BREAST CANCER

What is breast cancer?
 
If at some point in our body there are growth of the cells is excessive, there will be a lump or tumor. These tumors can be benign or malignant. A malignant tumor is called cancer. Malignant tumors have unique properties, which can spread to other parts of the body to develop into new tumors. The spread is called metastasis. Cancer has different characteristics. There is growing rapidly, there is growing not too fast, such as breast cancer.

The first breast cancer cells can grow into tumors of 1 cm at the time of 8-12 years. Cancer cells are quiescent in the mammary gland. Breast cancer cells can spread via the blood stream throughout the body. When the deployment is taking place, we do not know. Breast cancer cells can hide inside our bodies for years without knowing, and suddenly active malignant or cancerous.
Cancer progression
Stage I (early stage)
Tumor size of not more than 2 - 2.25 cm, and there is no spread (metastases) in axillary lymph nodes. In stage I, the possibility of a perfect cure was 70%. To check for the presence or absence of metastases to other parts of the body, must be examined in the laboratory.
Stage II
The tumor was larger than 2.25 cm and has occurred metastases in lymph nodes in the armpit. At this stage, it is likely to recover only 30-40% depending on the extent of spread of cancer cells. In stage I and II are usually performed surgery to remove cancer cells that exist in all parts of the deployment, and radiation after surgery performed to ensure there are no more cancer cells left behind.
Stage III
The tumor was quite large, the cancer cells have spread throughout the body, and the possibility to live a little. Breast treatment had no meaning anymore. Radiation treatment is usually only done and chemotherapie (administration of drugs that can kill cancer cells). Sometimes also performed surgery to remove the breast that is severe. This business is only to inhibit the growth of cancer cells in the body and to alleviate the suffering of patients as much as possible.
Prevention of early
Need to know, that 9 out of 10 women found a lump in her breast. For primary prevention, to do yourself. Inspection should be done after completion of the menstrual period. Before menstruation, breast slightly swollen, making it hard examination. How examinations are as follows:
• Stand in front of the mirror and see if there are abnormalities in the breast. Usually both breasts are not the same, nor nipples located at the same height. Notice if there are wrinkles, indentations, or nipple drawn into. When there is disorder or blood or discharge from the nipple, immediately go to the doctor.
• Put your arms above your head and look back both breasts.
• Bend the body until the breasts hanging down, and check again.
• Lie down on the bed and put your left hand behind your head and a pillow under your left shoulder. Touch the left breast with your right fingers. Check if there is a lump in the breast. Then check also if there is a lump or swelling in the left armpit.
• Check and Touch nipple and surrounding areas. In general, the mammary gland when touched with your fingers will feel supple and easy to move. If there is a tumor, it will feel hard and can not be moved (can not be moved from its place). If you feel there is a lump the size of 1 cm or more, immediately go to the doctor. The earlier treatment, more likely to recover completely
• Do the same thing for breast and right armpit.
Treatment of advanced
When you find a lump, a doctor may recommend examination mammografie. Mammografie is a breast examination by means of X-rays and an examination of how a simple, painless, and only takes 5-10 minutes. The best time to undergo mammografie was a week after menstruation. The trick is to put the alternate breasts between 2 sheets of ironing, then X-rays are made from top to bottom and then from left to right. The images will be examined by a specialist radiologist. A lump of 0.25 cm can already be seen on a mammogram.
Another way is with a small operation to take a sample of tissue (biopsy) from the lump, and then examined under a microscope anatomic pathology laboratory. If known and confirmed that the lump was cancerous, then the breast should be removed entirely to avoid spreading to other parts of the body.
Who should undergo mammografie?
• Women aged over 50 years.
• Women who have a mother or sister who had breast cancer.
• Women who had undergone removal of one breast. Women in this group should be in supervision.
• Women who have never given birth children. Apparently the group is often found against breast cancer.
Health - 10 Ways to Prevent Breast Cancer
July 1, 2004 16:12:28

Recent research shows that breast cancer is the number one health concern for women in the UK. But statistics also show nine out of ten people want to change their lifestyle to reduce the risk of disease.

