Center at Fox Chase Cancer Center in Philadelphia.
"This is a new potential treatment paradigm for stage 3 and 4 ovarian cancer," added Dr. Jennifer Obel, an attending physician at Northshore University Health System and moderator of a Sunday news conference at which these results were presented.
The phase 3 study involved almost 1,900 women with stage 3 and stage 4 ovarian cancer.
Those who received standard chemotherapy plus Avastin, and then maintenance Avastin, for up to 10 months lived just over 14 months without their disease progressing compared with about 10 months for those receiving standard chemotherapy alone.
Those who received chemo plus Avastin but no maintenance drug lived without a recurrence for 11.2 months, a difference not considered statistically significant.
"I'm cautiously optimistic about this data. It clearly shows that those who had maintenance [Avastin] had improved profession-free survival," said Dr. Robert Morgan, co-director of the gynecologic oncology program at City of Hope Cancer Center in Duarte, Calif. "I think we have to wait for longer term outcomes before we make definite conclusions. It's too early for overall survival benefit data."
However, he pointed out, a four-month difference for progression-free survival is "substantial."
Doctors are already using Avastin off-label widely to treat ovarian cancer, he said, although it is not yet approved for this use. It has been shown to be more active in this cancer than in many cancers for which it is approved, Morgan noted.
"Clinicians will need to make decisions based upon the specific subsets of patients with advanced ovarian cancer, including the stage of the cancer," added Dr. Ursula Matulonis, director of medical gynecologic oncology at Dana-Farber Cancer Institute and an associate professor of medicine at Harvard Medical School in Boston.
"Also, Avastin has a lot of side effects," she pointed out. "The physician has to balance the benefit vs. the risk."
A second phase 3 study presented Sunday found that adding radiation to hormone therapy, also known as androgen-deprivation therapy (ADT) in patients with locally advanced or high-risk prostate cancer reduced the seven-year risk of dying by 43 percent compared to treating with hormone therapy alone.
"We know that radiation is better if added to ADT, but we didn't know if we could treat patients with ADT alone," said Obel. "The message here is that radiation is an indispensable element in the treatment of high-risk prostate cancer patients."
In the Canadian study, more than 1,200 men were randomized to receive either hormone therapy alone or hormone therapy with radiation.
Over the next seven years, those in the combination group had a 43 percent lower risk of dying from prostate cancer, the team found.
"After seven years, 74 percent of patients with the combined treatment were alive as compared to 66 percent in the ADT group alone," noted study author Dr. Padraig Warde, deputy head of the radiation medicine program at the University of Toronto's Princess Margaret Hospital. "At seven years, only 10 percent of patients who received radiation and ADT had died of prostate cancer vs. 21 percent in the ADT-alone group."
"Patients treated with the combined treatment -- radiation and hormones -- live longer and are less likely to die of prostate cancer," he said. "Radiation treatments should be part of the treatment package for this group of patients."
Also, radiation doses are higher today and may be even more potent, he added.
Finally, yet another phase 3 study -- albeit one with less encouraging results -- found that the monoclonal antibody drug cetuximab (Erbitux) did not aid people with (potentially curable) early-stage colon cancer if they carried the normal form of the KRAS gene.
The finding was a blow, given that Erbitux has helped patients with more advanced cancers.
Patients in this study had the normal form of the KRAS gene, for which the drug works in more advanced cancer.
The more than 1,600 patients in the study were followed for almost 16 months and were also treated with conventional chemotherapy.
"Much to our surprise, the trial showed that patients receiving standard therapy compared to those receiving cetuximab with standard therapy had no difference in outcomes," said study author Dr. Steven Alberts, a professor of oncology at the Mayo Clinic College of Medicine in Rochester, Minn. "It also indicates that disease in earlier stages may be different than diseases in later stages."
The trial, which was supported by the U.S. National Institutes of Health, Bristol-Myers Squibb, ImClone, Sanofi-Aventis and Pfizer, was halted after researchers realized there was no added benefit.
SOURCES: June 6, 2010, news conference with: Jennifer Obel, M.D., attending physician, Northshore University Health System, Padraig Warde, MBChB, deputy head, radiation medicine program, Princess Margaret Hospital, University of Toronto, Steven Alberts, M.D., professor, oncology, Mayo Clinic College of Medicine, Rochester, Minn. and Robert A. Burger, M.D., director, Women's Cancer Center, Fox Chase Cancer Center, Philadelphia; Robert Morgan, M.D., co-director, gynecologic oncology program, City of Hope Cancer Center, Duarte, Calif.; Ursula Matulonis, M.D., director, medical gynecologic oncology, Dana-Farber Cancer Institute, and associate professor, medicine, Harvard Medical School, Boston
HealthDay
Rabu, 16 Juni 2010
ASUHAN KEPERAWATAN (MORBILI/GABAG)
I. A. Definisi
Morbili adalah penyakit virus akut, menular yang ditandai dengan 3 stadium, yaitu
stadium prodormal ( kataral ), stadium erupsi dan stadium konvalisensi, yang
dimanifestasikan dengan demam, konjungtivitis dan bercak koplik ( Ilmu
Kesehatann Anak Edisi 2, th 1991. FKUI ).
Morbili adalah penyakit anak menular yang lazim biasanya ditandai dengan gejala –
gejala utama ringan, ruam serupa dengan campak ringan atau demam, scarlet,
pembesaran serta nyeri limpa nadi ( Ilmu Kesehatan Anak vol 2, Nelson, EGC,
2000 ).
Generated by Foxit PDF Creator © Foxit Software
http://www.foxitsoftware.com For evaluation only.
B. Patofisiologi
Droplet Infection
Virus Morbili
Eksudat yang serius, droliferasi sel mononukleus,
polimorfonukleus
Reaksi Inflamasi : Demam, suhu naik,
metabolisme naik, RR naik, IWL naik
Gangguan rasa nyaman :
Peningkatan suhu tubuh
Penyebaran ke berbagai organ melalui
hematogen
Resiko kurang volume cairan
Saluran cerna
Terdapat bercak koplik berwarna
kelabu dikelilingi eritema pada
mukosa bukalis, berhadapan pada
molar, palatum durum, mole
Mulut pahit timbul Anorexia
Gangguan kebutuhan
nutrisi < kebutuhan
Hygiene tidak dijaga dan
Imunitas kurang akan
meluas pada saluran cerna
bagian bawah ( usus )
Absorpsi turun
Diare
( BAB terus menerus )
Iritasi
Gangguan Integritas Kulit
Kurang volume cairan
elektrolit
Saluran nafas
Inflamasi saluran nafas
atas; bercak koplik pada
mukosa bukalis meluas
ke jari trakeobronkial
Batuk, pilek, RR
Gangguan
Polanafas; bersihan
jalan nafas
Brochopneumonia
Konjungtiva
Radang
Konjungtivis
Gangguan Persepsi
sensori
Kulit menonjol
sekitar sebasea dan
folikel rambut
Eritema membentuk
macula papula di
kulit normal
Rash, ruam pada daerah
balik telinga, leher, pipi,
muka, seluruh tubuh ,
deskuamasi rasa gatal
Gangguan Integritas
kulit
Gangguan Istirahat
Tidur
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II. Pengkajian
A. Identitas diri :
B. Pemeriksaan Fisik :
1) Mata : terdapat konjungtivitis, fotophobia
2) Kepala : sakit kepala
3) Hidung : Banyak terdapat secret, influenza, rhinitis/koriza, perdarahan
hidung ( pada stad eripsi ).
4) Mulut & bibir : Mukosa bibir kering, stomatitis, batuk, mulut terasa pahit.
