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.


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 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 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.


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.


            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.


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 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,


  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.

Another Benefit of Breastfeeding 

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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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.

The Duty oh Health Promoter

The duty of a Health Promoter when enjoyed is very pleasant. Why is that?
They went directly to the villages to provide counseling to the people in the interior to behave in a clean and healthy life. Obstacles and rural natural conditions that are not ideal become challenges for us public health workers. Roads are damaged, there is no electricity, and the absence of clean water facilities often occurs in villages.
Not only minimal public facilities, the low level of education of rural communities also greatly affects the behavior and culture of unhealthy communities. Burning garbage, defecating in an open place, also throwing garbage in the river happens a lot.
Health promoters must have a high spirit, perseverance and patience to carry out their heavy duties.
Voluntary souls, perseverance and dedication are the main capital.
In order to create a healthy society and to change the healthy behavior of the community, health promoters continue to work. Happiness will be felt when people become healthy and prosperous because of the hard work of the health promoter.

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


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. Look for the most comfortable position when sitting on a chair, or rocking chair, or armchair. 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. This is to get the best position and condition for breastfeeding process.

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

Mother can also lean on the back in bed.  Keep in a position facing the baby by using pillows as a buffer head, neck, back upper legs.

Baby Position

Breastfeeding preparations are very good to do. 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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Drinking Water Treatment

Mineral water or water in the body among them serves to keep fresh, help digestion and remove toxins. However, you know, there are many benefits that are water from water, in addition to the pleasure of freshness. Drinking Water treatment is very important to keep the availability of fresh water for everyone to stay alive every day.

Many people who do not know the efficacy of water other than to eliminate thirst alone. Water can also cure various diseases in an easy and inexpensive way. The benefits of water are to facilitate the digestive system, helps slow the growth of cancer-causing substances, beauty treatments, for fertility, heart-healthy, as a drug stroke, relaxation effects, body straightening, fitter body, and body balancing.

Water Treatment is Growing Fast

            Water treatment is growing very fast, has changed the paradigm of life in the modern society. The use of uncooked drinking water is not a new thing anymore. The trend of instant living in all lines stimulates scientists from all over the world, to create practical technology, both in process and in the final use of the product, of course with the guarantee of quality standards and excellent health.

Healthy water according to the World Health Organization (WHO) is water that is free from any outbreaks of both visible and invisible germs. From the definition can be simplified that healthy water is water that does not cause a person when consumed it becomes ill. That can be interpreted as a sense of healthy water from the aspect of Microbiology, said Ir. Angga Yuhistira Aryanto, Deputy Quality Manager (Deputy MM) Technology Laboratory and Environmental Management Department of Industrial Engineering.

Apart from that aspect, healthy water must also be seen from the physical and chemical aspects. Physical aspect, according to him, healthy water can be tested by organoleptic test or can be done in a simple way that is by using our five senses. An organoleptic test can be demonstrated by watermarks that are odorless, tasteless and colorless or clear in appearance, obviously Ir. Anga.

            While from chemical aspect, healthy water can be seen the content of organic chemical elements and inorganic chemistry The easiest is to see the pH level and dissolved solids content. That’s according to him has been made easier by the government by making standards for drinking water.

There are several ways of drinking water treatment, among others, as follows

Natural Processing

Processing is done in the form of storage from water obtained from various sources, such as lake water, river water, well water and so on. In this storage, water is left for several hours in place. Then there will be a coagulation of substances contained in the water and finally formed deposits. The water will be clear because the particles present in the water will also settle.

1.Water Treatment by Screening

Simple water filtration can be done with gravel, fibers, and sand. High-tech sand filtering is done by PAM (Drinking Water Company) whose results can be consumed publicly.

2.Water Treatment by Adding Chemical Substances

The chemical used can be 2 kinds of chemicals that function for coagulation and ultimately accelerate the precipitation (eg alum). The second chemical is to disinfect (killing the seeds of the disease in the water, for example, chlorine (Cl).

3.Water Treatment with Air Flowing

The main purpose is to eliminate the unpleasant taste and odor, eliminating unnecessary gases, such as CO2 and also raising the acidity of water.