There are certain steps that every woman can do to help reduce the chances of developing breast cancer. Here are 10 tips that can help prevent breast cancer:
• Awareness of the breast itself
More than 90% of breast tumors detected by women themselves. Perrhatikan any changes in the breast become an important part of women's health care. Currently, women are advised to be "breast aware". This means that women should know what their breasts in front of the mirror, and feel while bathing or lying at different periods every month so if there are abnormal changes can be seen immediately.
• Give milk to babies
Some penelitin showed no association between breastfeeding and reduced risk of developing breast cancer although there is no clear agreement on this. The researchers claim that the younger and older mothers breastfeeding at banyinya is getting better. This is based on the theory that breast cancer associated with estrogen. Breastfeeding will periodically reduce the level of these hormones.
• If you find a lump, see a doctor immediately
Research shows many women defer to a doctor if they find a lump in her breast, they are afraid of having cancer. This is the worst thing they do. If you find a lump, consult a doctor immediately as this will help to calm the mind. If the lump is cancer, please make the appropriate treatment to save lives.
• Find out if there is a family history of breast cancer
Still need more research to fully understand all the causes of breast cancer. But one thing you need to believe is the factor genes. This factor is at least 10% of all breast cancer cases. It is considered to be one in 500 people carry genes that make them suspected of having the disease.
• Pay attention to alcohol consumption
In some studies, alcohol has nothing to do with cancer. This is based on the fact that alcohol increases estrogen.
• Watch your weight
Obesity appears to menngkatkan risk of breast cancer. The researchers found women with a weight of 44 to 55 pounds after age 18 have a 40% higher risk of cancer than those who change only 4 or 5 pounds during adolescence.
• Exercise regularly
Some studies suggest that exercise can reduce the risk of breast cancer. This is because research shows that the lack of exercise, the higher the level esrogen in the body.
• Reduce fatty foods
There is much debate about the relationship of breast cancer with diet. But there is evidence that certain western lifestyle appears to increase the risk of disease.
• If more than 50 years, doing regular breast screening
Although much research is still needed to determine the causes of breast cancer, one of the major factor is the age factor. 80% of breast cancers occur in women aged over 50 years.
• Learn to relax
Many noted that stress can cause all kinds of health problems. Although there are still a lot of debate over these findings, lower stress levels will be beneficial to overall health, including the risk of breast cancer.
Breast Cancer Not the End


Preferential
Smoking may increase the risk of breast cancer

JAKARTA - For most people, cancer verdict could mean the end of everything, as if the death before the eyes. Advances in medical technology while allowing the cancer can be detected early and spread of cancer cells could be inhibited more quickly so that life expectancy was longer. In addition, the will to live is the main therapy of cancer treatment.
A woman aged in their 30s holding a mike with a trembling hand, said that she had undergone a mastectomy (breast removal surgery) due to his cancer. Despite all the relatives and the doctors say that age is a matter for the Lord, nevertheless he was very afraid of the coming of death. "I wish there was a support group that can help each other to deal with the pain and strengthen it," he said in a voice not to cry in open discussion on breast cancer treatment Cancer Hospital Dharmais held in Jakarta recently.
He did not want to ask the speaker, a physician who is one of the cancer experts at RS Dharmais. He just wants to complain, as the majority of other women who attended the forum, about breast cancer that eats away at their health. But nevertheless, dr. Sutjipto, who was a resource person Sp.B.Onk discussion saying that the statement "age is a matter of God" is the most honest thing the doctor said.
According Sutjipto, until now, the cause of cancer is not known with certainty. Therefore, prevention efforts do not actually exist. The only business that can be done is to find breast cancer as early as possible so that treatment can be done to help a person to prolong life expectancy. "Death can occur at any time and do not need to have cancer," said Sutjipto seriously.
Bespectacled man also said that there are some breast cancer patients completely recovered after mastectomy. It happens because children spread of the cancer cell does not exist. So once performed a mastectomy, the cancer cells completely lost. Even so, he recognizes the cancer cells are unique cells. Once there was a case in which the patient's cancer cells that have been raised 20 years ago suddenly come into her office and complained of pain. Later it was discovered that the cancer cells had disappeared 20 years ago show up again in a different place. "We call it double primary," said Sutjipto.
To date, the frequency of breast cancer reached 20 percent of all cancers. According to data from the World Health Organization (WHO), each year the number of breast cancer increased by about 7 million. The latest poll in the world showed every 3 minutes was found with breast cancer and every 11 minutes a woman was found dead from breast cancer.
While in Indonesia, the average breast cancer patient is 10 out of 100 thousand women, making this disease is second cancer that is often found after cervical cancer.