5) Kulit : Permukaan kulit ( kering ), turgor kulit, rasa gatal, ruam
makuler pada leher, muka, lengan dan kaki ( pada stad.
Konvalensi ), evitema, panas ( demam ).
6) Pernafasan : Pola nafas, RR, batuk, sesak nafas, wheezing, renchi, sputum
7) Tumbuh Kembang : BB, TB, BB Lahir, Tumbuh kembang R/ imunisasi.
8) Pola Defekasi : BAK, BAB, Diare
9) Status Nutrisi : intake – output makanan, nafsu makanan
C. Keadaan Umum : Kesadaran, TTV
III. Nursing Care Plan
A. Dx. Kep yang mungkin muncul
1) Gangguan rasa nyaman : peningkatan suhu tubuh
2) Resiko kurang volume cairan
3) Gangguan kebutuhan nutrisi kurang dari kebutuhan tubuh
4) Resiko terjadi gangguan pola nafas
5) Gangguan persepsi sensori
6) Gangguan integritas kulit
7) Gangguan istirahat tidur
8) Intoleransi aktivitas
B. Perencanaan Asuhan Keperawatan
1) Dx. Keperawatan 1
Dx Gangguan rasa nyaman : peningkatan suhu tubuh bd proses inflamasi
Data Subjektif :
•Pasien mengeluh pusing
•Pasien mengeluh panas
Data Objektif :
•Suhu tubuh
•Pasien tampak gelisah
•Mukosa mulut kering
•Keringat berlebihan
•Frekuensi pernafasan meningkat
•Kejang
•Takikardi
•Kulit terasa panas
Tujuan :
•Suhu tubuh normal dalam jangka waktu…
Kriteria Hasil :
•Suhu tubuh 36,6 – 37,4 0 C
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•Bibir lembab
•Nadi normal
•Kulit tidak terasa panas
•Tidak ada gangguan neurologis ( kejang )
•Aktivitas sisi kemampuan
Rencana Tindakan :
•Identifikasi penyebab atau factor yang dapat
menimbulkan peningkatan suhu tubuh: dehidrasi,
infeksi, efek obat, hipertiroid.
•Observasi TNSR per …..
•Observasi fungsi neurologis : status mental, reaksi
terhadap stimulasi dan reaksi pupil.
•Observasi cairan masuk dan keluar, hitung balance
cairan
•Observasi tanda kejang mendadak
•Beri cairan sesuai kebutuhan bila tidak kontraindikasi
•Berikan kompres air hangat
•Berikan cairan dan karbohidrat yang cukup untuk
meningkatkan hipermetabolisme akibat peningkatan
suhu.
•Anjurkan pasien untuk mengurangi aktivitas yang
berlebihan bila suhu naik / bedrest total.
•Anjurkan dan bantu pasien menggunakan pakaian
yang mudah menyerap keringat.
•Kolaborasi :
Pemberian anti piretik
Pemberian anti biotic
Pemeriksaan penunjang
2) Dx. Keperawatan 2
Dx Resiko kekurangan volume cairan tubuh B. D kehilangan sekunder terhadap
demam.
Data Subjektif :
•Pasien mengeluh haus
•Pasien mengeluh lemas
•Pasien mengeluh mencret ….x/hr
•Pasien mengeluh muntah …x/hr
Data Objektif :
•TD…mmttg, N..x/mnt, S.. 0 C, RR…x/mnt
•Turgor kulit jelek
•Perubahan produksi urine…cc/ 24 jam
•Penurunan pengisian vena ( capillary refill )
•Volume dan tekanan nadi menurun
•Denyut nadi meningkat
•Demam
•Kulit kering
•Bibir kering
•Mata cekung
•Akral dingin
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Tujuan :
•Tidak terjadi kekurangan volume cairan tubuh dalam
jangka waktu ….
Kriteria Hasil :
•Turgor baik
•Produksi urine …cc/jam <0,5 – 1 cc/kg BB/jam
•Kulit lembab
•TTV dalam batas normal
•Mukosa mulut lembab
•Cairan masuk dan keluar seimbang
•Tidak pusing pada perubahan posisi
•Tidak haus
•Hb, Ht, dbn
Rencana Tindakan :
•Observasi penyebab kekurangan cairan : muntah,
diare, kesulitan menelan, kekurangan darah aktif,
diuretic, depresi, kelelahan
•Observasi TNSR…
•Observasi tanda – tanda dehidrasi
•Observasi keadaan turgon kulit, kelembaban,
membran mukosa
•Monitor pemasukan dan pengeluaran cairan bila
kekurangan cairan terjadi secara mendadak, ukur
produksi urine setiap jam, berat jenis dan observasi
warna urine.
•Catat dan ukur jumlah dan jenis cairan masuk dan
keluar per….
•Perhatikan : cairan yang masuk, kecepatan tetesan
untuk mencegah edema paru, dispneu, bila pasien
terpasang infus
•Timbang BB setiap hari
•Pertahankan bedrest selama fase akut
•Ajarkan tentang masukan cairan yang adekuat, tanda
serta cara mengatasi kurang cairan
•Kolaborasi :
Pemberian cairan parenteral sesuai indikasi
Pemberian obat sesuai indikasi
Observasi kadar elektronik, Hb,Ht
3) Dx. Keperawatan 3
Dx. perubahan nutrisi kurang dari kebutuhan tubuh : Asupan makanan yang
kurang
Data Subjektif :
•Pasien mengatakan mual
•Pasien mengatakan tidak nafsu makan
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•Pasien mengatakan susah makan
Data Objektif :
•Bising usus….x/mnt
•Mukosa mulut kering
•Vomitus ….cc
•Porsi makan : …..porsi
•Hb …., Albumin…..
•Konjungtiva dan selaput lendir pucat
•Terdapat bercak – bercak merah pada mukosa mulut
Tujuan :
•Pasien dapat memperbaiki status gizi (nutrisi ) dalam
jangka waktu
Kriteria Hasil :
•BB meningkat
•Mual berkurang / hilang
•Tidak ada muntah
•Pasien menghabiskan makan 1 porsi
•Nafsu makan meningkat
•Pasien menyebutkan manfaat nutrisi
•Pasien mengungkapkan kesediaan mematuhi diit
•Tidak ada tanda – tanda malnutrisi
•Nilai Hb, Protein dalam batas normal
Rencana Tindakan :
•Kaji pola makan pasien
•Observasi mual dan muntah
•Jelaskan pentingnya nutrisi yang adekuat untuk
kesembuhan
•Kaji kemampuan untuk mengunyah dan menelan
•Auskultasi bising usus, catat adanya penurunan atau
hilangnya bising usus.
•Beri posisi semi fowler / fowler saat makan
•Identifikasi factor pencetus mual , muntah , diare,
nyeri abdomen
•Kaji makanan yang disukai dan tidak disukai sesuai
diit
•Sajikan makanan dalam keadaan hangat dan menarik
•Bantu pasien untuk makan , catat jumlah makanan
yang masuk
•Hindari makanan dan minuman yang merangsang
•Lakukan perawatan mulut sebelum dan sesudah
makan.
•Kolaborasi :
Penatalaksanaan diit yang sesuai ( dengan ahli gizi
)
Pemberian nutrisi parenteral
Pemberian anti emetik
Pemberian multivitamin, cara pemberian makanan
/ tambahan.
Generated by Foxit PDF Creator © Foxit Software
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Generated by Foxit PDF Creator © Foxit Software
http://www.foxitsoftware.com For evaluation only.
