DEMAM BERDARAH DENGUE (DBD) / DENGUE HAEMORRAGHIC FEVER (DHF)

A. PENDAHULUAN

Pada awal tahun 2004 kita dikejutkan kembali dengan merebaknya penyakit Demam Berdarah Dengue (DBD), dengan jumlah kasus yang cukup banyak. Hal ini mengakibatkan sejumlah rumah sakit menjadi kewalahan dalam menerima pasien DBD. Untuk mengatasinya pihak rumah sakit menambah tempat tidur di lorong-lorong rumah sakit serta merekrut tenaga medis dan paramedis. Merebaknya kembali kasus DBD ini menimbulkan reaksi dari berbagai kalangan. Sebagian menganggap hal ini terjadi karena kurangnya kesadaran masyarakat akan kebersihan lingkungan dan sebagian lagi menganggap karena pemerintah lambat dalam mengantisipasi dan merespon kasus ini.

B. PENGERTIAN

Demam berdarah (DB) atau demam berdarah dengue (DBD) adalah penyakit febril akut yang ditemukan di daerah tropis, dengan penyebaran geografis yang mirip dengan malaria. Penyakit ini disebabkan oleh salah satu dari empat serotipe virus dari genus Flavivirus, famili Flaviviridae. Setiap serotipe cukup berbeda sehingga tidak ada proteksi-silang dan wabah yang disebabkan beberapa serotipe (hiperendemisitas) dapat terjadi. Demam berdarah disebarkan kepada manusia oleh nyamuk Aedes aegypti.

C. EPIDEMOLOGI

a. Penyebab

Penyakit ini disebabkan oleh suatu virus yang menyebabkan gangguan pada pembuluh darah kapiler dan pada sistem pembekuan darah, sehingga mengakibatkan perdarahan-perdarahan. Vektor yang berperan dalam penularan penyakit ini adalah nyamuk Aedes aegypti.

b. Tanda dan Gejala

Ada beberapa gejala penyakit demam berdarah:

1. Bintik Merah

Seringkali di awal demam, tidak ada bintik merah. Ada beberapa kasus juga yang memang tanpa bintik merah.

2. Panas Tinggi
Panas bisa turun naik, bisa juga tidak turun sama sekali sepanjang hari.

3. Menggigil dan terasa ngilu tulang
Perasaan dingin di sekujur tubuh dan ada titik tertentu di tubuh terasa ngilu menusuk tulang.

4. Buang Air Besar berwarna hitam dan keras
Gejala ini terlihat jika trombosit sudah mulai rendah

5. Trombosit mulai turun
Kadar trombosit bisa diketahui dengan tes darah di laboratorium.

6. Sakit saat mata memandang ke samping
Beberapa teman mengalami ini, terasa sakit jika melirik ke samping kiri dan kanan.

7. Tengkuk sakit
Terkadang juga, terjadi pembengkakan di tengkuk dan terasa sakit

c. Masa Inkubasi
Masa inkubasi terjadi selama 4-6 hari.

d. Penularan

Penularan DBD terjadi melalui gigitan nyamuk Aedes aegypti / Aedes albopictus betina yang sebelumnya telah membawa virus dalam tubuhnya dari penderita demam berdarah lain. Nyamuk Aedes aegypti berasal dari Brazil dan Ethiopia dan sering menggigit manusia pada waktu pagi dan siang.

Orang yang beresiko terkena demam berdarah adalah anak-anak yang berusia di bawah 15 tahun, dan sebagian besar tinggal di lingkungan lembab, serta daerah pinggiran kumuh. Penyakit DBD sering terjadi di daerah tropis, dan muncul pada musim penghujan. Virus ini kemungkinan muncul akibat pengaruh musim/alam serta perilaku manusia.

e. Penyebaran

Kasus penyakit ini pertama kali ditemukan di Manila, Filipina pada tahun 1953. Kasus di Indonesia pertama kali dilaporkan terjadi di Surabaya dan Jakarta dengan jumlah kematian sebanyak 24 orang. Beberapa tahun kemudian penyakit ini menyebar ke beberapa propinsi di Indonesia.

D. FAKTOR RESIKO

ü Faktor host

ü Faktor lingkungan

ü Faktor virus

E. PENATALAKSANAAN

4 jenis pemeriksaan darah yang dilakukan pada penderita DBD :

1. Pemeriksaan darah tepi

Untuk mengetahui jumlah leukosit (sel darah putih yang berfungsi untuk mengatasi infeksi) pemeriksaan ini digunakan untuk mengantisipasi terjadinya leukopenia, yaitu jumlah leukosit kurang dari 5000 sel/mm³

2. Pemeriksaan limfosit atipikal (sel darah putih yang muncul pada saat infeksi virus)

Jika terjadi penjngkatan, mengindikasikan dalam waktu kurang lebih 24 jam penderita akan bebas demam dan memasuki fase kritis.