"Western Therapy"
According Sutjipto, about 70 percent of breast cancer patients come to the hospital are at an advanced stage of the condition. The cause of delay in the patient came to the doctor's, among others, fear of surgery, believe in traditional medicine or paranormal and economic factors or the lack of any cost. "In fact, the higher the stage the possibility of recovery will drop to 15 percent," said Sutjipto.
He added that women should not underestimate if there is a lump in her breast. Although not all breast lumps mean cancer, but it does not hurt to do the inspection so we can be sure and quickly handled.
In addition to the lump, another thing to suspect is a cyst in the breast accompanied by discharge from the nipple. Strengthened by the discovery of signs of spread of cancer cells when examined by ultrasound or mammography.
Even from experience, Sutjipto could ensure a lump in the breast is cancerous or not just by touch. "If the lump is hard to hold and feels like a potato or meatballs that are in the fridge, then certainly the lump is cancerous," he explained.
If cancer cells are at an early stage to stage 3 then the therapy is carried out in the form of surgery, chemotherapy (anticancer drug), radiation or hormonal therapy. "But if it had reached stage 4, we can not do anything, except for chemotherapy and radiation," said Sutjipto.
Until the middle of the 19th century, breast cancer treatment is done only with the removal of the tumor only and proved ineffective. The average patient died in the first year or recurrence. In 1863, British scientist dr. Sir James Paget suggests that surgery is more extensive, but it also does not work. Then, between the years 1875-1882, Dr. Charles H. Moore therapy by lifting the breast tissue, popular with the term mastectomy. "But this was not successful because the cancer cells are growing again in the armpit to the shoulder blade," said Sutjipto. Year 1875-1882, conducted therapy with mastectomy and removal of lymph nodes in the armpit.
When the therapy is not well managed, Dr. Wilham Halsted radical mastectomy came up with the idea in 1882. Radical mastectomy is not only lift the breast tissue, but also muscle tissue in the back of the breast. As a result, the skin becomes so thin that ribs visible to the naked eye. According Sutjipto, the side effects of radical mastectomy is a great hand.
Thankfully, the "horror stories" Halsted is now unnecessary since found about radiotherapy technology in the 1940s. The breast cancer patients "only" need to undergo regular mastectomy followed by radiation therapy pascapembedahan. Plus, the anticancer drug discovery 25 years ago has been able to reduce the likelihood of cancer recurrence.
Since the 1980's, early-stage breast cancer to get the stage 2 surgical therapy followed by administration of radiation, known as breast conserving therapy. Also appearing method of sentinel node for early-stage breast cancer, the surgical method without the need to remove the entire breast tissue.
Interestingly, in the sentinel node before surgery follow the method for determining the lymph nodes that are affected by the cancer cells. According Sutjipto, this makes surgery more purposeful act, and not all of the lymph nodes are removed, thereby reducing side effects. After surgery followed by radiation and chemotherapy. Meanwhile, if the cancer cells have entered the third stage, the only action that can be done is a mastectomy, followed by chemotherapy and radiation.
However Sutjipto added that it did not forbid if a breast cancer patient did Eastern Therapy, namely traditional medicine using herbs or other therapies formula that is believed to cure. "If he believes that with the therapy, that's fine," he said. But in addition to traditional therapy, the patient should also do therapy medical treatment, popular with the term Western Therapy. Due to medical therapy, at least the doctor can scientifically track the spread of cancer cells and perform treatment formula that has been tested truth. "Until now, there has been no case in which medical treatment conflict with traditional medicine," said Sutjipto. (San)

Avoid Breast Cancer Early

Nobody wants a woman suffering from breast cancer, including you and me. But the lack of knowledge about the disease, make us complacent. The result can be serious, and therefore at a time we need to check our breasts to avoid this terrible disease.
From inspection, we will be able to anticipate if there are strange signs with our breasts. The traits that are not healthy breast is not symmetrical nipples, nipples are interested in, such as the breast skin wrinkled orange rind and discharge from the nipple.
To know more about the condition of your breasts, frequent checks. This can not be done by a specialist, you can also do it at home. Step breast examination:
Observe
1. Standing in front of the mirror and look at your breasts one by one. Check: size, shape, color, line symmetry or shape of the breast and nipple color.
2. Raise your arms high over his head and look at the breast from side to side. Raba-Handle gently.
3. Press your hands in the groin and push it towards the front of the shoulder. Examine your breasts one by one.
Feel
1. Standing in front of the mirror and start doing checks just below the collarbone.
2. Wet your fingertips with the left hand body lotion. Press gently right breast with his left hand and make a small circle round breasts in a circular motion over the entire breast including the nipple.
3. Continue checking the breast tissue under the armpit.
4. Do the same thing on the left breast, using the right hand.
5. Lie down and raise one arm you exceed the head.
Please check once again right with the left breast and felt it. Make a note of the results of the examination today and mark your calendars for the examination next month. If from the examination, you Feel the odd thing please do not hesitate to consult a doctor immediately. (Mydoc / Tutut)
Avoid Breast Cancer Early

Nobody wants a woman suffering from breast cancer, including you and me. But the lack of knowledge about the disease, make us complacent. The result can be serious, and therefore at a time we need to check our breasts to avoid this terrible disease.
From inspection, we will be able to anticipate if there are strange signs with our breasts. The traits that are not healthy breast is not symmetrical nipples, nipples are interested in, such as the breast skin wrinkled orange rind and discharge from the nipple.

To know more about the condition of your breasts, frequent checks. This can not be done by a specialist, you can also do it at home. Step breast examination:

Observe

1. Standing in front of the mirror and look at your breasts one by one. Check: size, shape, color, line symmetry or shape of the breast and nipple color.

2. Raise your arms high over his head and look at the breast from side to side. Raba-Handle gently.

3. Press your hands in the groin and push it towards the front of the shoulder. Examine your breasts one by one.

Feel

1. Standing in front of the mirror and start doing checks just below the collarbone.

2. Wet your fingertips with the left hand body lotion. Press gently right breast with his left hand and make a small circle round breasts in a circular motion over the entire breast including the nipple.

3. Continue checking the breast tissue under the armpit.

4. Do the same thing on the left breast, using the right hand.

5. Lie down and raise one arm you exceed the head.

I hope this information useful for my friend ... 

CANCER naso pharynx

I hope this information useful for my friend ...