Morbili adalah penyakit virus akut, menular yang ditandai dengan 3 stadium, yaitu
stadium prodormal ( kataral ), stadium erupsi dan stadium konvalisensi, yang
dimanifestasikan dengan demam, konjungtivitis dan bercak koplik ( Ilmu
Kesehatann Anak Edisi 2, th 1991. FKUI ).
Morbili adalah penyakit anak menular yang lazim biasanya ditandai dengan gejala –
gejala utama ringan, ruam serupa dengan campak ringan atau demam, scarlet,
pembesaran serta nyeri limpa nadi ( Ilmu Kesehatan Anak vol 2, Nelson, EGC,
2000 ).
Generated by Foxit PDF Creator © Foxit Software
http://www.foxitsoftware.com For evaluation only.
B. Patofisiologi
Droplet Infection
Virus Morbili
Eksudat yang serius, droliferasi sel mononukleus,
polimorfonukleus
Reaksi Inflamasi : Demam, suhu naik,
metabolisme naik, RR naik, IWL naik
Gangguan rasa nyaman :
Peningkatan suhu tubuh
Penyebaran ke berbagai organ melalui
hematogen
Resiko kurang volume cairan
Saluran cerna
Terdapat bercak koplik berwarna
kelabu dikelilingi eritema pada
mukosa bukalis, berhadapan pada
molar, palatum durum, mole
Mulut pahit timbul Anorexia
Gangguan kebutuhan
nutrisi < kebutuhan
Hygiene tidak dijaga dan
Imunitas kurang akan
meluas pada saluran cerna
bagian bawah ( usus )
Absorpsi turun
Diare
( BAB terus menerus )
Iritasi
Gangguan Integritas Kulit
Kurang volume cairan
elektrolit
Saluran nafas
Inflamasi saluran nafas
atas; bercak koplik pada
mukosa bukalis meluas
ke jari trakeobronkial
Batuk, pilek, RR
Gangguan
Polanafas; bersihan
jalan nafas
Brochopneumonia
Konjungtiva
Radang
Konjungtivis
Gangguan Persepsi
sensori
Kulit menonjol
sekitar sebasea dan
folikel rambut
Eritema membentuk
macula papula di
kulit normal
Rash, ruam pada daerah
balik telinga, leher, pipi,
muka, seluruh tubuh ,
deskuamasi rasa gatal
Gangguan Integritas
kulit
Gangguan Istirahat
Tidur
Generated by Foxit PDF Creator © Foxit Software
http://www.foxitsoftware.com For evaluation only.
II. Pengkajian
A. Identitas diri :
B. Pemeriksaan Fisik :
1) Mata : terdapat konjungtivitis, fotophobia
2) Kepala : sakit kepala
3) Hidung : Banyak terdapat secret, influenza, rhinitis/koriza, perdarahan
hidung ( pada stad eripsi ).
4) Mulut & bibir : Mukosa bibir kering, stomatitis, batuk, mulut terasa pahit.
5) Kulit : Permukaan kulit ( kering ), turgor kulit, rasa gatal, ruam
makuler pada leher, muka, lengan dan kaki ( pada stad.
Konvalensi ), evitema, panas ( demam ).
6) Pernafasan : Pola nafas, RR, batuk, sesak nafas, wheezing, renchi, sputum
7) Tumbuh Kembang : BB, TB, BB Lahir, Tumbuh kembang R/ imunisasi.
8) Pola Defekasi : BAK, BAB, Diare
9) Status Nutrisi : intake – output makanan, nafsu makanan
C. Keadaan Umum : Kesadaran, TTV
III. Nursing Care Plan
A. Dx. Kep yang mungkin muncul
1) Gangguan rasa nyaman : peningkatan suhu tubuh
2) Resiko kurang volume cairan
3) Gangguan kebutuhan nutrisi kurang dari kebutuhan tubuh
4) Resiko terjadi gangguan pola nafas
5) Gangguan persepsi sensori
6) Gangguan integritas kulit
7) Gangguan istirahat tidur
8) Intoleransi aktivitas
B. Perencanaan Asuhan Keperawatan
1) Dx. Keperawatan 1
Dx Gangguan rasa nyaman : peningkatan suhu tubuh bd proses inflamasi
Data Subjektif :
•Pasien mengeluh pusing
•Pasien mengeluh panas
Data Objektif :
•Suhu tubuh
•Pasien tampak gelisah
•Mukosa mulut kering
•Keringat berlebihan
•Frekuensi pernafasan meningkat
•Kejang
•Takikardi
•Kulit terasa panas
Tujuan :
•Suhu tubuh normal dalam jangka waktu…
Kriteria Hasil :
•Suhu tubuh 36,6 – 37,4 0 C
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•Bibir lembab
•Nadi normal
•Kulit tidak terasa panas
•Tidak ada gangguan neurologis ( kejang )
•Aktivitas sisi kemampuan
Rencana Tindakan :
•Identifikasi penyebab atau factor yang dapat
menimbulkan peningkatan suhu tubuh: dehidrasi,
infeksi, efek obat, hipertiroid.
•Observasi TNSR per …..
•Observasi fungsi neurologis : status mental, reaksi
terhadap stimulasi dan reaksi pupil.
•Observasi cairan masuk dan keluar, hitung balance
cairan
•Observasi tanda kejang mendadak
•Beri cairan sesuai kebutuhan bila tidak kontraindikasi
•Berikan kompres air hangat
•Berikan cairan dan karbohidrat yang cukup untuk
meningkatkan hipermetabolisme akibat peningkatan
suhu.
•Anjurkan pasien untuk mengurangi aktivitas yang
berlebihan bila suhu naik / bedrest total.
•Anjurkan dan bantu pasien menggunakan pakaian
yang mudah menyerap keringat.
•Kolaborasi :
Pemberian anti piretik
Pemberian anti biotic
Pemeriksaan penunjang
2) Dx. Keperawatan 2
Dx Resiko kekurangan volume cairan tubuh B. D kehilangan sekunder terhadap
demam.
Data Subjektif :
•Pasien mengeluh haus
•Pasien mengeluh lemas
•Pasien mengeluh mencret ….x/hr
•Pasien mengeluh muntah …x/hr
Data Objektif :
•TD…mmttg, N..x/mnt, S.. 0 C, RR…x/mnt
•Turgor kulit jelek
•Perubahan produksi urine…cc/ 24 jam
•Penurunan pengisian vena ( capillary refill )
•Volume dan tekanan nadi menurun
•Denyut nadi meningkat
•Demam
•Kulit kering
•Bibir kering
•Mata cekung
•Akral dingin
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Tujuan :
•Tidak terjadi kekurangan volume cairan tubuh dalam
jangka waktu ….
Kriteria Hasil :
•Turgor baik
•Produksi urine …cc/jam <0,5 – 1 cc/kg BB/jam
•Kulit lembab
•TTV dalam batas normal
•Mukosa mulut lembab
•Cairan masuk dan keluar seimbang
•Tidak pusing pada perubahan posisi
•Tidak haus
•Hb, Ht, dbn
Rencana Tindakan :
•Observasi penyebab kekurangan cairan : muntah,
diare, kesulitan menelan, kekurangan darah aktif,
diuretic, depresi, kelelahan
•Observasi TNSR…
•Observasi tanda – tanda dehidrasi
•Observasi keadaan turgon kulit, kelembaban,
membran mukosa
•Monitor pemasukan dan pengeluaran cairan bila
kekurangan cairan terjadi secara mendadak, ukur
produksi urine setiap jam, berat jenis dan observasi
warna urine.
•Catat dan ukur jumlah dan jenis cairan masuk dan
keluar per….
