ASUHAN KEPERAWATAN

New York , a few weeks after introducing a new family of the i - series BMW , BMW was caught testing a variant of the Megacity electric car or i 3 in the polar north . As quoted from leftlanenews , Sunday ( 14 / 3 / 2011 ) from the image shown when i 3 Boxy- style design brings an urban car today . At first glance the car looks like the Toyota iQ, although i 3 will have a wider rear seat. I own BMW 3 previously known as the Megacity which will become the first city - owned BMW vehicles in 2013 that use pure electricity as their driving force . Megacity will use a powertrain similar to BMW ' s Active E 2011 . So that these vehicles will be equipped with lithium - ion battery that can deliver power to an electric motor that can produce 170 hp ( 127 kW / 172 PS ) and 184 lb - ft ( 249 Nm ) of torque. Unfortunately specification Megacity not yet known in detail. But if we bandaingkan with BMW Active E , this vehicle can reach 000- 100 km per hour in less than 9 seconds , and has a top speed of about 145 km per hour , and sped up to 161 km when the battery is full . While other family members namely i - series BMW i 8 developed based on the BMW Vision EfficientDynamics concept car that will use a hybrid system that makes high- performance but with low fuel consumption . Both models will be based on a new construction called the LifeDrive. This new construction will use the aluminum chassis with carbon fiber - reinforced packing plastic (CFRP ) on the body which makes the car lighter without sacrificing strength of the material . Both these cars will be built at BMW factory in Leipzig , Germany which has enhanced its ability to spray money around 400 million euros . For starters sub - brand new BMW will be born in New York , the United States after the BMW i will begin to colonize other areas around the world , perhaps also including Indonesia.

JAKARTA - The U . S . Embassy in Jakarta joined the news The Age responded that also touched on the leaked information from Wikileaks . For the U . S . Embassy , it did not want to comment on the material contained in the paper The Age is . However, the U . S . ambassador to Indonesia , Scott Marciel deplores any information leakage events are intended as confidential, including the private conversation between colleagues or assessments and personal observations of the diplomats. " Our official foreign policy is not determined by the message - this message, but in Washington , " said Scott Marciel in a release to the Legal , Friday ( 11 / 3 / 2011 ) . According to Scott, U . S . policy is not something secret . It has been proven according to the U . S . when it issued the policy to the whole world . Disclosure of confidential information against unauthorized by Wikileaks has implications for the lives of individuals mentioned in distress , but also for cooperation between the countries - countries. As written in The Age one of U . S . Embassy personnel involvement is when an agent from the U . S . Embassy in Indonesia to get information from the NGO Anti - Corruption in Indonesia , which mentions no credible data showing the campaigns of President SBY in the 2009 election and then use the bailout funds Century .,

TOKYO - Japan ' s earthquake and tsunami victims continues to grow. Japanese police records , the death toll has exceeded 2 . 000 people. Most have not been identified . This amount is still far above the Japanese Government official data that put the death toll around 800 people . Japanese Police quoted by Kyodo News Agency on Sunday ( 13 / 3 / 2011 ) mentions in Fukushima Prefecture alone was found 1 . 167 dead , while 600 more bodies have been found in Miyagi and Iwate Prefecture. Those areas directly facing the Pacific ocean , the location of the epicenter point 8 , 9 on the Richter Scale which is then revised the Meteorology and Climatology Japan to 9 , 0 SR . While local governments in each prefecture is still difficult to know the fate of tens of thousands of its citizens because of damage to infrastructure . So far , a total of 20 . 820 buildings reportedly razed to the ground and carried away by the tsunami. While more than 300. 000 people in six prefectures teklah evacuated. Of this amount , as many as 180. 000 of whom are residents living within a radius of 20 kilometers from the reactor at the Fukushima No . 1 nuclear. As a result of radiation leaks , 19 were found to have contaminated .,