 
A. Definition.
Nasopharyngeal cancer is a malignancy that occurs diadaerah nasopharynx. It happened more than half the incidence of all head and neck carcinoma adaerah. High incidence is associated with eating behavior, environment, and epstein-barr virus.

B. Etiology
Nasopharyngeal cancer can be caused by the consumption habits of salted fish or epstein-bar virus infection.
C. Pathophysiology

D. Clinical Manifestations
Sometimes there are only minor complaints such as headache, or hearing about, and often no complaints at all so dileher metastasis is the first sign. Symptoms and signs that may be obtained is dense nasal epistaxis, tinnitus and deafness. Not infrequently patients present with strabismus and bilateral cranial swelling dileher. If the disease has advanced, a complaint can be rinolia, eksoptalmus, and trismus.
On the neck there is a lump cranial medial to the m. sernokleidomastoid the end that eventually form large masses to the skin shiny. Neurologic signs often appear in the form of paresis or paralysis dar nerves III, IV, and VJ (petrosfenoidal syndrome) because these tumors are nerve discharge area as well as other brain sarap base of the skull.
Interruption of nerve IX, X, XI, XII, and the cervical sympathetic nerve called the pharyngeal syndrome. Infiltration of the sympathetic nerves in the neck cause Horner syndrome as miosis, enoftalmus, and ptosis.
Symptoms and signs perceived as the Eustachian tube appendix full feeling in the ear, tinnitus, and hearing loss to deafness.
E. Examination Support.
The diagnosis is established by nasofaringoskopi that also functions untuik biopsimultipel and photos Rongten.
If there are symptoms and signs of suspicious yng be a nasopharyngeal carcinoma, whereas in nasofaringoskopi not visible abnormalities, it is recommended to perform multiple blind biopsies in the nasopharynx ..
F. Handling
Radiotherapy is given in the form of radiation utuk nasofring neck squamous left and right due to the spread trjadi generally bilateral. Prognosis alive after 5 years on the deployment tnkat I sd. IV are respectively 85, 75, 45, and 10%. Approximately one third of patients died of distant metastasis can be found ditulang, lung, and liver. Adjuvant therapy such as chemotherapy can produce a significant improvement for a limited time.

II. NURSING ISSUES AND COLLABORATION
1. Nursing Issues
a. Acute pain b.d damage the tissue (tumor).
b. Impaired sensory perception (hearing) damage bd sensory perception.
c. Anxious bd changes in health status
d. Impaired neuromuscular dysfunction bd ingestion.
2. Collaboration Issues
a. PK: bleeding

Bibliography:
a. Jong et al, 1977, Textbook of Surgery, EGC, Jakarta.
b. Joanne et al, Nursinbg Calsification Intervention, Mosby, USA
c. Swearingen. , 2001. keperawatn Medical Surgery. EGC. Jakarta
d. Nanda. , 2004. Nursing Diagnosis A Guide to Planning Care. Down load from www.Us.Elsevierhealth.

I wait for comments ...

NURSING CARE AS A SERVICE APPROACH TO CASE misuse of psychotropic

Good morning bloggers, I will be on a sunny little sharing of Psychotropic Drugs ...
I hope this information useful for my friend ...

INTRODUCTION
 

We see people with drug misuse first categorized as a criminal, but now it ditanganni as patients with mental disorders. Family environment and place hang out and with whom she befriended a trigger factor recognized by all parties, even the drug dealers are now put to death by his parents diiklaskan with the statement that "my child's mistakes as narcotics traffickers my fault for not educating my child" . From the statement we understand that parents are very dominant role in drug misuse pencegaha.
What about people who are already ill from using drugs improperly or dependence, any problems encountered and how nurses provide nursing care approach to nursing care.

NEGATIVE IMPACT OF HEALTH FOR PSYCHOTROPIKA misuse:
 

Some classes of Narcotics and Psychotropic substances are still used by the medical indication for purposes of the patient. While it has expanded the use of Narkatika and Psychotropic substances harmful. Deployment and use of illegal psychotropic substances is known as drug abuse and Psychotropic Substances. The World Health Organization (WHO, 1974) have cited Drugs (Addictive substances or substances that bring dependency, addiction, recovering addict), includes factions alcohol, Opioida or Opiates, cannabis or marijuana, cocaine, Barbiturates, Amphetamines, Hallucinogens, Vilote solvents (volatile addictive substances), Khat, Narkotin, Caffeine, Analgesic.

The types of narcotics and psychotropic groups in Indonesia are incorrectly used highly variable (data RSKO 1972-1994).

   Organic Mental Disorders Due to Substance
    Addictive substances cause syndrome or collection of symptoms as a direct result of the effect and substance of the central nervous system. These symptoms are referred to as
Organic Brain Syndrome. Broadly speaking, Organic brain syndrome consists of:

    Delirium
     Patients showed clouding of consciousness (decreased clarity of awareness of the environment). Patients difficult to focus, move and maintain attention to stimulation from outside and within. There is often a misinterpretation due to impaired sensory perception. Patients thinking irregularly, unclear and uncertain direction of the goal. He showed disorientation, impaired memory and concentration problems.
The talk became incoherent, and there when I wake up, and unusual bedtime. Physical activity may be reduced or exaggerated. Deleriu condition usually occurs a few hours or days.
      Delerium usually caused by the immediate effects of the adverse effects of alcohol use (Delerium Putud Alcohol), barbiturates or other Hypnotics Sedatives Amphetamines, Fensiklidin.

