Lima Cara Kurangi Peradangan

Oleh: Merry Wahyuningsih - DetikHealth

Mengurangi peradangan di dalam tubuh sangat penting karena merupakan kondisi yang dapat mengakibatkan kondisi medis serius seperti penyakit jantung dan gangguan autoimun. Bagaimana cara mengurangi peradangan?

Tangan, kaki, dan bagian tubuh lainnya menjadi merah, bengkak, panas dan menyakitkan adalah gejala-gejala terjadinya peradangan. Peradangan adalah kemampuan dari sistem kekebalan tubuh kita untuk merespon sebuah iritasi.

Misalnya, jika lutut cedera saat berolahraga, sistem kekebalan tubuh akan mengeluarkan protein, yang disebut protein C-reaktif, menuju ke daerah lutut yang cedera dan mengakibatkan rasa sakit, bengkak dan peradangan.

Peradangan sebenarnya adalah kondisi tubuh untuk mencegah kerusakan lebih lanjut. Namun, penelitian juga menunjukkan bahwa peradangan kronis dapat menjadi akar penyebab beberapa penyakit kronis seperti gangguan autoimun dan penyakit jantung koroner.

Oleh karena itu sangat penting untuk mengurangi peradangan sesegera mungkin. Seperti dilansir dari Ehowdan Buzzle, Jumat (30/4/2010), berikut 5 cara untuk mengurangi peradangan, yaitu:

1. Makan makanan yang kaya antioksidan
Antioksidan selain dapat meningkatkan sirkulasi dan percernaan, juga secara alami dapat mengurangi peradangan dalam tubuh.

Banyak kondisi atau penyakit seperti arthritis, gangguan pencernaan, katarak, tekanan darah tinggi, kanker, hipertensi, cacat lahir, dan sebagainya, dapat dihindari atau disembuhkan dengan makan makanan yang kaya antioksidan 5-9 kali sehari.

Contoh makanan yang kaya antioksidan adalah stoberi, blueberry, raspberry, blackberry, anggur, plum, ikan salmon, mackerel, brokoli, pepaya, melon, kacang-kacangan, merica, asparagus, ubi jalar, wortel, labu, aprikot, tomat, minyak zaitun, dan coklat.

2. Hindari makanan olahan
Makanan olahan adalah makanan yang sudah dikemas dalam bentuk kotak, kaleng atau yang siap saji.

Makanan olahan ini mengandung lemak jenuh, lemak trans, karbohidrat olahan dan pengawet yang dapat meningkatkan peradangan di seluruh tubuh.

3. Minum banyak air dan menghindari minuman manis
Air putih dapat membuat tubuh tetap terhidrasi dan membantu melancarkan pencernaan. Selain itu, teh hijau juga merupakan sumber antioksidan yang baik, tapi hindari penggunaan gula pada minuman teh ini.

4. Latihan teratur
Berolahraga selama 30-60 menit 3 hingga 5 kali dalam seminggu akan membantu menurunkan berat badan secara alami, sehingga mengurangi jumlah tekanan pada sendi dan ligamen. Kurang tekanan berarti mengurangi peradangan dalam tubuh.

Selain itu, olahraga seperti jalan cepat, jogging, bersepeda atau berenang dapat membuat tubuh melepaskan senyawa yang disebut endorphins dalam aliran darah, yang akan membantu meredakan peradangan.

5. Kurangi stres
Stres menyebabkan pelepasan beberapa hormon stres di dalam tubuh, yang mengakibatkan peradangan. Ada beberapa cara untuk menghilangkan stres dan kecemasan, seperti aromaterapi, beribadah, pijat, dan lainnya, yang dapat digunakan untuk menenangkan jiwa.

Mengurangi stres berarti mengurangi peradangan. Selain itu, tidur nyenyak juga membantu mengurangi peradangan. Pastikan tubuh mendapatkan sekitar 7-9 jam tidur, sehingga dapat membatalkan semua respon peradangan tubuh.

Stress dan Ansietas Pada Pasien Yang Menjalani CAGB [Stressors and Anxiety in Patients Undergoing Coronary Artery Bypass Surgery]

By: Robyn Gallagher, RN, PhD, and Sharon McKinley, RN, PhD

Background Patients undergoing coronary artery bypass surgery who have increased anxiety levels have poorer outcomes than patients with lower levels, yet few studies have identified the concerns associated with this anxiety.

