BREAST CANCER

Breast cancer is now a serious concern for all community groups. Teenagers, parents and social institutions need to be involved in dealing with breast cancer. So that no more victims of this disease. If earlier can be overcome and prevented, then this breast cancer will not spend a lot of money for healing

WARNING TO ALL OF US

One in eight women in the United States has a life-threatening mass to experience breast-cancer. Incidence continues to increase while mortality remains the same. The most common type of breast cancer is ductal infarction carcinoma (75% of cases). These tumors are hard on palpation, usually axillary to axillary nodes, and have a worse prognosis than other tilapia breast-cancer. Inflammatory lobular carcinoma is responsible for 5-10% of cases. These tumors come with multicenter tumors and clear-cut thickening. The axillary nodes are exposed equally to infiltrating ductal carcinomas, but different metastatic sites. Ductal carcinoma usually spreads in the lungs, lungs, liver, or brain, while lobular carcinoma metastasizes meningeal surface or in other unusual places. There are many other types of breast-cancer, indicated by various percentages and prognosis. Now there is no cure for breast-cancer. There is no specific cause; it seems that genetic, hormonal, and environmental factors can support the development of this cancer. If the lymph nodes are not affected, then the prognosis will be better. The key to improved healing is early diagnosis before attacking metabolism.

THEORETICAL REVIEW

2.1 Definitions

  • Breast Cancer is one of the most common cancers found in Indonesia is usually found in cancer aged 40-44 years and most locations in the upper kernron laternal
  • The most common type of breast cancer is ductal infarction carcinoma (75% of cases). Inflammatory lobural carcinoma is responsible for 5-10% of cases. The affected nodusilaris is the same in the ductal carcinoma of the infiltrate, but the place of treatment is different, ductal carcinoma usually spreads in the liver, lung, liver, or brain, while lobular carcinoma metastasizes meningeal surface or in other unusual places.

2.2 Etiology

The etiology of breast cancer is not known with certainty. However, some patient risk factors are suspected to be associated with the incidence of the breast cancer, namely:

  1. Age> 30 years
  2. Delivery of the first child at age> 35 years
  3. Not married and nullipara
  4. Age menars <12 years
  5. Age of menopause> 55 years
  6. Have had an infection, trauma, or surgical operation of benign breast tumor
  7. Old hormonal therapy
  8. Have contralateral breast cancer
  9. Have had gynecological surgery such as ovarian tumor
  10. Ever experienced a radiation in the area of the chest
  11. Family history with breast cancer on mother, sister, mother, sister, brother/sister
  12. Oral contraceptives in patients with benign breast tumors such as malignant fibroctical disorders

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BREAST CANCER STAGE

There are several categories of breast cancer stage. This is supposed to show the severity of the disease in a patient.

The tumor has stage I-IV depending on size, affected lymph node, and metastasis (Other stages are expressed in TNM symbols: T = primary tumor, N = involved lymph node, M = metastasis).

  • Stage I: small tumor less than 2 cm, negative lymph node, not detected metastases
  • Stage II: tumor larger than 2 cm but less than 5 cm, non-fixated lymph node negative or positive, undetectable metastasis.
  • Stage III: Tumor larger than 5 cm, or tumor of any size with a skin invasion or chest wall or positive fixed lymph nodes in the clavicular area without evidence of metastasis.
  • Stage IV: the tumor of any size with positive or negative lymph nodes with distant metastases.

Management

  • Modified radical mastectomy: the entire breast tissue is removed together with the axillary lymph nodes.
  • breast-conservation surgery: segmental lumpectomy, or quadranectomy, and axillary dyslexery followed by radiation therapy against residual microscopic disease.
  • Mastectomy provides the maximum chance of removal of affected tumors and nodes.
  • A series of external beam radiation therapy on tumor mass to reduce the chances of recurrence and eradication of residual cancer.
  • Chemotherapy is recommended for the eradication of the spread of micrometastases of the disease, eg, Cytoxan (C), Methotrexate (M), Fluorouracil (F), and Adriamycin (A).
  • CMF or CAF regimens are a frequent treatment protocol.
  • Autologous bone marrow transplants (ABMT) today often indicate an increase in their use; the use of growth factors to stimulate bone marrow has a high mortality decrease.
  • Hormonal therapy based on estrogen and progesterone receptor index. Tamoxifen is the principal hormonal agent used to suppress hormone-dependent tumors. Other hormonal preparations are Megace, DES, Halotestin, and Cytadren.
  • Elective reconstructive surgery provides psychological benefits but is contraindicated if cancer is a local, metastatic, or inflammatory stage.