      Dementia
       The patient showed loss of intellectual abilities such severity that impede social functioning (he acted childish), memory disturbances, difficulty thinking abstractly power, interference assessing reality, often indicate a change or accentuation of personality, often accompanied by disturbances of cortical function such as aphasia, apraxia, agnosia, and other gangguansyaraf. demikiandapat occurs by physical causes such as in Alzheimer's disease, because of trauma capitis, infections, fungus, toksikmetabolik disorders or vascular disorders.
        Usually dementia occurs as a result of substance immediate effects of alcohol are harmful interference.

        Amnestic syndrome
        Patients lose the ability to short-term memory and long-term. He was unable to learn new information, and are not able to recall the information learned in the past. Sometimes accompanied by symptoms of disorientation, confabulation, ignorance and emotions flagstones.
        Amnesia syndrome usually occurs as a result of chronic alcohol use. There is damage to the brain tissue structure diensefalon and bilateral temporo-medial area.

           Organic Halusinosis as substance
        Patients showing symptoms of recurrent and persistent hallucinations, being patient awareness of the environment quite well, communicate with others though sosiolisasinya limited as a result of the hallucination of perception senses. Patients with conscious hallucinations that misery has said that is not true.
         Usually organic halusinosis there as a result of using hallucinogens (visual hallucinations), alcohol (auditory hallucinations)

         Organic delusional syndrome
         the use of certain substances such as some types of Amphetamines, Hallucinogens and cannabis can cause organic delusional syndrome. Syndrome can occur settled so similar to Skizotrenia mentally (though the body was not there anymore addictive substances). Clinically, patients mununjukkan the symptoms of delusions (the belief that patients can not be corrected, and contrary to reality). Awareness of patients in general is quite good. Examination of other organic abnormalities can not be obtained.
         Aside from addictive substances, organic delusional syndrome can also be due to brain disorders such as epilepsy labus temporal hemisphere brain damage and khorea Hutington.

         Organic personality syndrome
          The patient showed clinical personality aberrations is dependent upon the localization of damaged brain tissue. Patients often experience emotional instability, sudden tears, anger or difficulty controlling impulses suddenly cried for a little trivial reasons. Often show a lack of appropriate social behavior such as indecent behavior sexsual, less concerned, ignorance, indifference, loss of hobby and less reactive to environmental conditions.
          Organic personality syndrome can also be caused by damage to the temporal lobes (eg pressing lobe meningioma brain frontatis), head injury, vascular disease, multiple sklersis, khorea hutington endokrim.

          Because the substance intoxication
          Patients exhibit maladaptive behavior in the wake of the GCC using addictive substances.
Generally urinalysis examination showed positive results (ie, substances used are contained within the body of the patient). Maladaptive behavior depends on the type of substance used. Any substance causing clinical symptoms typical for these substances. Due to the direct influence of substances on the brain tissue causing a power deviation values, emotions kandali weakened, the social environment complain, decreased job performance, and failed to fulfill their responsibilities, although in general they are likely in a state case (wakefulness).
         Almost all addictive substances causing intoxication with clinical symptoms vary according to the uniqueness of each.

         Disconnect Syndrome Substance
         Patients exhibit specific symptoms after stopping or reducing the use of substances that have been used in a "less is more" regular order he obtained intoxication conditions. The intensity, duration, and clinical symptoms depend on the type of substance used. For example, a withdrawal syndrome Opioida suffer with the pain of the joints, lacrimation, rhinorrhea, dilated pupils, sweating, piloereksi, diarrhea, yawning constantly, takidardia mild hypertension, fever, and difficulty sleeping.
         Substance withdrawal syndrome occurs in the termination or reduction of substance use Opioda, Barbiturates, Amphetamines, Nikatin.

         Organic Brain Syndrome are not typical or Mixed
         Patients in waking showed complaints that can not be classified in organic brain syndromes such as he complained neurastenia related to the use of addictive substances.

          Psychiatric Disorders
          The use of narcotics and psychotropic substances in a non-medically caused tens janis psychiatric disorders. In this paper only explained some psychiatric disorders are common and often occur.
         
         Substance Dependence Syndrome
          Patients showed 3 of the following symptoms: presence of withdrawal symptoms, tolerance to subsequent substance use, lack of motivation is the desire nd embodiment strong feelings for substance use, failing or having difficulty controlling substance-seeking behavior, it is only to influence pleasure berpreokupasi sehungga substances in the body do not have time for another keunaan such activity from the use of addictive substances (as encouragement so great), causing the patient to be able to do "anything" even though the reason normal people will not want it to do.
          Some addictive substances that have the potential for very large dependence are: class Opioida Alcohol, Amphetamines and Nicotine.