•Perhatikan : cairan yang masuk, kecepatan tetesan
untuk mencegah edema paru, dispneu, bila pasien
terpasang infus
•Timbang BB setiap hari
•Pertahankan bedrest selama fase akut
•Ajarkan tentang masukan cairan yang adekuat, tanda
serta cara mengatasi kurang cairan
•Kolaborasi :
Pemberian cairan parenteral sesuai indikasi
Pemberian obat sesuai indikasi
Observasi kadar elektronik, Hb,Ht
3) Dx. Keperawatan 3
Dx. perubahan nutrisi kurang dari kebutuhan tubuh : Asupan makanan yang
kurang
Data Subjektif :
•Pasien mengatakan mual
•Pasien mengatakan tidak nafsu makan
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•Pasien mengatakan susah makan
Data Objektif :
•Bising usus….x/mnt
•Mukosa mulut kering
•Vomitus ….cc
•Porsi makan : …..porsi
•Hb …., Albumin…..
•Konjungtiva dan selaput lendir pucat
•Terdapat bercak – bercak merah pada mukosa mulut
Tujuan :
•Pasien dapat memperbaiki status gizi (nutrisi ) dalam
jangka waktu
Kriteria Hasil :
•BB meningkat
•Mual berkurang / hilang
•Tidak ada muntah
•Pasien menghabiskan makan 1 porsi
•Nafsu makan meningkat
•Pasien menyebutkan manfaat nutrisi
•Pasien mengungkapkan kesediaan mematuhi diit
•Tidak ada tanda – tanda malnutrisi
•Nilai Hb, Protein dalam batas normal
Rencana Tindakan :
•Kaji pola makan pasien
•Observasi mual dan muntah
•Jelaskan pentingnya nutrisi yang adekuat untuk
kesembuhan
•Kaji kemampuan untuk mengunyah dan menelan
•Auskultasi bising usus, catat adanya penurunan atau
hilangnya bising usus.
•Beri posisi semi fowler / fowler saat makan
•Identifikasi factor pencetus mual , muntah , diare,
nyeri abdomen
•Kaji makanan yang disukai dan tidak disukai sesuai
diit
•Sajikan makanan dalam keadaan hangat dan menarik
•Bantu pasien untuk makan , catat jumlah makanan
yang masuk
•Hindari makanan dan minuman yang merangsang
•Lakukan perawatan mulut sebelum dan sesudah
makan.
•Kolaborasi :
Penatalaksanaan diit yang sesuai ( dengan ahli gizi
)
Pemberian nutrisi parenteral
Pemberian anti emetik
Pemberian multivitamin, cara pemberian makanan
/ tambahan.
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Kamis, 18 Juni 2009
VAKSIN OR AUTISM
Vaksin penyebab Autis VERY TOP URGENT!!!!!
Buat para Pasangan MUDA. om dan tante yg punya keponakan... atau bahkan calon ibu ... perlu nih dibaca ttg autisme.. Bisa di share kepada yang masih punya anak kecil supaya ber-hati2... ..... Setelah kesibukan Lebaran yang menyita waktu, baru sekarang saya bisa dapat waktu luang membaca buku "Children with Starving Brains" karangan Jaquelyn McCandless , MD yang diterjemahkan dan diterbitkan oleh Grasindo. Ternyata buku yang saya beli di toko buku Gramedia seharga Rp. 50,000,-itu benar-benar membuka mata saya, dan sayang, sayang sekali baru terbit setelah anak saya Joey (27 bln) didiagnosa mengidap Autisme Spectrum Disorder. Bagian satu, bab 3, dari buku itu benar-benar membuat saya menangis.
Selama 6 bulan pertama hidupnya (Agustus 2001 –Februari 2002), Joey memperoleh 3 kali suntikan vaksin Hepatitis B, dan 3 kali suntikan vaksin HiB. Menurut buku tersebut (halaman 54 - 55) ternyata dua macam vaksin yang diterima anak saya dalam 6 bulan pertama hidupnya itu positif mengandung zat pengawet Thimerosal, yang terdiri dari Etilmerkuri yang menjadi penyebab utama sindrom Autisme Spectrum Disorder yang meledak pada sejak awal tahun 1990an. Vaksin yang mengandung Thimerosal itu sendiri sudah dilarang di Amerika sejak akir tahun 2001.Alangkah sedihnya saya, anak yang saya tunggu kehadirannya selama 6 tahun, dilahirkan dan divaksinasi di sebuah rumahsakit besar yang bagus, terkenal, dan mahal di Karawaci Tangerang, dengan harapan memperoleh treatment yang terbaik, ternyata malah "diracuni" oleh Mercuri dengan selubung vaksinasi. Beruntung saya masih bisa memberi ASI sampai sekarang, sehingga Joey tidak menderita Autisme yang parah. Tetapi tetap saja, sampai sekarang dia belum bicara, harus diet pantang gluten dan casein, harus terapi ABA , Okupasi,dan nampaknya harus dibarengi dengan diet supplemen yang keseluruhannya sangat besar biayanya.Melalui e-mail ini saya hanya ingin menghimbau para dokter anak di Indonesia , para pejabat di Departemen Kesehatan, tolonglah baca buku tersebut diatas itu, dan tolong musnahkan semua vaksin yang masih mengandung Thimerosal. Jangan sampai (dan bukan tidak mungkin sudah terjadi) sisa stok yang tidak habis di Amerika Serikat tersebut diekspor dengan harga murah ke Indonesia dan dikampanyekan sampai ke puskesmas-puskesmas seperti contohnya vaksin Hepatitis B, yang sekarang sedang giat-giatnya dikampanyekan sampai ke pedesaan.
Kepada para orang tua dan calon orang tua, marilah kita bersikap proaktif, dan assertif dengan menolak vaksin yang mengandung Thimerosal tersebut, cobalah bernegosiasi dengan dokter anak kita, minta vaksin Hepatitis B dan HiB yang tidak mengandung Thimerosal.
Juga tolong e-mail ini diteruskan kepada mereka yang akan menjadi orang tua, agar tidak mengalami nasib yang sama seperti saya.
Sekali lagi, jangan sampai kita kehilangan satu generasi anak-anak penerus bangsa, apalagi jika mereka datang dari keluarga yang berpenghasilan rendah yang untuk makan saja sulit apalagi untuk membiayai biaya
terapi supplemen, terapi ABA , Okupasi, dokter ahli Autisme (yang daftar tunggunya sampai berbulan-bulan) , yang besarnya sampai jutaaan Rupiah perbulannya.
Terakhir,mohon doanya untuk Joey dan ratusan, bahkan ribuan teman-teman senasibnya di Indonesia yang sekarang sedang berjuang membebaskan diri dari belenggu Autisme.
"Let's share with others... Show them that WE care!"
Buat para Pasangan MUDA. om dan tante yg punya keponakan... atau bahkan calon ibu ... perlu nih dibaca ttg autisme.. Bisa di share kepada yang masih punya anak kecil supaya ber-hati2... ..... Setelah kesibukan Lebaran yang menyita waktu, baru sekarang saya bisa dapat waktu luang membaca buku "Children with Starving Brains" karangan Jaquelyn McCandless , MD yang diterjemahkan dan diterbitkan oleh Grasindo. Ternyata buku yang saya beli di toko buku Gramedia seharga Rp. 50,000,-itu benar-benar membuka mata saya, dan sayang, sayang sekali baru terbit setelah anak saya Joey (27 bln) didiagnosa mengidap Autisme Spectrum Disorder. Bagian satu, bab 3, dari buku itu benar-benar membuat saya menangis.
