About Me

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Malang, East Java, Indonesia
love listening to music every morning, reading some books,articles (when having enough time) and watching movies.Enjoy writing short stories, novels, with a cup of cappucino and chocolate. Love the beach very much.

Monday, March 19, 2012


UNTITLED
Rasanya masih seperti kemaren, terbayang segera 2 tahun yang lalu, ketika datang tawaran itu, butuh 6 bulan untuk memikirkannya, can I....??, saat  itu aku hanya takut dengan ekspektasi mereka yang sangat tinggi padaku, padahal aku belum memiliki kompetensi untuk memenuhi ekspektasi mereka. Aku takut mengecewakan.
Hahhh toh akhirnya terdampar juga aku disini, di dunia pendidikan yang sama sekali baru untukku. Tapi akhirnya juga, aku sangat menikmatinya, sangat dan sangat.
Hari – hariku di dunia kampus yang sekarang aku pandang dengan sudut berbeda, sangat menyenangkan. Belajar  dan belajar, adalah  kegiatan yang setiap hari aku lakukan. Belajar menyiapkan  bahan mengajar, belajar bagaimana menjadi lecturer yang baik, menyenangkan sehingga materi kuliah dapat terserap.
Baru 3 bulan aku menikmati dunia baru pendidikan, (Sebelumnya aku di pelayanan, Puskesmas), tiba – tiba saja, duniaku seperti kembali, aku diterima sebagai  CPNSD Malang. Dengan kebimbangan luar biasa aku harus memutuskan memilih dunia yang mana, stay di kampus atau pergi ke pelayanan (lagi...??). Banyak konsultasi kesana – kemari yang aku lakukan. Termasuk konsultasi kepada orang tua, yang sangat penting.
Bangga....???? jadi CPNSD....?? menyingkirkan berapa ratus pesaing, mungkin iya, bangga, namun dengan segera rasa bangga itu tergeser dengan kebimbangannku yang teramat dalam.

Finally
Life is choice, and every choices have consequences.
Dengan segenap hati aku berangkat ke BKD, mengurus pemberkasan. Ya aku pilih pelayanan, meski aku masih sangat cinta dengan kampusku. Aku tahu kensekuensi dari keputusanku.
Mungkin aku akan segera tidak bertemu dengan teman – teman yang penuh idealisme semangat di kampus, tim kodok yang sok kuat, sok bisa survive, padahal semua cengeng, nangisan, nyak Ika Cahya, si bawel Aren, bumil Wyssie hmmmm....masa itu, mana bisa lupa..???. Rasanya aku belum bisa kehilangan mereka semua.
2 tahun yang indah, yang tidak mungkin aku lupakan, pengalaman yang sangat berharga. Aku ingat ketika aku berkata pada mahasiswa suatu hari di parkiran salah satu Rumah Sakit Di Jawa Timur “Tinggalkan track record yang bagus dimanapun kalian berada, even itu hanya praktek klinik. Karena kita tidak pernah tahu, suatu saat kita akan butuh dengan tempat yang kita tempati sekarang”.
Ya, Track Record, aku berusaha meninggalkan track record yang bagus, membangun citra image yang baik. Entah kegelisahan hati macam apa yang sedang aku alami. Karena ketika pada saatnya nanti aku resign dari kampus tercinta ini, orang – orang akan menerimaku kembali ketika aku mampir untuk sekedar melepas kangen dengan teman – teman seperjuangan.
Dan duniaku seolah kembali terbalik, aku datang kembali ke pelayanan. Dunia baru yang awalnya membuatku denial, namun pada akhirnya aku bisa beradaptasi segera. Tidak pernah aku sangka, aku menikmati bekerja di pelayanan, dunia yang memang berbeda dengan pendidikan. Aku belajar satu hal penting di pelayanan : Komunikasi Terapeutik. Lucunya “KomTer” adalah topik penelitianku ketika masih kuliah di Diploma 3. So everything seems easy to me now.

Akhirnya memang aku harus “Merelakan” sebagian waktuku di pelayanan yang sekarang seperti rumah buatku. Ya rumah, yang akan selamanya kuhuni, rumah yang harus diperindah, bukan oleh orang lain tapi olehku sendiri. Yah....meningkatkan kompetensi adalah harga mati, aku belajar dan belajar lagi, berusaha mengerti, memahami dengan hati dan menikmati. Pilihan ini adalah pilihan yang aku pilih sendiri dengan tingkat kesadaran compus mentis, dan aku harus bertanggung jawab atasnya. Tapi jika harus kehilangan ini semua .......................................??????????
I can’t imagine that.

