Understanding proposals - Proposals derived from English to propose a simple means to submit proposals and can be interpreted as a form submission or a request, offer whether it be ideas, ideas, ideas or plans to others to gain the support of both the nature permits, approvals, funds and others - others. The proposal can also be interpreted as a post created by the author is intended to describe or explain an activity plan and a purpose to the reader.
Definition of Proposal
To know the meaning of the proposal, I include understanding the proposal of several views of the experts
1.Hasnun Anwar (2004: 73) proposals are: plans drawn separately certain activities
2 Jay (2006: 1) the proposal is a standard management tool that management can function efficiently
The proposal in the world of science (education) is a draft design of the study (study proposal) which will be conducted by a researcher about a study material
Big Indonesian Dictionary defines proposal as a plan as outlined in the work plan form
The purpose of Proposal
Proposals goal is to obtain financial assistance, support or sponsor, and obtain licensing. The elements of the proposal, the name / title of activity, introduction, purpose, time and place, the target activity, the composition of the committee, the budget, closing, signature and name of the light.
Types of Proposals
In general, the proposals can be divided into 4 types:
Business Proposal - This proposal relates to the business world either individually or in groups and examples of these proposals such as the establishment of a business proposal, a proposal in the form of co-operation between companies
Proposal Project - This project proposals generally refers to the world of work which contains a series of business plans or commercial development project proposal example
Research Proposal - This proposal type is more commonly used in the field of academic research, for example for the manufacture of paper, thesis and others. contents of this proposal is the filing of the research activities
Proposal activity - an activity that is the plan for the tub to be individual and group activities such as art and culture performance proposal
Based on the proposal form is divided into 3 types:
Proposals Formal form - the form of a formal proposal consists of three main parts, namely the introduction, the contents of the proposal, and the supplementary cover. The introduction consists of: cover and title page, letter of introduction (foreword), overview, table of contents, and request validation. Part of the contents of the proposal consists of: background, barring problems, the scope of the purpose, the basic idea (basic assumption), methodologies, facilities, personnel (the composition of the committee), the advantages and disadvantages, time, and cost. While the complementary cover contains a bibliography, appendix, tables, and so on.
Proposal forms of non-formal - non-formal proposal is not complete and a formal proposal is usually presented in the form of a memorandum or letter. Non-formal proposal should always contain the following matters, namely, problems, suggestions, solutions, and application.
Proposals semi-formal - this type of proposal is similar to the proposal because it is not as complete non-formal types of formal proposals
Tuesday, 9 September 2014
Monday, 8 September 2014
NATURE SOCIETY PAPERS
PART I
INTRODUCTION
Society is an embodiment of human life together. In the ongoing process of community social life is the process of inter-relationships and interactions. In the community as an institution of human life also takes the overall development of human life. Communities can be defined a container or field venue for community interaction. Communities can also be defined as the subject, ie, as the embodiment of all citizens with nature (character) in a particular manifestation or symptom and overall, socio-psychological.
Every citizen consciously or not, is always involved with the process in the mechanism of the society. Each person not only be passive citizens, but in certain circumstances it becomes active citizens. The fact that the society we live associate, worked to death in the community. Live together as a community institution, as a Gemeinschafts, even can not be separated from the society with all its citizens and the relationship between the ongoing antaraksi therein.
To understand the nature of the community, how the position of the person (people), what is the role of citizen rights and obligations to the public, as the public relations propaganda, then briefly discuss the following matters. [1]
CHAPTER II
DISCUSSION
A. DEFINITION OF COMMUNITY AND SOCIAL structure
People who equated with the term (Community Society) scientific technically have specific definitions. Which sometimes vary according to sociologists. However, the Common-Sense, community is defined as a life together in a certain area and time with life patterns formed by the relationship between the citizens and antraksi with the natural surroundings. [2]
In general, society is a group of people who live in a region and interacting with others to achieve goals. Members of the community consists of a wide variety of education, profession, expertise, tribe, nation, religion, or social layer so that it becomes a pluralistic society. Directly and indirectly every member of the community has established communication cooperate and influence each other in order to achieve the goal. [3]
Oqburn and Nimkoff explain terms used in the sense of real community is very broad. United nations include community between nations and even we sometimes call it the world community. The sense of community is sometimes used to express the entire region, state or nation.