Selama 6 bulan pertama hidupnya (Agustus 2001 –Februari 2002), Joey memperoleh 3 kali suntikan vaksin Hepatitis B, dan 3 kali suntikan vaksin HiB. Menurut buku tersebut (halaman 54 - 55) ternyata dua macam vaksin yang diterima anak saya dalam 6 bulan pertama hidupnya itu positif mengandung zat pengawet Thimerosal, yang terdiri dari Etilmerkuri yang menjadi penyebab utama sindrom Autisme Spectrum Disorder yang meledak pada sejak awal tahun 1990an. Vaksin yang mengandung Thimerosal itu sendiri sudah dilarang di Amerika sejak akir tahun 2001.Alangkah sedihnya saya, anak yang saya tunggu kehadirannya selama 6 tahun, dilahirkan dan divaksinasi di sebuah rumahsakit besar yang bagus, terkenal, dan mahal di Karawaci Tangerang, dengan harapan memperoleh treatment yang terbaik, ternyata malah "diracuni" oleh Mercuri dengan selubung vaksinasi. Beruntung saya masih bisa memberi ASI sampai sekarang, sehingga Joey tidak menderita Autisme yang parah. Tetapi tetap saja, sampai sekarang dia belum bicara, harus diet pantang gluten dan casein, harus terapi ABA , Okupasi,dan nampaknya harus dibarengi dengan diet supplemen yang keseluruhannya sangat besar biayanya.Melalui e-mail ini saya hanya ingin menghimbau para dokter anak di Indonesia , para pejabat di Departemen Kesehatan, tolonglah baca buku tersebut diatas itu, dan tolong musnahkan semua vaksin yang masih mengandung Thimerosal. Jangan sampai (dan bukan tidak mungkin sudah terjadi) sisa stok yang tidak habis di Amerika Serikat tersebut diekspor dengan harga murah ke Indonesia dan dikampanyekan sampai ke puskesmas-puskesmas seperti contohnya vaksin Hepatitis B, yang sekarang sedang giat-giatnya dikampanyekan sampai ke pedesaan.
Kepada para orang tua dan calon orang tua, marilah kita bersikap proaktif, dan assertif dengan menolak vaksin yang mengandung Thimerosal tersebut, cobalah bernegosiasi dengan dokter anak kita, minta vaksin Hepatitis B dan HiB yang tidak mengandung Thimerosal.
Juga tolong e-mail ini diteruskan kepada mereka yang akan menjadi orang tua, agar tidak mengalami nasib yang sama seperti saya.
Sekali lagi, jangan sampai kita kehilangan satu generasi anak-anak penerus bangsa, apalagi jika mereka datang dari keluarga yang berpenghasilan rendah yang untuk makan saja sulit apalagi untuk membiayai biaya
terapi supplemen, terapi ABA , Okupasi, dokter ahli Autisme (yang daftar tunggunya sampai berbulan-bulan) , yang besarnya sampai jutaaan Rupiah perbulannya.
Terakhir,mohon doanya untuk Joey dan ratusan, bahkan ribuan teman-teman senasibnya di Indonesia yang sekarang sedang berjuang membebaskan diri dari belenggu Autisme.
"Let's share with others... Show them that WE care!"
Sabtu, 06 September 2008
Healthy Aging
How will you spend the rest of your life? Odds are you'll have a few more years to think about it than your ancestors did. Thanks to better nutrition, sophisticated medical care, and protection against infectious diseases, humans are pushing the envelope of longevity. In the years between 1900 and 1990, the average life expectancy increased by 27 years. That's the same number of years life expectancy increased in the forty-five hundred years from the Bronze Age to 1900.
At this rate, you might think we'll be living to 200 before long. That's not likely, though. As we age, our individual cells grow and divide to replace themselves as they wear out. Scientists have found that human cells can replace themselves only about 50 times before they simply run out of gas. But although you may not be able to live forever, you can do a lot to stay active and healthy in your later years.
R-E-S-P-E-C-T
Aretha Franklin sang about it and we all want it, but many older people are not treated with great respect, at least in this country. As Dr. Andrew Weil describes in his book Healthy Aging, siblings in traditional Okinawa households argue over who will get the privilege of caring for their aging parents. Okinawans who live to be 97 are often honored with a kajimaya celebration in their communities. Okinawan folklore says that a person who has lived to such an old age has special powers, and people who participate in the kajimaya ceremony may share in his or her good fortune. Is it a coincidence that Okinawans enjoy what could be the world’s longest life expectancy?
No matter what your cultural heritage says about aging, you can improve your quality of life by recognizing and, valuing your position in the world. A good attitude may even help you live longer. A Yale University study of 660 people 50 years and older found that those who had a positive self-image about aging lived 7.5 years longer than those with a negative self-image.
Consider the following benefits of being the age you are now:
•Life has been a good teacher. The experiences you've had and the lessons learned from them better equip you to meet challenges now and in the future.
•Skills you learned early in life -- like managing your finances or dealing with difficult people -- are likely to improve with age and practice.
•You're less likely to obsess over situations that would have caused you substantial worry and stress when you were younger. They may not seem so daunting when viewed from your current perspective.
If you find your self-confidence flagging, consider trying one of the following:
•Learn something new: take a gourmet cooking class, or learn to play a musical instrument, or delve into a different culture through books you get from the library.
•Join a group. It could be a support group with a specific focus, a book group, or just a few friends who meet regularly to offer each other encouragement.
•Become more comfortable in your body. If you've become less active because of a fear of falling, contact your local community center, gym, or healthcare facility about classes that teach balance and how to position your body if you fall.
•Get regular exercise. We'll talk more about exercise in a later class, but one of its many benefits is that it fosters a sense of personal control and confidence.
Combating ageism
Too often aging is viewed in terms of failing health, frailty, and loneliness. Gerontologist Robert Butler, founding director of the National Institute on Aging, coined the term "ageism" to describe this negative view of older people.
You don't have to look far to find examples of ageism. Older people are often made to look foolish or frail in advertisements aimed at a younger audience. At the opposite end of the spectrum, some ads aimed at an older audience feature healthy, wealthy retired folks golfing or sailing or relaxing on a tropical beach with a Mai-Tai in hand -- a view of retirement grossly at odds with reality, given that one in four Baby Boomers may have a net worth at retirement of less than $50,000.
Ageism has an even more sinister face when you consider elder abuse and discrimination. As many as 3 million Americans over 65 have been injured or mistreated by their caregivers, according to the U.S. branch of the International Longevity Center, a research policy organization associated with the Mount Sinai School of Medicine in New York City. The AARP reports that complaints of age discrimination in the workplace jumped 41 percent between 1999 and 2002.
The problem of ageism is rooted in denial of its very existence, according to Drs. John Rowe and Robert Kahn, researchers involved in one of the most extensive studies on aging in the United States. As they write in their book Successful Aging, "Acknowledging the truth about aging in America is critical… if we are to move ahead toward successful aging as individuals and as a society.” What can you do to combat ageism?
•Refuse to be invisible. If you see an ad that portrays an older person in a negative way, write to the company and let them know they've lost your business. Likewise, support companies that use older people in their ads or show them in a positive light.
• Learn what your rights are in the workplace and speak up if you feel you are being discriminated against because of your age.
•Vote. Find out how candidates stand on issues concerning older Americans and support the candidates who will work for causes that concern you. Even better, volunteer to help in their campaigns.
Anti-aging vs. aging well
Enter the words, "anti-aging" into any Web browser and you'll get a staggering number of results -- including information from reputable sources along with many sites promising the fountain of youth in the form of pills, supplements, hormones, and other therapies. However scientific experts on aging say there is little or no evidence that anti-aging remedies actually work. Instead of promising a “cure” to aging, health care providers should focus on helping people to stay healthy as long as possible.
