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Hb(Fe2+)O2
oksiHb
Cara Kerja :
A. OksiHb
1. Ke dalam sebuah tabung reaksi encerkan 2 ml darah dengan 6 ml air suling. Campur
dengan baik dan perhatikan warna merah terang dari oksihemoglobin yang
terbentuk.
2. Bagi 2 isi tabung tersebut sehingga masing-masing tabung berisi 4 ml. Gunakan
tabung 1 sebagai kontrol.
B. Pembentukan deoksiHb
1. Isi tabung ketiga dengan 2 ml pereaksi Stokes dan tambahkan NH 4OH secukupnya
untuk melarutkan endapan yang segera terbentuk. Campuran ini merupakan larutan
pereduksi yang kuat.
2. Masukkan beberapa tetes larutan Stokes ke dalam tabung 2. Terlihat perubahan
warna karena terbentuknya deoksiHb. Bandingkan dengan tabung 1.
C. Pembentukan kembali oksiHb dari deoksiHb
1. Kocok kuat-kuat tabung yang bereaksi deoksiHb, maka akan terjadi kembali
oksigenasi dari udara. Perhatikan dan catat warna HbO2 yang kembali terbentuk.
Buku Panduan Praktikum ( BPP) Modul Respirasi PSPD FK Universitas Palangka
Raya
Page 2
Tabung 1
oksiHb
Tabung 2
deoksiHb
Tabung 3
reoksigenasiHb
Kesimpulan :
Hb (Fe3+)
MetHb
+ K3Fe(CN)6
oksidator
+ K4Fe(CN)6
4. Disposible syringe
5. Alumunium foil
6. Alkohol swab
7. Penjepit tabung
Cara Kerja
1. Encerkan 1 ml darah dengan 4 ml air suling dalam tabung reaksi.
2. Ke dalam tabung itu tambahkan beberapa tetes K3Fe(CN)6 33 %. Perhatikan dan catat
perubahan warna yang terjadi. Kemudian tambahkkan pereaksi Stokes ke dalaam
tabung itu dan kocok kuat-kuat. Perubahan apakah yang terlihat?
3. Encerkan 3 ml darah dengan 3 ml air suling dan panaskan sebentar, lalu tambahkan
6 ml K3Fe(CN)6. Campur dengan membalik-balikannya. Perhatikan gelembunggelembung oksigen yang terbentuk.
Hasil
Tabung
Warna Tabung 1
+ K3Fe(CN)6
Pengocokan kuat
+ Stokes
Pengocokan kuat
Warna Tabung 2
+ K3Fe(CN)6
Gelembung udara
Pembahasan :
Kesimpulan :
T AH AN N AP AS
TUJUAN
Tujuan Instruksional Umum
Memahami pengaruh berbagai kondisi pernapasan terhadap tercapainya breaking point
pada waktu menahan napas.
Tujuan Perilaku Khusus
Menentukan lama tercapainya breaking point seseorang pada waktu menahan napas
pada berbagai kondisi pernapasan.
Menerangkan sebab terjadinya perbedaan lama kesanggupan menahan napas pada
kondisi pernapasan yang berbeda-beda.
Alat Yang Diperlukan
Stopwatch
Beberapa kantong plastik:
berisi O2 murni
Catat lamanya OP dapat menahan napas pada berbagai kondisi pernapasan di atas
(dalam detik).
P-TN.1. Apa yang dimaksud dengan breaking point?
P-TN.2.
4.
PHYSIO
EX
PHYSIOLOGY
8.0:
R E S P I R ATOR Y
SYSTEM
OBJECTIVES
1. To define the following terms: ventilation, inspiration, expiration, forced expiration, tidal
volume, expiratory reserve volume, inspiratory reserve volume, residual volume, vital
capacity, forced expiratory volume, minute respiratory volume, surfactant, and
pneumothorax.
2. To describe the role of muscles and volume changes in the mechanics of breathing.
3. To understand that the lungs do not contain muscle and that respirations are therefore
caused by external forces.
4. To explore the effect of changing airway resistance on breathing.
5. To study the effect of surfactant on lung function.
6. To examine the factors that cause lung collapse.
7. To understand the effects of hyperventilation, rebreathing, and breath holding on the
CO2 level in the blood.
INSTRUMENTS
1.
2.
PROCEDURES
I. ACCESSING THE PHYSIO EX 8.0 WEBSITE
1.
