Tuesday, October 4, 2011

[sehat] Digest Number 16186

Messages In This Digest (25 Messages)

1a.
Ank magang nginfus pasien From: rezka rosalina
1b.
Re: Ank magang nginfus pasien From: irma-mama zafran
1c.
Re: Ank magang nginfus pasien From: Endah
1d.
Re: Ank magang nginfus pasien From: marcella.kasih@indosat.blackberry.com
1e.
Re: Ank magang nginfus pasien From: Desty Farlina
2a.
Re: risk-benefit olah raga bela diri From: heidy_jo@yahoo.com
3a.
Re: Ruam Merah From: Y.Rieka
3b.
Re: Ruam Merah From: purnamawati.spak@cbn.net.id
4a.
Kesegaran jantung-paru lemah From: azzajelita@yahoo.com
4b.
Re: Kesegaran jantung-paru lemah From: aina
5a.
Re: takaran suplemen zat besi? From: purnamawati.spak@cbn.net.id
5b.
Re: takaran suplemen zat besi? From: Amanda Kania P
6a.
JAPRI Re: [sehat] Buat yang punya keluarga stroke From: -imelda
7a.
Anak jatuh From: Lindi
7b.
Re: Anak jatuh From: diahfa@yahoo.com
8a.
Ternyata ISK From: mentari.lunaira@gmail.com
8b.
Re: Ternyata ISK From: ChiciErnest
9a.
Re: KUMAN DI INDONESIa From: Laksmi Purwitosari
10.
Gigi tanggal From: syahlla@yahoo.com
11a.
Re: Bls: Re: [sehat] Stroke atau apa ya? From: dewi ck
11b.
Re: Bls: Re: [sehat] Stroke atau apa ya? From: Laksmi Purwitosari
11c.
Re: Bls: Re: [sehat] Stroke atau apa ya? From: Laksmi Purwitosari
12a.
Re: (Tanya) ISKkah? From: feby eboy
13.
dokter kulit yg rum From: dika wulandari
14.
(Tanya) Infeksi kronis mengarah ke TBC? From: Theresia

Messages

1a.

Ank magang nginfus pasien

Posted by: "rezka rosalina" lopelope_funky@yahoo.com   lopelope_funky

Tue Oct 4, 2011 6:40 am (PDT)



Selamat mlm dok,,

Kecenderungan di rumah sakit di kota saya jika ada yg akan rawat inap dan harus di pasang infus,, mk yg masang infus adalah anak magang, bukan suster jaga(profesional),, apakah hal tsb d perpolehkan? Kok seperti pasien di jadikan kelinci percobaan ya,, krn kan kondisi mahasiswa magang tersebut lagi belajar ya blm lulus :D

Pasien selaku konsumen bs kah menolak di infus oleh mhsiswa tersebut?

Mohon share nya :D

Rezka,
sent from mommaazkaberry

1b.

Re: Ank magang nginfus pasien

Posted by: "irma-mama zafran" irmayantidwilestari@yahoo.com   irmayantidwilestari

Tue Oct 4, 2011 6:51 am (PDT)



Sharing ya...maaf kl kurang tepat dg kasus yg ditanyakan..

Almarhum ibu saya dulu waktu rawat inap sempat diambil darahnya oleh mahasiswa magang. Entah krn darahnya mmg lebih kental pengaruh diabet atau mmg mahasiswa nya kurang profesional..itu darah gak keluar keluar,meski sdh bbrpa kali njus..hati saya kan ya miris liat ibu yg sdh lemas harus nambah sakitnya. Akhirnya saya kompalin ke ruang perawat *eh,apa ya nama ruangnya,lupa..uda bertahun2 yll* kira2 dg muka yg keliatan dongkolnya. datanglah perawat 'betulan' keruang ibu saya.eeeh sekali njus lgsg keluar...

Jadi saya rasa bisa ya kita komunikasikan dg pihak rs nya,,asal ngomongnya gak sambil bawa golok aja :D *cmiiw


-irma♡mama zafran-
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1c.

Re: Ank magang nginfus pasien

Posted by: "Endah" endahgunawan@ymail.com

Tue Oct 4, 2011 7:08 am (PDT)



Kami, para tenaga kesehatan, perlu belajar langsung dari pasien. Berlatih di boneka dengan praktek langsung ke pasien tentu beda. Kalau tidak ada pasien yang bersedia menjadi tempat kami belajar, lalu bagaimana kami dapat menjadi tenaga kesehatan yang handal?

Jika kita dirawat di RS pendidikan, konsekuensinya memang mungkin para mahasiswa akan belajar dari kita. Seharusnya, para mahasiswa itu dibimbing/disupervisi oleh perawat/dokter yang menjadi pembimbingnya, tidak dilepas sendiri. Jika dirasa sudah bisa, baru dilepas sendiri. Jika keberatan, coba minta didampingi oleh perawat yang siap utk menggantikan jika tindakan tsb gagal.

Endah

1d.

Re: Ank magang nginfus pasien

Posted by: "marcella.kasih@indosat.blackberry.com" marcella.kasih@indosat.blackberry.com

Tue Oct 4, 2011 8:12 am (PDT)



Jadi ingat paman saya
Dokter gigi di puskesmas tebet
Berkat praktek disana, teknik cabut giginya bisa gak sakit. Bahkan cabut geraham bungsu saya gak terasa sudah lepas.

Triknya cuma satu, banyak berlatih.
Kalau dulu pasiennya menolak pas dia dokter muda, pasti tidak seahli saat ini.

Sampai sekarang baliau masih disana, wujud terima kasihnya.

Regards,
Marcella
*mendongeng sebelum tidur
Sent from my BlackBerry�0�3
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1e.

Re: Ank magang nginfus pasien

Posted by: "Desty Farlina" desty_farlina@yahoo.com   desty_farlina

Tue Oct 4, 2011 8:55 am (PDT)



Mba marcella,

Boleh tau nama pamannya?

Regards
Desty
*yg takut ke dr gigi :p
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2a.

Re: risk-benefit olah raga bela diri

Posted by: "heidy_jo@yahoo.com" heidy_jo@yahoo.com   heidy_jo

Tue Oct 4, 2011 6:40 am (PDT)



Satoojoooo pak E!!!

Anakku nanti kalo udah gede musti belajar bela diri....n balet juga.

Erika (maminya Heidy)
Sent from my BlackBerry�
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-----Original Message-----
From: /ghz <ghozan10032005@gmail.com>
Sender: sehat@yahoogroups.com
Date: Tue, 04 Oct 2011 16:07:17
To: <sehat@yahoogroups.com>
Reply-To: sehat@yahoogroups.com
Subject: Re: [sehat] risk-benefit olah raga bela diri

maaf gak baca thread awal
menurut saya diutamakan.
untuk mencegah bullying disekolah dsk...
kl perempuan utk menghajar lelaki yg 'macem2'......apalagi di metro
maraknya kasus perkosaan.
kl laki2....utk belain mamanya kl bapaknya 'macem2'...:)

salam dojo
bapakeghozan




[Non-text portions of this message have been removed]

3a.

Re: Ruam Merah

Posted by: "Y.Rieka" y.rieka@yahoo.co.id

Tue Oct 4, 2011 7:13 am (PDT)



Dear dokter Wati

Terima kasih banyak penjelasannya.
Saat ini anak saya masih 38.2C, batuk berdahak tidak pilek tidak diare. Keluhannya hanya gatal di seluruh tubuhnya, saya beri salycil untuk mengurangi gatalnya.

Alhamdulillah minum banyak, makan sedikit berkurang tapi masih beraktifitas biasa. Obatnya sudah 2x diberikan.