That's where you can play a big role. You can control many of the factors that influence your health as you age. We're all going to end up in the same place, but to some extent you can influence how you get there. As Weil says, "To age gracefully means to let nature take its course while doing everything in our power to delay the onset of age-related disease…" The goal of this class is to give you the tools to do just that.
To do before the next class:
•Think about the advantages your age provides you. What knowledge or skills do you have now that you didn't have when you were younger?
•Make a list of at least 5 words that describe the positive things about being older. Post them where you can see them every day.
•Is there anything you've always wanted to do or learn about? Take one step towards making it happen, whether it's researching a class, checking a book out of the library about a place you've always wanted to visit, or writing a few pages of the novel you've always felt you had in you.
At this rate, you might think we'll be living to 200 before long. That's not likely, though. As we age, our individual cells grow and divide to replace themselves as they wear out. Scientists have found that human cells can replace themselves only about 50 times before they simply run out of gas. But although you may not be able to live forever, you can do a lot to stay active and healthy in your later years.
R-E-S-P-E-C-T
Aretha Franklin sang about it and we all want it, but many older people are not treated with great respect, at least in this country. As Dr. Andrew Weil describes in his book Healthy Aging, siblings in traditional Okinawa households argue over who will get the privilege of caring for their aging parents. Okinawans who live to be 97 are often honored with a kajimaya celebration in their communities. Okinawan folklore says that a person who has lived to such an old age has special powers, and people who participate in the kajimaya ceremony may share in his or her good fortune. Is it a coincidence that Okinawans enjoy what could be the world’s longest life expectancy?
No matter what your cultural heritage says about aging, you can improve your quality of life by recognizing and, valuing your position in the world. A good attitude may even help you live longer. A Yale University study of 660 people 50 years and older found that those who had a positive self-image about aging lived 7.5 years longer than those with a negative self-image.
Consider the following benefits of being the age you are now:
•Life has been a good teacher. The experiences you've had and the lessons learned from them better equip you to meet challenges now and in the future.
•Skills you learned early in life -- like managing your finances or dealing with difficult people -- are likely to improve with age and practice.
•You're less likely to obsess over situations that would have caused you substantial worry and stress when you were younger. They may not seem so daunting when viewed from your current perspective.
If you find your self-confidence flagging, consider trying one of the following:
•Learn something new: take a gourmet cooking class, or learn to play a musical instrument, or delve into a different culture through books you get from the library.
•Join a group. It could be a support group with a specific focus, a book group, or just a few friends who meet regularly to offer each other encouragement.
•Become more comfortable in your body. If you've become less active because of a fear of falling, contact your local community center, gym, or healthcare facility about classes that teach balance and how to position your body if you fall.
•Get regular exercise. We'll talk more about exercise in a later class, but one of its many benefits is that it fosters a sense of personal control and confidence.
Combating ageism
Too often aging is viewed in terms of failing health, frailty, and loneliness. Gerontologist Robert Butler, founding director of the National Institute on Aging, coined the term "ageism" to describe this negative view of older people.
You don't have to look far to find examples of ageism. Older people are often made to look foolish or frail in advertisements aimed at a younger audience. At the opposite end of the spectrum, some ads aimed at an older audience feature healthy, wealthy retired folks golfing or sailing or relaxing on a tropical beach with a Mai-Tai in hand -- a view of retirement grossly at odds with reality, given that one in four Baby Boomers may have a net worth at retirement of less than $50,000.
Ageism has an even more sinister face when you consider elder abuse and discrimination. As many as 3 million Americans over 65 have been injured or mistreated by their caregivers, according to the U.S. branch of the International Longevity Center, a research policy organization associated with the Mount Sinai School of Medicine in New York City. The AARP reports that complaints of age discrimination in the workplace jumped 41 percent between 1999 and 2002.
The problem of ageism is rooted in denial of its very existence, according to Drs. John Rowe and Robert Kahn, researchers involved in one of the most extensive studies on aging in the United States. As they write in their book Successful Aging, "Acknowledging the truth about aging in America is critical… if we are to move ahead toward successful aging as individuals and as a society.” What can you do to combat ageism?
•Refuse to be invisible. If you see an ad that portrays an older person in a negative way, write to the company and let them know they've lost your business. Likewise, support companies that use older people in their ads or show them in a positive light.
• Learn what your rights are in the workplace and speak up if you feel you are being discriminated against because of your age.
•Vote. Find out how candidates stand on issues concerning older Americans and support the candidates who will work for causes that concern you. Even better, volunteer to help in their campaigns.
Anti-aging vs. aging well
Enter the words, "anti-aging" into any Web browser and you'll get a staggering number of results -- including information from reputable sources along with many sites promising the fountain of youth in the form of pills, supplements, hormones, and other therapies. However scientific experts on aging say there is little or no evidence that anti-aging remedies actually work. Instead of promising a “cure” to aging, health care providers should focus on helping people to stay healthy as long as possible.
That's where you can play a big role. You can control many of the factors that influence your health as you age. We're all going to end up in the same place, but to some extent you can influence how you get there. As Weil says, "To age gracefully means to let nature take its course while doing everything in our power to delay the onset of age-related disease…" The goal of this class is to give you the tools to do just that.
To do before the next class:
•Think about the advantages your age provides you. What knowledge or skills do you have now that you didn't have when you were younger?
•Make a list of at least 5 words that describe the positive things about being older. Post them where you can see them every day.
•Is there anything you've always wanted to do or learn about? Take one step towards making it happen, whether it's researching a class, checking a book out of the library about a place you've always wanted to visit, or writing a few pages of the novel you've always felt you had in you.
Selasa, 27 Mei 2008
DIETARY FAT
Dietary Fat
different typs of fatty foods
What counts as fat? Are some fats better than other fats? While fats are essential for normal body function, some fats are better for you than others. Trans fats, saturated fats and cholesterol are less healthy than polyunsaturated and monounsaturated fats.
* Trans Fat
* Saturated Fat
* Cholesterol
* Polyunsaturated Fats and Monounsaturated Fats
We also have a page on Controlling Fat in Your Diet.
photo of french fries, donuts and other snacks
Some fried foods and commercially baked goods may contain trans fats.
Trans Fat
You may have heard about trans fats recently in the news. These fats made headlines when food manufacturers were required to list them on the Nutrition Facts Label in 2006.
So what's the story with trans fats? These fats are created during food processing when liquid oils are converted into solid fats — a process called hydrogenation. This creates partially-hydrogenated oils that tend to keep food fresh longer while on grocery shelves. The problem is that these partially-hydrogenated oils contain trans fats which can also increase low-density lipoprotein LDL-cholesterol and decrease high-density lipoprotein (HDL) cholesterol — risk factors for heart disease.
The Recommendation
The Dietary Guidelines for Americans 2005 recommend keeping the amount of trans fat you consume as low as possible.
The good news is that some manufacturers have changed how they process foods to reduce the amounts of trans fats in their products. Be on the look out for foods that contain trans fats, such as commercially-baked cookies, crackers, and pies. Some commercial restaurants may also use partially-hydrogenated oils when frying their entrees and side items.
For more, see Controlling Your Trans Fat Intake.
Saturated Fat
photo of meat, cheese, icecreamYou may have heard that saturated fats are the "solid" fats in your diet. For the most part, this is true. For example, if you open a container of meat stew, you will probably find some fat floating on top. This fat is saturated fat.
