NURSING ENGLISH

PEDIATRIC DISEASE .GERATRIC DISEASE AND HEALTH EDUCATION

NAME : KETUT CHRISSELDA ARISTA PURWATI

NIM

: 047 STYC 13

CLASS : A2

YAYASAN RUMAH SAKIT ISLAM NUSA TENGGARA BARAT

SEKOLAH TINGGI ILMU KESEHATAN YARSI MATARAM
PROGRAM STUDI S1 KEPERAWATAN
TAHUN AKADEMIK 2015/2016

GERATRIC DISEASE
Geriatrics is the branch of medicine with a focus on aging and management
advanced age related diseases . Aging process resulted in a decrease in the function of organ
systems such as the sensory system , central nervous , digestive , cardiovascular , and
respiratory systems . Additionally occurred Similarly changes in body composition , ie a
decrease in muscle mass , an increase in time and centralization fat , and increased
intramuscular fat .
DIABETES MELITUS
2.1 Understanding Diabetes Melitus
Diabetes mellitus is a chronic disease that results in a complex metabolic disorder
of carbohydrate , protein , fat and complications develop macrovascular , microvascular and
neurologic . ( Barbara C. Long )
Diabetes mellitus is a chronic disease that causes multi- system disorder and has the
characteristics hyperglikemia caused by deficiency of insulin or inadequate insulin action .
( Brunner and Sudart )
Diabetes mellitus is a chronic hyperglikemia circumstances caused by
environmental factors and heredity together , have a chronic hyperglikemia characteristics
can not be cured but can be controlled ( WHO ) .
Diabetes mellitus is a collection of symptoms that occur in a person due to an
increase in blood glucose levels caused by insulin deficiency both absolute and relative
( Suyono , 2002).
2.2 Etiology Diabetes Melitus
According to many experts a number of factors that are often considered to be the cause ,
namely : genetic
a.Family factor history of diabetes :
Pincus and White argue comparison families who suffer from diabetes mellitus with healthy
family health , family turns morbidity with diabetes mellitus reach 8 , 33 % and 5 , 33 %
when compared to the healthy family that shows only numbers 1 , 96 % .
b.Faktor non-genetic
a. Infection
The virus is considered a " trigger " to those who already have a genetic predisposition to
diabetes mellitus .
b. Nutrition
Obesity is considered to cause resistance to insulin .
Malnutrition protein
c. The alcohol , considered to add to the risk of pancreatitis .

d. Stress
Stress in the form of surgery , myocardial infarction , burns and emotions usually cause
temporary hyperglikemia .
e. Hormonal Cushing's syndrome due to the concentration of hydrocortisone in high blood
pressure , because the amount of somatotropin rising acromegaly , pheochromocytoma
due to high concentrations of glucagon in the blood , pheochromocytoma due to
increased catecholamine levels.
2.3 Patofisiology
Most of the pathology of diabetes mellitus can be associated with one of the three
main effects of insulin deficiency as follows: (1) Reduction in the use of glucose by the cells
of the body, with the result that the increase in blood glucose concentrations as high as 300 to
1200 mg / day / 100 ml. (2) Increased mobilization of fat from fat storage areas, causing
abnormalities of lipid metabolism and lipid deposition in the vascular wall lead to
atherosclerosis. (3) Reduction of protein in the body tissues.
But besides that occurred some problems pathophysiology of diabetes mellitus who
are not easily visible is lost into the urine client diabetes mellitus. When the amount of
glucose entering the kidney tubules and glomerular filtration increased by approximately
above 225 mg.menit glucose in significant amounts ranging dumped into the urine. If the
number of glomerular filtration formed each minute stay, then the surge of glucose occurs
when glucose levels increase beyond 180 mg%.
Acidosis in diabetes, the shift from metabolism to carbohydrate metabolism has
been discussed. When the body depend almost all its energy in fat, acid levels aseto Bihidroksibutirat acetic acid in body fluids can be increased from 1 mEq / liter to as high as
10 mEq / Lite.
2.4 Sign and symptom
Symptoms that commonly occur, in diabetes mellitus as follows:
In the early stages often found:
a.Poliuri (lots of urine)
This is caused by increased blood glucose levels to exceed the absorptive capacity
of the kidneys to glucose resulting in osmotic diuresis which attract a lot of sugar and
electrolyte liquid so that the clients complain much pee.
b.Polidipsi (much to drink)