2.
3.
4.
Connect your laptop to the wireless internet access in the physiology laboratory.
Open your browser, go to www.myaandp.com
Click the Log In button in the lower left area of the page.
Choose the Human Anatomy & Physiology, 8e book by Elaine Marieb &
Katja Hoehn
5. Type faalui in the Login Name.
6. Ask your tutor to fill in the Password.
7. Choose PhysioEx 8.0 at the lower left area of the page.
II. SIMULATING
CAPACITIES
SPIROMETRY:
MEASURING
RESPIRATORY
VOLUMES
AND
Choose Exercise 7: Respiratory System Mechanics from the drop-down menu and
click GO. Then click Respiratory Volumes. The opening screen for the Respiratory
Volumes experiment will appear in a few seconds.
A. Measuring Respiratory Volumes
2.
4.
5.
6.
7. Now click Record Data to record the current experimental data in the data
grid. Then click Clear Tracings.
8. Click Tools Print Data and choose Adobe PDF as the printer to save the
data in PDF format (attach the data in your lab report).
B. Examining the Effect of Changing Airway Resistance on Respiratory
Volumes
2.
4.
5.
6.
Here you will explore what effect changing the diameter of the airway has on
pulmonary function.
1. Do not clear the data table from the previous experiment.
Adjust the radius of the airways to 4.50 mm by clicking the (-) button next to the
Radius window.
3. Click Start to begin respirations.
Click FVC. As you saw in the previous test, the simulated lungs will inhale
maximally and then exhale as forcefully as possible. FEV1 will be displayed in the
FEV1 window below the oscilloscope.
When the lungs stop respiring, click Record Data to record the current data in the
data grid.
Decrease the radius of the airways in 0.50-mm decrements and repeat steps 4
and 5 until the minimum radius (3.00 mm) is achieved. Be sure to click Record
Data after each trial. Click Clear Tracings between trials. If you make an error
and want to delete a single value, click the data line in the data grid and then click
Delete Line.
7. A useful way to express FEV1 is as a percentage of the forced vital capacity. Copy
the FEV1 and vital capacity values from the computer screen to Chart 1, and then
calculate the FEV1 (%) by dividing the FEV1 volume by the vital capacity volume
and multiply by 100. Record the FEV1 (%) in Chart 1.
What happened to the FEV1 (%) as the radius of the airways was
decreased? Explain your answer.
8. Click Tools Print Data and choose Adobe PDF as the printer to save the
data in PDF format (attach the data in your lab report).
How did the pressure in the left lung differ from that in the right lung?
Explain your reasoning.
How did the total air flow in this trial compare with that in the previous trial
in which the pleural cavities were intact?
What do you think would happen if the two lungs were in a single large
cavity instead of separate cavities?
9. Now close the valve you opened earlier by clicking it again, and then click
Start to begin a new trial.
10. When the run completes, click Record Data to display the data in the grid.
Did the deflated lung reinflate? Explain your answer.
11. Click the Reset button atop the bell jar. This action draws the air out of the
intrapleural space and returns it to normal resting condition.
12. Click Start, and allow the run to complete.
13. When the run completes, click Record Data to display the data in the grid.
14. Click Tools Print Data and choose Adobe PDF as the printer to save the data
in PDF format (attach the data in your lab report).
Why did lung function in the deflated (left) lung return to normal after you
clicked Reset?
IV. SIMULATING VARIATIONS IN BREATHING
Choose Variations in Breathing from the Experiment menu. The opening screen will
appear in a few seconds.
A. Exploring Various Breathing Patterns
You will establish the baseline respiratory values in the first part of this experiment.
1. If the grid in the data control unit is not empty, click Clear Table to discard all previous
data.
2. Adjust the radius of the airways to 5.00 mm by clicking the appropriate button next to
the Radius window. Now, read through steps 3-5 before attempting to execute them.
Click Start, and notice that it changes to Stop to allow you to stop the respiration.
3. Watch the simulated lungs begin to breathe as a result of the external mechanical
forces supplied by the pump below the bell jar. Simultaneously, the oscilloscope
will display a tracing of the tidal volume for each breath.
4. After 2 seconds, click the Hyperventilation button and watch the PCO2 displays. The
breathing pattern will change to short, rapid breaths. The PCO2 of the air in the lungs
will be displayed in the small window to the right of the Hyperventilation button.