          Substance use disorders are detrimental
           Patients showed patterns of use of narcotics and psychotropic substances which adverse physical health (eg, hepatitis), or mental (eg depression secondary). So the type of disturbance is clearly no real mental and physical damage as a result of substance use.

         Homocide
          Aggressive behavior, loss of emotional control and assess the reality of disorder is the leading cause of action homocide on misuse of addictive substances. When they experience withdrawal syndrome, they get a big push to get the substance condition often becomes a reason to kill someone else. Some forms of intoxication (alcohol, barbiturates, Cannabis, cocaine) can cause a trigger riots and murder. Psychotic conditions due to substances that cause delusions (Cannabis, Amphetamines) often lead to the death of ideology at odds with

          Suicide Trial
          Suicide attempts found in patients using barbiturates as benzodiazepun (nitrazepam, Humitrazepam). Often they expressed drink tablets to over 100 items consisting of various types of derivatives Benzodiazepines with disappointment, frusrtasi or demanding something from her family members.

          Behavior Disorders
          Usually found in adolescents less than 18 years old who use narcotics or psychotropic substances. kinis behavioral disorder characterized by the attitude of the "rebellion" parents have a history of losing luggage or valuables (without any real evidence that patients "take it" without permission, but the only person who suspected the patient himself), often deceive people old, came home late at night until the morning or not come out at all, often damaging the property of others without charge, ignorance, selfishness, and his will must be obeyed, and difficult to resist the urge for a moment. Generally, the use of addictive substances non-medical done is uncertain, and often used as a "tool" to scare parents to meet permintaanya. Generally, behavior disorders in adolescence is a "signal" would be a more severe deviation personality in adulthood.

          Depression
          patients on drug and substance Psikoropika often show symptoms of secondary depression. Although depression has always been a primary reason for them to use substances (known as Part of psychotropic substances has the effect of sedation on patients). The use of repeated substance will bring more severe depression.

          Schizophrenia Affective
           Affective disorders occur in the form of substance users: showing mournful emotions sometimes happily changed markedly excessive. Patients showed delusions of greatness or nihilistic delusions about problems in understanding the reality of values, emotions are very unstable and highly reactive sensitive to stimulation from outside.

           Secondary Insomnia
            Complaints of insomnia in substance abusers is a very common complaint. Use monthly to yearly often show the same complaint. To overcome the problem of insomnia is not uncommon habit repeat patients using substances and conditions as a reason for relapse. Patients often overcome insomnia by playing songs loudly at night that disturb the environment.
         Indigestion
         Group of narcotic and psychotropic substances entered the body through the oral (by mouth) can cause gastrointestinal disturbances. The use of marijuana is smoked through mouth cause damage to the mucous membranes of the oral cavity. Oral cavity becomes dirty, black or brown. The use of cannabis and nicotine increase the weight of the mouth. Oral hygiene becomes memprehatinkan. Alcohol use causes stomach ulcers (peptic and ulcers ilkus ventrikuli). Rupture causes inflammation of ulcers perit cavity causing pain and repeated for years, intestinal bleeding, until the death. Accompanying infections: salmonella, parathypus.
          one drop Opioida syndrome is severe acute diarrhea. Patients often to the bathroom due to diarrhea and often unconsciously he defecated his pants when subjected to conditions Opioida Disconnect Syndrome.

          Fluid and Electrolyte Balance Disorders
          Complications of fluid and electrolyte balance disorder occurs in patients with alcohol use disorders nutrition "hard core heroin addicts," Amphetamines in an overdose, chronic marijuana users with "unmotivated syndrom" nuisance condition requires immediate medical attention that needs to be taken immediately to the Unit Hospital Emergency Room to get the infusion. In most patients can not be helped, because they are in an isolated place. Disorders of fluid and electrolyte balance may also occur because of the symptoms of diarrhea, nausea, vomiting, severe withdrawal syndrome due Opioida. Generally patients showed a lack of attention to hygiene themselves so as to facilitate secondary infection.
         
         Vascular Disorders
          Patients are substance users direct intravenous injection (Cocaine, Heroin, Amphetamines, Benzodiazepam) can cause complications in vascular organs. These patients were substance users often wear clothing with long sleeves to cover the scars cicatrix resulting from injections in the arm. Network cicatrix \ is black or brown depending on the duration of the habit of going to form a straight line or curved according to the shape of the blood flow. If the substance is used consisting of a composition which is not hygienic, there will be complications that are in other body organs such as heart, liver, pancreas to the brain. Often, too, the occurrence of gangrene due to lower veins causing impaired avaskularisasi lower limbs. Vascular disorders can lead to death as a result of emboli into the heart.