3. Pemeriksaan trombositopenia dan trombosit ( berfungsi dalam proses pembekuan darah)

Jika terjadi penurunan jumlah keduanya, mengindikasikan penderita DBD memasuki fase kritis dan memerlukan perawatan ketat di rumah sakit.

4. Pemeriksaan hematokrit

Peningkatan nilai hematokrit/Ht ( perbandingan antara komponen butir sel darah merah dengan cairan darah atau plasma) 10 – 20 % mengindikasikan penderita memasuki fase kritis dan memerlukan pengobatan cairan intravena.

Uji serologi dengue Ig M dan Ig G (protein yang diproduksi tubuh dan berperan sebagai antibodi). Uji ini merupakan pemeriksaan penunjang untuk membantu dalam mendiagnosis akhir penyakit DBD.

Penatalaksanaan Medis untuk Penderita DBD

1. Memberikan obat penurun demam dengan dosis ringan. Contoh : parasetamol

2. Pemeriksaan uji bendung

3. Pemeriksaan darah untuk mengetahui derajat kebocoran plasma dan jumlah tromboosit penderita.

4. Infus melalui intravena, pemberian transfusi darah dan antibiotik tidak perlu diberikan, kecuali jika ada indikasi khusus.

F. PENCEGAHAN

1. Vaksin untuk mencegah Demam Berdarah belum ditemukan, sehingga satu-satunya cara mencegah Demam Berdarah adalah dengan cara memberantas nyamuk penularannya.

2. Seperti nyamuk lainnya, Aedes Aegypti berkembang biak melalui proses perubahan bentuk : Telur à Jentik à Kepopompong à Nyamuk Dewasa.

3. Bagi Aedes, proses perubahan bentuk terjadi dalam air jernih, khususnya di tempat penampungan air yang airnya tidak langsung berhubungan dengan tanah.

4. Perubahan bentuk dari telur hingga nyamuk dewasa memerlukan waktu kurang lebih 10 hari.

5. Memberantas nyamuk saja dengan penyemprotan belumlah cukup, selama jentik-jentiknya masih dibiarkan hidupmemberantas jenti-jentiknya tidak memerlukan biaya besar dan bebas dari efek samping. Lagi pula jauh lebih mudah dari padapenyemprotan nyamuk.

6. Lingkungan
Metode lingkungan untuk mengendalikan nyamuk tersebut antara lain dengan Pemberantasan Sarang Nyamuk (PSN), pengelolaan sampah padat, modifikasi tempat perkembangbiakan nyamuk hasil samping kegiatan manusia, dan perbaikan desain rumah.Sebagai contoh: Menguras bak mandi/penampungan air- sekurang-kurangnya sekali seminggu. Mengganti/menguras vas bunga dan tempat- minum burung seminggu sekali. Menutup dengan rapat tempat penampungan- air. Mengubur kaleng-kaleng bekas, aki bekas dan ban bekas di sekitar rumah- dan lain sebagainya.

7. Biologis
Pengendalian biologis antara lain dengan menggunakan ikan pemakan
jentik (ikan adu/ikan cupang), dan bakteri.

8. Kimiawi
Cara pengendalian ini antara lain dengan:

· Pengasapan/fogging (dengan menggunakan malathion dan fenthion), berguna untuk mengurangi kemungkinan penularan sampai batas waktu tertentu.

· Memberikan bubuk abate (temephos) pada tempat-tempat penampungan air seperti, gentong air, vas bunga, kolam, dan lain-lain.

Cara yang paling efektif dalam mencegah penyakit DBD adalah dengan mengkombinasikan cara-cara di atas, yang disebut dengan 3M Plus, yaitu menutup, menguras, menimbun. Selain itu juga melakukan beberapa plus seperti memelihara ikan pemakan jentik, menabur larvasida, menggunakan kelambu pada waktu tidur, memasang kasa, menyemprot dengan insektisida, menggunakan repellent, memasang obat nyamuk, memeriksa jentik berkala, dll

Women and Love on Sense & Sensibility

Introduction

1. General Info

Sense and Sensibility is a novel by the English novelist Jane Austen. It is published in 1811. This novel is first publihed under “a Lady”. It has been adaptation film and television a number of times.