Objective To describe the concerns of patients undergoing coronary artery bypass surgery and to identify concerns that were associated with higher levels of anxiety.

Method Patients (n = 172) were interviewed to determine their concerns and anxi­ety levels before surgery, before discharge, and 10 days after discharge. Multiple regression was used to determine the predictors of anxiety.

Results Although individual concerns changed over time, anxiety levels did not change from before to after surgery, remaining low to moderate. Being female and having more concerns about waiting for the surgery, being in pain/discomfort, and resuming lifestyle were predictors of increased anxiety before surgery. Predictors of increased anxiety while hospitalized after the surgery included taking anxiolytic or antidepressant medications, higher anxiety levels before surgery, concerns about personal things being inaccessible, and difficulty sleeping. Patients with higher anxiety levels after discharge were older, more anxious before surgery, and had concerns about being in pain/discomfort.

Conclusion Patients waiting for coronary artery bypass surgery should be routinely assessed for anxiety before the procedure, and interventions to prevent or reduce anxiety should be provided. Interventions must be multifactorial, including infor­mation and support for pain management and realistic information about surgery schedules and resuming lifestyle after the surgery. Women and older patients may need to be targeted for intervention.

Sumber: American Journal of Critical Care.2007;1 6:248-257

NURSES’ IMPLEMENTATION OF GUIDELINES FOR VENTILATOR-ASSOCIATED PNEUMONIA FROM THE CENTERS FOR DISEASE CONTROL AND PREVENTION

By: Carolyn L. Cason, RN, PhD, Tracy Tyner, RN, MSN, CEN, CCRN , Sue Saunders, RN, MSN, CCRN, and Lisa Broome, RN, MSN. From the School of Nursing, University of Texas at Arlington (CLC), Parkland Memorial Hospital, Dallas, Tex (TT), RHD Memorial Hospital, Dallas, Tex (SS), and Baylor Regional Hospital, Plano, Tex (LB).

BACKGROUND Ventilator-associated pneumonia accounts for 47% of infections in patients in intensive care units. Adherence to the best nursing practices recommended in the 2003 guidelines for the preven­tion of ventilator-associated pneumonia from the Centers for Disease Control and Prevention should reduce the risk of ventilator-associated pneumonia.

OBJECTIVE To evaluate the extent to which nurses working in intensive care units implement best prac­tices when managing adult patients receiving mechanical ventilation.

METHODS Nurses attending education seminars in the United States completed a 29-item question­naire about the type and frequency of care provided.

RESULTS Twelve hundred nurses completed the questionnaire. Most (82%) reported compliance with hand-washing guidelines, 75% reported wearing gloves, half reported elevating the head of the bed, a third reported performing subglottic suctioning, and half reported having an oral care protocol in their hospital. Nurses in hospitals with an oral care protocol reported better compliance with hand washing and maintaining head-of-bed elevation, were more likely to regularly provide oral care, and were more familiar with rates of ventilator-associated pneumonia and the organisms involved than were nurses working in hospitals without such protocols.

CONCLUSIONS The guidelines for the prevention of ventilator-associated pneumonia from the Centers for Disease Control and Prevention are not consistently or uniformly implemented. Practices of nurses employed in hospitals with oral care protocols are more often congruent with the guidelines than are practices of nurses employed in hospitals without such protocols. Significant reductions in rates of ventilator- associated pneumonia may be achieved by broader implementation of oral care protocols.

Selengkapnya: (American Journal of Critical Care. 2007;16:28-38)

Penyebab Kanker Orang Indonesia

Oleh: Irna Gustia - DetikHealth

Kanker adalah pertumbuhan sel yang tidak normal yang menyerang organ dengan cepat sehingga fungsinya hancur dan menyebabkan kematian. Kanker bisa disebabkan faktor genetik dan lingkungan.

Di Indonesia dan dunia tiap tahun kasus kanker terus meningkat. Mulai dari yang tertinggi kanker payudara, kanker leher rahim (serviks), kanker paru, Kanker usus besar (kolorektal), kanker prostat, kanker darah, kanker tulang, kanker hati, kanker kulit. Setidaknya di dunia ada lebih dari 100 jenis kanker.

