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THE PROSEDUR OF TREATMENT ANGINA PEKTORIS The most specific medicine to treat angina is nitroglycerin.

It is a potent vasodilator that makes more oxygen available to the heart muscle. Beta-blockers and calcium channel blockers act to decrease the heart's workload, and thus its requirement for oxygen. Nitroglycerin should not be given if certain inhibitors such as Sildenafil (Viagra), Tadalafil (Cialis), or Vardenafil (Levitra) have been taken by the casualty within the previous 12 hours as the combination of the two could cause a serious drop in blood pressure. Treatments are balloon angioplasty, in which the balloon is inserted at the end of a catheter and inflated to widen the arterial lumen. Stents to maintain the arterial widening are often used at the same time. Coronary bypass surgery involves bypassing constricted arteries with venous grafts. This is much more invasive than angioplasty. The main goals of treatment in angina pectoris are relief of symptoms, slowing progression of the disease, and reduction of future events, especially heart attacks and, of course, death. Beta blockers (e.g., carvedilol, propranolol, atenolol) have a large body of evidence in morbidity and mortality benefits (fewer symptoms, less disability and longer life) and short-acting nitroglycerin medications have been used since 1879 for symptomatic relief of angina. Calcium channel blockers (such as nifedipine (Adalat) and amlodipine), isosorbide mononitrate and nicorandil are vasodilators commonly used in chronic stable angina. A new therapeutic class, called If inhibitor, has recently been made available: ivabradine provides pure heart rate reduction. leading to major anti-ischemic and antianginal efficacy. ACE inhibitors are also vasodilators with both symptomatic and prognostic benefit and, lastly, statins are the most frequently used lipid/cholesterol modifiers which probably also stabilize existing atheromatous plaque. Low-dose aspirin decreases the risk of heart attack in patients with chronic stable angina, and was previously part of standard treatment; however, it has since been discovered that the increase in haemorrhagic stroke and gastrointestinal bleeding offsets this gain so they are no longer advised unless the risk of myocardial infarction is very high. Exercise is also a very good long term treatment for the angina (but only particular regimens - gentle and sustained exercise rather than intense short bursts),

probably working by complex mechanisms such as improving blood pressure and promoting coronary artery collateralisation. Identifying and treating risk factors for further coronary heart disease is a priority in patients with angina. This means testing for elevated cholesterol and other fats in the blood, diabetes and hypertension (high blood pressure), encouraging stopping smoking and weight optimisation. The calcium channel blocker nifedipine prolongs cardiovascular event- and procedure-free survival in patients with coronary artery disease. New overt heart failures were reduced by 29% compared to placebo; however, the mortality rate difference between the two groups was statistically insignificant.

THE PROSEDURE OF TREATMENT EMERGENCY FOR ACCIDENT PATIENT 1. Definition of Triage Triage is a process where patients are classified according to type and severity level condition. Triage consists of classification efforts injury cases quickly based on their severity of injury and chances of their survival through prompt medical intervention. Triage system should be tailored to local expertise. Higher priority given to victims of short-or long-term prognosis in length can be dramatically affected by simple intensive care. Triage system is used to determine priority handling kegawat daruratan. So that medical personnel actually provide relief to patients who desperately need a fast and precise handling, may save the life of these patients. 2. Purpose of Triage The main objective is to identify life threatening conditions. The next goal is to assign triage level or degree of severity that requires emergency assistance. 3. a. International Color Code In Triage: Priority 1 or Emergency: Color RED (severe cases) Patients with life-threatening condition, requiring immediate evaluation and intervention, severe bleeding, the patient was taken to the resuscitation room, the waiting time 0 (zero) 1) 2) 3) 4) 5) b. Asphyxia, cervical injury, injury to the maxilla Head trauma with coma and shock processes are fast Open fractures and compound fractures Burns> 30% / Extensive Burn Shock of any type Priority 2 or Urgent: YELLOW color (the case is) Patients with an acute illness, may need a trolley, wheelchair or on foot, waiting time 30 minutes, the area of critical care. 1) 2) Trauma thorax non asphyxia Closed long bone fractures

3) 4) c. (mild cases)

A burn is limited (<30% of TBW) Injury to the section / soft tissue Or Non-Urgent Priority 3: Color GREEN Patients are usually able to walk with minimal medical problems, old

injuries, conditions which arise long, ambulatory area / space P3. 1) 2) d. (case of death) 1) 2) 3) 4) 4. There was no response at all stimulation There was no spontaneous respiration There is no evidence of cardiac activity There was no pupillary response to light START (Simple And Rapid Treatment triage) Is a system that was developed to allow paramedics to sort out the victims in a short time about - about 30 seconds. That need to be observed: respiration, Perfusion, and Mental Status (RPM). START system is designed to help rescuers to find a patient who suffered serious injuries. START is based on three observations: RPM (respiration, perfusion, and Mental Status) a. Respiration / breathing If the patient is breathing, then specify the frequency pernafasanya, if more than 30 / minute, the victim is marked Red / immediate. This victim showed signs - a sign of shock and need a primer perolongan soon. If the patient is breathing and the frequency of less than 30 / min, immediately do the next observation (perfusion and mental status). If the patient is not breathing, quickly clear the mouth of the victims of the material - the foreign material. b. Perfusion or circulating Minor injuries All cases of ambulant / road Priority 0: Color BLACK

Aims to check if his heart still has the ability to circulate blood adequately, by checking the pulse. If the pulse weak and irregular marked immediate victims. If the pulse was palpable immediately done obserbasi mental status.

c.

Mental status To test this can be done by giving a simple instruction on the victim:

"open your eyes" or "close your eyes".