The story explains about Elinor and Marianne, two daughters of Mr. Dashwood by his second wife. They have a younger sister, Margaret, and an older half-brother named John. When their father dies, the family estate passes to John, and the Dashwood women are left in reduced circumstances. The novel follows the Dashwood sisters to their new home, a cottage on a distant relative's property, where they experience both romance and heartbreak. The contrast between the sisters' characters is eventually resolved as they each find love and lasting happiness. This leads some to believe that the book's title describes how Elinor and Marianne find a balance between sense and sensibility in life and love.

2. Author Biography

Jane Austen, a nineteenth-century English novelist, is considered one of Britain's most important writers. Her talent has been compared to that of Shakespeare, and her work remains an integral and important part of what is commonly accepted as the canon of classic English literature.

Austen was born December 16, 1775, in Steventon, Hampshire, the seventh child and second daughter of Rev. George Austen and his wife Cassandra. As a clergyman's daughter, Austen was a member of the professional class. As she lived her entire life in the country, she wrote about her society and her surroundings, and she would become famous for her insightful portrayals of upper-class English country life.

Austen was schooled largely at home, benefitting from her father's extensive library. Austen's novels often focus on the necessity of women of her society to marry for security. Although Austen did have several suitors throughout her early adulthood, she never did marry, either because of a lack of money on both sides or because of a lack of compatibility.

As a teenager, Jane wrote plays and stories, mostly satires and parodies of contemporary work, for the amusement of her family. She began the manuscripts for her serious novels in her early twenties, but she was hard-pressed to find publishers for any of them. Sixteen years after first beginning Sense and Sensibility as "Elinor and Marianne," a publisher finally agreed to take the manuscript. Austen published her first book anonymously. Sense and Sensibility proved to be successful. Encouraged, she went on to publish three more novels: Pride and Prejudice (1813), Mansfield Park (1814), and Emma (1816).

Austen died in Winchester on July 18, 1817, after a gradual illness.

3. Characters

• Henry Dashwood : A wealthy gentleman who dies at the beginning of the story. The terms of his estate prevent him from leaving anything to his second wife and their children together. He asks John, his son by his first wife, to look after (meaning ensure the financial security of) his second wife and their three daughters.

• Mrs. Dashwood : The second wife of Henry Dashwood, who is left in difficult financial straits by the death of her husband. She is 40 years old at the beginning of the book. Much like her daughter Marianne, she is also very emotive and often makes poor decisions based on emotion rather than reason.

• Elinor Dashwood : The sensible and reserved eldest daughter of Mr. and Mrs. Henry Dashwood. She is 19 years old at the beginning of the book. She becomes attached to Edward Ferrars, the brother-in-law of her elder half-brother, John. Always feeling a keen sense of responsibility to her family and friends, she places their welfare and interests above her own, and suppresses her own strong emotions in a way that leads others to think she is indifferent or cold-hearted.

• Marianne Dashwood : The romantically inclined and eagerly expressive second daughter of Mr. and Mrs. Henry Dashwood. She is 16 years old at the beginning of the book. She is the object of the attentions of Colonel Brandon and Mr. Willoughby. She is attracted to young, handsome, romantically spirited Willoughby and does not think much of the older, more reserved Colonel Brandon. Marianne does the most development within the book, learning her sensibilities have been selfish. She decides her conduct should be more like her elder sister's, Elinor.

• Margaret Dashwood : The youngest daughter of Mr. and Mrs. Henry Dashwood. She is thirteen at the beginning of the book. She is also romantic and well-tempered but not expected to be as clever as her sisters when she grows older.

• John Dashwood : The son of Henry Dashwood by his first wife. He intends to do well by his step-sisters, but he has a keen sense of avarice, and is easily swayed by his wife

.

• Fanny Dashwood : The wife of John Dashwood, and sister to Edward and Robert Ferrars. She is vain, selfish, and snobbish. She spoils her son Henry. Very harsh to her husband's half-sisters and stepmother, especially since she fears her brother Edward is attached to Elinor.

• Sir John Middleton : A distant relative of Mrs. Dashwood who, after the death of Henry Dashwood, invites her and her three daughters to live in a cottage on his property. Described as a wealthy, sporting man who served in the army with Colonel Brandon, he is very affable and keen to throw frequent parties, picnics, and other social gatherings to bring together the young people of their village. He and his mother-in-law, Mrs. Jennings, make a jolly, teasing, and gossipy pair.

• Lady Middleton : The genteel, but reserved wife of Sir John Middleton, she is quieter than her husband, and is primarily concerned with mothering her four spoiled children.

• Mrs. Jennings : Mother to Lady Middleton and Charlotte Palmer. A widow who has married off all of her children, she spends most of her time visiting her two daughters and their families, especially the Middletons. She and her son-in-law, Sir John Middleton, take an active interest in the romantic affairs of the young people around them and seek to encourage suitable matches, often to the particular chagrin of Elinor and Marianne.