5. Watch the oscilloscope display and the PCO2 window, and click Stop before the
tracing reaches the end of the screen.
What happens to PCO2 during rapid breathing? Explain your answer.
6. Click Record Data.
7. Now click Clear Tracings to prepare for the next run.
REBREATHING
When Rebreathing is clicked, a small bag will appear over the end of the air tube
to allow the air within the lungs to be repeatedly inspired and expired.
1. Click Start, wait 2 seconds, and then click Rebreathing.
2. Watch the breathing pattern on the oscilloscope, and notice the PCO2 during the
course of the run. Click Stop when the tracing reaches the right edge of the
oscilloscope.
What happens to PCO2 during the entire time of the rebreathing activity?
Did the depth of the breathing pattern change during rebreathing? (Carefully
examine the tracing for rate and depth changes; the changes can be subtle.)
Explain your observations.
3. Click Record Data, and then click Clear Tracings to prepare for the next run.
BREATH HOLDING
1. Click Start, wait a second or two, and then click Breath Holding.
2. Let the breath-holding activity continue for about 5 seconds, and then click
Normal Breathing.
3. Click Stop when the tracing reaches the right edge of the oscilloscope.
What happened to the PCO2 during breath holding?
3. After these selections are made, click the Start button and watch as the drum
starts turning and the spirogram develops on the paper rolling off the drum
across the screen, left to right.
4. When half the screen is filled with unforced tidal volumes and the trace has
paused, select the Forced Vital Capacity button in the Breathing Pattern
Options box.
5. Click the Start button and the trace will continue with the FVC maneuver. The
trace ends as the paper rolls to the right edge of the screen.
6. Now click on the individual measure buttons that appear in the data table
above each data column to measure the lung volume and lung capacity data.
Note that when a measure button is selected, two things happen
simultaneously: (1) a bracket appears on the spirogram to indicate where that
measurement originates on the spirogram and (2) the value in milliliters appears in the data table. Also note that when the FEV1 measure button is
selected, the final column labeled FEV1/FVC will be automatically calculated
and appear in the data table. The calculation is (FEV1/FVC) X 100%, and the
result will appear as a percentage in the data table.
What do you think is the clinical importance of the FVC and FEV1 values?
Why do you think the ratio of these two values is important to
the clinician when diagnosing respiratory diseases?
FEV1/FVC X 100% = _______________
EMPHYSEMA BREATHING
1. Select Emphysema from the drop-down menu in the Patient Type box.
2. Select the patients breathing pattern as Unforced Breathing from the Breathing
Pattern box.
3. After these selections are made and the existing spirogram screen clears, click the
Start button and watch as the drum starts turning and a new spirogram develops
on the paper rolling off the drum.
4. Repeat steps 4-6 of the Normal Breathing section in this activity.
5. Now consider the accuracy of your predictions (what changed versus what you
expected to change). Compared to the values for normal breathing:
is
this
condition
similar
to
having
emphysema?
How
is
Emphysema and asthma are called obstructive lung diseases as they limit
expiratory flow and volume. How would a spirogram look for someone with a restrictive
lung disease, such as pulmonary fibrosis?
What volumes and capacities would change in this case, and would these
values be increased or decreased?
ACUTE
ASTHMA
ATTAC K
BREATHING
INHALER MEDICATION APPLIED
WITH
1. Select Plus Inhaler from the drop-down menu in the Patient Type box.
2. Select the patients breathing pattern as Unforced Breathing from the Breathing
Pattern box.
3. After these selections are made and the existing spirogram screen clears, click the
Start button and watch as the drum starts turning and a new spirogram develops
on the paper rolling off the drum.
4. Repeat steps 4-6 of the Normal Breathing section in this activity.
5. Now consider the accuracy of your predictions (what changed versus what you
expected to change). Compared to the values for the patient experiencing asthma
symptoms:
In moderate aerobic exercise, which do you predict will change more, the ERV
or the IRV?
Do you predict that the respiratory rate will change significantly in moderate
exercise?
Comparing heavy exercise to moderate exercise, what values do you predict
will change when the bodys significantly increased metabolic demands are
being met by the respiratory system?
During heavy exercise, what will happen to the lung volumes and capacities
that have been considered thus far?
Will the respiratory rate change? If so, how?
1. Select Moderate Exercise from the drop-down menu in the Patient Type box.
The existing spirogram clears.
