Академический Документы
Профессиональный Документы
Культура Документы
TUTOR
dr. Danti Nur Indiastuti, M.ked
SCENARIO COMPOSER
Dr. Sri Umijati,dr.,MS
Dr. Sulistiawati,dr,Mkes
EDITOR
Prof. Dr. N. Margarita Rehatta, dr., Sp.AnKIC., KNA
Page 1
COMPOSED BY
4B GROUP
LEADER
Muhammad Bagas Pratista
(011511133066)
SECRETARY
Elvin Nuzulistina
(011511133068)
NOTULEN
Hanifa Imansari
(011511133064)
MEMBERS
Cholifatin Nur Ardhiyah
(011511133056)
(011511133058)
Ismi Masyithah
(011511133060)
(011511133062)
Erlyta Zulfaizah
(011511133070)
(011511133072)
Page 2
CONTENTS
Cover..1
Group member...2
Contents.3
Chapter I: Brain Storming.5
1.1 Scenario.....5
1.2 Main Problem....5
1.3 Keywords..5
1.4 First Hypothesis....5
1.5 Learning Issues I...6
Chapter II: Problem Analysis7
2.1 Answer..7
2.1.1 How is holistic approach?..........7
2.1.2 Causes and Symptoms of Tuberculosis, Asthma, Pneumonia,
Emphysema and Lung Cancer...8
2.1.3 What is cement and cotton containing?............11
2.1.4 How is a holistic approach based on the scenario?............14
2.1.5 How can happen the problem of medical based on holistic
approach?......................15
2.2 Method and Steps to Find Information...18
2.3 First Mind Mapping....19
Chapter III : Tutorial Conclusion....20
3.1 Data Analysis .....20
3.2 Final Hypothesis.22
3.3 Concept Mapping....23
3.4 Pathophysiologic Dyspnea;;;.......24
3.5 Problem Solving......26
Reference.29
Journal Appraisal.31
PBL Group 4B Faculty of Medicine Airlangga University
Holistic Module
Page 3
Critical Appraisal.34
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CHAPTER I
BRAIN STORMING
1.1 Scenario
Nia is 23rd years old girl come from Jakarta. She feel that, she always cough and
sometimes dyspnea in 3 month after she move to X city. She boarding in house that
have religious people . That boarding house rather dusty because it near to semen
factory.
1.2 Main Problem
Nia has cough and dyspnea after she move to X city.
1.3 Keywords
From the scenario and main problem, we use 3 keywords for it. They are :
1. 23rd years old girl
2. Move to X city
3. Religious environmet.
4. The boarding house near to Semen factory
1.4 First Hypothesis
From the scenario and a main problem that we choose. We hypothesize :
1. Dust allergic
2. Tuberculosis
3. Asthma
4. Pneumonia
5. Emfisema
6. Lung Cancer
1.5 Learning Issues 1
From all above, there are many learning issues that we state. For the learning
issues there are:
1. What is cough and dyspnea ?
2. What are the causes and symptoms of tuberculosis, asthma, pneumonia,
emphysema and lung cancer?
3. What is cement and cotton containing ?
4. How is holistic approach?
5. How is holistic approach based on the scenario?
PBL Group 4B Faculty of Medicine Airlangga University
Holistic Module
Page 5
CHAPTER II
PROBLEM ANALYSIS
2.1 Answers
2.1.1 Cough and Dyspnea
Cough
The cough is a natural response body to clean mucus or irritation factor causes, like
dust, smoke. Usually So it can go out from the respiratory system. An irritant stimulates
nerves there to send a cough impulse to the brain. Then, the brain gives the signal to abdomen
and chest wall. Abdomen and chest wall will give a push the air to the lungs and expel the
irritant.
Cough is the symptom of some diseases either acute or chronic. The chronic diseases
like allergies, asthma, bronchitis, GERD, and postnasal drip. The acute diseases like
influenza, common cold, pneumonia, and COPD. Cough can be acute if it lasts than three
weeks while cough can be chronic if it lasts longer than eight weeks (Mayo Clinic, 2013).
Dyspnea
Dyspnea is a feeling difficult to breathe. Usually it happen when physical activity.
Dyspnea has many causes affecting either the breathing passages and lungs or the heart. The
dyspnea can occurs gradually or all of a sudden. The causes of dyspnea can be asthma,
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Allergic can trigger reaction in respirational tract, and it will produce excessive
sputum and respirational tract become narrow, and asthma occurred. Third is a
psychologic, emotion and stressed can cause asthma.