This is due to the burning of too much and lose a lot of fluids because of polyuria,
so as to compensate the client more drink.
c.Polipagi (much to eat)
This is because glucose does not get into the cells undergo starvation (hungry). So
as to fulfill the client will continue to eat. But even though the client a lot of eating, the food
is still just going to be up in the blood vessels.
d.Heavy,Weight, limp, quickly tired, lacking energy.
This is due to run out of glycogen that has melted so glucose, the body berusama
got smelting substances from the body portion is fat and protein, because the body continues
to feel hungry, your body will further break down the food reserves in the body, including
those in muscle tissue and fat so that clients with DM although many will remain meager
meal
e.blurred eyes
This is caused by traffic disruption polibi (glucose - sarbitol fruktasi) due to
insufficiency of insulin. There are hoarding sarbitol result of the lens, resulting in the
formation of cataracts.
2.5 Management Diabetes Melitus
The main objective management of clients with diabetes mellitus is to regulate blood
glucose and prevent complications acut and chronic. If the client successfully cope with
diabetes who suffered, he will avoid hyperglikemia or hypoglycemia. Management of
diabetes depends on the accuracy of the interaction of three factors of physical activity,
dietary and pharmacological intervention with oral and insulin preparations hyperglikemik.
In patients with diabetes mellitus should hamper sugar and sweet foods forever. Three
important things that must be considered in patients with diabetes mellitus are three J
(number, schedule and type of food) are:
JI: the number of calories in accordance with a doctor's prescription should be spent.
J 2: meals schedule should be followed in accordance with the registered dining hours.
J 3: types of food should be considered (abstinence sugar and sweets).
Diet on penderitae diabetes mellitus can be divided into several parts, among others:
a.Diet A: consisting of foods that contain 50% carbohydrates, 30% fat, 20% protein.
b.Diet B: consisting of 68% carbohydrates, 20% fat, 12% protein.

c.Diet B1: composed of 60% carbohydrates, 20% fat, 20% protein.

d.Diet B1 and B2 given to diabetic nephropathy with impaired renal function.
A diet Indications:
Given to all patients with diabetes mellitus in general.
Indications diet B:
Given to people with diabetes, especially that:
a.less hold eight with his diet.
b.Have hyperkolestonemia.
c.have microangiopathy complications for example have experienced cerobrovaskuler
acident (CVA) of coronary heart disease.
d.Mempunyai microangiopathy complications eg diabetic retinopathy, but there is no real
nephropathy.
e.Hve diabetes of 15 years
Indications diet B1
Given to diabetics who require a high protein diet, the diabetics especially:
a.Mampu or high-protein eating habits but normalip idemia.
b.Kurus (underweight) with relative body weight less than 90%.
Young c.Masih need growth.
d.Mengalami fractures.
e.Hamil and breastfeeding.
f.Menderita chronic hepatitis or cirrhosis hepatitis.
g.Menderita pulmonary tuberculosis.
h.Menderita Graves' disease (Morbus basedou).
i.Menderita cellulitis.
j. postoperative state.
Indications are above long as no contraindications, use high levels of protein.
Indications B2 and B3
Diet B2
Administered in patients with nephropathy with chronic renal failure who are still wide
creatinine clearance of 25 ml / min.
The properties of dietary B2

a.High calories (over 2000 calories / day but contain less protein.
b.Composition together with diet B, (68% carbohydrate, 12% protein and 20% fat) diet B2
only rich in essential amino acids.
c. practice there are only B2 diet with a diet from 2100 to 2300 calories / day.
Because if not then the number will change daily.
Diet B3
Administered in patients with diabetic nephropathy with chronic renal failure who klibers
creatinine less than 25 MI / mt
B3 diet nature
a.Higth calories (over 2000 calories / day).
b.Low high protein essential amino acids, the amount of protein 40 grams / day.
c.the reason No. 2 then only be prepared diet B3 2100 and 2300 calories / day. (When it will
not change the amount of protein).
d.Tinggi carbohydrates and low in fat.
e.Choose saturated fat.
All patients with diabetes mellitus is recommended for light exercises conducted
regularly every day during the half-hour after eating. Also recommended to do light exercise
every day, morning and evening with a view to lowering the BB.
Health education .
To improve understanding then conducted through individual counseling among
physicians with patients who come . It also carried out through the media - print and
electronic media .
2.6 Complication
a.Akut
1.Hypoglycemia
2.Ketoacidosis
3.Diabetic
b.Kronic
1.

Makroangiopati , the large blood vessels , heart blood vessels peripheral blood vessels ,
blood vessels of the brain .

2.

Mikroangiopati the small blood vessels diabetic retinopathy , diabetic nephropathy .