Understanding Breathing

Common Therminology

Term
Meaning
Aerobic
With oxygen
Anaerobic
Without oxygen
Anoxia
No oxygen reaching the brain
Apnoea
Absence of breathing
Apnoeustic breathing
Prolonged gasping inspiration and short inefficient expiration

Asthmatic breathing
Difficulty on expiration with an audible expiratory wheeze. Caused
by spasm of the respiratory passages and partial blockage by increased mucus secretion
Biot’s respirations
Periods of hyperpnoea occurring in normal respiration. Sometimes
seen in clients with meningitis
Bradypnoea
Slow but regular breathing. Normal in sleep but may be a sign of
opiate use, alcohol indulgence or brain tumour
Cheyne-Stokes respirations
Gradual cycle of increased rate and depth followed by gradual decrease with the pattern repeating every 45 seconds to three minutes. Also associated with periods of apnoea, particularly in the dying
Cyanosis
A bluish appearance of the skin and mucous membranes caused by
inadequate oxygenation
Dyspnoea
Difficulty breathing
Expiration
The act of breathing out
Haemoptysis
Blood in the sputum
Homeostasis
The automatic self-regulation of man to maintain the normal state of the body under a variety of environmental conditions
Hypercapnia
High partial pressure of carbon dioxide
Hyperpnoea
Deep breathing with marked use of abdominal muscles
Hyperventilation
Increased rate and depth of breathing
Hypoventilation
Irregular, slow, shallow breathing
Hypoxia
A lack of oxygen concentration
Hypoxaemia
A lack of oxygen in the blood
Inspiration
The act of breathing in
Kussmaul’s respirations
Increased respiratory rate (above 20 rpm), increased depth, panting
laboured breathing. Causes include diabetic ketoacidosis and renal
failure
Orthopnoea
The ability to breath easily only when in an upright position
Perfusion
The flow of oxygenated blood to the tissues
Stridor            
A harsh, vibrating, shrill sound produced during  respiration. Usually indicates an obstruction
Tachypnoea
Increased rate of breathing
Tracheostomy
Making of an opening into the trachea or windpipe
Ventilation
The movement of air in and out of the lungs

                                                           
Monitoring respiratory rate
Monitoring a client’s respiration rate is essential to facilitate the evaluation of medical treatment and nursing interventions.
 Equipment
ü  A digital watch or watch with a second hand, together with an appropriate chart for recording, is required.
ü  The procedures and rationales are given below.

Procedure
Rational
Explain procedure and ensure adequate understanding
Promote client co-operation and obtain informed consent, though this step is often omitted where there is a danger that the person may voluntarily control their breathing and thus alter the rate
Count respirations as chest rises and falls for a period of one minute
To monitor rate and compare to normal values
1.      New-born: 30–80 rpm
2.      Early childhood: 20–40 rpm
3.      Late childhood: 15–25 rpm
4.      Adult male: 14–18 rpm
5.      Adult female: 16–20 rpm
Pulse-to-respiration ratio = 5:1
Observe depth of respirations
To monitor depth and compare to norm – usually shallow and effortless
Listen for breath sounds, e.g. stridor, wheeze, rub, rattle
To monitor sounds and compare to norm –usually almost inaudible
Observe pattern of breathing and
use of accessory muscles
To monitor pattern and compare to norm –
usually effortless
Observe colour of skin/mucous membranes, e.g. pallor, cyanosis
To ensure that adequate oxygen is getting to the tissues (i.e. tissue perfusion)
Record rate on appropriate chart and report any abnormalities
Legal requirement to maintain documentation and safeguard client through good communications

Refferences
Mills, Elizabeth Jacqueline. 2004. Nursing Procedures, 4th Edition. USA : Lippincott
Penelope Ann Hilton.2004.Fundmental OF Nursing Skill. London : Whurr Publishers
Temple, Jean Smith and Johnson, Joyce Young. 2006. Nurse’s Guide To Clinical  Procedure, 5th Ed.  USA : Lippincott