Asthmas symptoms are dyspnea with a wheezing sound. For the prevention,
asthma sufferer have to clean their environment like clean their bed from dust, avoid
high humidity room, pets and food that trigger allergic.
C. Pneumonia
Pneumonia is a infectious disease that occurred in lung tissue and caused by
bacteria, virus and fungi. Streptococcus bacteria, mycoplasma pneumonia are a
common bacteria that can occurred pneumonia. The symptoms are a cough with
sputum, chest pain, and dyspnea with high temperature.
D. Emphysema
Chronic obstructive pulmonary disease (COPD) is a disease characterized by
airflow limitation that is not fully reversible. The pathogenesis of COPD is thought to
be chronic inflammation throughout the airways, parenchyma, and pulmonary
vasculature. Pathologic changes characteristic of COPD occur in all these respiratory
structures. Among these changes, destruction of the lung parenchyma is commonly
referred to as pulmonary emphysema, defined as an abnormal permanent
enlargement of the air space distal to the terminal bronchioles, accompanied by
destruction of the alveolar walls, and without obvious fibrosis
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Cotton
Cotton comes from randu trees. Many people think that sleep on the kapuk is
more comfortable and not hot (cooler). But a bed of cotton can flat after being used
for a long time. Bed from cotton is not being suggested for people who have allergic.
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Because catton keep the dust inside bed. Kapuk has smooth piecess that can inhale
on repiratory system.
2.1.3 Definition of Holistic Approach
Holism is derived from the Greek, holos, which means whole, was first used by South
African philosopher Jan Christian Smuts (1926) in Holism and Evolution (Daniel and
Equlinet, 2006). Holistic approach to medicine is we can see the whole person. The whole
person means their body, mind, and spirit. The concept of holistic approach is a link between
physical health and the close interrelation with that physical health like biological,
psychological, social, and cultural. An holistic approach is not only treating the syptoms but
also thinking about the causes of those symptoms. It is usually called the story behind the
story. Daniel Mengistu and Equlinet Misganaw. 2006. Community Health Nursing. Page 12
Holisic Approach divide into 3 part :
AGENT
Agent is factor outside the body that have ability to causes, triggers, or worsen
disease. Agent can be from physical hazard, Biological Hazard, Chemical Hazard or
Psychosocial Hazard. Each Hazard described below (Comcare.gov.au, 2014).
1. Physical Hazard
A physical hazard is defined as a factor within the environment that can harm
the body without necessarily touching it. Vibration and noise are examples of
physical hazards". Physical hazards include but aren't limited to electricity, radiation,
pressure, noise, heights and vibration amongst many others.
2. Biologycal Hazard
Biological hazards are organic substances that pose a threat to the health
of humans and other living organisms. Biological hazards include pathogenic
micro-organisms, viruses, toxins (from biological sources), spores, fungi and bioactive substances. Biological hazards can also be considered to include biological
vectors or transmitters of disease.
Biological hazards pose risks for many people in a wide variety of ways.
For example, workers in health care professions are exposed to biological hazards
via contact with human bodily matter, such as blood, tissues, saliva, mucous,
PBL Group 4B Faculty of Medicine Airlangga University
Holistic Module
Page 11
urine and faeces, because these substances have a high risk of containing viral or
bacterial diseases. Likewise, people who work with live animals or animal
products (blood, tissue, milk, eggs) are exposed to animal diseases and infections,
some of which (zoonoses) have the potential to infect humans (for example, Qfever, avian flu or Hendra virus) or cause serious allergy via sensitisation.
3. Chemical Hazard
Hazardous chemicals in the workplace are substances, mixtures and
materials that can be classified according to their health and physicochemical
risks and dangers.
Health hazards include skin irritants, carcinogens or respiratory sensitisers that
have an adverse effect on a worker's health as a result of direct contact with or
exposure to the chemical, usually through inhalation, skin contact or ingestion.
Physicochemical hazards generally result from a substance's physical and
chemical properties, as is the case with flammable, corrosive, oxidising or
explosive substances.
4. Social Hazard
Psychosocial hazards include but arent limited to stress, violence and
other workplace stressors.
There are circumstances, however, in which work can have adverse
consequences for health and wellbeing. Risks to psychological health at work
may arise from organizational or personal factors, with the major factors being
poor design of work and jobs, poor communication and interpersonal
relationships, bullying, occupational violence and fatigue. Risks to psychological
health due to work should be viewed in the same way as other health and safety
risks and a commitment to prevention of work-related stress should be included in
an organizations health and safety policies.