PEDIATRIC DISEASE
Pediatrics , or pediatrics is the medical specialty that deals with babies and children .
Pediatrics word taken from two ancient Greek words , paidi which means " child " and iatros
which means " doctor " . Most pediatricians are members of a national body such as the
Indonesian Pediatric Association , the American Academy of Pediatrics , the Canadian
Pediatric Society , and others. Abraham Jacobi is the father of pediatrics .
Pediatrics differs from adult medicine . The obvious physical differences body
growth and maturity of the child health makes spesialisasis stands as its own . A smaller
body of the infant has a different physiological aspects of an adult . Other medical aspects

are affected such as congenital defects , oncology , and immunology . Simply put ,
addressing pediatric patients is not like dealing with adult patients " small version " .
EXTRINSIC ASTHMA
sthma is a chronic respiratory disease that is most often found in children with
high hospitalization rates . Where asthma is a complex disorder with many factors play a
role in pathogenesis. Therefore , it is not easy to make a simple definition that satisfy all
parties . The framers of the National Asthma Consensus Child , 2002, defines asthma as
recurrent wheezing and persistent cough with or seebagai following characteristics ; arise
Episodic , inclined at night / early morning ( nocturnal ) , seasonal , after physical activity as
well as their history of asthma or other atopic to the patient / family.
The prevalence of asthma increased from time to time both in the developed and
developing countries. The increase is thought to be related to lifestyle change and the role of
environmental factors, especially pollution both indoors and outdoors. Total prevalence of
asthma worldwide is estimated to 7.2% (10% in children) and vary between countries.
Asthma prevalence in Indonesia is based on research in 2002 in children aged 13-14 years is
6-7%. The prevalence of asthma varies in different studies around the world, among others,
are affected by asthma definitions used by researchers and methods in conducting research.
The study, obtained by using a questionnaire generally lower than the prevalence obtained in
clinical research. Other factors that influence is the state of the environment as well as the
geographic and race. The prevalence of asthma in children ranged from 2-30%. In
Indonesia, the prevalence of asthma in children of about 10% at primary school age, and
approximately 6.5% in the first secondary school age.
This disease can occur at any age although most in children . Asthma can be mild
and do not interfere with the activity , but can be persistent and interfere with daily activities
and even activities . National guidelines for childhood asthma in their operational limits
agree suspicion of asthma when the child showed symptoms of coughing and / or wheezing
that arise episodic , inclined at night / early morning ( nocturnal ) , seasonal , after physical
activity , as well as a history of asthma and atopy in patients or family.
1.1 Understanding extrinsic asthma
Bronchial asthma is intermittent obstructive airway disease , reversible
hyperactivity where trakheobronkhial responds to certain stimuli .

Bronchial asthma is a disease characterized by increased responsiveness of the

trachea and bronchi to various manifestations rangsangandengan airway narrowing broad
and rank can change either spontaneously or result from the treatment .
1.2 Etilogy
There are some things that are predisposing factors and precipitation onset
bronchial asthma attacks.
1. Predisposing Factors
- Genetic
Is derived allergies talent despite the decline is not known how. Patients with
allergic illnesses usually have close relatives who also suffer from this allergy alergi.Karena
their talent, patients are very susceptible to bronchial asthma disease if exposed to the
trigger factors.
2. Factors Precipitation
- Allergens
Allergens can be divided into three types, namely:
a. Inhalants, entering through the respiratory tract. Example: dust, animal dander, pollen,
mold spores, bacteria, and pollution.
b. Ingestan, which enter through the mouth. Examples: food and medicine
c. Kontaktan, entering through skin contact. Example: jewelry, metal, and watches.
- Changes in the weather
The weather was damp and cold mountain air often affects asma.Kadang
sometimes attack associated with the season, such as the rainy season, dry season,
bunga.Hal season is related to the direction of the wind, pollen, and dust.
- Stress
Stress / emotional disorders can trigger asthma attacks and aggravate asthma
already ada.Penderita given motivation to resolve his personal problems because if the stress
is not addressed then the asthma symptoms can not be treated.
- Sports / heavy physical activity
Most people will come under attack juka doing physical activity or sports fast
berat.lari easiest cause asthma attacks.