Direktur Jenderal Pengendalian Penyakit dan Penyehatan Lingkungan (P2PL) Kementerian Kesehatan Prof. dr. Tjandra Yoga Aditama dalam seminar di Jakarta, Senin (26/4/2010) mengatakan kanker merupakan salah satu penyakit tidak menular yang menjadi masalah kesehatan masyarakat, baik di dunia maupun di Indonesia.

Di dunia, 12 persen seluruh kematian disebabkan oleh kanker dan pembunuh nomor 2 setelah penyakit kardiovaskular. WHO dan Bank Dunia memperkirakan setiap tahun, 12 juta orang di seluruh dunia menderita kanker dan 7,6 juta di antaranya meninggal dunia.

Jika tidak dikendalikan, diperkirakan 26 juta orang akan menderita kanker dan 17 juta meninggal karena kanker pada tahun 2030. Ironisnya, kejadian ini akan terjadi lebih cepat di negara miskin dan berkembang.

dr. Tjandra mengatakan ada beberapa faktor yang menyebabkan tingginya angka kanker di Indonesia yaitu:

1. Merokok 23,7 persen

2. Obesitas pada penduduk usia di atas 15 tahun yakni pria 13,9 persen dan pada perempuan 23,8 persen.

3. Kurang konsumsi buah dan sayur 93,6 persen

4. Konsumsi makanan diawetkan 6,3 persen

5. Makanan berlemak 12,8 persen

6. Makanan dengan penyedap 77,8 persen

7. Kurang aktivitas fisik sebesar 48,2 persen.

Agar jumlah penderita kanker tidak terus bertambah perlu dilakukan pencegahan seperti:

1. Tidak merokok dan tidak mengonsumsi minuman beralkohol.

2. Menghindari paparan sinar ultraviolet berlebih

3. Mencegah obesitas dengan diet sehat (mengkonsumsi buah dan sayur 5 porsi sehari)

4. Melakukan ktivitas fisik (gerak badan) 30 menit sehari.

5. Melakukan deteksi dini secara berkala di fasilitas-fasilitas kesehatan.

Berdasarkan data Riskesdas, 2007, menurut Prof. Tjandra Yoga, di Indonesia rasio tumor atau kanker adalah 4,3 per 1000 penduduk. Kanker merupakan penyebab kematian nomor 7 (5,7%) setelah stroke, TB, hipertensi, cedera, perinatal dan Diabetes Melitus.

Sedangkan berdasarkan data Sistem Informasi Rumah Sakit (SIRS) tahun 2007, kanker payudara menempati urutan pertama pada pasien rawat inap di seluruh RS di Indonesia (16,85%), disusul kanker leher rahim (11,78%).

Kanker tertinggi yang diderita wanita Indonesia adalah kanker payudara dengan angka kejadian 26 per 100.000 perempuan, disusul kanker leher rahim dengan 16 per 100.000 perempuan.

"Para ahli memperkirakan 40% kanker dapat dicegah dengan mengurangi dan menghindari faktor risiko kanker," ujar Prof. Tjandra Yoga.

Sejak tahun 2007, proyek percontohan pengendalian kanker leher rahim dan payudara melaui deteksi dini telah dikembangkan. Pada tahun 2010, program pengendalian kanker paru menjadi salah satu program yang akan dikembangkan.

Pengendalian kanker paru dilaksanakan melalui pencegahan primer (promosi dan edukasi), sekunder (penemuan dini dan pengobatan segera), dan tersier (perawatan paliatif).

"Pengendalian yang paling efektif dan efisien adalah dengan pencegahan primer, yaitu menerapkan gaya hidup sehat," jelas Prof. Tjandra.

Symptoms Across the Continuum of Acute Coronary Syndromes: Differences Between Women and Men

By: Holli A. DeVon, Catherine J. Ryan, Amy L. Ochs and Moshe Shapiro

Background The urgency and level of care provided for acute coronary syndromes partially depends on the symptoms man­ifested.