4.Water Treatment by Heating Up to Boiling

The goal is to kill germs found in water. Processing of this kind is more appropriate only for small consumption for example for household needs. Viewed from consumers, water treatment in principle can be classified into 2 namely:

  • Drinking Water Treatment for the Public
  • Rain Water Shelter. Rainwater can be accommodated in a dam (artificial lake) built on the participation of local communities. All the rainwater flowed into the lake through the water channels. Then around the lake is made a good pump or dug well to the public. Rainwater can also be accommodated with ferosemen tubs and nearby roofs are built to collect rainwater. Around the basin were made outlets for public water retrieval. The good rainwater from the well (lake) and the reservoir is bacteriologically not guaranteed for it then the obligations of families to cook it themselves for example by boiling the water.

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Causes of diarrhea

The causes of diarrhea are usually associated with an unclean environment. Also unhealthy environment. Environmental pollution caused by poor waste management. And the habit of defecating in rivers and open waterways is still comm

Understanding diarrhea

According to WHO (1999) clinically diarrhea is defined as

  1. more defecation than usual. More than three times a day, accompanied by consistent changes of stool (into liquid) with or without blood.
  2. Clinically differentiated between three kinds of diarrhea syndrome are acute, acute, dysentery and persistent diarrhea.

Meanwhile, according to the MOH RI (2005), diarrhea is a disease with signs of changes in the shape and consistency of the stool, which softens to melt and increases the frequency of defecation is usually three or more times a day.

Acute diarrhea is limited as an increase in frequency, increased fluid, or increased amount of stool removed, but it is very relative to the patient’s habit and lasts no more than one week. If diarrhea lasts between one to two weeks then it is said that prolonged diarrhea (Soegijanto, 2002)

Causes of diarrhea

Diarrhea occurs due to stimulation of the autonomic nerves in the intestinal wall causing reflex to accelerate peristaltic intestine, this stimulation can be caused by:

  1. Infections by pathogenic bacteria, eg E.Colie bacteria
  2. Infection by typhoid (occasionally) and cholera bacteria
  3. Infection by viruses, such as stomach influenza and ‘travelers diarrhea
  4. As a result of worm diseases (roundworms, tapeworms)
  5. Food and drink poisoning
  6. Nutritional disorders
  7. The effect of certain enzymes
  8. The influence of nerves (shock, fear, etc.)

Some behaviors that may increase the risk of diarrhea in infants, namely (MOH RI, 2007):

  1. Not fully breastfeeding the first 4-6 months of life. Infants without breastfeeding are at greater risk of developing diarrhea than full-breasted infants, and possibly more severe dehydration.
  2. Using a bottle of milk, the use of this bottle facilitates contamination by germs because bottles are difficult to clean. Use of bottles that are not clean or have been used for hours is left in a hot environment, often causing severe intestinal infections because the bottles can be contaminated by germs/bacteria that cause diarrhea. So that toddlers who use these bottles are at risk of infected diarrhea.
  3. Store food cooked at room temperature, if food is stored for several hours at room temperature, food will be reflected and germ will multiply.
  4. Using contaminated drinking water.
  5. Do not wash hands after defecation and after disposing of stool or before eating and feeding the child.
  6. Do not throw stool properly, often assume that the stool is not dangerous, but actually contains a virus or bacteria in large quantities. In addition, animal feces can also cause infection in humans.

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The Diarrheal Disease

The 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 facts show us that:

1. The number of environmental diseases that attack the community due to lack of clean surrounding environment.

2. 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.

3. 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.

4. Diarrhea is a dangerous disease because it can lead to death. Also can cause extraordinary events (KLB).

5. 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.

6. About the management and prevention of diarrhea, the most important is the parent role.

7. The level of knowledge of parents about diarrhea in infants is very influential in an arrangement and prevention of diarrhea itself.

8. 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.  The waste 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 a clean and healthy life. Also due to the 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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The Hemorrhoids

Hemorrhoids are health problems that greatly disrupt our routine work activities. At first, we considered this hemorrhoid as a mild problem. but if left unchecked it will become more serious and dangerous.

Definition of Hemorrhoids

The hemorrhoid is a disease that occurs in the anus where the anal lips are swollen sometimes accompanied by bleeding. The actual anatomy of hemorrhoids is not a disease but a change in the veins in the anus. Where on the anus there are three blood vessels or arteries. If one of them is disturbed or there is a dam of blood flow then the vessels will widen or swell. This is called hemorrhoids.