1.3 Patofisiology
Asthma in children occurs narrowing of the airway and hyperactivity in response
to irritants and other stimulus material.
With the presence of irritation or allergen bronchial muscles into spasm and
antibodies body appears (immunoglobulin E or IgE) in the presence of allergy. IgE on the
mast cell receptors muculkan on bond and due IgE and antigen induces histamine and other
mediators substances. The mediator will provide asthma symptoms.
Response asthma occurs in three stages: the first stage is characterized by
immediate bronkokontriksi (1-2 hours); delayed phase which can brokokontriksi repeated in
4-6 hours and continually 2-5 hours longer; late stage characterized by inflammation and
airway hyperresponsiveness few weeks or months.
asthma can also occur due to factors originators exercise, anxiety, and cold air.
During the attack asthmatik, bronkiulus become inflamed and increased mucus
secretion. This causes the lumen airway becomes swollen, then increase airway resistance
and can cause respiratory distress
Children with asthma easy for inhalation and the exhalation difficult because of
edema in this nafas.Dan roads lead to hyperinflation in the alveoli and changes in exchange
gas.Jalan breathing becomes obstructed then inadequate ventilation and saturation of 02,
resulting in a decrease in P02 (hypoxia) .During astmati attack, CO2 retained with increased
airway resistance during expiration, and cause respiratory acidosis and hypercapnea. Then
the respiratory system will hold compensated by increasing breathing (tachypnea), the
compensation can lead to hyperventilation and reduce levels of CO2 in the blood
(hypocapnea).
Disruption of gas exchange , ineffective airway clearance , and ineffective
breathing patterns associated with bronchospasm , mucosal edema and increased production
of secretions .
1. Fatigue associated with hypoxia increased effort breath .
2. Anxiety associated with hospitalization and respiratory distress
3. The risk of lack of fluid volume associated with increased respiratory and decreased fluid intake
4. Family processes associated with chronic conditions
5. Lack of knowledge related to the disease process and treatment

1.4 Sign and Symptom

Clinical manifestations in patients with asthma are coughing, dyspnoe, and
wheezing. In the majority of patients accompanied by chest pain, in patients who were free
of clinical symptoms of the attack was not found, while the time of the attack seemed patient
breathes faster, in, agitated, sat with his hands and looks forward to refute the muscles
worked hard respirator.
There are several levels of asthma, namely:
1) Level I:
a. Clinically normal with no abnormal physical examination and lung function.
b. arises when there is a precipitating factor obtained either naturally or with a bronchial
provocation test in the laboratory.
2) Level II:
a. Without complaint and physical examination abnormalities but lung function showed
signs of airway obstruction.
b. Many found on the client after recovering attack.
3) Level III:
a) No complaints.
b) physical examination and lung function showed airway obstruction.
c) The patient has recovered and if the drugs are not forwarded vulnerable back.
4) Level IV:
a) The client complained of cough, shortness of breath and wheezing wheezing.
b) physical examination and lung function obtained signs of airway obstruction.
5) Level V:
1. Status asthmaticus is a medical emergency such as severe acute asthma attacks are
refrator while on medication commonly used.
2. Asthma is basically a disease that is reversible airway obstruction.
3. At severe asthma-like symptoms can arise:
4. Contraction of the muscles of breathing, cyanosis, disturbance of consciousness

1.5 Complication

Various complications that may arise are :

1)

Status asthmaticus is a severe asthma attack or any later became heavy and

did not provide a response ( refractory ) or aminophylline injection of adrenaline and

can be classified in status asthmaticus . Patients should be treated with intensive
therapy .
2)

atelectasis is shrinking part or all of the lung due to blockage of the airways

( bronchi or bronchioles ) or due to very shallow breathing .

3)

Hypoxemia is the body is deprived of oxygen

4)

pneumothorax is the presence of air in the pleural cavity causing the lung

collapse .
5)

Emphysema is a disease whose main symptom is narrowing ( obstruction )

airway due to the air sacs in the lungs ballooned in excess and suffered extensive
damage
1.6 Management Extrinsic astma
The general principle is the treatment of bronchial asthma:
1. Eliminate airway obstruction immediately
2. Identify and avoid factors that can trigger asthma attacks
3. Provide information to patients or their families about asthma. Includes the treatment
and course of the disease so that patients understand the purpose of the treatment given
and in cooperation with the treating doctor or nurse.
- Treatment
Treatment of bronchial asthma is divided into two, namely:
1) Treatment of non-pharmacologic
a. Provide counseling
b. Avoid precipitating factors
c. Fluid administration
d. Physiotherapy
e. Give O if necessary
2) Treatment pharmacologic
- Bronchodilators: drugs that dilate the airways. Divided into two groups:
a. Sympathomimetic / andrenergik (adrenaline and ephedrine)

Name drugs: Orsiprenalin (Alupent), fenoterol (berotec), terbutaline (bricasma).

b. Santin (theophylline)
Drug name: Aminophylline (Amicam supp), Aminofilin (Euphilin Retard), Theophylline
(Amilex)
Patients with gastric disease should be careful when taking this medicine.
- Kromalin
Kromalin not bronchodilators but it is but it is a preventive medicine asthma attacks.
Kromalin usually given together other anti-asthma drugs and new effect is seen after one
month of usage.
- Ketolifen
Possessed preventive effect against asthma as kromalin.Biasanya given a dose of 2 times 1
mg / hari.Keuntungan this drug is that it can be administered orally.