CALIFORNIA - Android operating system again attacked by viruses that are considered dangerous . After the previous virus targeting the handset. Currently , the target is a direct application store, the Android Market . According to reports security company Sophos, the Android Market on- jacked and then infiltrated with malware and then users are directed to the Android Market application store in China. Reported by TG Daily , Saturday (12 / 3 / 2011 ) , a virus that attacks the Android Market is kind of Trojan , which utilizes a menganganga hole in Android, which is an open- based operating system . " Defrauding includes functionality to send MMS messages, for example , when the device boots up itself, " explained Svajcer , from Sophos. " The pattern of attack to create a fake security tool that detects threats that do not exist is very common in the PC world and has brought a lot of revenue for cybercriminals , " he said .,

Tidak semua bayi beruntung dilahirkan cukup bulan. Ibu yang melahirkan bayi prematur dapat merasa sedih, kecewa, dan khawatir karena si bayi mungil malah dimasukkan ke dalam kotak kaca bernama inkubator.

Bayi prematur adalah bayi yang lahir sebelum usia kehamilan 37 minggu (36 minggu 7 hari). Angka kematian pada bayi prematur cukup tinggi di negara berkembang seperti Indonesia, sekitar 26% dari seluruh bayi prematur yang lahir, menurut data dari RS Ciptomangunkusumo, Jakarta. Sedangkan menurut data dunia, kelahiran prematur mencapai 75-80% dari seluruh bayi yang meninggal pada usia kurang dari 28 hari.

Dibandingkan bayi cukup bulan, bayi prematur mudah terserang infeksi karena daya tahan tubuhnya yang belum sempurna, mudah mengalami henti napas karena ketidakmatangan paru dan susunan saraf pusat, serta sulit mempertahankan suhu tubuh (hipotermia).



Hipotermia dan inkubator: kebutuhan vs ketersediaan

Bayi prematur memiliki cadangan lemak tubuh (brown fat) yang masih sedikit untuk menahan panas dan metabolisme yang belum sempurna untuk memproduksi panas sendiri. Disamping itu, kehilangan panas lebih mudah terjadi pada bayi prematur karena perbandingan luas permukaan terhadap massa tubuhnya relatif lebih luas dibandingkan pada bayi cukup bulan. Keadaan ini merupakan ancaman terhadap kehidupan bayi karena hipotermia dapat mengakibatkan terjadinya penumpukan zat asam dalam darah (asidosis), hipoglikemia, gangguan pembekuan darah, dan meningkatkan risiko distres pernapasan pada bayi, yang pada akhirnya dapat berakibat kematian.

Karena alasan itulah bayi prematur dirawat dalam inkubator segera setelah lahir untuk menjaga suhu tubuhnya tetap hangat, antara 36,5-37,5°C. Sayang selain jumlahnya terbatas, perawatan dengan inkubator memerlukan biaya tinggi. Terlebih lagi, bayi yang dirawat di rumah sakit memiliki risiko tertular infeksi dari bayi lain.

Adakah alternatif penghangat yang murah dan mudah didapat di negara berkembang seperti di Indonesia? Perawatan metode kanguru jawabannya.



Apa itu perawatan metode kanguru?

Manfaat perawatan metode kanguru (PMK) atau perawatan bayi lekat yang kerap disebut kangaroo mother care sebenarnya sudah banyak dibicarakan di masyarakat. Metode ini diperkenalkan pertama kali oleh Rey dan Martinez dari Bogota, Kolombia, dan merupakan metode perawatan bayi kecil atau bayi prematur yang diilhami oleh cara ibu kanguru merawat anaknya yang selalu lahir prematur.

Metode kanguru: bagaimana caranya?

1. Posisi kanguru. Bayi diletakkan diantara payudara ibu dalam posisi tegak dengan dada bayi menempel pada dada ibu. Kepala bayi dipalingkan ke sisi kanan atau kiri, dengan posisi sedikit tengadah. Kedua tungkai bayi ditekuk sedikit seperti posisi kodok. Dalam posisi demikian tubuh ibu dan bayi diikat dengan kain selendang atau kemben berbahan elastis untuk menahan badan bayi agar tidak jatuh.(Lihat gambar). Bayi hanya mengenakan popok, topi hangat, dan kaus kaki. Tetapi apabila suhu sedang dingin, boleh dipakaikan baju tanpa lengan berbahan katun yang dibuka di bagian depannya, agar dada bayi tetap dapat menempel (kulit ke kulit) pada dada ibu.