In patients with hemorrhoids are generally difficult to sit and defecate. Because it hurts when the anal lips get pressure. Now there are still many people who say people with severe hemorrhoids sometimes difficult to treat. So it can be given surgical removal of hemorrhoids that can give side effects are sometimes not good. Therefore,  hemorrhoids need to be wary and handled properly for easy to treat. Now with the Mangosteen Juice XAMthone Plus, patients with hemorrhoids do not feel the need to suffer a lifetime due to surgery is done. Because Mangosteen Juice XAMthone Plus can heal hemorrhoid or hemorrhoids without surgery. Do not ignore and underestimate the sickness of hemorrhoids that you suffer.  Because you can be made to suffer for life by the disease or hemorrhoids if this is not addressed properly to the roots.

Types of hemorrhoids there are two kinds, namely hemorrhoids inside and outside hemorrhoids.

The Kinds of Hemorrhoids

1.      Hemorrhoids inside.  This hemorrhoid inside veins of the anus covered by wet mucous membranes. If left untreated may appear to stand out like outside hemorrhoids. Symptoms of internal hemorrhoids are like there is blood coming out of the anus when defecating. Generally, if it is severe it can stand out and continue to grow as big as a tennis ball so surgical action should be taken to remove the hemorrhoids.

2.      External hemorrhoids are varicose veins under the muscles that are generally associated with the skin. Usually, this hemorrhoid or hemorrhoids look bluish swelling on the edge of the anus pain and itchy.


The community must know about the dangers of cigarettes for health. And the government must always drive anti-cigarette campaigns to the community. The benefits of the tobacco industry are very small compared to the adverse effects on health. And more tragically, cigarettes will damage the potential of the younger generation. Besides that, cigarette addicts will be more easily tempted to use drugs.

Understanding Cigarettes

  1. A cigarette is a paper-sized slender of 70 to 120 mm long with a diameter of about 10 mm containing tobacco leaves that have been chopped.
  2. By burning cigarettes at one end and allowed to burn so that the smoke can be inhaled through the mouth at the other end.
  3. Cigarettes are dangerous & addictive products (causing dependence).
  4. In the cigarette, there are 4000 dangerous chemicals 69 of which are carcinogenic (can cause cancer).
  5. Hazardous substances contained in cigarettes include tar, carbon monoxide, cyanide, arsenic, formaldehyde, nitrosamine, and others.

Types of smokers

Based on the type of smokers can be divided into:

  1. Active smoker
    They have gotten used to and actually smoked cigarettes and paid for the consequences themselves.
  2. Passive smoker
    They actually do not smoke but because there are other people who smoke nearby then they automatically participate in the smoking cigarette with all the consequences.
    Based on the number of smokers divided into:
  3. Light smokers.
    Smokers who smoke or spend about 1-10 cigarettes per day.
  4. Medium smokers.
    Smokers who spend about 10-20 cigarettes per day.
  5. Heavy smokers.
    Smokers who spend more than 20 cigarettes per day.

Substances contained in smoking

  1. Nicotine
    This substance contains opium can cause a person addicted to keeping smokes cigarettes.
    Influence on the human body
    a. Causing addiction or dependence damages brain tissue
    b. Cause blood rapidly freezes
    c. Hardened artery walls
  2. Tar
    The basic ingredients of making the asphalt that can stick to the lungs and can cause irritation and even cancer
    Influence on the human body
    a. Kill the cells in the bloodstream
    b. Increase the production of mucus in the lungs
    c. Causes lung cancer
  3. Carbon Monoxide
    Gas that can cause heart disease because this gas can bind oxygen in the body.
    Influence on the human body
    a. Binds hemoglobin, so the body is deprived of oxygen
    b. blocking transport in the blood
  4. Carcinogenic substances
    Influence on the human body
    It triggers the growth of cancer cells in the body
  5. Irritants
    Influence for human body
    a. To pollute the airways and airbags in the lungs
    b. Causes a cough.
    As we know there are 4000 toxic chemicals in a cigarette. 40 of them are harmful substances such as hydrogen cyanide (HCN), arsenic, ammonia, polonium, and carbon monoxide (CO). This chemical is composed of 85% gas components and particles.

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