ENVIRONMENT
Environment is factor that can affect on health. Environment including
(Umijati, 2015) :
PBL Group 4B Faculty of Medicine Airlangga University
Holistic Module
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1. Family
Including parents, dietary habit, lifestyle, family culture, familys economic,
health and nutritional status, and Spiritual.
2. Home Environment
Including home sanitation.
3. Health Services
Including policies and programs of nutrition and company health services.
4. Work Environment
Including work place sanitation, labor compensation, bio-psycho-socioculture hazard, and social and cultural conditions of society.
2.1.4 Holistic Approach Based on Scenario
We know that holistic approach divide into 3, based on scenario that is :
1. HOST
a.
b.
c.
d.
e.
less
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b. Work
Lived by 6 person
too many person in a house
Bed were built by kapok
Humidity 85 %
too high
Live with religious family
Her friend has cough and asthma too
Located near cement factory
Machine Company
As acountant
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in line with how the disease occurs because of the home environment that is close to a
cement plant and a large housing conditions without air circulation .
Job
Host
Cough and
shortness of
breath
causes
Medical history
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Biological
Physical
Agent
Chemical
Social
Microorganisms
and fungus
Houses dust
Cough, and
Shortness of
breath
causes
Silica in Portland
Semen
house mate
The third is part of the environment , this is very important because most
diseases of the human body definitely has a direct relationship with the environment.
As in the environment section is divided into two, namely the workplace and home
environments . The first is the environment of the working environment , the working
environment of women is related to the engine , which means he often interact with
machines which can cause respiratory problems . Both are part of the home
environment , as described earlier , again and again from the rooming house is a big
woman but with little meaningful ventilation air flow is not smooth in the house and
will accumulate dust and pollution cement are in the neighborhood .
Job environment
In
ac
h
Environmen
t
environtment
ll
Sma
in
e
co
m
pa
ny
Cough, and
shortness of
breath
n
ilatio
vent
Viewed from the third exposure above , between these three aspects can we
analissi well and get how the disease can strike women . So if we draw the third part
in a table is as follows
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Job
Host
Often hang
out
Eat
outside
Medical
history
Biologi
cal
HOLISTIK
Agent
Physic
al
Chemi
cal
Social
Biologi
cal
Agent
Physic
al
Chemic
a.l
Social
cause
Microorganis
ms and
fungus
Cough and
shortness of
breath
dust
Silica in
portland semen
House
mate
Microorganism
s and fungus
dust
Silica in
portland
semen
House mate
2.2.1 Open web browser and type the keywords, such as : holistic approach, holistic,
holistic approach to medicine,physical hazard etc.
2.2.2 Search engine and web address that we used are :
www.google.com
www.scholar.google.com
www.gopubmed.org/web/gopubmed/
PBL Group 4B Faculty of Medicine Airlangga University
Holistic Module
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www.ncbi.nlm.nih.gov/pubmed/
HOST
AGENT
Age
ENVIRONMET
Biological Hazard
Kost
Education
Chemical Hazard
Work Place
Work
Physical Hazard
(Machine Company)
Hygiene
Social Hazard
Family
HOLISTIC
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CHAPTER 3
TUTORIAL CONCLUSION
3.1 Data Analysis
Cough and dyspnea are common symptoms of some diseases related to
lung or cardiac. We dont discuss about what the disease host suffered but we just
can analyze about why cough and dyspnea happened. In this modul, we use the
holistic approach. It is like knowing the story behind the story.
Based on holistic approach, we can use a model called epidemiology triangle.
It is a model usually used to study about the health problems (cough and dyspnea).
These health problems can be associated with three major factors. These factors are :
1. Host (the person with the health problems)
The host is a woman 23 years old. She is an accountant in a company
based machine. She has past medical history, had experienced dust allergy
since 12 years old. Her families (her father and aunt) have rhinitis allergic and
bronchiale asthma. She moves from her domicile to city X. She lives in a
kos which is owned by religious people. After three months she lives in her
new domicile, she has the health problems (cough and dyspnea)
2. Agent (hazards in the environment)
Biological hazard
: Microorganims
Chemical hazard
: The composition of cement dust, SiO2 (Silicon
dioxide)
Physical hazard
Social hazard
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2. Meso environment
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host has past medical history, had experienced dust allergy since 12 years old. Her
families (her father and aunt) have rhinitis allergic and bronchiale asthma.