Based on such understanding, the understanding of society (relatively) vast territory, and includes the (relatively) many members or citizens therefore also relatively large in number, and spread so wide, will happen anyway "community" within the community there are a variety of factors that cause formation of "community" that the differences are known term "urban communities, rural communities, rural communities, agrarian society", and there is also a "society that" and so on. [4]
B. VIEWS OF THE NATURE OF PHILOSOPHICAL SOCIETY
The history of the development of society is the history of human existence and civilization. Therefore, how to shape the nature of community rights can be separated by an attempt to understand the role of humans in the community. Man is the subject in the community. So the description of the people must be associated with the function and position of humans in the community. The theories about the nature of a thriving community and embraced the world in its age into adulthood it is [5]:
1 atomistic theory
Community, social kebersamaa is the result of a voluntary willingness of citizens to perform inter-relationships and antraksi for welfare purposes. Society is the embodiment of the ideals, equality knotted in their rights. Without the principles of freedom and the values of individual rights, will occur in sintegrasi-social, threatening dis-harmonious eksintensis masyarakat.menyadari the principles of social life according to theory based otomistik definitely democratic values. Man as an individual is the center of orientation, because man is the subject in society and even in some adherents of this theory of society is the main purpose in life. [6]
2 Theory of Organisms
Basically each individual and develop in the community. Humans are not born in a family will and free choice but rather takes place by nature, in other words, humans are born without a choice which, in a society that is how, and in what he had to family was born.
The principle of the implementation of the patterns of life in society according to the theory of the organism are:
a. That wealth and will of the community as an institution above the rights, interests, desires, ideals and individual power.
b. Community agencies covering the whole nation, national, totalitarian, education serves to realize the ideal citizen, and not as an individual human being ideal.
3 Theory Integralistic
In theory though society as an institution that reflects togetherness as a totality, but the undeniable reality of man as a person. Should always be present in humans as a unity in the community. The existence (eksistensis) persons in the same community with the existence of a society. [7]
C. CHARACTERISTICS OF ISLAMIC SOCIETY
Studynya based on the concept of an ideal society, according to the Quran, so concluded the special features of an ideal society according to the Quran as follows:
1 People who are fully based on the firm belief. Faith that serves as the driving force in all processes at the same time balancing the progress made in the community. In addition, with the faith community to reach the glory of heights.
2 Community where each works together to govern the mutual ma'ruf or any form of goodness.
3. Society whose members always endeavored to prevent any munkar.
4. community where each member makes deliberation as one of the pillars of community life.
5. People who uphold the values of justice as part of ma'ruf.
Society created 6 wherein the brotherhood of fellow citizens. Brotherhood is not limited only to fellow Muslims, but includes countrymen and seketurunan fraternity and brotherhood among Muslims.
D. PUBLIC RELATIONS WITH Da'wah
There is some urgency in the public relations implications of the propaganda that is:
1 Community is as subject and object in the success and failure of propaganda.
2 Community is the place to apply the values of propaganda
3 People are ethics and aesthetics of propaganda, because the norms of individuals will proceed into social norms, and social norms which society is agreed upon aesthetics of life.
4 People are propagators for all human beings who have the willingness to have the will to take the lessons that occur in any phenomenal.
CHAPTER III
CONCLUSION
Society is a group of people who live together in a region with the procedures of thinking and acting that is (relatively) all of which make the citizens aware of themselves as a single entity or group.
Mechanism in a society that is with the institutions that exist with all its functions. Actually sourced from the view of the overall view of the community about the value system. Value system is a philosophy of life than they have. Even looking at the nature of how human society, and of course with its consequences, derived from the philosophical view of life. Thus, it is true that the philosophy of life is a source of value for human life,
INTRODUCTION
Society is an embodiment of human life together. In the ongoing process of community social life is the process of inter-relationships and interactions. In the community as an institution of human life also takes the overall development of human life. Communities can be defined a container or field venue for community interaction. Communities can also be defined as the subject, ie, as the embodiment of all citizens with nature (character) in a particular manifestation or symptom and overall, socio-psychological.
Every citizen consciously or not, is always involved with the process in the mechanism of the society. Each person not only be passive citizens, but in certain circumstances it becomes active citizens. The fact that the society we live associate, worked to death in the community. Live together as a community institution, as a Gemeinschafts, even can not be separated from the society with all its citizens and the relationship between the ongoing antaraksi therein.
To understand the nature of the community, how the position of the person (people), what is the role of citizen rights and obligations to the public, as the public relations propaganda, then briefly discuss the following matters. [1]
CHAPTER II
DISCUSSION
A. DEFINITION OF COMMUNITY AND SOCIAL structure
People who equated with the term (Community Society) scientific technically have specific definitions. Which sometimes vary according to sociologists. However, the Common-Sense, community is defined as a life together in a certain area and time with life patterns formed by the relationship between the citizens and antraksi with the natural surroundings. [2]
In general, society is a group of people who live in a region and interacting with others to achieve goals. Members of the community consists of a wide variety of education, profession, expertise, tribe, nation, religion, or social layer so that it becomes a pluralistic society. Directly and indirectly every member of the community has established communication cooperate and influence each other in order to achieve the goal. [3]
Oqburn and Nimkoff explain terms used in the sense of real community is very broad. United nations include community between nations and even we sometimes call it the world community. The sense of community is sometimes used to express the entire region, state or nation.