THE PROSEDURE OF URINE TEST 1. COLLECTING THE SPECIMEN 1. COLLECTING THE SPECIMEN The specimen collection procedure should be explained to the patient clearly and appropriately, taking into account his or her level of understanding and knowledge of medical language. This helps to ensure that the sample is collected properly, a crucial factor in obtaining accurate results. a. When collecting specimens, nurses should beaware of the differences in cultural attitudes towards handling and collection of body fluids, and should be sensitive to any wishes the patient might have. b. The patients privacy should be maintained at all times during the procedure. The person carrying out the procedure should wear non-sterile gloves for his or her own protection and to prevent cross-contamination of the specimen. c. The patient should be given the appropriate container for sample collection. This will be determined by how mobile the patient is, as well as the type of sample required (ie. for testing on site, or for laboratory testing). A commode or bedpan, with a sterile container placed inside, might be required. Children may require assistance to hold a clean container, and parents with babies should be provided with appropriate collection bags. d. e. If a mid-stream specimen of urine is required, a nurse may need to be All patients should be offered hand-washing facilities after the sample has If a catheter specimen is required, the patients privacy and dignity must still be maintained. To obtain a catheter specimen, use a sterile needle and syringe, wearing gloves at all times during the procedure. Clean the coloured cuff, found on the tubing of the catheter bag, with an alcohol swab. Insert the needle into the cuff and withdraw the plunger to collect the specimen. Then withdraw the needle and clean the cuff again with an alcohol swab. Specimens should never be taken directly from the catheter bag as urine in it may have been standing for several hours. present to collect the sample appropriately. been collected.

2.

OBSERVATIONS It is useful to observe the urine before testing it with the reagent strip because

its colour and odour can indicate disease. a. Colour In its normal state, urine should be straw coloured and clear. Cloudiness or debris may indicate an increase in the number of abnormal cells, indicating the presence of disease. b. Odour Freshly voided urine has practically no smell. Urine left standing for several hours has a slight smell of ammonia. Infected urine has a fishy smell. Ketoacidotic urine (urine with a high level of ketones present causing acid imbalance), or urine from anorexic patients, has a sweet peardrop odour. c. Testing with reagent strips Manufacturers produce single test strips to test only for, for example, the presence of glucose or protein or blood (Table 1). Or one strip with multiple reagent areas can be used to test for several substances. Follow the manufacturers instruction relating to storage and use of reagent strips. Slight differences might exist between strips from different manufacturers. Usually, the strips must be stored in the container provided, and kept dry using the desiccant (drying agent) provided in the storage bottle. Check the expiry date on the bottle before using any strips Note any medications the patient is taking at the time of the test. Some preparations can alter the colour of urine, as well as reagent reactions. Beetroot may colour urine red.

3. a.

TESTING USING A STRIP Dip the strip into the urine. Fluid should be allowed to cover all the reagent areas on the strip. Any excess urine should be wiped off on the edge of the specimen container. b. c. Lay the strip flat, on a dry surface, to prevent urine from the reagent areas Observe the reagent area(s) during the recommended reaction time. mixing together. Manufacturers recommend time to reading for each type of test (eg. between 1-2 minutes for protein) and this should be followed. Changes on the reagent test area after this time may not have any diagnostic meaning. Use a watch to ensure each reading is taken accurately. d. Compare the colour of reagent areas on the strip with the colour chart provided on the side of the bottle to read the results, once the recommended time has elapsed. e. All test results should be recorded in the appropriate patient documentation at the time of testing. This is an important stage of the process because the results form an integral part of holistic patient care. Inform the nurse in charge or doctor of any abnormal results. f. Dispose of the urine in a toilet once testing is complete. Examples of diseases for which urinalysis can show early signs and

symptoms: a. b. c. d. e. f. g. h. Liver disease Renal disease Diabetes mellitus Hypertension Pre-eclampsia Biliary disease Renal stones Malignant tumour

Urinalysis yaitu substances which can be screened for : Protein : A morning specimen is best for detecting abnormal levels of protein, hich may indicate hypertension, pre-eclampsia, glomerulonephritis, infection, or diabetes. Normal urine has a low level of albumin Blood Ketones Nitrite : Presence may indicate infection, renal stones, injury to the urinary tract or kidneys, or malignancy. Blood is not normally present in urine : Are produced by the breakdown of fatty acids. Can be indicative of uncontrolled diabetes or anorexia : Optimal results are obtained from first morning specimen of urine, or urine passed four hours after the last voiding. Indicative of infection. Not normally present Glucose : Present if renal absorption is abnormal, or patient has raised blood glucose levels. Not normally present in urine Urobilinogen : Small amount normally present, but elevated levels indicate hepatic abnormalities or red blood cell breakdown Bilirubin : May indicate biliary disease. In conjunction with raised levels of urobilinogen, may indicate hepatic disease Urine Test for Culture & Sensitivity In this test, urine is tested for organisms that may cause an infection. This test can also tell the physician which are the best antibiotics to use if there is an infection. Patient Preparation & Procedure Ideally, the sample is collected in the morning because urine is more concentrated then. The vulva or tip of the penis must be cleaned well with soap and water and dried with sterile gauze. This helps to prevent any bacteria normally found on the skin from getting into the urine sample.

A clean catch or midstream sample is needed. Patients must begin to urinate into the toilet, stop, and then continue to urinate into a sterile plastic jar. When finished, patients should tell the nurse because the sample must be sent to the lab right away. Some patients find it hard to urinate into the small container and may want to wear plastic gloves. Gloves are kept in all patient rooms.