If all three sections are connected to the host, agent and environment as the
cause medical problems, it can be found links between each other. Changes in the
environment on the host would cause changes to the agent, so there will be many
factors that affect the health of the host. It is not only host, agent, or environment
itself. But, all of those are linked each other.
First Host
3.2 Final Hypothesis
The environment
Medical
change
dan Medical
will be follow
Familyby
History
the agent changes that will affect
the host so that arose symptoms such as cough and dyspnea. According holistic
approach, asthma is a disease that
has most likely suffered by the host.
Domicile
Movement
Causing a change
to
AGENT
Biological Hazard :
3.3 Concept Mapping
Mold
Chemical Hazard :
Cement dust
Psychological Hazard :
dust
Social Hazard : stress
about work
HOS
T
Life Style
ENVIRONMEN
T
Kost
Workplace
Pstology
PBL Group 4B Faculty ofCough
Medicine
Airlangga University
and Dyspnea
Holistic Module
Solution
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Respiratory centers
(Respiratory drive)
Sensory Cortex
Corollary
Pathophysiology of Dyspnea
Chemoreceptors
Feedback
Motor
discharge
A. Decreased tissue oxygenation
Cortex of
Disease or acutely certain circumstances can cause the speed of delivery
Mechanoreceptors
Feed-forward
oxygen
to all tissues decreases . A decrease in tissue oxygenation will improve
Metaboreceptors
Error Signal
shortness of breath . Oxygen depends
on transport because of the circulation
of blood
Error Signal
Ventilatory
and hemoglobin levels , then some circumstances such as bleedingMuscles
, anemia
Dyspnea intensity and
( hemolysis ) , change in hemoglobin
( sulfhemoglobin , methemoglobin ,
quality
carboxyhemoglobin ) may cause shortness of breath .
Parenchyma lung disease that causes intrapulmonary shunt , ventilation
disorders also cause asphyxiation . So , shortness of breath can be caused by diseases
of bronchial asthma, bronchitis and pulmonary blood vessels disease group such as
emboli , vasculitis and primary pulmonary hypertension .
B. The need of oxygen increases
Disease or condition suddenly increased oxygen requirement would give the
sensation of shortness of breath . For example , acute infection will require more
PBL Group 4B Faculty of Medicine Airlangga University
Holistic Module
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Symptoms of health problem that was taken by host is caused by some factors
depends on holistic. In every part of host, agent, and environment can support hosts
health problem. Therefore, to solve this health problem, we should fix every part of
host, agent, and environment depends on holistic.
In holistic, the solution of factors that support health problem are :
a. Host
In host, part that support health problem are education, life style, medical history,
and social roles. The education means host with s1 bachelor of economics maybe has
less health education. So, by increasing health education also can increase hosts
health level.
The second is life style, someones bad habit will influence hosts health
condition. In this scenario, host often going home late until night, this condition gives
bad impact to host because night wind has low temperature. By this low temperature,
maybe hosts immunity can not control it or maybe host has night-wind allergic.
Moreover, this condition can trigger pneumonia. Therefore, host should decrease her
bad habit not to going home late at night often.
The third is medical history, medical history are medical history in the past and
family. For disease history, host was ever taken allergic to dust at 12 years old.
Allergy can appear for the second time if there are some triggers.
The last is social roles. In this scenario, social roles means host roles as female
who works outside town far from her family, this condition can build stress to host.
So, the solution are decreasing work portion and fixing her communication with her
family.
b. Agent
In agent, there are some factors that support this health problem. There are
biological hazard, physical and social hazard. Biological hazard is about
microorganism and fungi that cause this health problem based on the condition in
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scenario. So, ways to solve and prevent this health problem are adding more
ventilation in the kost and cleaning kost regularly.
Second is physical hazard. Physical hazard based on scenario means the dust that
was inhaled by host then flew in host respiratory system and humidity. Level
humidity in scenario is too high, so it can triggers cough and dyspnea. To balancing
humidity, host should keep the kost dry and setting air circulation. Then, to decrease
the dust, host should keep the ventilation only open when wind outside kost is calm.
c. Environment
In environment, some factors that cause symptom of cough and sesak are house
environment and workplace. In house environment based on scenario, hosts kost
located near cement company with less ventilation and kost area is too wide. Hosts
workplace based on scenario is machine company. To prevent new health problem,
host must clean kost and workplace where she often spend her most time there
regularly and maybe host needs use masker in kost or at work.