2. Click the Start button and watch as the drum starts turning and a new spirogram
develops. Half of the screen will fill with breathing volumes and capacities for
moderate exercise.
3. When the trace pauses, click on the individual measure buttons that appear in the
data table above each data column to measure the lung volume and lung capacity
data.
4. Select Heavy Exercise from the drop-down menu in the Patient Type box.
5. Click the Start button and the trace will continue with the breathing pattern for
heavy exercise. The trace ends as the paper rolls to the right-hand edge of the
screen.
6. Now click on the individual measure buttons that appear in the data table above
each data column to measure the lung volume and lung capacity data.
7. Now consider the accuracy of your predictions (what changed versus what you
expected to change).
S E S AK N AP AS
TUJUAN
Tujuan Instruksional Umum
Mengenal sensasi dan penyebab sesak napas.
Tujuan Perilaku Khusus
1.
2.
Stopwatch
Karet penutup hidung (nose piece) berlubang dengan 3 ukuran diameter lubang:
3 mm
4 mm
5 mm
TATA KERJA
1.
2.
3.
Pasanglah karet penutup hidung (nose piece) ukuran 5 mm pada salah satu hidung
OP. Tutuplah lubang hidung yang lain (dengan jari telunjuk OP), sehingga udara
harus mengalir melalui hidung dengan nose piece.
Minta OP untuk terus bernapas sampai napas terasa menjadi sangat sesak dan tidak
sanggup lagi bernapas menggunakan karet penutup hidung tersebut. Bila OP masih
dapat bertahan sampai 5 menit, hentikan percobaan.
P-SN.2.
4.
5.
Catat lama waktu OP dapat bernapas melalui karet penutup hidung dalam detik.
Ulangi percobaan butir 2 s/d 4 dengan menggunakan karet penutup hidung ukuran 4
mm dan 3 mm. Beri istirahat 5 menit antara 2 percobaan.
P-SN.3.
OBJECTIVES
1. To define pH, and to identify the normal range of human blood pH levels.
2. To define acid and base, and to explain what characterizes each of the following: strong
acid, weak acid, strong base, and weak base.
3. To explain how chemical and physiological buffering systems help regulate the bodys
pH levels.
4. To define the conditions of acidosis and alkalosis.
5. To explain the difference between respiratory acidosis and alkalosis and metabolic
acidosis and alkalosis.
6. To understand the causes of respiratory acidosis and alkalosis.
7. To explain how the renal system compensates for respiratory acidosis and alkalosis.
8. To understand the causes of metabolic acidosis and alkalosis.
9. To explain how the respiratory system compensates for metabolic acidosis and
alkalosis.
INSTRUMENTS
1.
2.
PROCEDURES
I. ACCESSING THE PHYSIO EX 8.0 WEBSITE
1.
2.
3.
4.
Connect your laptop to the wireless internet access in the physiology laboratory.
Open your browser, go to www.myaandp.com
Click the Log In button in the lower left area of the page.
Choose the Human Anatomy & Physiology, 8e book by Elaine Marieb &
Katja Hoehn
5. Type faalui in the Login Name.
6. Ask your tutor to fill in the Password.
7.
Choose PhysioEx 8.0 at the lower left area of the page.
II. RESPIRATORY ACIDOSIS AND ALKALOSIS
From the drop-down menu, select Exercise 10: Acid/Base Balance and click GO.
Then click Respiratory Acidosis/Alkalosis. You will see the opening screen for the
Respiratory Acidosis/Alkalosis experiment
A. Normal Breathing
We will begin by observing what happens during normal breathing in order to
establish baseline data.
Click Start. Notice that the Normal Breathing button dims, indicating that
1. the simulated lungs are breathing normally. Also notice the reading in the pH
meter at the top left, the readings in the P CO2 displays, and the shape of the trace
that starts running across the oscilloscope screen. As the trace runs, record the
readings for pH at each of the following times:
At 20 seconds, pH = _______________
At 40 seconds, pH = _______________
At 60 seconds, pH = _______________
2. Allow the trace to run all the way to the right side of the oscilloscope screen. At
this point, the run will automatically end.
3. Click Record Data at the bottom left to record your results.
4. Click Tools Print Graph and choose Adobe PDF as the printer to save the
data in PDF format (attach the data in your lab report).
5. Click Clear Tracings to clear the oscilloscope screen.
Did the pH level of the blood change at all during normal breathing? If so,
how?