Based on such understanding, the understanding of society (relatively) vast territory, and includes the (relatively) many members or citizens therefore also relatively large in number, and spread so wide, will happen anyway "community" within the community there are a variety of factors that cause formation of "community" that the differences are known term "urban communities, rural communities, rural communities, agrarian society", and there is also a "society that" and so on. [4]
B. VIEWS OF THE NATURE OF PHILOSOPHICAL SOCIETY
The history of the development of society is the history of human existence and civilization. Therefore, how to shape the nature of community rights can be separated by an attempt to understand the role of humans in the community. Man is the subject in the community. So the description of the people must be associated with the function and position of humans in the community. The theories about the nature of a thriving community and embraced the world in its age into adulthood it is [5]:
1 atomistic theory
Community, social kebersamaa is the result of a voluntary willingness of citizens to perform inter-relationships and antraksi for welfare purposes. Society is the embodiment of the ideals, equality knotted in their rights. Without the principles of freedom and the values of individual rights, will occur in sintegrasi-social, threatening dis-harmonious eksintensis masyarakat.menyadari the principles of social life according to theory based otomistik definitely democratic values. Man as an individual is the center of orientation, because man is the subject in society and even in some adherents of this theory of society is the main purpose in life. [6]
2 Theory of Organisms
Basically each individual and develop in the community. Humans are not born in a family will and free choice but rather takes place by nature, in other words, humans are born without a choice which, in a society that is how, and in what he had to family was born.
The principle of the implementation of the patterns of life in society according to the theory of the organism are:
a. That wealth and will of the community as an institution above the rights, interests, desires, ideals and individual power.
b. Community agencies covering the whole nation, national, totalitarian, education serves to realize the ideal citizen, and not as an individual human being ideal.
3 Theory Integralistic
In theory though society as an institution that reflects togetherness as a totality, but the undeniable reality of man as a person. Should always be present in humans as a unity in the community. The existence (eksistensis) persons in the same community with the existence of a society. [7]
C. CHARACTERISTICS OF ISLAMIC SOCIETY
Studynya based on the concept of an ideal society, according to the Quran, so concluded the special features of an ideal society according to the Quran as follows:
1 People who are fully based on the firm belief. Faith that serves as the driving force in all processes at the same time balancing the progress made in the community. In addition, with the faith community to reach the glory of heights.
2 Community where each works together to govern the mutual ma'ruf or any form of goodness.
3. Society whose members always endeavored to prevent any munkar.
4. community where each member makes deliberation as one of the pillars of community life.
5. People who uphold the values of justice as part of ma'ruf.
Society created 6 wherein the brotherhood of fellow citizens. Brotherhood is not limited only to fellow Muslims, but includes countrymen and seketurunan fraternity and brotherhood among Muslims.
D. PUBLIC RELATIONS WITH Da'wah
There is some urgency in the public relations implications of the propaganda that is:
1 Community is as subject and object in the success and failure of propaganda.
2 Community is the place to apply the values of propaganda
3 People are ethics and aesthetics of propaganda, because the norms of individuals will proceed into social norms, and social norms which society is agreed upon aesthetics of life.
4 People are propagators for all human beings who have the willingness to have the will to take the lessons that occur in any phenomenal.
CHAPTER III
CONCLUSION
Society is a group of people who live together in a region with the procedures of thinking and acting that is (relatively) all of which make the citizens aware of themselves as a single entity or group.
Mechanism in a society that is with the institutions that exist with all its functions. Actually sourced from the view of the overall view of the community about the value system. Value system is a philosophy of life than they have. Even looking at the nature of how human society, and of course with its consequences, derived from the philosophical view of life. Thus, it is true that the philosophy of life is a source of value for human life,
Papers hernia
BACKGROUND A.
Hernia, or better known as turunberok, is a disease caused by the decline over the weakening of the scrotal muscle layer of the abdominal wall. Patients with hernias, indeed most men, especially children. Most sufferers will feel the pain, if there is an infection in it, for example, if the children are too active sufferers.
Derived from the Latin, herniae, the prominence of the contents of a cavity through a thin connective tissue that is weak in the wall cavity. The weak cavity walls forming a bag by the door in the form of a ring. This disorder often occurs in the abdomen with the content that comes out of part of the intestine. A hernia that occurs in children, is due to defective procesus vaginalis to close in line with the decline in the testes or testicles. While the adults to a person, because of the high pressure in the abdominal cavity and due to aging that causes muscle weakness of the abdominal wall.
Hernia suffered by people who live in urban areas, which is actually filled with a flurry of activity as well as the proceeds of which require high stamina. If stamina is not good and continues to be forced then, hernia will soon be over her.
A description of the hernia and the nursing process will be discussed in the next chapter.
B. PROBLEM FORMULATION
What and how understanding, etiology, classification, stage, pathways, pathophysiology, diagnostic examinations, treatment, and nursing care to clients with a hernia.
C.TUJUAN
Students are able to understand the definition, etiology, classification, stage, pathways, pathophysiology, diagnostic examinations, treatment, and nursing care to clients with hernias
PART I
INTRODUCTION
A. Understanding
In general hernia is a protrusion of the contents proskusi or cavities of various internal organs through an abnormal opening or weakness in the muscles that surround and weakness in the connective tissue of an organ (Griffith, 1994) .Hernia is: bulge discharge organ or tissue through the wall of the cavity where the organs which is supposed to be closed in the normal state. Hernia or bowel down is an abnormal protrusion of an organ / part of an organ through the hole on the surrounding structures.