Suami masih belum bisa diajak duduk bersama setelah tadi siang bersitegang di rumah sakit. Mudah2n sebelum tidur bisa diajak bicara

Terima kasih dokter Wati untuk atensi nya.

Wass,
Rieka
Sent from my Bogorberry

3b.

Re: Ruam Merah

Posted by: "purnamawati.spak@cbn.net.id" purnamawati.spak@cbn.net.id

Tue Oct 4, 2011 7:23 am (PDT)



Dear Rieka
Sama2, my pleasure dear
Cuma serem aja sama obatnya
Decision is yours dear

Wati
Patient Safety, first

4a.

Kesegaran jantung-paru lemah

Posted by: "azzajelita@yahoo.com" azzajelita@yahoo.com   azzajelita

Tue Oct 4, 2011 7:16 am (PDT)



Dear all,

Sesuai judul,sy ingin menanyakan apa mksdnya kesegaran jantung-paru sangat rendah yah?
Ibu sy br melakukan med check up,disuruh treadmill,dan dr hsl lab nya,dokter meminta ibu sy segera konsultasi ke spesialis jantung dikarenakan dr hasil lab nya tertulis kesegaran paru jantung sangat rendah..

Adakah yg punya rekomen dokter jantung yg bagus di jakarta? Mungkin pertamina atau RS lain?

Mohon infonya yah..

Azza
Sent from my BlackBerry� smartphone from Sinyal Bagus XL, Nyambung Teruuusss...!
4b.

Re: Kesegaran jantung-paru lemah

Posted by: "aina" aina.anwar@yahoo.com   aina.anwar

Tue Oct 4, 2011 7:18 am (PDT)



Dr. Munawar .....RSJ binawaluya SOL

merci beaucoup
wassalamu'alaikum wr wb,

aina f.

5a.

Re: takaran suplemen zat besi?

Posted by: "purnamawati.spak@cbn.net.id" purnamawati.spak@cbn.net.id

Tue Oct 4, 2011 7:24 am (PDT)



Amanda
Bagaimana kalau dishare hasil labnya, kondisi anakmu secara keseluruhan dst dst?
Wati
Patient Safety, first

5b.

Re: takaran suplemen zat besi?

Posted by: "Amanda Kania P" amandaunique@yahoo.com.au   amandaunique

Tue Oct 4, 2011 8:51 am (PDT)




Baru ketemu hasilnya mba
hemoglobin 11,4 dr nilai normal (14-17)
Hematokrit 34,3 (42-54)
Lekosit 6700 (4500-11000)
Trombosit 304000 (150000-350000)

Hitung jenis
Basofil 0 (0-1)
Eosinofil 4 (1-3)
Batang 0 (2-6)
Segmen 21 (50-70)
Limposit 73 (20-40)
Monosit 2 (2-8)

Fe-nya 3 mg per 1 ml

Amanda

--- In sehat@yahoogroups.com, "wulan" <wulan.wuls@...> wrote:
>
> Screening anemia aja maksudnya, cuma hb nya berarti ya? Penyebab anemia banyak mba, bkn semata kekurangan zat besi. Jd imho, sblm terapi zat besi, pastikan dl apakah benar adb.
>
> Perihal dosis, 1ml ferokid mengandung brp mg zat besi?
>
> Rgds,
> - Wulan -
> @wulsnih
>

6a.

JAPRI Re: [sehat] Buat yang punya keluarga stroke

Posted by: "-imelda" imelda.santos@gmail.com   imeldamarliana

Tue Oct 4, 2011 7:29 am (PDT)



Mau dong, ci...

Thanks buat advice ttg "teguran dr guru" ya... Imel lg print out ttg batuk dan alergi dari bbrp website. Mudah-mudahan bisa ketemu guru kelas Fabian Jumat pagi ini.

Tapi tau kan tipikal guru2 ursulin... ;)

Mudah-mudahan mereka mau denger sih.

BTW, klo disini kok jd bawel... Di sebelah jadi "kuper" :D


Love,
-imelda
Sent from my smartphone supported by my lovely hubby

-----Original Message-----
From: marcella.kasih@indosat.blackberry.com
Sender: sehat@yahoogroups.com
Date: Tue, 4 Oct 2011 10:37:23
To: <sehat@yahoogroups.com>
Reply-To: sehat@yahoogroups.com
Subject: [sehat] Buat yang punya keluarga stroke

Tadi saya kirim ke mbak Dewi, form kontrol selama di rs, buat pas jaga keluarga yang stroke.

Jauh dari sempurna
Tapi lumayan buat tahu detail kondisi ybs
Terutama kalau yang jaga ganti2, jadi status ybs bisa diketahui dengan pasti.
Termasuk buat catat obat2an, treatment atau terapi.

Kalau ada yang mau juga, tolong email JAPRI ya, sekalai lagi JAPRI, yang ke jalum otomatis diabaikan.

Regards,
Marcella
*mpok kumat bawel
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7a.

Anak jatuh

Posted by: "Lindi" watok_indi@yahoo.com   watok_indi

Tue Oct 4, 2011 7:50 am (PDT)



Slmt malam semua..
Mau tny.. Anak sy 11 bln barusan jatuh dr posisi berdiri. Dia jatuh mentah2 kena kepala belakang sm punggungnya.. Td lgs diksh air putih.. Saya khawatir skali, mau ke dsa langganan tp ini sdh malam.. Mohon pencerahannya, kira2 penanganan apa lagi yg hrs sy lakukan. Kepala bagian belakang kyknya agak benjol.. Cm sy gak tau dgn tulang belakangnya.

Thanks before.. :)
Lindi
Sent from my BlackBerry� smartphone from Sinyal Bagus XL, Nyambung Teruuusss...!
7b.

Re: Anak jatuh

Posted by: "diahfa@yahoo.com" diahfa@yahoo.com   diahfa

Tue Oct 4, 2011 7:58 am (PDT)



Mba,
Bantu link ini aja ya...maaf ga sempat copas..
http://kidshealth.org/parent/firstaid_safe/emergencies/head_injury.html

Semoga bermanfaat

Diah
@diahapt

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8a.

Ternyata ISK

Posted by: "mentari.lunaira@gmail.com" mentari.lunaira@gmail.com   mentari_mayang

Tue Oct 4, 2011 7:59 am (PDT)



Hola...

Sudah lama rasanya gak sharing disini :)
Mumpung ada yg bisa diceritain, dan mumpung sakitnya si neng kali ini menyandera badan bundanya, jd jempol nya bebas ketak ketik...hehehe....

Sabtu, 1 oktober'11

Bangun tidur kok gak kaya biasanya, matanya sembab, agak lemes, dibawa pergi ke pengajian di mobil tumben minta tidur,
Diperhatikan di kaki muncul bentol2 besaaaar banget..khas nya aira kalau daya tahan tubuhnya turun adalah kulitnya jadi super sensitif, kena debu sedikit langsung bentol2..udh waspada aja saya..bener sore2 badannya sumeng,geraknya gak seaktif biasanya...walaupun masih lari2..jam 7 malam mulai demam, semakin malam semakin tinggi

Minggu, 2 oktober'11

Seharian masih main, demam on off, gak ada batuk & pilek, gak ada keluhan lain2...ditanya pusing apa gak pun jawabannya gak...keliatan sih gak pusing, karena msh cerewet luar biasa dan lari2 walaupun keliatan tidak seperti biasanya..
Malamnya demamnya naik kembali, walaupun masih kategori mild fever..