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BREAST CANCER (POST SURGERY)

Breast cancer is now increasingly happening. this disease is very dangerous. the culture of eating fast food, and canned foods containing preservatives, is one of the causes of this disease

Reduce Stress and Improve Koping Skill

  1. Preoperative, give patients time to absorb the meaning of the diagnosis and provide information to help evaluate the availability of treatment options.
  2. The best level of physical condition, psychology, and preoperative nutrition; consider the patient as an active member and healthcare team and allow to discuss with those who will provide care.
  3. Avoid pressing the patient to see where the incision is if the patient is not ready.
  4. Get help from family or friends who provide support to improve the acceptance of body change.
  5. Recognize that couples often need more guidance, support, and counseling to cope with the crisis.

Improved Self-Care

  1. Provide information on the development of postoperative surgical edema and strategies to prevent it; cuts, bruises, and infections in operative sites are dangerous that can trigger problems.
  2. Encourage to grab when free of post-anesthesia nausea and fluid tolerance; do range motion exercises fast, and prevent stiffness.
  3. Encourage self-care and exercise such as “climbing the wall” with the fingers to prevent contraction; pain other than a mild discomfort, there should be no therapeutic exercise; Radical mastectomy causes greater difficulty.
  4. Encourage normal work-related activities and arm-related work, arm motion when walking, cleaning operation spots, avoiding injuries with therapeutic exercises; loosen clothes that do not cause constriction.

Improving Sexual Function

  1. Talk about how the patient sees him and the libido-related decrease associated with exercise, nausea, or ancients.
  2. Clarify concept errors, eg, cancer can be sexually transmitted.
  3. Encourage an open discussion of fear.
  4. Provide suggestions that vary the time of the day for sexual activity (when not tired) or positions that most comfort, and position change, eg, hugging, kissing, manual stimulation.

Conclusion

That breast cancer is one of the most common cancers found in Indonesia, usually this cancer is found in women aged 40-49 years and located lateral up. The most common types of breast cancer, the infertile ductal carcinoma (75% of cases) and infiltration lobural lymphoma are responsible for 5-10% of cases.

The cause of breast cancer carcinoma with certainty. However, some risk factors in the client allegedly associated with the incidence of breast cancer, namely:

  1. Age> 30 years
  2. Delivery of the first child at age> 35 years
  3. Not married and nulipara
  4. Age of menopause <12 years
  5. ever has an infection, trauma, or benign tumor surgery
  6. Old hormonal therapy
  7. Have experienced chest radiation
  8. Family history with breast cancer in mother, mother sister, sister / brother

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BREAST CANCER (CASE REVIEW)



Breast cancer is now a terrible disease for women, young and old. even many teenage girls began to experience this disease. that is why the case review of this disease needs to be informed to the public.

Assessment: Preoperative

  1. Assess the patient’s reaction to the diagnosis and ability to resolve the problem.
  2. Complete gynecology and complete.
  3. Ask related questions include the following: coping skills, support systems, lack of knowledge, and a sense of discomfort.
  4. Perform a complete physical assessment with special attention to breast and related signs and associated mass symptoms.

Post-operative Assessment

  1. Monitor pulse and blood pressure against signs of shock and hemorrhage.
  2. Avoid measuring blood pressure, injection, IV flow, and venous function on the operated side to prevent infection and disruption of circulation.
  3. Inspection of bandages against bleeding in a legislative manner; monitor drainage, pain, swelling, or drainage.

            Nursing diagnoses

Diagnosis Preoperative Pregnancy

  1. Lack of knowledge about breast cancer and treatment options.
  2. Fear and ineffectiveness of coping associated with cancer diagnosis, treatment, and prognosis.