The Recommendation
Diets high in saturated fat have been linked to chronic disease, specifically, coronary heart disease. The Dietary Guidelines for Americans 2005 recommend consuming less than 10% of daily calories as saturated fat.
But other saturated fats can be more difficult to see in your diet. In general, saturated fat can be found in the following foods:
* High-fat cheeses
* High-fat cuts of meat
* Whole-fat milk and cream
* Butter
* Ice cream and ice cream products
* Palm and coconut oils
It's important to note that lower-fat versions of these foods usually will contain saturated fats, but typically in smaller quantities than the regular versions.
As you look at this list above, notice two things. First, animal fats are a primary source of saturated fat. Secondly, certain plant oils are another source of saturated fats: palm oils, coconut oils, and cocoa butter. You may think you don't use palm or coconut oils, but they are often added to commercially-prepared foods, such as cookies, cakes, doughnuts, and pies. Solid vegetable shortening often contains palm oils and some whipped dessert toppings contain coconut oil.
For more, see Controlling Your Saturated Fat Intake.
photo of meat, egg and milkDietary Cholesterol
Cholesterol is a fatty substance that's found in animal-based foods such as meats, poultry, egg yolks, and whole milks. Do you remember the other type of fat that is found in animal-based products? That's right — saturated fat.
So, when you follow the tips to reduce your saturated fat intake, in most cases, you will be reducing your dietary cholesterol intake at the same time. For example, if you switch to low-fat and fat-free dairy products, you will reduce your intake of both saturated fat and cholesterol.
The Recommendation
The Dietary Guidelines for Americans 2005 recommend that individuals consume less than 300 milligrams (mg) of cholesterol each day.
Quick Q& A
I've heard that some people have high blood cholesterol because of the foods they eat but that other people have high cholesterol because of genetics. What's the difference?
Not only do you get cholesterol from the foods you eat (your diet) your body also makes cholesterol to use in normal body functions.
The cholesterol made by your body is partly influenced by your genes and these genes are shared by your family members.
Even though genetics play a role, families often also share the same eating and lifestyle habits. Some health problems that seem to run in families may be worsened by these unhealthful habits. If you have a genetic tendency to produce more cholesterol, you may still obtain additional benefits from reducing the cholesterol in your diet.
For more, see Cholesterol in Your Blood.
Polyunsaturated Fats and Monounsaturated Fats
Most of the fat that you eat should come from unsaturated sources: polyunsaturated fats and monounsaturated fats. In general, nuts, vegetable oils, and fish are sources of unsaturated fats. The table below provides examples of specific types of unsaturated fats.
Monounsaturated Fat Sources Omega-6 Polyunsaturated Fat Sources Omega-3 Polyunsaturated Fat Sources
Nuts
Vegetable oils
Canola oil
Olive oil
High oleic safflower oil
Sunflower oil
Avocado
Soybean oil
Corn oil
Safflower oil Soybean oil
Canola oil
Walnuts
Flaxseed
Fish: trout, herring, and salmon
photo of olives, walnuts, canola oil, olive oil and fishPolyunsaturated fats can also be broken down into two types:
* Omega-6 polyunsaturated fats — these fats provide an essential fatty acid that our bodies need, but can't make.
* Omega-3 polyunsaturated fats — these fats also provide an essential fatty acid that our bodies need. In addition, omega-3 fatty acids, particularly from fish sources, may have potential health benefits.
For more, see Controlling Your Polyunsaturated Fat and Monounsaturated Fat Intake.
different typs of fatty foods
What counts as fat? Are some fats better than other fats? While fats are essential for normal body function, some fats are better for you than others. Trans fats, saturated fats and cholesterol are less healthy than polyunsaturated and monounsaturated fats.
* Trans Fat
* Saturated Fat
* Cholesterol
* Polyunsaturated Fats and Monounsaturated Fats
We also have a page on Controlling Fat in Your Diet.
photo of french fries, donuts and other snacks
Some fried foods and commercially baked goods may contain trans fats.
Trans Fat
You may have heard about trans fats recently in the news. These fats made headlines when food manufacturers were required to list them on the Nutrition Facts Label in 2006.
So what's the story with trans fats? These fats are created during food processing when liquid oils are converted into solid fats — a process called hydrogenation. This creates partially-hydrogenated oils that tend to keep food fresh longer while on grocery shelves. The problem is that these partially-hydrogenated oils contain trans fats which can also increase low-density lipoprotein LDL-cholesterol and decrease high-density lipoprotein (HDL) cholesterol — risk factors for heart disease.
The Recommendation
The Dietary Guidelines for Americans 2005 recommend keeping the amount of trans fat you consume as low as possible.
The good news is that some manufacturers have changed how they process foods to reduce the amounts of trans fats in their products. Be on the look out for foods that contain trans fats, such as commercially-baked cookies, crackers, and pies. Some commercial restaurants may also use partially-hydrogenated oils when frying their entrees and side items.
For more, see Controlling Your Trans Fat Intake.
Saturated Fat
photo of meat, cheese, icecreamYou may have heard that saturated fats are the "solid" fats in your diet. For the most part, this is true. For example, if you open a container of meat stew, you will probably find some fat floating on top. This fat is saturated fat.
The Recommendation
Diets high in saturated fat have been linked to chronic disease, specifically, coronary heart disease. The Dietary Guidelines for Americans 2005 recommend consuming less than 10% of daily calories as saturated fat.
But other saturated fats can be more difficult to see in your diet. In general, saturated fat can be found in the following foods:
* High-fat cheeses
* High-fat cuts of meat
* Whole-fat milk and cream
* Butter
* Ice cream and ice cream products
* Palm and coconut oils
It's important to note that lower-fat versions of these foods usually will contain saturated fats, but typically in smaller quantities than the regular versions.
As you look at this list above, notice two things. First, animal fats are a primary source of saturated fat. Secondly, certain plant oils are another source of saturated fats: palm oils, coconut oils, and cocoa butter. You may think you don't use palm or coconut oils, but they are often added to commercially-prepared foods, such as cookies, cakes, doughnuts, and pies. Solid vegetable shortening often contains palm oils and some whipped dessert toppings contain coconut oil.
For more, see Controlling Your Saturated Fat Intake.
photo of meat, egg and milkDietary Cholesterol
Cholesterol is a fatty substance that's found in animal-based foods such as meats, poultry, egg yolks, and whole milks. Do you remember the other type of fat that is found in animal-based products? That's right — saturated fat.
So, when you follow the tips to reduce your saturated fat intake, in most cases, you will be reducing your dietary cholesterol intake at the same time. For example, if you switch to low-fat and fat-free dairy products, you will reduce your intake of both saturated fat and cholesterol.
The Recommendation
The Dietary Guidelines for Americans 2005 recommend that individuals consume less than 300 milligrams (mg) of cholesterol each day.
Quick Q& A
I've heard that some people have high blood cholesterol because of the foods they eat but that other people have high cholesterol because of genetics. What's the difference?
Not only do you get cholesterol from the foods you eat (your diet) your body also makes cholesterol to use in normal body functions.
The cholesterol made by your body is partly influenced by your genes and these genes are shared by your family members.
Even though genetics play a role, families often also share the same eating and lifestyle habits. Some health problems that seem to run in families may be worsened by these unhealthful habits. If you have a genetic tendency to produce more cholesterol, you may still obtain additional benefits from reducing the cholesterol in your diet.
For more, see Cholesterol in Your Blood.
Polyunsaturated Fats and Monounsaturated Fats
Most of the fat that you eat should come from unsaturated sources: polyunsaturated fats and monounsaturated fats. In general, nuts, vegetable oils, and fish are sources of unsaturated fats. The table below provides examples of specific types of unsaturated fats.