Solution Of Cough And Dyspnea In Common
A medical problem suffered by host is cough and dyspnea. Dsypnea can cause
lack of oxygen in the body, it happened because of trouble in breathing. Thus, the
solutions are plant more trees, daily exercise and live in a clean and wide
environment.
Chronic dyspnea sufferer have to avoid a food and drink that contain a high
sugar like milk, white sugar, candy, wheat, and rice. Beside unhealthy food and
drinks, sufferer must consume fruit and vegetable, and also enough mineral water.
Dyspnea can be prevented and cured by a daily exercise, the funcion of the
exercise are to increase movement of back and chest that can train muscle around
lung, diaphragm and blood circulation. Best exercise is swimming because all of the
body move in swimming.
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Medicines that can cure dyspnea is a kind of drug that can enlarge respiratory
tract. The main reaseon why dyspnea can occur in human body is a psychologic
pressure that trigger dyspnea. Thud, we have to enjoy our life and dont think to much.
Sigit Nugroho (2009) cited in Wara Kushartanti (2002) said that breathing
exercise must be done everyday in few minutes. These are the direction :
a. Exhale air through nose until mucus is pulled up.
b. Take short inhale pass through nose and take long exhale through mouth so it
can produces voice.
c. Loose clothes or pants then setting air breath. Tell someone if there is ngik
voices during first few minutes from diaphragm breathing.
d. Drink a glass of water before and after take an exercise.
References
C. Shiel Jr., William. 2015. Shorness of Breath (Dyspnea). MedicineNet, Inc.
http://www.medicinenet.com/script/main/mobileart.asp?articlekey=34434 (online)
[Accessed 22 Nov. 2015].
Comcare.gov.au,
(2014).
Managing
hazards.
[online]
Available
at:
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901570378753.pdf&usg=AFQjCNG6w6TC46xn7ewYhXuiOlBQuzuSsw&sig2=eU8
sGo8q97RQXrlmKOGmZA [Accessed 24 Nov. 2015].
Longo, D.L., et al. 2011. Harrisons Principles of Internal Medicine., 18th ed. United
States: McGraw-Hill Professional
Mengistu Daniel and Equlinet Misganaw. 2006. Community Health Nursing. Page 12
(PDF) [Accessed 24 Nov. 2015]
Ober, Carole, and TsungChieh Yao. "The genetics of asthma and allergic disease: a
21st century perspective." Immunological reviews 242.1 (2011): 10-30.
Nugroho, Sigit, Dosen Pendidikan Olahraga Kesehatan Fakultas Ilmu, and
Keolahragan Universitas Negeri. "Terapi Pernapasan Pada Penderita Asma." (2008).
Prescott, Hallie C., Michael W. Sjoding, and Theodore J. Iwashyna. "Diagnoses of
Early and Late Readmissions after Hospitalization for Pneumonia. A Systematic
Review." Annals of the American Thoracic Society 11.7 (2014): 1091-1100.
Umijati, Sri. 'Modul Pendekatan Holistik Manusia Dan Lingkungan'. 2015. Lecture.
LINK :
http://mitaunair-fk12.web.unair.ac.id/
http://www.alodokter.com/batuk-batuk/
http://www.mayoclinic.org/diseases-conditions/barretts-esophagus/multimedia/vid-20078526
http://artikel.co/72/sesak-nafas-dan-solusinya.html
http://www.medicinenet.com/script/main/mobileart.asp?articlekey=34434
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JOURNAL APPRAISAL
Grup : 4B
Title
:
Avaibility
Title
Yes (page 1)
Yes (page 1)
Introduction, background
Yes (page 1)
Method
Yes (page 2)
Result
Yes (page 4)
Discussion
Yes (page 6)
Acknowledgement
Yes (page 8)
Reference
Yes (page 8)
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Result
Design
Case-Control Study
hierarchy of evidence
Sample
Sample Size
Exclusion Criteria
Sampling Frame
Random Sampling
Instrument
questionnaires
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Randomization
Intervention
Analysis Method
compatible
b) Compatibility of The Measurement & The instruments
compatible
Consclusion : Valid / Not Valid
3.
IMPORTANCE OF RESEARCH
A. P
= 0.06, if the research was reheld 100 times, 6 among of them didnt
give results as this research.
OR
= 0,79 (0.511.21) in the low hazard category, 1.43 (1.101.86) in the
medium, to 1.60 (1.162.21) in the high water hazard category.
B. Conclusion : Importance/Not Importance.
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