Postoperative Nursing Diagnosis

  1. Pain and discomfort.
  2. Damage to skin integrity due to surgical incision.
  3. Impaired self-image associated with loss of body parts, changes in self-image, and fear of the partner’s reaction to the loss experienced.

            Nursing Intervention

Fixing Less Knowledge

  1. Teach follow-up through telephone connection for curiosity about incision, pain management, and family and patient adjustment; may permit the patient to make contact with the community nursing service if necessary.
  2. Teach how to empty the reservoir and measure the drainage if going home using drain.

Eliminate Pain and Discomfort

  1. Provide patient-controlled analgesia (PCA).
  2. Elevate moderately affected limbs only.

Maintenance of Skin Integrity

  1. Maintain the patency of the surgery to prevent fluid accumulation under chest wall incisions.
  2. Inform the decrease of sensation in the operative area due to neurological disorders; call for signs of infection or irritation.
  3. Teach to gently massage the surgery with vitamin E or other lotions to improve circulation and improve skin elasticity.

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MOTHERS AND BREASTFEEDING

Mothers and breastfeeding are things that cannot be separated.  Mothers must breastfeed their children in order to grow optimally and always maintain their health.  Because there is no comparable food to replace breast milk.

  1. UNDERSTANDING OF EXCLUSIVE BREASTFEEDING

Breast Milk is a fatty emulsion in protein, lactose and inorganic salts secreted by the mother’s mammary glands, which are useful as food for the baby. Exclusive breastfeeding is breastfeeding without food and other supplementary beverages in infants aged 0 to 6 months. Even water is not given in this exclusive breastfeeding stage.

Breast milk in sufficient quantities is the best food in infants and can meet the nutritional needs of infants during the first 6 months. Breast milk is the first and main natural food for the baby so as to achieve optimal growth. In 2001 the World Health Organization stated that exclusive breastfeeding during the first six months of life is best. Thus, the preceding provision (that the exclusive ASI is four months) is no longer valid.

2. HOW TO ACHIEVE EXCLUSIVE BREASTFEEDING

            WHO and UNICEF recommend the following steps to initiate and achieve exclusive breastfeeding by breastfeeding within one hour after birth Exclusive breastfeeding: only breastmilk. That is, no added food or other drinks, even water. Breastfeed whenever the baby asks (on-demand), as often as the infant wants, day and night. Do not use bottles of milk or pacifiers.

Eating milk by pumping or blushing by hand, while not with the child and controlling emotions and thoughts to calm down.

3. ERRORS OF EXCLUSIVE BREASTFEEDING

After the exclusive breastfeeding of six months, it does not mean breastfeeding is stopped. Along with the introduction of food to the baby, breastfeeding is still done, should breastfeed two years according to WHO recommendations.

Breastfeeding and Its Benefit

Breastfeeding as baby food has the following virtues:

  1. Breast milk is a good natural food for babies, practical, economical, easily digested to have the composition, the ideal nutrient according to baby’s digestive needs and abilities.
  2. Breast milk contains higher lactose compared to artificial milk.

In the intestine lactose will be fermented into lactic acid. which is useful

for:

* Inhibits the growth of pathogenic bacteria.

* Stimulate the growth of microorganisms that can produce acids organic and synthesize some types of vitamins.

* Facilitate the occurrence of calcium-cassienate deposition.

* Facilitate the delivery of herbagai types of minerals, such as calcium,

magnesium.

  1. Breast milk contains protective substances (antibodies) that can protect the baby during the first 5-6 months, such as Immunoglobin, Lysozyme, Complement C3, Complement C4, Antistapiloccocus, Lactobacillus, Bifidus, Lactoferrin.
  2. Breast milk does not contain beta-lactoglobulin which can cause allergies baby.
  3. Breastfeeding process can establish a psychological relationship between mother and baby.