Senin, 3 oktober'11

Pagi2 suhu normal, bundanya seneeeng...kirain virusnya udh lewat kepanggang td malem..siang menjelang sore badannya sumeng lagi..maghrib tambah naik suhunya..sehabis bersih2 mau tdr, dan pipis malam, neng mengeluh vagina nya sakit..suhu pun makin naik..
Semalaman saya belajar ISK..
Kok gejalanya pas...

-----------
Contekan saya

===================

From: anto
Subject: RE: [sehat]tanya:Pengobatan ISK
Date: Monday, 28 December, 2009, 21:45

Mba nita untuk diagnosis ISK kita berpedoman pada gejala klinis dan bantuan
laboratorium.

Bila gejala mengarah kepada ISK (demam, nyeri saat BAK, terasa panas,
anyang-anyangan) kemungkinan penyebab lain sudha disingkirkan maka kita
melakuakn pemeriksaan urin sebelum memulai pengobatan.

Pemeriksaan urin ada 2

1. Urin lengkap

2. Urin kultur dan resistensi

Gold-standar/ standar baku ISK adalah ditemukan bakteri penyebab ISK
>100.000/ml pada pemeriksaan kultur urin.

Hasil kultur bisa 1-2mg. Hasil urin lengkap bisa 1 hari.

Dari urin lengkap kita bisa menegakkan ISK dari gejala klinis mengarah
kepada ISK dan urin lengkap ditemukan sedimen leukosit urin >5/LPB (bisa
diperkuat dengan leukosit esterase +, nitrit +). Pengobatan bisa dimulai
sambil kita menunggu hasil kultur dan resistensi urin.

Tujuan kita melihat kultur dan resistensi =

1. Memastikan diagnosis

2. Bila pada pengobatan sebelumnya ternyata anak tetap demam maka ada
kemungkinan bakteri resisten terhadap antibiotik lini pertama, untuk itu
kita melihat hasil kultur dan resistensi

Pengobatan dilakukan dalam durasi yg sesuai (7 hari).

Setelah pengobatan dilakukan pemeriksaan ulang untuk mengetahui ISK sudah
sembuh atau belum. (pemeriksaan ulang bisa urin lengkap saja-disesuaikan
dengan keadaan pasien).

Bila ISK berulang kemungkinan bisa dicek kembali :

1. Pemberian durasi dan atau dosis antibiotik tidak sesuai (kepatuhan
pengobatan)

2. Antibiotik resisten

3. bila setelah pengobatan yg sesuai panduan dan hasil urin lengkap
setelah AB sudah dllakukan dan hasilnya normal, namun ISK terus berulang
maka sebaiknya didiskusikan dengan dsa nefrologi untuk mencari kemungkinan
factor yg mendasari ISK (umumnya kelainan anatomi saluran kemih)

langkah pencegahan juga selalu dilakukan : tidak menahan BAK, banyak minum
air putih, membasuh vagina arah dari depan ke belakang dengan air yg bersih.

Mohon maaf bila belum membantu

-anto-

-------

Dan ini

http://milissehat.web.id/?p=30

-------
Berbekal bacaan diatas, saya memutuskan besoknya sowan ke dr. Endah sekalian test lab

Selasa, 4 okt'11

Pagi2 demamnya 38,6 maunya tidur2an terus...akhirnya saya bawa ke lab, maksudnya sebagai bekal untuk konsultasi ke dr. Endah..
Setelah hasil lab keluar, kami ke dr. Endah..
Melihat gejala klinis, dan didukung hasil lab..aira +ISK
Dijelaskan secara detil oleh dr endah, termasuk terapi AB yg diberikan dan keharusan untuk melakukan pemeriksaan urine kultur.
AB segera diberikan,tidak menunggu urine kultur yang bisa sampai 5 hari keluar hasilnya, karena kalau menunggu hasil kultur terlalu lama..
Nanti setelah hasil kultur keluar, maka akan dilakukan evaluasi apakah AB yg sudah diberikan cocok atau tidak (mudah2an sih cocok yaa)

Sekarang aira sudah tidur, suhu 37,6 nafsu makan agak menurun, mudah2an besok sudah kembali nafsu makannya..

Segitu dulu sharing saya...mohon doanya supaya ABnya pas, dan tidak ada ISK berulang setelah ini :)

Regards,
Mayang
*yang agak pegel gak bisa alihan gara2 dipeluk terus :p *curcol
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8b.

Re: Ternyata ISK

Posted by: "ChiciErnest" chici.ernest@gmail.com

Tue Oct 4, 2011 8:27 am (PDT)



Thanks for sharing.. May! Bantu doa, semoga ABnya cocok yaa.. Dan Neng Aira bisa aktif lagi.

Langsung save email.. :D

Regards,
@chiciernest

9a.

Re: KUMAN DI INDONESIa

Posted by: "Laksmi Purwitosari" laksmipurwitosari@yahoo.com   laksmipurwitosari

Tue Oct 4, 2011 8:00 am (PDT)



Dear dr. Anto.

dr.Anto:
ISPA viral setahu saya tidak berkomplikasi kepada meningitis.

Saya:
Semoga definisi dan persepsi yang saya mengerti tentang ISPA dan komplikasi meningitis sama dengan yang dimaksud oleh dr.Anto
Allah telah menganugrahi kita sawar darah otak, suatu barier yang mampu melindungi otak dari masuknya zat zat yang tidak diperlukan atau menganggu otak termasuk kuman penyakit.
Tidak semua kuman dapat menembus sawar darah otak, beberapa bakteri dan virus dapat menyebabkan infeksi otak, tetapi ada beberapa bakteri dan virus tidak dapat menembus ke sawar darah otak hanya toksinnya saja yang menembus.

Beberapa referensi mengenai sebagian penyebab viral meningitis terutama yang berasal dari virus saluran nafas.

http://www.lapublichealth.org/acd/Diseases/Meningitis.pdf

Nonpolio enteroviruses, the most common cause of viral meningitis, are not vaccine-preventable and account for 85% to 95% of all cases in which a pathogen is identified. Estimates from the Centers for Disease Control and Prevention (CDC) indicate that 10 to 15 million symptomatic enteroviral infections occur annually in the US, which includes 30,000 to 75,000 cases of meningitis. Transmission of enteroviruses may be fecal-oral, respiratory or by another route specific to the etiologic agent.

Other viral agents that can cause viral meningitis include: herpes, mumps, lymphocytic choriomeningitis, human immunodefieciency virus, adenovirus, parainfluenza virus type 3, influenza virus, measles and arboviruses, such as West Nile virus (WNV). Since the arrival of WNV in Southern California in 2003, this etiology should be considered an important cause of aseptic meningitis, especially in adults (during the summer and fall), and the appropriate diagnostic tests should be obtained

Enteroviruses, the etiologic agents most commonly associated with viral meningitis, are not vaccine-preventable (except for polioviruses) and account for 85% to 95% of all cases in which a pathogen is identified. Estimates from the Centers for Disease Control and Prevention (CDC) indicate that 10 to 15 million symptomatic enteroviral infections occur annually in the US, which includes 30,000 to 75,000 cases of meningitis. Transmission of enteroviruses may be fecal-oral, respiratory or by another route specific to the etiologic agent

http://www.formatex.org/microbio/pdf/pages894-901.pdf

The first big influenza pandemics occurred in 1918 killing 40 million people, nearly 10% of victims [80]. Shortly before that epidemic encephalitis emerged as a fulminant encephalitis lethargica in 1916 continuing for years [81, 82]. It was considered influenzal but later on identified poststreptococcal [83]. Hongkong influenza was the first pandemic of Asian origin in 1957 [84]. Both influenza A and B cause various CNS infections in toddlers, in young adults and in elderly people [1, 2, 5, 85-87]. The viruses circle all-around the year but in Western countries they accumulate in cold seasons. Influenza is of zoonotic origin and their genetic instability makes them unique as emerging threats [3].