An inguinal hernia is a protrusion of a hernia that occurs in the inguinal canal (groin). Hernia surgery is surgery performed to restore the original position and isihernia close the hernia ring. Definition A hernia is a prominence of an organ or structure of organs and normal place malalui an effect konsenital or acquired. (Long, 1996: 246). A hernia is a prominence of the state of the intestinal contents of a cavity through the hole (Oswari, 2000: 216). A hernia is the protrusion of an organ, tissue or structure passing through the wall cavity that normally contains it is these parts (Nettina, 2001: 253). An inguinal hernia is a hernia that appears in the stomach contents groin area (inguinal region). (Oswari, 2000: 216)
B. CLASSIFICATION
Lots of explanation regarding the classification according to kinds of hernia, and the nature of the process. Here's the explanation:
Various kinds of hernia:
a. Various kinds of hernia is based according to the location, such as:
Inguinal 1. Inguinal hernia is further divided into:
· Indirect / lateral: This hernia occurs through the inguinal ring and passes spermatikus cord through the inguinal canal. It generally occurs in women priadaripada. High incidence in infants and young children. Hernias can be very large and often descend into the scrotum. Generally, the patient said turunberok, hernia or kelingsir or say a lump in the groin / pubic. The lump could shrink or disappear at bedtime and when crying, straining or lifting heavy objects or when the patient is standing positions can arise again
· Direk / medial: This hernia past the wall area abdomendi muscle weakness, not through channels such as the indirect inguinal hernia and femoral. It is more common in the elderly. Direct inguinal hernias are bertahapterjadi on this weak area due to congenital deficiency. A hernia is called direkta due directly to the external inguinal ring so that although the internal inguinal ring is pressed when the patient is standing or straining, still there will be bumps. If the hernia is up to the scrotum, then just be up to bagianatas scrotum, testes and funikulus while spermatikus can be separated from the hernia. In patients seen a round mass at the external inguinal ring is smaller when pasientidur. Because of the large defect in the wall hernias rarely posteriormaka be ireponibilis.
2 Femoral: Femoral hernias occur through the femoral ring and is more common in women than men. It began as a cap of fat in the femoral canal is enlarged and gradually pull the peritoneum and virtually unavoidable bladder into the bag. There is a high incidence of incarcerated and strangulated with this type of hernia.
3 Umbilical: an umbilical hernia in adults and is more common in women because of increased abdominal pressure. It usually occurs on the client obese and multiparous women. This type of hernia occurs in the previous surgical incision has healed due to inadequate post-operative problems such as infections, inadequate nutrition, extreme distention or obesity.
4 Incisional: intestinal stem or other organ protrudes through a weak scar tissue
b. Based on the occurrence, hernia divided into:
Pathogenesis of congenital or congenital hernia at the lateral inguinal hernia type (indirect): inguinal canal is a canal that is normal in fetus.Pada 8th month of pregnancy, occurs desensus melaluikanal the testes. Testicular descent will pull the peritoneum to the scrotum resulting in protrusion of the peritoneum is called the processus vaginalisperitonei. In infants who have been born, these processes generally have undergone obliteration of the abdominal cavity so that the contents can not pass through the canal. But in some ways, this canal does not close. Because the left testicle down first, then the right inguinal canal open more often. When the canal is left open, then usually the right is also open. Under normal circumstances, this open canal will close at the age of 2 months. Bilaprosesus open continuously (for not having obliteration) will arise lateral congenital inguinal hernia. To a person of the old canal has been closed. However, because it is the locus minoris resistensie, then the keadaanyang cause intra-abdominal pressure increases, the channel can open again and herniainguinalis arise lateral akuisita.
Hernia acquired or akuisita (acquisitus = obtained).
c. By their very nature, hernias can be called:
Hernia reponibel 1 / reducible, ie if the hernia contents out of the can. Intestines come out when standing or straining and enter again when lying down or pushed in, no complaints of pain or symptoms of intestinal obstruction.
Hernia ireponibel 2, ie if the hernia contents of the bag can not be returned into the cavity. This is usually caused by the contents of the bag attachment to the fairy Tonium kantonghernia. This is also called a hernia hernia accreta (accretus = attachment as fibrosis). No complaints of pain or signs of intestinal obstruction.
3. Hernia Strangulated or incarcerated (incarceratio = trapped, carcer = prison), which is sandwiched by the contents of the hernia when the hernia ring. Incarcerated hernia contents of the bag means trapped, unable to return to the abdominal cavity with the consequences for the passage or vascularization disorders. Clinically "incarcerated hernia" is intended for hernia ireponibel with impaired passage, whereas vascularization disorders referred to as "herniastrangulata". Strangulated hernia resulting in necrosis of the abdominal contents in it because it does not have blood vessels due to pinched suppliers. A hernia is an emergency jenisini therefore need to get help immediately.