Monounsaturated Fat Sources Omega-6 Polyunsaturated Fat Sources Omega-3 Polyunsaturated Fat Sources
Nuts
Vegetable oils
Canola oil
Olive oil
High oleic safflower oil
Sunflower oil
Avocado
Soybean oil
Corn oil
Safflower oil Soybean oil
Canola oil
Walnuts
Flaxseed
Fish: trout, herring, and salmon
photo of olives, walnuts, canola oil, olive oil and fishPolyunsaturated fats can also be broken down into two types:
* Omega-6 polyunsaturated fats — these fats provide an essential fatty acid that our bodies need, but can't make.
* Omega-3 polyunsaturated fats — these fats also provide an essential fatty acid that our bodies need. In addition, omega-3 fatty acids, particularly from fish sources, may have potential health benefits.
For more, see Controlling Your Polyunsaturated Fat and Monounsaturated Fat Intake.
WATER
Water: Meeting Your Daily Fluid Needs
Water: Meeting Your Daily Fluid Needs
photo of man holding water bottleEver notice how lifeless a house plant looks when you forget to water it? Just a little water and it seems to perk back up. Water is just as essential for our bodies because it is in every cell, tissue, and organ in your body. That's why getting enough water every day is important for your health.
Healthy people meet their fluid needs by drinking when thirsty and drinking fluids with meals. But, if you're outside in hot weather for most of the day or doing vigorous physical activity, you'll need to make an effort to drink more fluids.
Where do I get the water I need?
Most of your water needs are met through the water and beverages you drink.
You can get some fluid through the foods you eat. For example, broth soups and other foods that are 85% to 95% water such as celery, tomatoes, oranges, and melons.
What does water do in my body?
Water helps your body with the following:
* Keeps its temperature normal.
* Lubricates and cushions your joints.
* Protects your spinal cord and other sensitive tissues.
* Gets rid of wastes through urination, perspiration, and bowel movements.
Why do I need to drink enough water each day?
You need water to replace what your body loses through normal everyday functions. Of course, you lose water when you go to the bathroom or sweat, but you even lose small amounts of water when you exhale. You need to replace this lost water to prevent dehydration.
photo of man drinking waterYour body also needs more water when you are�
* In hot climates.
* More physically active.
* Running a fever.
* Having diarrhea or vomiting.
To help you stay hydrated during prolonged physical activity or when it is hot outside, the Dietary Guidelines for Americans 2005 recommend these two steps:
1. Drink fluid while doing the activity.
2. Drink several glasses of water or other fluid after the physical activity is completed.1
Also, when you are participating in vigorous physical activity, it's important to drink before you even feel thirsty. Thirst is a signal that your body is on the way to dehydration. For more information, visit Fit Facts, Healthy Hydration from the American Council on Fitness.*PDF file (PDF-1.4Mb)
Some people may have fluid restrictions because of a health problem, such as kidney disease. If your healthcare provider has told you to restrict your fluid intake, be sure to follow that advice.
Tips for Increasing Your Fluid Intake by Drinking More Water
photo of water bottlesUnder normal conditions, most people can drink enough fluids to meet their water needs. If you are outside in hot weather for most of the day or doing vigorous activity, you may need to increase your fluid intake.
If you think you're not getting enough water each day, the following tips may help:
* Carry a water bottle for easy access when you are at work or running errands.
* Freeze some freezer-safe water bottles. Take one with you for ice-cold water all day long.
* Choose water instead of sugar-sweetened beverages. This tip can also help with weight management. Substituting water for one 20-ounce sugar-sweetened soda will save you about 240 calories.
* Choose water instead of other beverages when eating out. Generally, you will save money and reduce calories.
* Give your water a little pizzazz by adding a wedge of lime or lemon. This may improve the taste, and you just might drink more water than you usually do.
Do sugar-sweetened beverages count?
rethink your drinkAlthough beverages that are sweetened with sugars do provide water, they usually have more calories than unsweetened beverages. To help with weight control, you should consume beverages and foods that don't have added sugars.
Examples of beverages with added sugars:
* Fruit drinks.
* Some sports drinks.
* Soft drinks and sodas (non-diet).
Visit Rethink Your Drink for more information about the calories in beverages and how you can make better drink choices to reduce your calorie intake.
Water: Meeting Your Daily Fluid Needs
photo of man holding water bottleEver notice how lifeless a house plant looks when you forget to water it? Just a little water and it seems to perk back up. Water is just as essential for our bodies because it is in every cell, tissue, and organ in your body. That's why getting enough water every day is important for your health.
Healthy people meet their fluid needs by drinking when thirsty and drinking fluids with meals. But, if you're outside in hot weather for most of the day or doing vigorous physical activity, you'll need to make an effort to drink more fluids.
Where do I get the water I need?
Most of your water needs are met through the water and beverages you drink.
You can get some fluid through the foods you eat. For example, broth soups and other foods that are 85% to 95% water such as celery, tomatoes, oranges, and melons.
What does water do in my body?
Water helps your body with the following:
* Keeps its temperature normal.
* Lubricates and cushions your joints.
* Protects your spinal cord and other sensitive tissues.
* Gets rid of wastes through urination, perspiration, and bowel movements.
Why do I need to drink enough water each day?
You need water to replace what your body loses through normal everyday functions. Of course, you lose water when you go to the bathroom or sweat, but you even lose small amounts of water when you exhale. You need to replace this lost water to prevent dehydration.
photo of man drinking waterYour body also needs more water when you are�
* In hot climates.
* More physically active.
* Running a fever.
* Having diarrhea or vomiting.
To help you stay hydrated during prolonged physical activity or when it is hot outside, the Dietary Guidelines for Americans 2005 recommend these two steps:
1. Drink fluid while doing the activity.
2. Drink several glasses of water or other fluid after the physical activity is completed.1
Also, when you are participating in vigorous physical activity, it's important to drink before you even feel thirsty. Thirst is a signal that your body is on the way to dehydration. For more information, visit Fit Facts, Healthy Hydration from the American Council on Fitness.*PDF file (PDF-1.4Mb)
Some people may have fluid restrictions because of a health problem, such as kidney disease. If your healthcare provider has told you to restrict your fluid intake, be sure to follow that advice.
Tips for Increasing Your Fluid Intake by Drinking More Water
photo of water bottlesUnder normal conditions, most people can drink enough fluids to meet their water needs. If you are outside in hot weather for most of the day or doing vigorous activity, you may need to increase your fluid intake.
If you think you're not getting enough water each day, the following tips may help:
* Carry a water bottle for easy access when you are at work or running errands.
* Freeze some freezer-safe water bottles. Take one with you for ice-cold water all day long.
* Choose water instead of sugar-sweetened beverages. This tip can also help with weight management. Substituting water for one 20-ounce sugar-sweetened soda will save you about 240 calories.
* Choose water instead of other beverages when eating out. Generally, you will save money and reduce calories.
* Give your water a little pizzazz by adding a wedge of lime or lemon. This may improve the taste, and you just might drink more water than you usually do.
Do sugar-sweetened beverages count?
rethink your drinkAlthough beverages that are sweetened with sugars do provide water, they usually have more calories than unsweetened beverages. To help with weight control, you should consume beverages and foods that don't have added sugars.
Examples of beverages with added sugars:
* Fruit drinks.
* Some sports drinks.
* Soft drinks and sodas (non-diet).
Visit Rethink Your Drink for more information about the calories in beverages and how you can make better drink choices to reduce your calorie intake.
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