2.4. Respiratory and respiratory like viruses
Respiratory viruses, adeno, corona, and respiratory syncytial virus (RSV) may cause encephalitis with acute onset and high fever, mainly in children [1]. Adenovirusinfection may present with delirious state and pulmonary infiltrate but with rapid recovery. Seroconversion, specific IgM and detection of specific nucleic acid or antigen are diagnostic. Mycoplasma pneumoniae and Chlamydia pneumoniae, often called honour viruses, are indisputable causes of CNS infections, mainly encephalitis in hemispheral and even in other sites. Their diagnosis is challenging [47, 88-90]. PCR from CSF is seldom successful. Diagnosis is based on seroconversion or IgM finding in serum.

Laksmi Purwitosari

[Non-text portions of this message have been removed]

10.

Gigi tanggal

Posted by: "syahlla@yahoo.com" syahlla@yahoo.com   syahlla

Tue Oct 4, 2011 8:15 am (PDT)



Dearr smart parents n docs..
To the point aja,salah satu baby kembar ku 14month gigi nya baru ada 4(dua di bawah dua di atas)bagian atas yg 1 nya blm tumbuh sempurna baru setengah keluar gt,naah 3hari yg lalu mnurut nanny nya sempat jatuh dan lidah nya berdarah,dia pikir gak knp2..berhubung saya kerja dan baru kembali hari ini dan saya perhatikan kok gigi nya tinggal 3,dan di tempat gigi sebelum nya kaya ada gusi menggelantung,dan terlihat seperti darah tp gak berdarah..apa itu normal ya??
Kok saya deg deg an dan ngeri liat nya kaya gigi tpi lembek gt :(

Apa ada yg pernah ngalamin atau bbrp doc disini bisa bantu mengurangi kekhawatiran saya??

Trima kasih sebelum nya..

Dinar,mommy adam gibran 14month
Sent from my BlackBerry� smartphone from Sinyal Bagus XL, Nyambung Teruuusss...!
11a.

Re: Bls: Re: [sehat] Stroke atau apa ya?

Posted by: "dewi ck" ck_kusumadewi@yahoo.com   ck_kusumadewi

Tue Oct 4, 2011 8:19 am (PDT)



Dok, menyangkut survival apakah stroke ini menjadi rusak yg permanen?
Pada kasus ayah saya ini ternyata sebelumnya baru diketahui pernah mengalami stroke infark juga tp tdk disadari(atau mungkin tidak dirasa rasakan oleh beliau)..
Dok pemulihan sumbatan ini bagaimana ya? Apakah akan menetap?
Pada saat pemberian oksigen apakah ada posisi kepala khusus yg membantu memperlancar aliran oksigennya?

Neurorestorasi t bentuknya seperti apa ya?

Mohon maaf pertanyaanya, td swaktu dr visit malah saya sedang antar eyang pulang kemobil, jd tdk bisa tanya2 sendiri.

Trimakasih ya buat sp dan dokter yang telah share dan support,
Dr anto,dr lasmi, bunda, mba marcela dgn tabelnya sangat berguna sekali,mba monik,mba hilda,dan yang sps lainya serta milis tercinta ini..

Love,
Dewi ck

11b.

Re: Bls: Re: [sehat] Stroke atau apa ya?

Posted by: "Laksmi Purwitosari" laksmipurwitosari@yahoo.com   laksmipurwitosari

Tue Oct 4, 2011 8:38 am (PDT)



Mba Dewi,
Saya copy kan prognosis stroke

http://www.healthcentral.com/heart-disease/stroke-000045_4-145.html

Stroke Prognosis

A stroke, the third leading cause of death in the U.S., is always serious. In 2003, 167,366 Americans died of stroke. The mortality rates are declining, however. Over 75% of patients survive a first stroke during the first year and over half survive beyond 5 years.

The Severity of an Ischemic Versus Hemorrhagic Stroke

People who suffer ischemic strokes have a much better chance for survival than those who experience hemorrhagic strokes. Among the ischemic stroke categories, the greatest dangers are posed by embolic strokes, followed by thrombotic and lacunar strokes. Hemorrhagic stroke not only destroys brain cells but also poses other complications, including increased pressure on the brain or spasms in the blood vessels, both of which can be very dangerous. Studies suggest, however, that survivors of hemorrhagic stroke have a greater chance for recovering function than those who suffer ischemic stroke.

Factors that Affect Quality of Life in Survivors

Between 50 - 70% of people recover functional independence after a stroke. However, between 15 - 30% of those who survive either an ischemic or hemorrhage stroke suffer some permanent disability. On the encouraging side, one study reported that people who survived for many years after a stroke had a chance for independent living that was about the same as for their peers who had not suffered strokes. The stroke patients even appeared to be less depressed than the comparison group.

The National Institutes of Health (NIH) have devised a scoring system that helps predict the severity and outcome of the stroke by scoring 11 factors (levels of consciousness, gaze, visual fields, facial movement, motor functions in the arm and leg, coordination, sensory loss, problems with language, inability to articulate, and attention). Up to 70% of patients with ischemic strokes who score less than 10 have a favorable outlook after a year, while only 4- 16% of patients do well if their score is more than 20.

Factors Affecting Recurrence

The risk for recurring stroke is highest within the first few weeks and months. The risk is about 14% in the first year and about 5% thereafter, so preventive measures should be instituted as soon as possible. Some specific risk factors for early recurrence include:

Older age
Evidence of blocked arteries (a history of coronary artery disease, peripheral artery disease, ischemic stroke, or TIA)
Hemorrhagic or embolic stroke
Diabetes
Alcoholism
Valvular heart disease
Atrial fibrillation

Laksmi Purwitosari

[Non-text portions of this message have been removed]

11c.

Re: Bls: Re: [sehat] Stroke atau apa ya?

Posted by: "Laksmi Purwitosari" laksmipurwitosari@yahoo.com   laksmipurwitosari

Tue Oct 4, 2011 8:44 am (PDT)



Dear Mba Dewi,
Ini referensi lengkap tentang motor recovery in stroke

http://emedicine.medscape.com/article/324386-overview#showall

Motor Recovery In Stroke
Stroke rehabilitation is a combined and coordinated use of medical, social, educational, and vocational measures to retrain a person who has suffered a stroke to his/her maximal physical, psychological, social, and vocational potential, consistent with physiologic and environmental limitations. The cellular mechanisms behind stroke are seen in the image below.

Evidence from clinical trials supports the premise that early initiation of therapy favorably influences recovery from stroke. When the initiation of therapy is delayed, patients may in the interim develop avoidable secondary complications, such as contractures and deconditioning.

In addition, many studies show that stroke rehabilitation can improve functional ability even in patients who are elderly or medically ill and who have severe neurologic and functional deficits.

The initial clinical examination of a patient with an acute stroke includes a thorough, detailed neurologic examination. The neurologic findings are used by the rehabilitation team for prognostication, development of the specific details of the rehabilitation plan, and selection of the appropriate setting for rehabilitation.

Reassessment of the patient's condition during rehabilitation provides a means of monitoring progress and subsequently evaluating outcome. The initial rehabilitation assessment should begin immediately following onset, within 2-7 days, and then subsequently at repeated intervals.

Go to Stroke, Ischemic, for more complete information on this topic.

Timing, extent, and types of recovery
Patients recover after stroke in 2 different, but related, ways.