In addition to providing well for the baby, breastfeeding with a baby can also provide benefits for mothers, namely:

  • A sense of pride from mom, that she can give “life” to the baby.
  • A closer relationship due to the close natural contact of the skin, for psychic and emotional development between mother and child.
  • With breastfeeding for the mother’s uterus will contract which can lead to sized return before pregnancy
  • Accelerate cessation of postpartum bleeding.
  • By breastfeeding the mother’s fertility becomes reduced for several months (pregnancy rationing)
  • Reduce the chances of breast cancer in the future.
  • Increasing the length of postpartum fertility return, so
  • Giving distance between children is longer aka delay the next pregnancy
  • Because delayed menstrual returns, breastfeeding mothers do not require a lot of substances during menstruation
  • Mother slimmer faster. Research shows that nursing mothers six months slimmer than half a kg of mothers who breastfed for four months.

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THE “GREEN ARMY” FOR HEALTH PROMOTION IN KUDUS CITY WAS DECLARED

Kudus City, a small town in Central Java Province, Indonesia, proudly declared their team of health promotion. There are 25 members of the team that come from different skills: Nurse, midwife and environment health promotion.

They have work for many years in the civil servant of the district government of Kudus City.

And the main goal of their duty now is keeping the public of Kudus City stay healthy.   And the population of the Kudus city is currently 800.000 peoples.  And at least 20% of them are still poor. Although it is not supported by an adequate health promotion budget, however, the determination and working spirit of the team of health promoters will keep strong.

Congratulations on the duty of volunteer health promotion in the Kudus District. May God bless you and make your way easier.

BREASTFEEDING SKILL

Breastfeeding skill is very important for a mother. As important as keeping her baby  stay healthy.  Many breastfeeding problems (nipple pain, small amounts of breast milk/food, or uncomfortable mothers in breastfeeding) can be solved by improving basic techniques in breastfeeding, especially in correctly positioning the mother and baby.

Mother’s Position:

Sit down comfortably and look for the most comfortable position when sitting on a chair, or rocking chair, armchair or even sitting on a mattress leaning against a wall or mattress.

Place the pillow behind your back, and under the arm that will provide support when the mother holds the baby.

Use footstool or footing when the mother is sitting, especially when using a high enough chair.

Mother can also lean on the back of the mattress with a position facing the baby by using a pillow as a buffer head, neck, back upper legs.

Baby Position:

It is advisable to start breastfeeding preparations by wearing simple clothes on babies or even not wearing clothes, to increase contact with mothers.

Lay the baby in the mother’s arms, with the position facing the breast. The position of the neck in the folds of the arm, the body lying along the arm and butt held by the hand.

After that turn the baby’s body in such a way that the baby’s position against the mother’s body.

The baby’s body position should be in perpendicular to the mother’s body, do not rotate the baby’s neck to reach the mother’s nipple.

If the baby’s position is not high, use a pillow to support the arm.

Position the baby’s arm well, the forearm is positioned under the breast and the upper arm when disturbed can be withheld using the thumb of the arms that carry.

Breast position:

The first thing to do in preparing breast before breastfeeding. Manually massage the breast to get a few drops of breast milk on the nipple, this will moisturize the mother’s breast.

Hold the breast, the burden of the breast is held with the palms of the hands and fingers beneath and the thumbs on it.

Keep your fingers away from the areola area, so stay away from the area where the baby sucks milk, it aims to avoid contamination.

Starting breastfeeding:

Bring your baby’s mouth to the damp nipple, then massage the baby’s lips gently to stimulate the baby’s sucking reflexes.

When the baby’s mouth is open, immediately attach the baby’s mouth in the middle of the breast and close the baby tightly to the mother’s body.

Make sure the baby sucks up to the breast areola instead of the mother’s nipple, with this pain in the breast during breastfeeding can be avoided.

Make adjustments to the baby’s breathing rhythm.

When the baby has been sucking milk/breast food well then make sure we set the position of the breast well, hold the weight of the breast with the hand so that the breast weight does not entirely burden the baby’s mouth and lips.

The last important thing is when we will stop breastfeeding, do not pull the baby’s mouth from the breast when the baby is still sucking. So stop before the baby sucking and then keep the baby from the breast slowly, it aims to stop the breastfeeding does not hurt the breast, which can result in pain until breast infection.

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Diarrheal disease

Diarrheal disease is one of the most environmentally-based diseases.  It is still the biggest health problem in Indonesia. It is due to the poor condition of basic sanitation, physical environment and low behavior of people to live clean and healthy, and there are many factors that cause diarrheal disease.