2. Monitor. Selama bayi cukup mendapat ASI dan berada dalam dekapan ibu, biasanya suhu akan mudah dipertahankan antara 36,5-37,5°C. Walaupun demikian, pemantauan suhu ketiak bayi perlu dilakukan setiap 6 jam selama 3 hari pertama PMK dimulai. Selanjutnya pengukuran dilakukan 2 kali sehari. Selain suhu, ibu perlu memantau pernapasan bayi. Pernapasan normal bayi prematur berkisar 40-60 kali per menit dan kadang dapat disertai periode apnu (tidak bernapas). Beberapa tanda bahaya adalah bayi sulit bernapas, merintih, bernapas sangat cepat atau sangat lambat, berhenti napas yang sering dan lama (>20 detik), bayi terasa dingin walau sudah dihangatkan, sulit minum, muntah-muntah, kejang, diare, atau kulit menjadi kuning. Bila menjumpai tanda-tanda diatas, segeralah mencari pertolongan pada tenaga kesehatan.


3. Waktu dan siapa saja. PMK idealnya dilakukan 24 jam sehari, tetapi pada permulaan dapat dilakukan bertahap dari minimal 60 menit, kemudian ditingkatkan sampai terus-menerus, siang dan malam, disela hanya untuk mengganti popok. Ibu dapat tetap melakukan pekerjaan sehari-hari seperti berdiri, duduk, memasak, jalan-jalan, bahkan bekerja. Waktu tidur pun ibu dapat berbaring atau setengah duduk sambil tetap mempertahankan posisi kanguru.

Meskipun demikian, ibu harus tetap menjaga kebersihan pribadi dengan mandi 2 kali sehari dan sering mencuci tangan. Ketika ibu berhalangan, PMK tetap dapat diteruskan oleh anggota keluarga lain seperti ayah atau nenek.

Apakah pada semua bayi prematur boleh dilakukan PMK?

Dengan adanya PMK tidak berarti semua bayi prematur boleh keluar dari inkubator. PMK intermitten (jangka pendek) boleh dimulai pada bayi dalam proses penyembuhan yang masih memerlukan infus atau sedikit tambahan oksigen. Namun, PMK kontinu (terus-menerus) baru dapat dilakukan jika bayi dalam keadaan stabil, bernapas alami tanpa bantuan oksigen.

Metode Kanguru: Hold me, Feed me, Love me…

Pada bayi prematur yang stabil, yang dalam perawatan rumah sakit hanya memerlukan kehangatan, metode kanguru dapat memberikan hasil yang lebih baik daripada inkubator. Mengapa?

Seperti yang diungkapkan oleh dr. Nils Bergman, pakar PMK di Afrika Selatan,

“If I could say it as simply as possible, from a child’s point of view, I can define Kangaroo Baby Care as: Hold Me, Feed Me, Love Me…”

Bayi didekap oleh ibunya, merasakan sentuhan kulit ke kulit yang tentu memberikan kenyamanan dan ketenangan pada bayi. Suhu tubuh ibu dapat naik dan turun dengan sendirinya sesuai kebutuhan bayi (maternal neonatal thermal synchrony), tanpa pengaturan manual seperti halnya inkubator. Kontak kulit ke kulit ini juga meminimalkan kehilangan panas dari permukaan tubuh bayi, yang tidak dapat dilakukan inkubator. Dengan kontak emosional yang erat antara ibu dan bayi pada PMK, produksi ASI meningkat karena adanya refleks letdown oleh hormon oksitosin dalam tubuh ibu. Bayi pun tidak perlu repot dikeluar-masukkan dari inkubator untuk bisa mendapat ASI. Bayi dapat langsung menghisap ASI dari payudara ibu dengan sedikit mengubah posisi.