A reduction in the extent of neurologic impairment can result from spontaneous, natural neurologic recovery (via the effects of treatments that limit the extent of the stroke) or from other interventions that enhance neurologic functioning. A patient demonstrating this form of recovery presents with improvements in motor control, language ability, or other primary neurologic functions.

The second type of recovery demonstrated by stroke patients is the improved ability to perform daily functions within the limitations of their physical impairments. A patient who has sensorimotor, cognitive, or behavioral deficits resulting from stroke may regain the capacity to carry out activities of daily living (ADL), such as feeding himself/herself, dressing, bathing, and toileting, even if some degree of residual physical impairment remains.

The ability to perform these tasks can improve through adaptation and training in the presence or absence of natural neurologic recovery, which is thought to be the element of recovery on which rehabilitation exerts the greatest effect.

Hemiparesis and motor recovery have been the most studied of all stroke impairments. As many as 88% of patients with acute stroke have hemiparesis.

In a classic report, Twitchell described in detail the pattern of motor recovery following stroke.[1] At onset, the upper extremity (UE) is more involved than the lower extremity (LE), and eventual motor recovery in the UE is less than in the LE. The severity of UE weakness at onset and the timing of the return of movement in the hand are important predictors of eventual motor recovery in the UE. The prognosis for return of useful hand function is unfavorable when UE paralysis is complete at onset or grasp strength is not measurable by 4 weeks.

However, as many as 9% of patients with severe UE weakness at onset may gain good recovery of hand function. As many as 70% of patients showing some motor recovery in the hand by 4 weeks make a full or good recovery. Full recovery, when it occurs, usually is complete within 3 months of onset.

Bard and Hirshberg asserted that if no initial motion is noticed during the first 3 weeks or if motion in one segment is not followed within a week by the appearance of motion in a second segment, the prognosis for recovery of full motion is not favorable.

Although most recovery from stroke takes place in the first 3 months, and only minor additional measurable improvement occurs after the 6 months following onset, recovery may continue over a longer period of time in some patients who have significant partial return of voluntary movement.

Criteria for admission to a comprehensive rehabilitation program
Criteria for a patient's admission to a comprehensive rehabilitation program may include the following:

Stable neurologic status
Significant persisting neurologic deficit
Identified disability affecting at least 2 of 5 functions, including mobility, self-care activities, communication, bowel or bladder control, and swallowing
Sufficient cognitive function to learn
Sufficient communicative ability to engage with therapists
Physical ability to tolerate the active program
Achievable therapeutic goals
Theories of Recovery
One theory of motor recovery is that collateral sprouting from intact cells to the denervated region occurs after some or all input has been destroyed.

Another theory suggests that there is an unmasking of neural pathways and synapses that are not normally used but that can be called upon when the dominant system fails (excitability to capture effects of remaining input).

Mechanisms of Recovery
The first recovery mechanism is resolution of harmful local factors, which generally accounts for early spontaneous improvement after stroke (usually within the first 3-6 mo). These processes include resolution of local edema, resorption of local toxins, improvement of local circulation, and recovery of partially damaged ischemic neurons.

Neuroplasticity
The second recovery mechanism, which may continue for many months, is neuroplasticity, which can take place early or late. Brain plasticity is the ability of the nervous system to modify its structural and functional organization. The 2 most plausible forms of plasticity are collateral sprouting of new synaptic connections and unmasking of previously latent functional pathways.

Other mechanisms of plasticity include assumption of function by undamaged, redundant neural pathways, reversibility from diaschisis, denervation supersensitivity, and regenerative proximal sprouting of transected neuronal axons. Experimental evidence indicates that plasticity can be altered by several external factors, including pharmacologic agents, electrical stimulation, and environmental stimulation.

A key aspect of neuroplasticity that has important implications for rehabilitation is the fact that the modifications in neuronal networks are use-dependent. Animal experimental studies and clinical trials in humans have shown that forced use and functional training contribute to improved function. On the other hand, techniques that promote nonuse may inhibit recovery.

In the past, the conventional wisdom was that benefits from rehabilitation were achieved primarily through training patients in new techniques that compensate for impairments (for example, using the uninvolved hand to achieve self-care independence). This approach avoided intense therapy on the weak upper limb.

Currently, it is recognized that repeated participation by patients in active physical therapeutic programs probably provides direct influence on the process of functional reorganization in the brain and enhances neurologic recovery.

Pattern of Disability
After stroke occurs, total loss of voluntary movement may be noted in involved extremities, with loss or decrease in muscle stretch reflexes (MSRs). Within 48 hours, MSRs and finger jerks are more active on the involved side, although they may require 3-29 days to develop. Within a short period, tone appears in the wrist and finger flexors, as well as in the ankle plantar flexors. As a result, the UE is prone to demonstrate the adductor/flexor pattern, and the LE is prone to demonstrate the adductor/extensor pattern.

Development of spasticity
In 1-30 days, spasticity appears, resulting in resting posture. In the upper extremity, this posture takes the following form:

Shoulder - In adduction and internal rotation
Elbow - In flexion
Forearm - In pronation/supination
Wrist and fingers - In flexion
In the lower extremity, resting posture develops as follows:

Hip - In adduction and extension
Knee - In extension
Ankle - In plantar flexion
Foot - In inversion
Within 1-38 days after stroke, clonus appears in ankle plantar flexors, and the onset of clasp-knife phenomenon occurs within 3-31 days.

Spasticity in the lower extremity decreases with increased volitional movement, but MSRs always remain increased, despite total recovery.

Pattern of Recovery
Recovery of function in the UEs
Recovery of UE flexor synergy occurs as follows:

Shoulder flexion - 6-33 days
Elbow flexion - 1-6 days later
Finger and wrist flexion - 1-13 days later
Shoulder adduction/internal rotation
Clinically, flexor synergy can also present as follows:

Scapula retraction/elevation
Shoulder abduction (90°)/external rotation
Elbow flexion (acute angle)
Forearm supination (full range)
Recovery of UE extensor synergy occurs as follows:

Shoulder
Elbow
Wrist/finger extension
Clinically, extensor synergy presents as follows:

Scapula protraction
Humerus flexion/internal rotation
Elbow extension
Forearm pronation
In a study of 188 patients with stroke, Nijland et al found that assessment of finger extension and shoulder abduction within 72 hours after stroke can help to predict upper limb recovery. If, by the second day following stroke, patients in whom upper limb motor function was affected were capable of some voluntary extension of the fingers and some abduction of the hemiplegic shoulder, there was a 0.98 probability that they would regain some dexterity by 6 months.[2]

Patients with no such voluntary movement on the second day, according to the study, had only a 0.25 probability of regaining dexterity by 6 months. Full recovery at 6 months was achieved in 60% of patients with some early finger extension.

Recovery of function in the LEs
Recovery of LE flexor synergy occurs as follows:

Hip flexion/adduction - 1-31 days
Knee flexion - 1-2 days later
Ankle/toe dorsiflexion - 25-90 days
LE extensor synergy is recovered first in hip/knee extension and then in ankle plantar flexion.

PT Options in Stroke
Rehabilitation should include physical therapy (PT) that is directed at specific training of skills and at functional training.[3] Therapy should be given with sufficient intensity to promote skill acquisition. Major theories of rehabilitation training include the following:

Traditional therapy
Bobath Concept– Neurodevelopmental training
Proprioceptive neuromuscular facilitation
Brunnstrom
Traditional therapy
This form of therapy employs range-of-motion (ROM), strengthening, mobilization, and compensatory techniques. The process of mental practice may also be used to improve the performance of certain activities.[4] This is when a patient mentally rehearses an action without physically performing the action. Current evidence is not clear on whether this practice, in conjunction with physical practice, actually improves motor capacity of the upper limb region. Further studies are required.