C. Etiology
Inguinal Hernia / Congenital
Inguinal hernias can occur due to congenital anomalies or because obtained. More in men than in women. Factors considered causal role is the presence of an open processus vaginalis, elevation of pressure in the abdominal cavity (due to pregnancy, chronic cough, a job lifting heavy objects, straining during defecation and micturition, for example due to prostatic hypertrophy) and abdominal wall muscle weakness due to age.
The presence of a patent processus vaginalis is not a single cause but necessary faktorlain hernia like inguinal ring is quite large. Intra-abdominal pressure is chronically elevated as batukkronik, prostate hypertrophy, constipation and anxiety are often accompanied by inguinal hernia. In the pathophysiology of inguinal hernia is the most bowel prolapse inguinal ring into the scrotum at the top of the bag, caused by weakness or failure of closing that is congenital.
Incarcerated hernia occurs when the intestine is prolapsed it causes constriction of the blood supply to the scrotum pouch, then the symptoms they will experience pain and bowel obstruction symptoms (abdominal bloating, pain kolikabdomen, no flatus, no feces, vomit)
The weakness of the abdominal wall muscles, among others, caused by damage n.ilioinguinalis and n.iliofemoralis after apendiktomi.
Persistent processus vaginalis of the peritoneum
· Testicular not until the scrotum, so keep an open processus new decline occurred 1-2 days before the birth, so processus not time to close and at the time of birth is still open
· Predilection place: the right side because the right testis desensus after having left first.
· Can appear during infancy or after adult. Indirect hernias in infants associated dengancriptocismus and hidroceleb.
b. Femoral hernia
Generally found in older women, the incidence in women is approximately 4 times the male. The entrance is a femoral hernia femoral ring. In pathophysiologic elevation of intra-abdominal pressure will push the pre peritoneal fat into the femoral canal will be opening the hernia. Other factors are multiparous pregnancy, obesity and connective tissue degeneration due to old age
There is a predisposing factor:
Structural weaknesses aponeurosis and fascia tranversa
In the elderly because of degeneration / atrophy
Increased intra-abdominal pressure
Job lifting heavy objects
chronic cough
CHAPTER disorders, eg ani structure, hard stools
BAK disorders, eg BPH, veskolitiasis
Often breeds: femoral hernia (karisyogya.blog.m3-access.com)
D. Pathophysiology
A hernia develops when intra-abdominal pressure such as pressure grew when lifting something heavy, when defecating or coughing or sneezing strong movement of the intestines and abdominal muscles stricken, excessive pressure on the abdominal area will certainly lead to a possible weakness due to abdominal wall is thin or not enough strength in the area where the condition existed or occurred on a long development process, abdominal surgery and obesity. First of all very minor damage to the abdominal wall, hernia occurs later. Because the organs are always always done heavy work and takes place within the cukuplama, resulting in the protrusion and cause damage very parah.sehingga eventually cause stomach pouch be contained in or experiencing weakness if the blood supply is disrupted dangerous and can lead to gangrene .
E. MEDICAL MANAGEMENT
1) Conservative therapy / non-surgical include:
- The use of temporary buffer such as the use of a belt / corset padahernia ventralis.
- Do postural repositioning in patients with hernias inkaseata who showed no symptoms of systemic
2) common therapy is operative therapy.
3) If the successful repositioning effort herniografi surgery can be performed effectively.
4) If a white power operation Hernia contents doubt, given a warm compress and after 5 minutes in the re-evaluation.
5) If you find that the less powerful abdominal wall surgery should be used to strengthen the abdominal wall marleks local.
6) Engineering plastic hernia, an endoscopic approach with the patient in a lying position trendelernberg 40o C
7) Treatment with administration of pain medications, such as acetaminophen, antibiotics to eradicate the infection, and drug stool softeners to prevent constipation.
8) a liquid diet until the gastrointestinal tract functions again, then eat a balanced diet and high protein to accelerate constipation and mengadan during a bowel movement, avoid coffee coffee, tea, chocolate, cola, alcoholic beverages can aggravate the symptoms.
9) Avoid heavy activities.
F. Complications
v recurrent hernia,
v Damage to the blood supply, nerves if pasienlaki testes or male,
Excessive bleeding v / lluka surgical infections,
v Injury to the bowel (if not careful),
v After herniografi hematoma can occur,
v Fostes urine and feces,
v Residip,
v Complications long is testicular atrophy due to lesions
NURSING MANAGEMENT G.
assessment
Post operative assessment of the patient's (Doenges, 1999) are included:
circulation
Symptoms: a history of heart problems, CHF, edemapulmonal, peripheral vascular disease, or stasisvascular (increased risk of thrombus formation).
ego integrity
Symptoms: feelings of anxiety, fear, anger, apathy; multiple stress factors, such as financial, relationship, lifestyle. Mark: can not break, the increase in tension / sensitive excitatory; sympathetic stimulation.