Objectives To detect differences between women and men in the type, severity, location, and quality of symptoms across the 3 clinical diagnostic categories of acute coronary syn­dromes (unstable angina, myocardial infarction without ST- segment elevation, and myocardial infarction with ST-segment elevation) while controlling for age, diabetes, functional sta­tus, anxiety, and depression.

Methods A convenience sample of 112 women and 144 men admitted through the emergency department and hospitalized for acute coronary syndromes participated. Recruitment took place at 2 urban teaching hospitals in the Midwest. Data were collected during structured interviews in each patient’s hospi­tal room. Forty-eight symptom descriptors were assessed. Demographic characteristics, health history, functional status, anxiety, and depression levels also were measured.

Results Regardless of clinical diagnostic category, women reported significantly more indigestion (â = 0.25; confidence interval [CI] = 0.01-0.49), palpitations (â = 0.31; CI = 0.06-0.56), nausea (â = 0.37; CI = 0.10-0.65), numbness in the hands (â = 0.29; CI = 0.02-0.57), and unusual fatigue (â = 0.60; CI = 0.27- 0.93) than men reported. Differences between men and women in dizziness, weakness, and new-onset cough did differ by diagnosis. Reports of chest pain did not differ between men and women.

Conclusions Women with acute coronary syndromes reported a higher intensity of 5 symptoms (but not chest pain) than men reported. Whether differences between the sexes in less typical symptoms are clinically significant remains unclear.

Selengkapnya: (American Journal of Critical Care. 2008;17:14-25

Stress in the Nurse

by: Tina Moore

Caring for the critically ill patient may be stressful. If stress remains unrecognised or unalleviated, burn-out is likely to occur. The quality of care may deteriorate (clinical errors) and staff may avoid or distance themselves from all but the absolutely necessary interactions with the patient. Staff dissatisfaction at work may become evident in the form of sickness and absenteeism.

Causes

Causal factors of stress can be interpersonal (conflicts within a multidisciplinary team, bureaucracy, inadequacies of nursing care by others) or extrapersonal (environmental). Kincey et al. (2003) identified that a combination of workload, resources and a global sense of the NHS caused stress.

Clinical features

Stress can interfere with individuals’ appraisal of their situation – ‘can’t see the wood for the trees’ syndrome. Clinical features of stress (Roberts, 1986) may be:

n Emotional – increasing irritability

n Behavioural – indecisiveness

n Psychological – increasing suspiciousness and distrust

n Cognitive – inability to concentrate or listen

n Physiological – stress response (discussed earlier).

Long-term stress can lead to ill health, e.g. gastric ulcers, coronary heart disease and a compromised immune system (increased infection, common colds).

Management

Management comprises prevention and coping strategies. Crisis situations cannot be totally avoided, but strategies involve identifying the stress and taking owner­ship in working towards reducing stress to a manageable level.

Albert Einstein (cited in Davidson, 1999) suggested that the significant prob­lems we face cannot be solved at the same level of thinking we were at when we created them. Therefore, stress challenges us to take a ‘mental helicopter’ to a point above the situation so that we can get a different view on it and be pre­pared to entertain new thoughts and ideas and develop a new focus and perspect­ive. Strategies involve identifying the stress and taking ownership in working towards reducing stress, but in order to do this, stress needs to be of a manage­able level.

Kincey et al. (2003) identified that junior staff are more vulnerable to the negative aspects of stress. Coping with stress needs a supportive working environ­ment through preceptorship and effective teamwork. Keeping a diary or journal as a way of expressing oneself may be useful. The use of reflection through clini­cal supervision may help nurses to examine their practice critically and learn through this process, identifying areas for future development. Debriefing can be offered by a supervisor, but this requires great skill (see Chapter 38). Active teaching programmes and regular appraisals can help facilitate knowledge and skill development, and detailed induction programmes for new staff should help to reduce stress.

Nurses need to be able to prioritise the management and delivery of care. This involves breaking work down into series of tasks and placing these tasks in a logical order. Implications of those tasks should be examined.

Thinking ahead, making predictions and creating deadlines for the completion of tasks should help nurses to manage their time and efforts effectively and effi­ciently. This will leave time for real crises, should they arise.

As a coping mechanism, some nurses detach themselves from patients by being ‘too efficient’ or ‘too busy’, and therefore adopt a depersonalised approach to care. Balancing engagement and detachment should enable nurses to care effi­ciently and effectively for the patient and themselves.