• Edward Ferrars : The elder of Fanny Dashwood's two brothers. He forms an attachment to Elinor Dashwood. Years before meeting the Dashwoods, Ferrars proposed to Lucy Steele, the niece of his tutor. The engagement has been kept secret owing to the expectation that Ferrars' family would object to his marrying Miss Steele. He is disowned by his mother on discovery of the engagement after refusing to give up the engagement.

• Robert Ferrars : The younger brother of Edward Ferrars and Fanny Dashwood, he is most concerned about status, fashion, and his new barouche. He subsequently marries Miss Lucy Steele after Edward is disowned.

• Mrs. Ferrars : Fanny Dashwood and Edward and Robert Ferrars' mother. A bad-tempered, unsympathetic woman who embodies all the foibles demonstrated in Fanny and Robert's characteristics. She is determined that her sons should marry well.

• Colonel Brandon : A close friend of Sir John Middleton. In his youth, Brandon had fallen in love with his father's ward, but was prevented by his family from marrying her because his father was determined to marry her to his older brother. He was sent into the military abroad to be away from her, and while gone, the girl suffered numerous misfortunes partly as a consequence of her unhappy marriage, finally dying penniless and disgraced, and with a natural (i.e., illegitimate) daughter, who becomes the ward of the Colonel. He is 35 years old at the beginning of the book. He falls in love with Marianne at first sight as she reminds him of his father's ward. He is very honorable friend to the Dashwoods, particularly Elinor, and offers Edward Ferrars a living after being disowned by his mother.

• John Willoughby : A philandering nephew of a neighbour of the Middletons, a dashing figure who charms Marianne and shares her artistic and cultural sensibilities. It is generally understood that his is engaged to be married to Marianne by many of their mutual acquaintances.

• Charlotte Palmer : The daughter of Mrs. Jennings and the younger sister of Lady Middleton, Mrs. Palmer is jolly but empty-headed and laughs at inappropriate things, such as her husband's continual rudeness to her and to others.

• Thomas Palmer : The husband of Charlotte Palmer who is running for a seat in Parliament, but is idle and often rude.

• Lucy Steele : A young, distant relation of Mrs. Jennings, who has for some time been secretly engaged to Edward Ferrars. She assiduously cultivates the friendship with Elinor Dashwood and Mrs. John Dashwood. Limited in formal education and financial means, she is nonetheless attractive, clever, manipulative, cunning and scheming (in modern terms, a "gold digger").

• Anne/Nancy Steele : Lucy Steele's elder, socially inept, and less clever sister.

• Miss Sophia Grey : A wealthy but malicious heiress who Mr. Willoughby marries in order to retain his comfortable lifestyle after he is disinherited by his aunt.

• Lord Morton : The father of Miss Morton.

• Miss Morton : A wealthy woman whom Mrs. Ferrars wants her eldest son, Edward, and later Robert, to marry.

• Mr. Pratt : An uncle of Lucy Steele and Edward's tutor.

• Eliza Williams : The ward of Col. Brandon, she is about 15 years old and bore an illegitimate son to John Willoughby.

• Mrs. Smith : The wealthy aunt of Mr. Willoughby who disowns him for not marrying Eliza Williams.

4. Phenomena

When we love someone and leaved by them. Just take it easy. Don’t extremely regreted. Because we still have friends and family and happiness around us.

Problem statement

· Why were women hard finding true love in 20^th century?

As in story Sense and sensibility, women are like hard finding true love because when that something love sense just can influenced by money and position. In sense and sensibility we can see that willoughby refuse marianne’s love and choose miss gray because have much money.

· Why do women always easy for broken hearth?

We can see Marianne live can’t for give her love sense to Willoughby so that she sick and can’t doing he live. There we can look how a woman such as very easy for broken hearth does. Woman is something has sense. She always walking want hearth.

Objective

Other opinion about problem in sense and sensibility

· Same as now position vary influence for everything but this is a Love. Many people think love is blind. Its mean love not see everything, it not see rich or poor, old or young.

· Although we are leaved by people which very we love as Mariaane leaved Willoughby. But don’t regret or angry because partner in God’s hand. May be we are leaved but God will give more good for you.