Food / fluid
Symptoms: pancreatic insufficiency / DM, (predisposing to hypoglycemia / ketoacidosis); malnutrition (termasukobesitas); dry mucous membranes (restriction intake / preoperative fasting period).
breathing
Symptoms: infection, chronic conditions / cough, smoking.
security
Symptoms: allergic / sensitive to medications, foods, plasters, and solutions; Immune deficiency (peningkaan risk of systemic infection and delay healing); The emergence of cancer / cancer therapies latest; Family history of malignant hyperthermia / anesthesia reaction; History penyakithepatic (effect of detoxification of drugs and may alter coagulation); History of blood transfusion / transfusion reactions.
Signs: menculnya infection exhausting process; fever.
Counseling / Learning
Symptoms: pengguanaan anticoagulation, steroids, antibiotics, antihypertensive, cardiotonic glokosid, antidisritmia, bronchodilator, diuretic, decongestant, analgesic, anti-inflammatory, anticonvulsant or tranquilizer and also the-counter medicines, or recreational drugs. Alcohol use (risk of kidney damage, which affects coagulation and choice of anesthesia, and also post-surgery potensialbagi withdrawal)
2 Nursing Diagnosis recurring
Postoperative period (Doenges, 1999).
Impaired sense of comfort (pain) associated with diskontuinitas network due to surgery.
Risk of infection associated with surgical incision / surgery.
Disruption of sleep patterns associated with postoperative pain.
Activity intolerance related to general weakness.
Post surgery care diagnostics (Doengoes 1999)
1) Impaired sense of comfort (pain) associated dengandiskontuinitas network due to surgery.
Purpose: Pain is lost or reduced
Criteria results:
- The client revealed reduced pain
- Vital signs are normal
- The patient appeared calm and relaxed
Hernia, or better known as turunberok, is a disease caused by the decline over the weakening of the scrotal muscle layer of the abdominal wall. Patients with hernias, indeed most men, especially children. Most sufferers will feel the pain, if there is an infection in it, for example, if the children are too active sufferers.
Derived from the Latin, herniae, the prominence of the contents of a cavity through a thin connective tissue that is weak in the wall cavity. The weak cavity walls forming a bag by the door in the form of a ring. This disorder often occurs in the abdomen with the content that comes out of part of the intestine. A hernia that occurs in children, is due to defective procesus vaginalis to close in line with the decline in the testes or testicles. While the adults to a person, because of the high pressure in the abdominal cavity and due to aging that causes muscle weakness of the abdominal wall.
Hernia suffered by people who live in urban areas, which is actually filled with a flurry of activity as well as the proceeds of which require high stamina. If stamina is not good and continues to be forced then, hernia will soon be over her.
A description of the hernia and the nursing process will be discussed in the next chapter.
B. PROBLEM FORMULATION
What and how understanding, etiology, classification, stage, pathways, pathophysiology, diagnostic examinations, treatment, and nursing care to clients with a hernia.
C.TUJUAN
Students are able to understand the definition, etiology, classification, stage, pathways, pathophysiology, diagnostic examinations, treatment, and nursing care to clients with hernias
PART I
INTRODUCTION
A. Understanding
In general hernia is a protrusion of the contents proskusi or cavities of various internal organs through an abnormal opening or weakness in the muscles that surround and weakness in the connective tissue of an organ (Griffith, 1994) .Hernia is: bulge discharge organ or tissue through the wall of the cavity where the organs which is supposed to be closed in the normal state. Hernia or bowel down is an abnormal protrusion of an organ / part of an organ through the hole on the surrounding structures.
An inguinal hernia is a protrusion of a hernia that occurs in the inguinal canal (groin). Hernia surgery is surgery performed to restore the original position and isihernia close the hernia ring. Definition A hernia is a prominence of an organ or structure of organs and normal place malalui an effect konsenital or acquired. (Long, 1996: 246). A hernia is a prominence of the state of the intestinal contents of a cavity through the hole (Oswari, 2000: 216). A hernia is the protrusion of an organ, tissue or structure passing through the wall cavity that normally contains it is these parts (Nettina, 2001: 253). An inguinal hernia is a hernia that appears in the stomach contents groin area (inguinal region). (Oswari, 2000: 216)
B. CLASSIFICATION
Lots of explanation regarding the classification according to kinds of hernia, and the nature of the process. Here's the explanation:
Various kinds of hernia:
a. Various kinds of hernia is based according to the location, such as:
Inguinal 1. Inguinal hernia is further divided into:
· Indirect / lateral: This hernia occurs through the inguinal ring and passes spermatikus cord through the inguinal canal. It generally occurs in women priadaripada. High incidence in infants and young children. Hernias can be very large and often descend into the scrotum. Generally, the patient said turunberok, hernia or kelingsir or say a lump in the groin / pubic. The lump could shrink or disappear at bedtime and when crying, straining or lifting heavy objects or when the patient is standing positions can arise again
· Direk / medial: This hernia past the wall area abdomendi muscle weakness, not through channels such as the indirect inguinal hernia and femoral. It is more common in the elderly. Direct inguinal hernias are bertahapterjadi on this weak area due to congenital deficiency. A hernia is called direkta due directly to the external inguinal ring so that although the internal inguinal ring is pressed when the patient is standing or straining, still there will be bumps. If the hernia is up to the scrotum, then just be up to bagianatas scrotum, testes and funikulus while spermatikus can be separated from the hernia. In patients seen a round mass at the external inguinal ring is smaller when pasientidur. Because of the large defect in the wall hernias rarely posteriormaka be ireponibilis.