Carmack (1997) suggests the following strategies to aid the balancing of engagement and detachment:

n Maintain consciousness and pragmatism – be realistic about what can and cannot be achieved, and be aware of your limitations

n Set limits and boundaries

n Monitor yourself – a sense of personal control is essential

n Practise self-care – it is important not to become too immersed in care; looking after yourself is also important

n Let go of the outcomes and the need to control the outcome.

Sumber: Tina Moore & Philip Woodrow (2004). High Dependency Nursing Care Observation, Intervention and Support. London: Routledge

Stress

By: Tina Moore

Introduction

It is debatable whether caring for the critically ill is more stressful than other areas of nursing. Nurses working in critical care units are exposed to different types of stressors, e.g. life-sustaining treatment, complex decision-making, continuous crisis atmosphere and complex technology. Stress is a subjective phenomenon and is dependent upon multiple variables – e.g. the nurse’s level of competence and experience, the severity of the patient’s illness, past experiences, perceptions of the situation, and the complexity of decision-making. Considering these variables, any clinical environment has the potential to be stressful.

There are various definitions of stress, each containing many meanings, which makes them confusing and ill-defined. Nevertheless, they all have a common attribute – the relationship between environmental influences and the individual.

Stress is a constant state of tension to which an individual is subjected whilst being incapable of controlling or finding adequate responses to it (Goldhill and Worthington, 1999). Stress can be viewed as a response to perceived demand, and is therefore a situation that is created when an individual is faced with any stimulus that causes disequilibrium in homeostatic functioning (Hudak et al., 1998). This function is dependent upon the individual’s ability to perceive and appraise the situation. Consequently, any situation can activate stress.

There is a tendency to concentrate on the negative components of stress and, where possible, to attempt to avoid stress-provoking situations. Stress can and does act as a motivator. This can be seen in individuals who work in critical care environments for significant periods of time, and in those who thrive on some degree of stress. A certain amount of stress is considered to be desirable for adaptation to occur. Problems arise when coping mechanisms fail and stress becomes counterproductive. Initial signs include lack of concentration, anxiety and insomnia.

This chapter aims to identify some of the sources of stress from both patient and nurse perspectives.

Stressors

The inability to cope with excess demand will possibly lead to prolonged stress and abnormal responses (physical and/or psychological), affecting the quality of life and performance. Stressors may be:

n Biological (injury or illness)

n Psychosocial (interpersonal conflicts, poor communication)

n Environmental (unfamiliarity with the surroundings, technology).

Stressors can be harmful, threatening or indeed challenging. Individuals’ ability to cope will be different depending upon their perception and appraisal, and the supportive mechanisms in place, as well as their own health status. The more uncontrollable an event seems, the more likely it is to be perceived as stressful.

Coping strategies can be problem-focused and/or emotion-focused (Lookin‑land, 1995). Problem-focused strategies are directed towards alerting the stressor, and involve identification of the problem and the generation of ideas to solve it.

Emotion-focused strategies involve developing and regulating the accompany­ing distressful emotions. Strategies may involve distancing, escape avoidance, self- control, positive appraisal and acceptance of responsibility (Lookinland, 1995). Patients may view similar situations in different ways, resulting in different con­sequences for long-term adjustment.

Models of stress

There are various models of stress. Stimulus-based models relate to the relation­ship between the external causes of stress and the individuals who are exposed to it. These models may be useful in identifying external stressors, such as noise or poor air quality, but they fail to identify the individual’s responses to the stres­sor(s).

Probably the most well-known model is Selye’s (1956) General Adaptation Syndrome (GAS), an example of a response-based model involving physiological responses to stress. It recognises the individual’s ability to respond and adapt to the environment. This is demonstrated in three progressive phases:

1 The alarm state – the body mobilises to confront the threat (‘fight and flight’)

2 Resistance, or adaptation – physical and nervous energy is used up; coping mechanisms vary

3 Exhaustion and death – response to stress is initially appropriate and useful in aiding coping; responses in the long term will be detrimental.

Sumber: Tina Moore & Philip Woodrow (2004). High Dependency Nursing Care Observation, Intervention and Support. London: Routledge