Bobath concept
According to the Bobath concept, muscle patterns, not isolated movements, are used for motion. The theory states that persons with motor deficiencies following stroke are unable to direct nervous impulses to muscles in the different combinations used by persons with an intact central nervous system (CNS).

The therapy, therefore, is meant to suppress abnormal muscle patterns before normal patterns are introduced. Abnormal patterns are modified at proximal key points of control, such as the neck, spine, shoulder, and pelvis.

Proprioceptive neuromuscular facilitation
This form of therapy aims to stimulate nerve/muscle/sensory receptors to evoke response through manual stimuli to increase ease of movement and promote function.

Brunnstrom movement therapy
This therapy involves central facilitation using Twitchell's recovery. It aims to enhance specific synergies through the use of cutaneous/proprioceptive stimuli.

Studies
Every patient should avoid strenuous exercise after stroke, but it is a good idea to participate in an individualized exercise program. At 1 year post stroke, improvement in functional walking ability was seen in stroke patients who underwent either locomotor training, including body weight supported treadmill, or a progressive home exercise program supervised by a physical therapist. No significant differences in improvement were found between the two groups.[5] Reports in the literature state that for young stroke survivors who participated in an aerobic fitness program, improvement in fitness levels, ambulatory speed, and life satisfaction was statistically significant.

Results from a randomized, controlled, assessor-blinded study indicated that even long after a stroke, kinesthetic ability training, administered in combination with a conventional rehabilitation program, can improve balance in hemiparetic stroke patients.[6]

The inclusion of breathing retraining (BRT) and inspiratory muscle training (IMT) in the rehabilitation program of patients who have suffered a stroke can result in improved respiratory muscle function, exercise capacity, and quality of life, according to a study by Sutbeyaz et al. In this study, patients received BRT and IMT training for half an hour daily, 6 times a week for 6 weeks.[7]

Results from a systematic review indicate that modified constraint-induced movement therapy (CIMT) is more effective than traditional rehabilitation in reducing a patient's disability level.[8] It can improve upper extremity ability and increase movement spontaneity. Further studies are needed on CIMT's effectiveness in kinematic analysis.

Occupational Therapy in Stroke
Most patients with significant neurologic impairment who survive a stroke are dependent on others for performance of basic ADL (ie, bathing, dressing, feeding, toileting, grooming, transfers). The capacity of individuals to perform these activities usually is scored on disability rating scales, such as the Functional Independence Measure. Almost all patients show improved performance of ADL as recovery occurs.

Most improvement is noted in the first 6 months, although as many as 5% of patients show continued measurable improvement up to 12 months postonset. Other patients may show some functional improvement beyond 6 months, even though the disability scales usually fail to detect further improvement because of their limited sensitivity at the upper end of the functional range.

Reports of the levels of functional independence eventually reached by stroke patients after recovery vary from one author to another. This variability probably reflects differences between study populations, methods of treatment, follow-up, and data reporting. In most reports, 47-76% of patients achieve partial or total independence in the performance of ADL.

Most authors who have attempted to determine which factors predict ultimate ADL functional outcome have used multivariate analysis. Of the many independent variables tested, those listed below have been reported to have the most influence on outcome. However, not all of these factors have been shown to predict outcome status statistically in every study. Factors predicting poor ADL outcome include the following:

Advanced age
Comorbidities
Myocardial infarction
Diabetes mellitus
Severe stroke
Severe weakness
Poor sitting balance
Visuospatial deficits
Mental changes
Incontinence
Low initial ADL scores
Delay in initiating rehabilitation following onset
Aphasia Therapy
Approximately one third of patients with acute stroke have clinical features of aphasia. Language function in many of these patients improves, and, at 6 months or more after stroke, only 12-18% of patients have identifiable aphasia.

Skilbeck and colleagues reported that patients with aphasia continue to show some late improvement in language function even more than 1 year after onset.

Patients who are classified initially as having Broca aphasia have variable outcomes. In patients with large hemisphere lesions, Broca aphasia persists with little recovery. Patients with smaller lesions confined to the posterior frontal lobe often show early progressive improvement, but the impairment may evolve into a milder form of aphasia with anomia and difficulty finding words. Patients with global aphasia tend to progress slowly, with comprehension often improving more than expressive ability does.

The communicative ability of patients who initially have global aphasia improves over a longer period of time, up to a year or more postonset. Patients with global aphasia associated with large lesions may show only minor recovery, but recovery may be quite good in patients with smaller lesions. The extent of language recovery associated with Wernicke aphasia is variable.

Associated Conditions
Most patients with stroke who undergo rehabilitation have many other associated medical conditions that require professional attention. These problems might be preexisting medical illnesses that necessitate ongoing care (eg, hypertension, diabetes mellitus [DM]), secondary poststroke complications (eg, deep venous thrombosis, pneumonia), or acute poststroke exacerbations of preexisting chronic diseases (such as angina in a patient with ischemic heart disease).

Management of these conditions can constitute major portions of the rehabilitation effort. Some patients may be more disabled by certain associated comorbid diseases than by the stroke itself.

The occurrence of these associated conditions has several implications for management of stroke cases during and after rehabilitation. First, these problems can detract from the benefits of rehabilitation. Some medical problems, such as heart disease, have been found to affect the course and outcome of rehabilitation adversely following a stroke. Intercurrent medical complications can limit the patient's ability to participate in therapeutic exercise programs, inhibit functional skill performance, and reduce the likelihood of achieving favorable outcomes from rehabilitation.

The rehabilitation interventions also might affect the medical condition adversely, causing an exacerbation of the disease or necessitating an adjustment in the treatment program. Patients who are treated in a stroke unit have better outcomes at discharge than do patients who are not.[9]

Surgical Options
Tendon release can be performed in cases of severe spasticity or contractures.

Carotid endarterectomy can be carried out in patients with stenosis of 70% or greater.

There is no longer any clear indication for carotid artery bypass to prevent stroke or in patients who have had a TIA. No benefit has been demonstrated from the surgery.

Although there have been reports of successful cases involving surgical bypass or endarterectomy involving the posterior circulation, these procedures remain largely experimental.

Consultations in Stroke
Consultations with neurologists and physiatrists are important aspects of treatment in patients who have suffered stroke.

Consultations with psychologists are also essential. Psychosocial issues obviously are very important in cases of stroke. Numerous studies have reported on the influence of the psychological adjustment and coping mechanisms of the patient, as well as those of his/her spouse and other family members, in determining the patient's outcome.

Other Treatment Options
Biofeedback attempts to modify autonomic functions, pain, and motor disturbances through acquired volitional control, using auditory, visual, and sensory clues.[10]

Functional electrical stimulation commonly is employed in the UEs and LEs to improve strength, encourage and augment early active ROM, assist in the management of dependent peripheral edema through forceful isotonic muscle contraction, and establish early proprioceptive joint sense in the sensory-compromised patient.[11]

Rehabilitation programs are offered in different settings, such as acute inpatient rehabilitation units, subacute inpatient rehabilitation units, home care environments, and outpatient centers. The acute rehabilitation setting is appropriate for patients who meet the admission criteria and are able to tolerate 3 hours or more of active therapy per day.

An acute rehabilitation setting is preferred if the patient requires close monitoring of his/her medical status by medical and nursing professionals. If the patient's medical status is stable but the patient is unable to tolerate more than 1 hour of therapy a day, a subacute rehabilitation or skilled nursing setting is more appropriate. Patients who are independent or require only minimal assistance in self-care tasks and mobility are suited for outpatient therapy or a home care program.