         Infection
         Contaminated blood flow germs can cause an infection in the whole body (sepsis). Frequent infections are: from chronic bronchitis to tuberculosis (padaperokok nicotine and marijuana), typhoid and paratyphus digestive tract (due to alcohol), hepatitis (due to injection of heroin), infections of the oral cavity and teeth (smoking nicotine and marijuana), meningitis (for injection) and others.
Facilities
         Addictive substance use disorders can be life-threatening for both the individual user or the surrounding environment. In the state of substance intoxication, a patient will cause disruption in the control of emotion and aggression leading to violence and criminal behavior. With mild stimulation, patients often exhibit predictable responses difficult and able to act aggressively due to power are disturbed because of the value of the addictive substance. Traffic accidents caused by using excessive addictive drug can also harm to himself or others in the same traffic.
           Users addictive substances orally often leads to death Karene the digestive tract disorders such as bowel or stomach perfosi as drinking alcohol, chronic typhoid infection, sirrhosis hepatis, pancreatitis, epidemic dysentery.
           Alcohol misuse deaths from pneumonia as a result of respiratory tract infections has long been proved by Jellinek. as well as in Indonesia, many cases abusers who show abnormalities in lung rontgenfoto spots showed a lung to tuberculosis. This condition is exacerbated by their habit of smoking cigarettes in large numbers.
           Deaths from heart disease abusers showed greater frequency in the general population in the United States. Although heart disease is the most common cause of all deaths. The deaths allegedly related to a nutritional disorder, kardiomyopati, improve hypertension, obesity and infection sub-acute bacterial endocarditis can also occur due to injection of Cocaine, Amphetamines Opioda or intra venous.
          Alcohol abusers of death due to cancer larying oropharynx and esophagus, and liver cancer. Moderate lung cancer is usually a disease of chronic bronchitis due to terminal using nicotine.
           Patients who suffered from lead poisoning have been reported to be the cause of death of Meth-amphetamine users. Tin is a component that is used to manipulate the composition of the designer by clandestine laboratories. Another death on merth-Amphetamine users are traffic accidents (traffic death), inhalation of hydrogen gas that brings cyanid difficulty breathing, apneu, coma and death.
           Emboli that enter through the veins by injection can bring death due to sepsis. although common infections also mnimbulkan death in most of abusers. Thrombus occurring enter the blood stream cause brain strokes often cause death.
         At the Emergency Hospital in Jakarta frequent deaths from excessive use or overdose is lacking substance. Overdose due Opioida use often leads to death from respiratory center so that emphasis be apneu and if not helped immediately face turned blue, cold and died kekaurangan oxygen.
          Chronic alcohol abusers menghaabiskan diet, giving rise to conditions of malnutrition, and hence can bring fatality.
          Intravenous substance abusers are prone to terserangnya the HIV virus causing AIDS causes of death:

           Social Problems
           Impaired users of narcotics and psychotropic substances as well as various social problems, such as:
                      * Rape
                      * Contention
                      * Divorce
                      * Bankruptcy bankruptcy, debt
                      * Wearing teen
                      * Theft
                      * Coercion through violence and murder
                      * Robbery, plunder, jambret
                      * Traffic accident
                      * Prostitution
                      * Employ or melantarkan family (wife, kids)
                      * Corruption, embezzlement of company money


  NURSING CARE NURSING PROCESS

Below will be described on the nursing process is used to help patients with drug penyalahgunan, nurses awareness essential that nurses help patients in a comprehensive care kesehatanan a systematic approach of assessment and evaluation.

ASSESSMENT:

Attitudes and feelings of nurses:
The attitude of nurses is a component, is sensitive to the attitude of the nurse or health care team. what. Nurses with personal values, discomfort during patient contact can result in feelings jugment form (think nurses about the patient)
Do not use the word "drunk", "addictive", "alcoholic". Better to use a sentence using alcohol, drugs, heroin, feeling good or feeling fly.

Approach on the client:
 Clients may be embarrassed by his behavior may also uncooperative. Ways to support that the nurse is showing that nurses receive clients are. Convey stated that the nurse "I care about your health", "" I know that you are uncomfortable "," I will help you to feel better. "

Nurses maintain an empathetic approach during the interview, even if the client defense. Nurses do not respond with defensive and angry. Inquiries were made to obtain information specifik, when the client tried to divert attention, the nurse tried to get back to the focus of the discussion. Because the client is usually denial by the dependency information from family, friends and the people around him. While this information may not be valid due to the influence of emotions. It remains to be considered that it is important to involve the people around him since the beginning.

Behavioral defense
Denial: Denial is often used by clients ketergantungngan drugs. did not realize that dependence has severe consequences both physically and socially.
Projection: the individual is not responsible, always blaming someone else, where everything outside himself.
Rationalization: Clients usually give any reason of the use of drugs became aware that client dependency.
Small problem: He was indeed dependent but it was a minor issue.
Angry: mad expressing Client response to the talks about addiction, clients would rather resolve the confrontation of the problems faced.

Physical and safety needs
Physical conditions and meet their needs continuously implemented.
Potential infection of wounds. Treatment and factors due to the use of drugs such as organic mental disorders.
The potential for injury is a serious problem. Protection and security of client situations that add to the misery adal be considered as a matter of priority. Usually the patient / client was sleep disturbance, nightmares and dreams are always possible.
Anxiety because of the conflict.
Depression or feeling sad sehubunganan with a decrease in self-esteem due to social behavior and legal consequences also need at the assessment and individual treatments.