Health education to the patient's family

Education for patients and their families can help patients to better participate in the
care and treatment decisions. The education provided by various hospital staff. Education is
given when the patient interacts with the doctor or the nurse. The other party to provide
education at the time they provide specific services, such as rehabilitation or nutrition
therapy, or while preparing the patient for home and continued treatment. Therefore, the
number of staff who helped conduct the education of patients and their families, the hospital
staff need to coordinate their activities and focus on what are the requirements of patients.

Thus, effective education begins with assessing the learning needs of patients and
their families. This assessment determines what to learn and how best to implement the
learning. Learning itself will take place most effective when tailored to the learning options,
as well as religious and cultural values and language of a person's ability to read. Learning is
also affected by the implementation when the time in the treatment process.
Education includes the necessary knowledge during the process of care and
knowledge required after the patient was transferred to another care facilities or discharged.
Thus, education may include information about resources in the community for additional
care and treatment follow-up (follow-up) is needed and how to access emergency services if
necessary. Effective education in a hospital uses electronic and visual formats available, a
variety of distance learning techniques, and so on.
Education of patients and families at the hospital, especially for individuals who are
in need of treatment or care. Besides health promotion addressed to hospital visitors, both
outpatients and families of patients who escort or accompany patients in the hospital because
of the patient's family is expected to help support the healing process and recovery of the
patient.
Patients and their families should know the things that are associated with the disease
such as: the causes of disease, mode of transmission (when infectious diseases), prevention,
proper engobatan process and so on. When patients and their families understand the disease
is expected to be petrified accelerate the healing process and will not be affected by the same
disease.
Empowerment in the health of patients and their families intended if a patient had
recovered and returned to his home, they are able to make efforts in preventive and
promotive

health,

mainly

related

to

the

disease

that

has

suffered.

Implementation of the learning process in the hospital health means all hospital visitors,
patients either through information from hospital officials, but from what experienced, heard,
and seen in the hospital.
Effective education begins with the assessment of the learning needs of patients and
their families. This assessment describes not only the need for learning, but also how learning
can be implemented properly. Learning is more effective when customized with confidence,
learning the right choice, religious, cultural values, and the ability to read, as well as the
language. Likewise, when it was discovered it needed in the process of patient care.
Education includes both the knowledge needs of the patient during the process of service

delivery as well as the needs of patients after discharge to be referred to another health care
or return home.
Thus, education include information on community resources for additional services
and follow-up care if needed, and how access to emergency services when needed. Effective
education in the hospital should be provided visual and electronic formats, as well as a
variety of distance learning and other techniques.
1. Target health education for families
a. Help speed up the healing process of patients. In the healing process, not only the
drug factor alone, but the psychological factors of the patient, especially noncommunicable diseases such as coronary heart disease, hypertension, diabetes
mellitus, mental illness and so forth, psychological factors play an important role. In
realizing this psychosocial environment, the role of the family is very important.
Therefore, health promotion needs to be done also for the families of patients.
b. The family was not attacked or contracting the disease. By conducting health
education to the families of their patients will mengerahui and recognize the disease
suffered by the patient (family members), how it is transmitted, and how to prevent it.
Families of patients would have tried separately to avoid being exposed to or infected
with diseases such as those suffered by the ill family members
c. Helping to not transmit the disease to other family members. families of patients who
have acquired the knowledge and the means of transmission, then the family is
expected to help patients or their families are sick to not transmit the disease to
others, especially to or neighbor and friend nearby.

2. Type of activity
Based on health promotion goals, the type of patient and family education
activities can be done by:
a. Individual (Bedside Counseling)
Individual health promotion is done in the form of counseling. Counseling is done by
doctors, nurses, dietitians, medical rehabilitation personnel towards patients or
relatives of patients who have special health problems, or her illness
b. Group
Group counseling can be done by collecting the patient and / or the patient's family in

a room that has been set. Group counseling methods such as lectures, group
discussions and simulation can be used in this health education.
c. Mass
For all visitors to the hospital, both patients and families of patients and hospital
guests, is the target of health education in this form. Forms of health education is to
use mass extension methods such as posters or banners.