Rehabilitation units
Medical stability traditionally has been required for admission of a patient to a specialized rehabilitation unit; however, hospitals increasingly are transferring patients from acute wards to rehabilitation units at earlier stages, often when the patients still have unresolved medical problems.

This practice has forced rehabilitation centers to expand their resources to care for these more complex cases and to provide closer medical and nursing monitoring. Local institutional referral patterns and practices usually determine the timing of transfer, but if earlier transfer to rehabilitation can be accomplished safely, patient care may be enhanced by earlier active participation of the patient in the rehabilitation program.[12]

Planning for discharge from the inpatient rehabilitation program should begin on admission. Discharge functional status, destination of discharge, and length of hospital stay are comparable in patients with a good prognosis. Discharge functional status is comparable in patients with an unfavorable prognosis, but mortality is higher and the hospital stay is longer in medical wards.

Discharge from the hospital often is thought of as the end of rehabilitation, with the assumption that a good program prepares the patient for reintegration into the home and community; however, hospital discharge instead should be looked at as the end of the beginning of a new life in which the patient faces the challenge of adapting to different roles and relationships and of searching for new meaning in life.

This adaptation involves resuming former roles in the family and with friends as much as possible and finding ways to live a meaningful life in the community.

Postacute rehabilitation
During postacute rehabilitation, all patients should be monitored carefully for evidence of cardiac disease. The classic features of coronary artery disease and congestive heart failure may be present, but often they are not. Ischemia may be silent.[13]

The clinical clues to significant coexisting heart disease may be subtle (eg, slower than expected progress, excessive fatigue, lethargy, mental changes). These cardiac complications can be treated successfully and are not contraindications to rehabilitation. The patient should undergo appropriate cardiac investigation with electrocardiography, Holter monitoring, and echocardiography and also should receive optimal therapy.

Early initiation of therapies is desirable. Beginning rehabilitation early minimizes secondary complications, such as contractures and deconditioning, and helps to motivate the patient. Whether more intense therapy as an independent variable improves ultimate functional recovery is not known.[14]

Evaluation of neurologic impairments should be made repeatedly during the course of the rehabilitation program. Ideally, evaluation should be made weekly in the early phases of rehabilitation to allow monitoring of the recovery process and to guide the therapeutic intervention. A clear need for committed medical direction is evident in patients who have sustained strokes.

The role of the clinician includes provision of medical care. Many patients have ongoing associated medical problems that require appropriate monitoring and therapy. The clinician must act as a medical counselor, offering reasonable prognostication to patient and family, along with guidance in reduction of stroke risk factors and ongoing medical care. The clinician also must give leadership to the team and assist in developing treatment protocols and setting treatment expectations.

The multiple problems that a patient can have following stroke require the active participation of a team of professionals. The treatment activities of the team members must be coordinated so that detailed evaluations are shared and agreements made regarding goals and treatment interventions.

Each of the professional therapists on the team should be knowledgeable about the appropriate interventions within his/her discipline for treating the disabilities of patients following stroke. The interventions should be directed at achieving specific therapeutic goals, which may be for the short term (for example, weekly goals) or longer term (for instance, goals to be reached by discharge). Having achieved those goals, the patient moves on to the next phase of rehabilitation or is discharged home to continue treatment as an outpatient.

Rehabilitation requires a functional approach. When impairments cannot be altered, every effort should be made to assist patients in compensating for deficits and adapting to alternative methods so that they can achieve optimal functional independence.

Home Care in Stroke
A study by Young and Forster found home care to be cheaper than day hospital services (£385 vs £620 [approximately $546 vs $880]).[15]

Outcome measurements have indicated a modest advantage in favor of home care.

No difference in outcome was found between home care and hospital-based rehabilitation following acute care.

Hospital-based services are 27% more expensive than home care services.

Geriatric ward patients are 2.4 times less likely to die or to become institutionalized by 6 months if placed in day hospital service.

Stroke unit patients demonstrate superior ADL performance at 6 months with home care (2.6 times more expensive) than they do with outpatient therapy.

General medical ward patients had similar outcomes, although outpatient services cost 56% of home care.

Home care risks
Risks for suboptimal home care (72.6% prediction/validation rate) include the following:

A depressed caregiver
Inadequate knowledge of how to care for a family member following a stroke
A dysfunctional family
Cardiac Precautions
The rehabilitation management of patients with identified cardiac complications should include formal clinical monitoring of pulse and blood pressure during physical activities. Brief electrocardiac monitoring during exercise can add more specific information.

Note that in deconditioned patients, the resting heart rate may be high, and, in an elderly patient, the estimated limit for heart rate based on 50% above resting may be too high. For patients on beta blockers, a reasonable limit might be a heart rate of around 20 beats above the resting level.

A useful set of cardiac precautions in patients undergoing rehabilitation was developed by Fletcher and colleagues. Activity should be terminated if any of the following symptoms develop:

New onset of cardiopulmonary symptoms
Heart rate decreases to less than 20% of baseline
Heart rate increases to greater than 50% of baseline
Systolic BP increases to 240 mm Hg
Systolic BP decreases 30 mm Hg from baseline or to less than 90 mm Hg
Diastolic shortening fraction increases to 120 mm Hg
Complications During Rehabilitation
Medical complications frequently occur during the postacute phase of rehabilitation, affecting up to 60% of patients (and up to 94% of patients with severe lesions).

Common medical complications include the following:

Pulmonary aspiration, pneumonia - 40%
Urinary tract infection - 40%
Depression - 30%
Musculoskeletal pain, reflux sympathetic dystrophy - 30%
Falls - 25%
Malnutrition - 16%
Venous thromboembolism - 6%
Pressure ulcer - 3%
The means of treating depression in patients following stroke remains uncertain. One study found evidence that pharmacotherapy can reduce depressive symptoms in these patients but that it can also increase adverse events.[16] The report found no evidence that psychotherapy reduces depression.

Common neurologic complications include the following:

Toxic or metabolic encephalopathy - 10%
Stroke progression - 5%
Seizures - 4%
In ischemic stroke patients who were followed over the course of 2-4 years, seizures developed in 6-9% of patients. Seizures developed in 26% of patients with cortical lesions and in 2% of patients with subcortical lesions. Risk factors include the following:

Lobar hemorrhage (acute)
Cortical lesions (chronic)
Persistent paresis (50%)
Other risk factors include the following:

Language function deficit, dysarthria
Visual field defect (20%), hemianopia
Posture and balance deficit
Sensory, cognitive, and perceptual function deficits
Bowel and bladder incontinence
Deconditioning
Congestive heart failure
Hypertension
DM
Dysphasia
Spasticity
Contractures
Heterotopic calcification
Prognosis in Stroke
Significant improvement in UE function usually is seen only in the first 3 months poststroke. If no return of motor function is noted after more than 6 months, prognosis for useful function is unfavorable. If no return of voluntary motor function is noted after more than 1 week, it is unlikely that full use of the affected UE will return.

Poor prognostic indicators include the following:

Proprioceptive facilitation (tapping) response for more than 9 days
Traction response (shoulder flexors/adductors) in more than 13 days
Prolonged flaccid period
Onset of motion at longer than 2-4 weeks
Severe proximal spasticity
Absence of voluntary hand movement for more than 4-6 weeks
Stroke rehabilitation outcome
Predictors of outcome include the following:

Type, distribution, pattern, and severity of physical impairment[17]
Cognitive, language, and communication abilities
Number, types, and severity of comorbid conditions
level of motivation or determination
Coping ability and coping style
Nature and degree of family and social supports
Type and quality of the specific training and adaptation program provided
Remarkable recoveries have been reported in 3-6 years. (Patients have returned to work 3 years poststroke).