Nursing Diagnosis.
Due to problems arising very wide range of physical and emotional. Many nursing diagnoses according to the state for clients with drug dependence can be used to plan nursing.
Physical problems such as: Impaired balance (deficiency) of fluid, Altered nutrition: less of a need, potential injuries, potential infections, less able to care for themselves, ineffective airway, impaired skin integrity, impaired sleep, impaired elimination.
Emotional problems: Ineffective Individual Coping, ineffective family coping, impaired self-concept, lack of knowledge, self-destructive potential, impaired social relationships, spiritual distress, impaired perception and impaired thought processes.

PLANNING

Develop a plan with the participation of the client in the process tretmen that will affect the optimal healing. Nursing assessment individually and helping clients generate goals that will help the client in the healing process that will give life to client's satisfaction with the freeing of feeling and thought disorder drug dependency.

GOAL:
Make goals for individuals with drug addiction are as follows:
1. Satisfying their physical needs clients
2. Menjada emasi so stable patients
3. Clients are aware of makanisme defense does is pathology.
4. Clients understand and accept about dependence on drugs
5. Finding peers to exploration.
6. Developing hope for recovery
7. Being able to socialize and improve the ability to relate to others.
8. Improving self-esteem and satisfaction / well being.
9. membangaun alternative coping.
10. Continuously improve motivation for treatment and prevention.
11. Families involved in the treatment and healing process.

INTERVENTION
The rehabilitation process
The rehabilitation process is focused on clients with drug dependence, because they usually lose their jobs, marital conflict, legal issues. Physical problems, family and the law can be addressed with rehabilitation. Another problem whether physical, emotional, and social overcome with clients with addiction treatment.

Rehabilitation phase as follows:
Detoxification by detoxifying the fault of the drug. physical and emotional recovery so stable, action methods to increase motivation in order to continue treatment, addressing defense committed clients, improving client's self-esteem, develop an awareness of the problem, discharge planning and follow-up plan.

Break through the defense that carried the client.
It is a gradual process, Nurse pay attention to the client and understand mngenali use client-specific defense. Gradually nurse assisting clients with face-to-face dialogue with the objective reality that the client might denial. Consistent and appropriate approach is essential.

Understanding and acceptance of the client.
Clients with drug dependence should dipahamkan about the client being sick is not a moral issue. Ketergantungab health education about drugs and clarify misconceptions will help the process of understanding the client about the situation experienced. Intellectual understanding will help the client be true. It will be required levels of emotional distress and healing in a long time but based on the handling of day-to-day.

Find a friend.
Friend or peer group through konfrotasi and identification of problems is very strength helping clients. Individuals will know and realize that the client does not own and then the client will feel the suport and the hope of returning. The group will bring the client to a discussion of defense were not useful to the client and to bring awareness of the client's behavior. Nurses will be as a leader to encourage the group to discuss issues that may be experienced by those who participate in discussions.

Developing expectations.
Clients with a feeling of no hope, no encouragement, and probably immoral. Clients should be aware that the escape from reality makes no hope. Find other people who have similar problems or people who already have hope. The positive attitude of nurses and other health professionals will make the client a chance.

Re-socialization
Drug users are usually only focused his medication and eventually just focused on ourselves. The ability to relate to others is non-existent. It is important to assist clients in the social life as well as building relationships with other people.

Development of self-concept.
Generally akann clients to increase self-esteem if the client is able to recognize that they experienced a client is sick. so the client to change behaviors and attitudes that will result in the satisfaction of achieving a relationship with someone else. And feel responsible for the healing process.
Nurses also help develop self-discipline. For example, nurses assist in the daily routine that may be difficult for clients who are used to living without rules because just thinking about medicine. So the nurse encourages the client to participate actively with the program activities that are part of the healing. From the experience of successful clients, with confidence, self-esteem and hope. This is the motivation in the healing process.

EVALUATION:
Evaluation is a continuous process in which nurses assess client progress by determining the success of the goals set both short term and long term. If successful what influences or failed why? Including team work that has been done, as well as family involvement, ability to relate to others and the ability to live normally in society.

Reference:
1. Beck, CM, Rawlins and Williams, SR, 1996, Mental health psychiatric nursing: A Holistic Life-Cycle Approach, St Louis, Mosby Co..
2. Fortinash, CN and Holoday, PA, 1991, Psychiatric nursing care plan, St Louis, Mosby year Book.
3.Patricia G, O'Brion, Winifred ZK and Karen AB, 1999.Psychiatric nursing, an integration of theory and practice. Mc Graw Hill nursing core serie, New York.
4. Stuart, G.W and Sundeen, S.J, 1995. principles and practice of psychiatric nursing, St. Louis, Mosby Year Book.
5 ........, 1998. Pocket book: Mental Nursing, Interpreting, End Yani, Jakarta: EGC.
6. Townsen, Mary, 1998. Handbook: Diagnosis of psychiatric nursing, over language, Novi Helena, Jakarta, ECG.

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