2 Femoral: Femoral hernias occur through the femoral ring and is more common in women than men. It began as a cap of fat in the femoral canal is enlarged and gradually pull the peritoneum and virtually unavoidable bladder into the bag. There is a high incidence of incarcerated and strangulated with this type of hernia.
3 Umbilical: an umbilical hernia in adults and is more common in women because of increased abdominal pressure. It usually occurs on the client obese and multiparous women. This type of hernia occurs in the previous surgical incision has healed due to inadequate post-operative problems such as infections, inadequate nutrition, extreme distention or obesity.
4 Incisional: intestinal stem or other organ protrudes through a weak scar tissue
b. Based on the occurrence, hernia divided into:
Pathogenesis of congenital or congenital hernia at the lateral inguinal hernia type (indirect): inguinal canal is a canal that is normal in fetus.Pada 8th month of pregnancy, occurs desensus melaluikanal the testes. Testicular descent will pull the peritoneum to the scrotum resulting in protrusion of the peritoneum is called the processus vaginalisperitonei. In infants who have been born, these processes generally have undergone obliteration of the abdominal cavity so that the contents can not pass through the canal. But in some ways, this canal does not close. Because the left testicle down first, then the right inguinal canal open more often. When the canal is left open, then usually the right is also open. Under normal circumstances, this open canal will close at the age of 2 months. Bilaprosesus open continuously (for not having obliteration) will arise lateral congenital inguinal hernia. To a person of the old canal has been closed. However, because it is the locus minoris resistensie, then the keadaanyang cause intra-abdominal pressure increases, the channel can open again and herniainguinalis arise lateral akuisita.
Hernia acquired or akuisita (acquisitus = obtained).
c. By their very nature, hernias can be called:
Hernia reponibel 1 / reducible, ie if the hernia contents out of the can. Intestines come out when standing or straining and enter again when lying down or pushed in, no complaints of pain or symptoms of intestinal obstruction.
Hernia ireponibel 2, ie if the hernia contents of the bag can not be returned into the cavity. This is usually caused by the contents of the bag attachment to the fairy Tonium kantonghernia. This is also called a hernia hernia accreta (accretus = attachment as fibrosis). No complaints of pain or signs of intestinal obstruction.
3. Hernia Strangulated or incarcerated (incarceratio = trapped, carcer = prison), which is sandwiched by the contents of the hernia when the hernia ring. Incarcerated hernia contents of the bag means trapped, unable to return to the abdominal cavity with the consequences for the passage or vascularization disorders. Clinically "incarcerated hernia" is intended for hernia ireponibel with impaired passage, whereas vascularization disorders referred to as "herniastrangulata". Strangulated hernia resulting in necrosis of the abdominal contents in it because it does not have blood vessels due to pinched suppliers. A hernia is an emergency jenisini therefore need to get help immediately.
C. Etiology
Inguinal Hernia / Congenital
Inguinal hernias can occur due to congenital anomalies or because obtained. More in men than in women. Factors considered causal role is the presence of an open processus vaginalis, elevation of pressure in the abdominal cavity (due to pregnancy, chronic cough, a job lifting heavy objects, straining during defecation and micturition, for example due to prostatic hypertrophy) and abdominal wall muscle weakness due to age.
The presence of a patent processus vaginalis is not a single cause but necessary faktorlain hernia like inguinal ring is quite large. Intra-abdominal pressure is chronically elevated as batukkronik, prostate hypertrophy, constipation and anxiety are often accompanied by inguinal hernia. In the pathophysiology of inguinal hernia is the most bowel prolapse inguinal ring into the scrotum at the top of the bag, caused by weakness or failure of closing that is congenital.
Incarcerated hernia occurs when the intestine is prolapsed it causes constriction of the blood supply to the scrotum pouch, then the symptoms they will experience pain and bowel obstruction symptoms (abdominal bloating, pain kolikabdomen, no flatus, no feces, vomit)
The weakness of the abdominal wall muscles, among others, caused by damage n.ilioinguinalis and n.iliofemoralis after apendiktomi.
Persistent processus vaginalis of the peritoneum
· Testicular not until the scrotum, so keep an open processus new decline occurred 1-2 days before the birth, so processus not time to close and at the time of birth is still open
· Predilection place: the right side because the right testis desensus after having left first.