Starting rehabilitation early correlates with better outcome but may be confounded by case severity. (See the graphs below.) However, stroke rehabilitation improves functional ability even in patients who are elderly or medically ill, as well as in those who have severe neurologic/functional deficits. Significant gains that are achieved are not attributable only to spontaneous recovery.

Of patients who survive stroke by more than 30 days, 10% demonstrate complete spontaneous recovery, 10% show no benefit from any treatment, and 80% may benefit from treatment. Stroke survivors who do not undergo rehabilitation are more likely to be institutionalized.

Eighty-five percent of patients went home after 3 months of participation in a stroke rehabilitation program. After 43 days, 80% of patients returned home, 85% were ambulatory, and 50-62% were independent in performance of ADL. Functional state improved in the stroke unit from 6-52 weeks.

Patients in outpatient and nonoutpatient therapy groups showed statistical improvement between stroke onset, discharge to home, and 1-year follow-up. The outpatient therapy group required a longer rehabilitation stay, was more impaired at onset, and did not perform as well as the nonoutpatient group. The outpatient therapy group was associated with complete UE/LE hemiplegia, unilateral neglect, impaired proprioception, and urinary incontinence.

Sphincter function, level of neurologic impairment, and capacity to perform ADL related to outcome are assessed, but these measures are not useful to anticipate the outcome of each patient.

Patients unable to walk 3 months poststroke received therapy up to 2 years after the stroke. Seventy-four percent of patients walked without assistance. Seventy-nine percent of patients had a modified Barthel score below 70.

Rehabilitation should include therapy directed at specific training of skills and functional training. Therapy should be given with sufficient intensity to promote skill acquisition.

A population-based study by Dhamoon et al suggests that within a group of patients who have suffered ischemic stroke, there will be an annual decline for up to 5 years in the proportion of patients who are functionally independent that is unrelated to recurrent stroke and other risk factors.[18]

In the study, 525 patients aged 40 years or older (mean age, 68.6 y) with incident ischemic stroke were prospectively followed at 6 months and annually for 5 years. During that time, the proportion of patients with a Barthel score of 95 or higher declined. The decline was independent of age, stroke severity, and other predictors of functional decline, occurring even in patients who did not suffer recurrent stroke or myocardial infarction. The authors also found that the decline occurred in patients who were receiving Medicaid or who had no health insurance but did not occur in those with Medicare or private insurance.

Degree of recovery
The degree of recovery of independent functioning during rehabilitation has been found to be greater than that which might have been expected through a reduction in neural impairments alone, suggesting that rehabilitation interventions play an important role in the patient's recovery of function.

The 2 types of improvement are related in subtle and complex ways. Alternative compensatory functional strategies, such as 1-handed dressing techniques for the hemiplegic patient, assume a major role in the performance of functional tasks when neurologic improvement is minimal or absent.

The degree of natural recovery of neurologic function varies, but figures on the relative frequencies of neurologic deficits during the early and later poststroke stages offer some insight into the degree of recovery that might be seen. The number of these deficits generally declines by approximately 33-50%. For example, the following reductions in prevalence from initial presentation have been found at 1-year follow-up:

Hemiparesis - From 73% at presentation to 37%
Aphasia - From 36% at presentation to 20%
Dysarthria - From 48% at presentation to 16%
Dysphagia - From 13% at presentation to 4%
Incontinence - From 29% at presentation to 9%
As previously mentioned, the time required for recovery also varies. Although most improvements in physical functioning occur within the first 3-6 months, later recovery also is commonly observed. Although it is tempting to specify a definitive prognosis in a stroke patient, it is important to recognize that a multiplicity of variables determine ultimate outcome, which is why expectations for recovery often are inaccurate.

Recovery and Diet
No special diet is required to improve the patient's motor recovery after stroke; however, the patient should avoid excessive weight gain and remain on the regular diet for conditions such as DM, hypertension, and hyperlipidemia.

A study did find evidence that intensive nutritional supplementation can improve motor recovery in previously undernourished patients who have suffered stroke and who are undergoing intensive inpatient rehabilitation.[19]

Laksmi Purwitosari

[Non-text portions of this message have been removed]

12a.

Re: (Tanya) ISKkah?

Posted by: "feby eboy" fetriplef@gmail.com

Tue Oct 4, 2011 8:22 am (PDT)



Urin rutin dulu mbak. Nanti kalo hasilnya positif baru urin kultur utk
mengetahui bakteri apa yg bersarang.

Feby

[Non-text portions of this message have been removed]

13.

dokter kulit yg rum

Posted by: "dika wulandari" deekawulandari@gmail.com

Tue Oct 4, 2011 8:47 am (PDT)



dear,mom's an doctors'l
tolong japri nama dokter kulit yg rum untuk dewasa di sekitar jaksel &
depok tp yg wanita..

thx,
umminya farisy

14.

(Tanya) Infeksi kronis mengarah ke TBC?

Posted by: "Theresia" peachberry_07@yahoo.com   peachberry_07

Tue Oct 4, 2011 8:51 am (PDT)



Dear Dr's n SP's,

Sktr 1 bln yg lalu, Marsha (1y9m) pilek n batuk, tp pileknya tmbh parah smp nyusu sm sy aj susah (mampet smp bgn berkali2 pas tidur mlm)-kl batuknya on off pdhl sdh HT.
Sy curiga Marsha alergi tp blm tau sm apa krn badannya jg kadang2 suka kering2 (kulit terkelupas2).
Akhirnya sy bw ke DSA alergi. Mnrt DSA nya hrs cek lab n alergi krn tanda2 yg sy sebutin n bb mmg ga sesuai (born:3.07kg, 12m:8.6kg, skrg 9.4kg, percentil 5-10).
Hsl lab sdh kluar dg hasil:
- Lekosit 10.200 (normal 5-10rb)
- Trombosit 430rb (normal 150-400rb)
- LED 25 (normal 0-20)
- Limfosit 36 (normal 20-30, dws 40)
- Ige (total) 102,92 (normal <2y<50)
Yg laennya msh dlm batas normal

Mnrt DSA Marsha + alergi bahkan hiperalergi n jg ad gejala infeksi kronis (mengarah ke paru2-diagnosanya HiperReactanBronchitis). Sblm cek lab, diagnosanya ISPA.
Jd hrs tes mantoux n ud dilakukan hr senin kmrn, bsk br kluar hasilnya.
Yg sy tanyakan apakah hsl lab mmg menunjukkan Marsha mengarah ke TBC?
Krn mnrt pengamatan sy Marsha sehari2 sgt aktif, tdk ad benjolan apapun n hsl mantoux tdk b'diameter 10mm. Yg mengkhawatirkan mmg bb yg hny naik sdkt2 bahkan ga sesuai anak normal (umur 12m hrsnya 3x bb), hampir setiap bln pasti batpil n setiap abis mkn bahkan blm abis pun Marsha *maaf pup.
Apa jk hsl tes mantoux + brarti +TBC?
Jk mantoux -, apa yg hrs sy lakukan?
Apa prl cari 2nd opinion? Sy hrs ke dktr mn ya?
Mohon pencerahan Dr's n SP's

Maaf panjang bgt ya, skalian curhat

Thanx bgt ya
Theresia
*bingung hrs ngapain, krn takut overtreatment or undertreatment
Sent from my BlackBerry� smartphone from Sinyal Bagus XL, Nyambung Teruuusss...!
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