Thursday, March 15, 2012


Understanding Body Themperature
Common terminology
ü  Apyrexia                                     A normal body temperature
ü  Body temperature                         Represents the balance between the heat produced by the body and the
heat lost
ü  Circadian rhythm             Sleep cycle (body temperature is lower at different times of the sleep
cycle)
ü  Conduction                      The transmission of heat from one object to another
ü  Convection                      The transmission of heat by movement of the heat through a liquid or gas
ü  Core temperature                         The temperature of the deep tissues and organs within the cranial,
thoracic and abdominal cavities
ü  Evaporation                     To lose heat through moisture, i.e. sweating
ü  Frenulum                        The thin membrane anchoring the tongue to the soft palate
ü  Heat stroke                     A potentially serious condition produced by    prolonged exposure to 
excessive temperatures, which can lead to coma and death
ü  Homeostasis                    Maintenance of a constant but dynamic internal environment
ü  Hyperpyrexia                   A very high body temperature
ü  Hypothermia                    A very low body temperature
ü  Metabolic rate                 The speed at which the body’s internal mechanisms     are functioning
ü  Pyrexia                           A high body temperature
ü  Surface temperature         Temperature of the skin surface (rises and falls in
response to the environment)
Normal body temperature
The following levels may vary slightly in different textbooks, but the following is intended to offer a simple, useful guide.
Ø Normal range              = 36–37oC
Ø Pyrexia                      = 38–40oC
Ø Hyperpyrexia             = 40.1oC and above
Ø Heat stroke                = Usually occurs around 41–42oC
Ø Death                        = 43oC and above
Ø Hypothermia               = 35oC and below
Ø Death                        = 20oC

The sites that can be used to monitor temperature are:
Ø the axilla (axillary)
Ø  the mouth (orally)
Ø  the tympanic membrane (inner ear, aural)
Ø  the rectum (rectally)
Ø  the skin
Monitoring temperature
Monitoring a client’s body temperature is essential to establish current health status, identify actual or potential problems, facilitate medical and nursing intervention, and monitor client progress.
Equipment
Ø  Appropriate thermometer (digital, tympanic, rectal, or mercury) paying due
Ø  regard to the age of the client, their level of ability to co-operate, local
Ø  clinical guidelines and contemporary evidence
Ø  Designated chart for recording
Ø  Protective covers/probe covers
Ø  Equipment for disposal, cleansing and disinfection
Axillary measurement
Procedure
Rational
Wash hands using effective techniques
To prevent cross-infection
Collect appropriate equipment
Remember that only electronic or mercury thermometers are suitable for axillary measurement
Hold mercury thermometer at eye level, rotating slightly to ensure mercury line is visible. Check mercury is low enough to record the temperature. If not, shake it down in a downward direction, taking care not to hit any nearby objects
For accuracy of measurement

To prevent breakage
Explain procedure and ensure client has understood
Promotes client co-operation and informed consent
Screen the bed or close door. Assist client to comfortable position and move clothing away from shoulder
Promotes comfort, maintains client’s privacy, prevents embarrassment, exposes axillary area
Place the thermometer in the centre of the client’s axilla
To ensure good contact with the skin when the arm is lowered
Rest the client’s arm across the chest, advising them to remain as still as possible
To avoid thermometer moving out of position
Leave in position until electronic thermometer signals, or 7–8 minutes for mercury thermometers
To ensure accuracy of measurement
Remove thermometer, read and record result, noting any significant changes
To ensure continuity of care and meet legislative requirements
Remove disposable cover and clean thermometer, adhering to local policy
To prevent cross-infection
Report any abnormal findings
To ensure client receives appropriate care

Oral measurement
Procedure
Rational
Assist client into a comfortable position, explain procedure, and gain consent
For information-giving and client comfort
Hold mercury thermometer at eye level, rotating slightly to ensure mercury line is visible. Check mercury is low enough to record the temperature. If not, shake it down in a downward direction, taking care not to hit any nearby objects
For accuracy of measurement.

To prevent breakage
Cover thermomenter with a disposable cover
To reduce infection risk
Place thermometer under the client’s tongue beside the frenulum
To ensure correct reading
Advise client not to talk, to keep lips closed to form a seal and, if fully co-operative, ask them to hold the thermometer in situ.
To keep thermomdter in place. If the client is unable to hold the thermometer in situ consider using another route.
Leave in place for a minimum of seven minutes
To allow adequate time for the thermometer to register
Remove thermometer, remove cover, read at eye level, record results and report any significant change
To ensure continuity of care and prompt attention if necessary
Clean thermometer according to local policy
To minimize cross-infection

Refferences
Mills, Elizabeth Jacqueline. 2004. Nursing Procedures, 4th Edition. USA : Lippincott
Penelope Ann Hilton.2004.Fundmental OF Nursing Skill. London : Whurr Publishers
Temple, Jean Smith and Johnson, Joyce Young. 2006. Nurse’s Guide To Clinical  Procedure, 5th Ed.
            USA : Lippincott