Selain itu, pada PMK risiko bayi mendapat infeksi minimal karena flora normal kulit ibu tentu lebih “aman” daripada kuman resisten antibiotik di ruang rawat rumah sakit. Bayi pun lebih cepat dipulangkan dari rumah sakit karena peningkatan berat badan yang lebih cepat dan PMK dapat dilanjutkan di rumah oleh ibu dibantu oleh anggota keluarga lainnya. Dengan demikian biaya perawatan rumah sakit dapat ditekan, dan karenanya metode ini sangat sesuai dengan kondisi ekonomi di Indonesia.

Metode Kanguru vs Inkubator: pilih mana?

Dari uraian di atas, jelaslah bahwa untuk bayi prematur yang stabil, perawatan metode kanguru memiliki banyak kelebihan yang tidak dimiliki oleh inkubator. Bahkan, bayi yang dirawat dengan metode kanguru lebih cepat mencapai suhu normal dibandingkan bayi yang dirawat dalam inkubator.

Nah, sekarang Anda pasti sudah tahu jawabannya jika si bayi mungil menyapa Anda, “Hold me, Feed me, Love me…”. Perawatan metode kanguru tidak hanya mampu menjadi bantuan kelangsungan hidup bayi prematur, tetapi juga cara seorang ibu untuk menyampaikan bahasa universal, bahasa cinta.

Pustaka:

World Health Organizati

on. Kangaroo mother care: a practical guide. Geneva: WHO; 2003.

Suradi R, Yanuarso PB. Metode kanguru sebagai pengganti inkubator bagi bayi berat lahir rendah. Sari Pediatri 2000;2(1):29-35.

Mannel R, Martens PJ, Walker M. International Lactation Consultant Association. Core Curriculum for Lactation Consultant Practice. Edisi 2. Sudbury, Massachusetts: Jones and Bartlett Publishers; 2008.

Vienna - An earthquake with a devastating tsunami waves devastated the island of Honshu, northeastern Japan. Now the Japanese government is focusing cope with casualties and severe damage from the disaster . Because nuclear power plants adjacent to the location of an earthquake is expressed in a safe condition . This was conveyed by the International Atomic Energy Agency ( IAEA ) , as reported by Reuters on Friday (11 / 3 / 2011 ) . IAEA , the UN nuclear watchdog are looking for information explaining further nuclear facilities in other countries at high risk of earthquake - damaged Japanese. " Four Japanese nuclear power plant near the quake has stopped its activities, " such as the IAEA released. However, communication with the relevant authorities in Japan continue to be done. " The IAEA has also sent an offer services to Japan " . Japanese media launch his government had decided to declared nuclear power in an emergency . This statement is to anticipate when a leak of radioactivity from a nuclear power plant or reactor coolant system is broken . Separately , Fukushima Prefecture , the site of Nuclear Power in Tokyo to ensure the reactor coolant system is working . The answer is once again denied rumors circulating on the plant such leakages .,

TOKYO - An earthquake with a strength of 8 , 8 SR menghamtam Japan. Berkuatan devastating earthquake that caused tsunami as high as 6 meters of Honshu. Severe damage was also visible location hit by the quake . Based on the report The Pacific Tsunami Warning Center in Hawaii, some countries also must wapada with subsequent tsunami . Countries that must be extra vigilant is Russia , Marcus Island , and Northern Marianas. The public broadcaster, NHK also showed black smoke billowing from a building in Odaiba , Tokyo suburb. Activities throughout the northern Japanese fast train was stopped . Television showed the car swinging - swinging the water in the boat that was leaning . Japan Meteorological Agency warned that a tsunami as high as 6 m also could hit the coast near the prefecture of Miyagi, the closest to the epicenter . The agency said the quake occurred at 14 : 46 in (13 : 46 Singapore time) Friday at a depth of 10 km , approximately 125 km off the east coast . The tsunami destroyed many buildings were reported. However, there are no reports of casualties due to tsunami .,