Environmental hygiene

Environmental hygiene is very influential on health in general. The number of environmental diseases that attack the community due to lack of clean surrounding environment. And also bad habits that pollute the environment. This can cause diseases carried by impurities in the environment freely either directly or indirectly through intermediaries. Diarrhea is a disease that has been known since the time of Hippocrates. Until now, diarrhea is still one of the main health problems of Indonesian society. 

Diarrhea is a dangerous disease because it can lead to death. Also can cause extraordinary events (KLB). The main cause of death of diarrhea is dehydration that is as a result of the loss of fluid and electrolyte salts in stool diarrhea (MOH, 1998). The state of dehydration if not immediately helped 50-60% of them can die.

About the management and prevention of diarrhea, the most important parent role. The level of knowledge of parents about diarrhea in infants is very influential in an arrangement and prevention of diarrhea itself. Knowledge of parents with the incidence of diarrhea in infants can be obtained from various sources.  Such as mass media, counseling health teams, the environment and from various other sources.

During this time the perception that often happened in the community about diarrhea is due to the removal of waste substances that are not needed by the body and does not require treatment because it will heal by itself. Or it may also appear perception if the toddler does not go away from diarrhea, then the mother’s orientation always wants her child immediately can defecate normally suggestions without taking into account the adverse effects of diarrhea drugs that are not an appropriate use.

Human behavior factor

Human behavior factor itself is less understanding of the importance of clean and healthy life, also due to poor sanitary conditions basic physical environment and low attitudes and behavior of people to live clean and healthy so it is needed a study to evaluate the level of knowledge, attitudes, and behavior of society in the prevention of home diarrhea.

Therefore, by studying the behavior of this society is expected to be a guide in our daily lives of the importance of clean.  And the importance of healthy living. And also the importance of immediately take treatment measures for people who have been infected with diarrhea.

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Cervical Cancer, Symptoms And Prevention

Cervical cancer is now one of a dangerous problem for a woman that causes a serious impact on life. In the early stages often there is often no sign – a sign that is typical but, sometimes found symptoms.

  1. The symptoms of Cervical Cancer as follows;
  • Whitish or dilute liquid out of the vagina.
  • Bleeding after copulation which then continues to be an abnormal bleeding.
  • An occurrence of bleeding after menopause.
  • In the Inpansif phase can exit fluid yellow – yellow, smelly and can be mixed with blood.
  • Anemia symptoms arise in the event of Chronic bleeding.
  • Arising pain Pelvis or lower abdomen if there is pelvic inflammation.
  • At the advanced stage, the body becomes emaciated because of malnutrition, edema of the foot, irritation of the bladder and the lower rectum (rectum).

The Cervical Cancer is one of the most dangerous 

Like another cancer, this type of cancer also undergoes spread (metastasis). Cervical Cancer spread there are three kinds, namely:

  1. Through the Lymph vessels (lymphogen) Towards other lymph nodes.
  2. Through a blood vessel (hematogen).
  3. Direct spread to the parametrium, uterine corpus, vagina, bladder.
  1. Cervical Cancer Stage

Determination of stadium in cervical cancer patients is very important. This is related to the type of treatment and recovery prospects that will be done. Staging of cervical cancer as follows:

            Stadium Description

  • 0 : Cervical cancer stage 0 can be called carcinoma in situ. Abnormal cells are found only in the lining of the cervix.
  • I : Cancer is found only in the cervix.
  • II : Cancer that has spread beyond the cervix, but does not spread to the pelvic wall or the lower third of the vagina.
  • III : Cancer that has spread to the lower third of the vagina. It may have spread to the pelvic wall and or has caused the kidney to malfunction.
  • IV : Cancer has spread of the bladder, rectum, or other body parts such as the lungs, bones, and liver.
  1. C. Prevention of Cervical Cancer
  2. Cervical cancer can be prevented by screening called PAP SMEAR and this screening is very effective because the examination is easy to do, fast and no pain. Screening aims to determine the existence (cancer) with a microscope.
  3. Now also been found Vaccine to prevent cervical cancer, even This vaccine can be given to girls from the age of 10 years. By doing this Vaccination prevention can be done, and for women who are active or have sexual intercourse must routinely perform PAP SMEAR or Visual Inspection.
  4. Have a healthy diet, rich in vegetables, cereals to stimulate the immune system.
  5. Avoid smoking.
  6. Avoid sex before marriage or at a very young age.
  7. Avoid having sex with many partners.
  8. Perform intimate organ cleaning or known as Vagina toilet.