· Can appear during infancy or after adult. Indirect hernias in infants associated dengancriptocismus and hidroceleb.
b. Femoral hernia
Generally found in older women, the incidence in women is approximately 4 times the male. The entrance is a femoral hernia femoral ring. In pathophysiologic elevation of intra-abdominal pressure will push the pre peritoneal fat into the femoral canal will be opening the hernia. Other factors are multiparous pregnancy, obesity and connective tissue degeneration due to old age
There is a predisposing factor:
Structural weaknesses aponeurosis and fascia tranversa
In the elderly because of degeneration / atrophy
Increased intra-abdominal pressure
Job lifting heavy objects
chronic cough
CHAPTER disorders, eg ani structure, hard stools
BAK disorders, eg BPH, veskolitiasis
Often breeds: femoral hernia (karisyogya.blog.m3-access.com)
D. Pathophysiology
A hernia develops when intra-abdominal pressure such as pressure grew when lifting something heavy, when defecating or coughing or sneezing strong movement of the intestines and abdominal muscles stricken, excessive pressure on the abdominal area will certainly lead to a possible weakness due to abdominal wall is thin or not enough strength in the area where the condition existed or occurred on a long development process, abdominal surgery and obesity. First of all very minor damage to the abdominal wall, hernia occurs later. Because the organs are always always done heavy work and takes place within the cukuplama, resulting in the protrusion and cause damage very parah.sehingga eventually cause stomach pouch be contained in or experiencing weakness if the blood supply is disrupted dangerous and can lead to gangrene .
E. MEDICAL MANAGEMENT
1) Conservative therapy / non-surgical include:
- The use of temporary buffer such as the use of a belt / corset padahernia ventralis.
- Do postural repositioning in patients with hernias inkaseata who showed no symptoms of systemic
2) common therapy is operative therapy.
3) If the successful repositioning effort herniografi surgery can be performed effectively.
4) If a white power operation Hernia contents doubt, given a warm compress and after 5 minutes in the re-evaluation.
5) If you find that the less powerful abdominal wall surgery should be used to strengthen the abdominal wall marleks local.
6) Engineering plastic hernia, an endoscopic approach with the patient in a lying position trendelernberg 40o C
7) Treatment with administration of pain medications, such as acetaminophen, antibiotics to eradicate the infection, and drug stool softeners to prevent constipation.
8) a liquid diet until the gastrointestinal tract functions again, then eat a balanced diet and high protein to accelerate constipation and mengadan during a bowel movement, avoid coffee coffee, tea, chocolate, cola, alcoholic beverages can aggravate the symptoms.
9) Avoid heavy activities.
F. Complications
v recurrent hernia,
v Damage to the blood supply, nerves if pasienlaki testes or male,
Excessive bleeding v / lluka surgical infections,
v Injury to the bowel (if not careful),
v After herniografi hematoma can occur,
v Fostes urine and feces,
v Residip,
v Complications long is testicular atrophy due to lesions
NURSING MANAGEMENT G.
assessment
Post operative assessment of the patient's (Doenges, 1999) are included:
circulation
Symptoms: a history of heart problems, CHF, edemapulmonal, peripheral vascular disease, or stasisvascular (increased risk of thrombus formation).
ego integrity
Symptoms: feelings of anxiety, fear, anger, apathy; multiple stress factors, such as financial, relationship, lifestyle. Mark: can not break, the increase in tension / sensitive excitatory; sympathetic stimulation.
Food / fluid
Symptoms: pancreatic insufficiency / DM, (predisposing to hypoglycemia / ketoacidosis); malnutrition (termasukobesitas); dry mucous membranes (restriction intake / preoperative fasting period).
breathing
Symptoms: infection, chronic conditions / cough, smoking.
security
Symptoms: allergic / sensitive to medications, foods, plasters, and solutions; Immune deficiency (peningkaan risk of systemic infection and delay healing); The emergence of cancer / cancer therapies latest; Family history of malignant hyperthermia / anesthesia reaction; History penyakithepatic (effect of detoxification of drugs and may alter coagulation); History of blood transfusion / transfusion reactions.
Signs: menculnya infection exhausting process; fever.
Counseling / Learning
Symptoms: pengguanaan anticoagulation, steroids, antibiotics, antihypertensive, cardiotonic glokosid, antidisritmia, bronchodilator, diuretic, decongestant, analgesic, anti-inflammatory, anticonvulsant or tranquilizer and also the-counter medicines, or recreational drugs. Alcohol use (risk of kidney damage, which affects coagulation and choice of anesthesia, and also post-surgery potensialbagi withdrawal)
2 Nursing Diagnosis recurring
Postoperative period (Doenges, 1999).
Impaired sense of comfort (pain) associated with diskontuinitas network due to surgery.
Risk of infection associated with surgical incision / surgery.
Disruption of sleep patterns associated with postoperative pain.
Activity intolerance related to general weakness.
Post surgery care diagnostics (Doengoes 1999)
1) Impaired sense of comfort (pain) associated dengandiskontuinitas network due to surgery.
Purpose: Pain is lost or reduced
Criteria results:
- The client revealed reduced pain
- Vital signs are normal
- The patient appeared calm and relaxed
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