Discussion

Synopsis

When Mr. Dashwood dies, he must leave the bulk of his estate to the son by his first marriage, which leaves his second wife and three daughters (Elinor, Marianne, and Margaret) in straitened circumstances. They are taken in by a kindly cousin, but their lack of fortune affects the marriageability of both practical Elinor and romantic Marianne. When Elinor forms an attachment for the wealthy Edward Ferrars, his family disapproves and separates them. And though Mrs. Jennings tries to match the worthy (and rich) Colonel Brandon to her, Marianne finds the dashing and fiery Willoughby more to her taste. Both relationships are sorely tried. But this is a romance, and through the hardships and heartbreak, true love and a happy ending will find their way for both the sister who is all sense and the one who is all sensibility.

Conclusion

From Sense and Sensibility, we can lesson that we aren’t brought love because love still can found.

Bibliography

Armstrong, Isobel, Jane Austen: "Sense and Sensibility," Penguin Group, 1994.

Armstrong provides a comprehensive criticism and examination of Sense and Sensibility, including the novel's social constructs and the philosophical beliefs of the characters.

Gilbert, Sandra, and Susan Gubar, The Madwoman in the Attic, New Haven, 1979.

Harding, D. W., Regulated Hatred and Other Essays on Jane Austen, edited by Monica Lawlor, Althone Press, 1998.

Jenkins, Elizabeth, Jane Austen, Farrar, Straus and Cudahy, 1949.

Monaghan, David, ed., Jane Austen in a Social Context, Macmillan Press, 1981.

This collection of essays examines Austen's contemporary social context and the way it is exhibited in her writing.

Neill, Edward, The Politics of Jane Austen, St. Martin's Press, 1999.

www. novelguide.com

www.wikipedia.com

Teori Betty Neuman

Betty Neuman (1972) mendefinisikan manusia secara utuh merupakan gabungan dari konsep holistic dan pendekatan sisitem terbuka (Mariner-Tomey,1994). Bagi neuman, manusia adalah makhluk dengan kombinasi kompleks yang dinamis dari fisiologis, sosiokultural, keyakinan dan variabel perkembangan yang berfungsi sebagai sistem terbuka. Sebagai sistem terbuka, manusia berinteraksi, beradaptasi dengan dan disesuaikan dengan lingkungan, yang digambarkan sebagai stressor (chin dan Jacobs, 1995). Lingkungan internal terdiri dari segala sesuatu yang mempengaruhi (interpersonal) yang berasal dari dalam diri klien. Lingkungan eksternal adalah segala sesuatu pengaruh yang berasal di luar diri klien. (interpersonal). Tiap lingkungan mempunyai kemungkinan terganggu oleh stressor yang dapat merusak sisitem. Pengaruh stressor pada seseorang tergantung pada tingkatan stressor, lamanya stressor serta kemampuan dan keefektifan koping yang digunakan.

Neuman meyakini bahwa keperawatan memperhatikan manusia secara utuh. Tujuan keperawatan adalah membantu inidividu, keluarga dan kelompok dalam mencapai dan mempertahankan tingkat kesehatan yang optimal (Neuman dan Young, 1972). Perawat mengkaji, mengatur dan mengevaluasi sitem klien. Perawatan berfokus pada variabel-variabel yang mempengaruhi respon klien terhadap stressor (chinn dan jakobs. 1995). Tindakan perawatan terdiri dari pencegahan pencegahan primer, sekunder dan tersier. Pencegahan primer terfokus pada peningkatan pertahanan tubuh melalui indentifikasi fktor-faktor resiko yang pontensial dan actual terjadi akibat stressor tertentu. Pecegahan sekunder berfokus pada penguatan pertahanan dan sumber internal melalui penentapan prioritas dan rencana pengobatan pada gejala-gejala yang tampak, sedangkan pencegahan tersier berfokus pada proses adaptasi kembali. Prinsip dari pencegahan tersier adalah untuk untuk memberikan penguatan pertahanan tubuh terhadap stressor melalui penbdidikan kesehatan dan untuk membantu dalam mencegah terjadi masalah yan sama. (Neuman, 1982; torres, 1986; Mariner-Tomey, 1994: chin dan Jacobs, 1995)

Apa Sich yang Indah dari Merauke

Apa Sich yang Indah dari Merauke

Kapan ya bisa balik ke merauke lagi. Rasanya liburan 3 minggu di merauke hanya seperti 3 hari saja. Padahal kota tersebut tidak sebesar kota yang saya tinggal saat ini. Apa merauke memiliki keindahan alam seperti tempat lainnya di papua. Saya rasa tidak sebab merauke tidak memiliki pasir pantai yang putih, air pantai yang biru, pemandangan pergunungan, serta jenis wisata lainnya yang banyak terdapat di daerah papua. Maklum saja merauke memiliki dasar tanah yang rendah dari permukaan laut serta berlumpur sehingga memiliki warna air laut yang coklat.