Plastic Waste Problem Solution (Part 2)

Actually plastic has several advantages, such as strong, light, and stable. However, the plastic is difficult to decompose by microorganisms in the environment causing serious environmental pollution.  To solve the problem of plastic waste, several approaches such as recycling, plastic waste processing technology, to the development of new plastic materials that can be destroyed and decomposed in the environment, known as biodegradable plastics.

Here we will discuss about waste management methods through combustion process using incinerator and recycling process to handle the combustion side product. It is expected that this method can be applied in Indonesia to deal with environmental problems caused by environmental disability (especially microorganisms) in remodeling and decomposing plastic waste.

The use of plastic continues to increase from year to year. Even in 1992, plastic waste was ranked third of all waste production in Bandung. Plastic waste itself is a waste that is difficult to degrade. It causes pollution on environmental sustainability.

During this effort to handle plastic waste is done by sanitary landfill method. This method is one of controlled waste management. Trash is discharged to the TPA (Final Disposal), then the garbage is compacted with the tractor and then covered with the ground. This will eliminate air pollution that will cause waste. At the bottom of the place is equipped leachate channel system that serves as a waste liquid waste channel that must be processed first before discharge into the river or into the environment.

This method is not effective because it often causes pollution of ground water and the environment around the landfill. Even recently, in Bandung there was a disaster due to landfill that does not meet the requirements. In addition there is the possibility of gas that can cause air pollution. Gases that may be produced are: methane, H2S, NH3 and other H2S and NH3 gases although the numbers are small, but can cause unpleasant odors that can damage the respiratory system of plants and make plants lack of oxygen gas and eventually die.

In the process of landfilling, waste should be processed first in a way destroyed in order to minimize the volume of waste in order to facilitate the compression of garbage. To do this would require additional work that led to additional funds.A better solution needs to be considered. The solution includes efforts to reduce plastic waste production and waste processing efforts that already exist.

Efforts to reduce waste production

Efforts to reduce waste production can be done by:

(1) Use of biodegradable plastics, (2) Much research has been done to obtain biodegradable plastics. Usually a plastic polymer is mixed with certain impurities that cause the polymer bonding strength to decrease. Reduced bond strength will cause the plastic more easily decomposes by the environment. The decomposition process can be accelerated by utilizing a decomposer which is usually microbial. (3) Reduction of plastic usage. (4)    Plastics may be replaced with other materials that are more environmentally friendly, such as shopping bags that have been made of plastic can be replaced with paper. (5) Sorting of organic and plastic waste.

The waste segregation should start from the household level. Household waste should have been split into organic and inorganic waste (including plastic) further sorting is also done by a higher level, such as the supermarket (which is more manageable than traditional market), offices, hotels and apartments. The government also should provide separate bins for each material so that the people who previously has been lighting and guide books just put the material in question to this particular tub. Not mixed like “primitive” household garbage before.

Combustion results are gases and combustion residues. The decrease in the volume of solid waste from combustion can reach 70%. This method is relatively more expensive than sanitary landfill, which is about three times as much.The advantages of this combustion system are:

  • Requires a relatively small area compared to sanitary landfills.• Can be built near industrial sites.
  • The combustion residue is relatively stable and almost all of them are inorganic.
  • Can be used as an energy source, both for steam generators, hot water, electricity, and metal melting.

The drawback lies in the expensive investment, labor, repair and maintenance costs, and still removing residues, also generating gas.In general, the combustion process inside the incinerator is:

  • Burnable waste is inserted in a container or supplier.
  • Next the garbage is set so that it is flat and then put into the burner stove.
  • Ash combustion results, can then be used as a waste cover on landfill.
  • While the results of gas will be channeled through a chimney that is equipped with a scrubber or accommodated to be utilized as an energy generator