Was the pH level always within the normal range for the human body?
Did the PCO2 level change during the course of normal breathing? If so,
how?
B. Hyperventilation - Run 1
Next, we will observe what happens to pH and carbon dioxide levels in the blood
during hyperventilation.
1. Click Start. Allow the normal breathing trace to run for 10 seconds; then at the
10-second mark, click Hyperventilation. Watch the pH meter display, as well
as the readings in the PCO2 displays and the shape of the trace. As the trace
runs, record the readings for pH at each of the following times:
At 20 seconds, pH = _______________
At 40 seconds, pH = _______________
At 60 seconds, pH = _______________
2. Allow the trace to run all the way to the right side of the oscilloscope screen. At
this point, the run will automatically end.
3. Click Record Data at the bottom left to record your results.
4. Click Tools Print Graph and choose Adobe PDF as the printer to save the
data in PDF format (attach the data in your lab report).
5. Click Clear Tracings to clear the oscilloscope screen.
Did the pH level of the blood change at all during this run? If so, how?
Was the pH level always within the normal range for the human body?
If not, when was the pH value outside of the normal range, and what acidbase imbalance did this pH value indicate?
Did the PCO2 level change during the course of this run? If so, how?
If you observed an acid-base imbalance during this run, how would you
expect the renal system to compensate for this condition?
How did the hyperventilation trace differ from the trace for normal breathing?
Did the tidal volumes change?
What might cause a person to hyperventilate?
C. Hyperventilation Run 2
This activity is a variation on Activity 2a.
1. Click Start. Allow the normal breathing trace to run for 10 seconds, then click
Hyperventilation at the 10-second mark. Allow the hyperventilation trace to
run for 10 seconds, then click Normal Breathing at the 20-second mark. Allow
the trace to finish its run across the oscilloscope screen. Observe the changes
in the pH meter and the PCO2 displays.
2. Click Record Data.
3. Click Tools Print Graph and choose Adobe PDF as the printer to save the
data in PDF format (attach the data in your lab report).
4. Click Clear Tracings to clear the oscilloscope screen.
Describe the trace after the 20-second mark when you stopped the
hyperventilation. Did the breathing return to normal immediately? Explain
your observation.
D. Rebreathing
In this activity, we will observe what happens to pH and carbon dioxide levels in
the blood during rebreathing.
1. Click Start. Allow the normal breathing trace to run for 10 seconds; then at the
10-second mark, click Rebreathing. Watch the pH meter display, as well as
the readings in the PCO2 displays and the shape of the trace. As the trace runs,
record the readings for pH at each of the following times:
At 20 seconds, pH = _______________
At 40 seconds, pH = _______________
At 60 seconds, pH = _______________
2. Allow the trace to run all the way to the right side of the oscilloscope screen. At
this point, the run will automatically end.
3. Click Record Data at the bottom left to record your results.
4. Click Tools Print Graph and choose Adobe PDF as the printer to save the
data in PDF format (attach the data in your lab report).
Click Clear Tracings to clear the oscilloscope screen
Did the pH level of the blood change at all during this run? If so, how?
Was the pH level always within the normal range for the human body?
If not, when was the pH value outside of the normal range, and what acidbase imbalance did this pH value indicate?
Did the PCO2 level change during the course of this run? If so, how?
If you observed an acid-base imbalance during this run, how would you
expect the renal system to compensate for this condition?
How did the rebreathing trace differ from the trace for normal breathing?
Did the tidal volumes change?
Give examples of respiratory problems that would result in pH and P CO2
patterns similar to what you observed during rebreathing.
5. To print out all of the recorded data from this activity, click Tools Print Data
and choose Adobe PDF as the printer to save the data in PDF format (attach
the data in your lab report).
III. METABOLIC ACIDOSIS AND ALKALOSIS
Click Experiment at the top of the screen, and select Metabolic Acidosis/Alkalosis.
The screen will appear.
A. Respiratory Response to Normal Metabolism
1.
2.
3.
4.
5.
This data will serve as a baseline against which we will compare our data in the
next 2 activities.
Make sure the Metabolic Rate is set to 50, which for the purposes of this
experiment we will consider the normal value.
Click Start to begin the experiment. Notice the arrows showing the direction of
blood flow. A graph displaying respiratory activity will appear on the oscilloscope
screen.
After the graph has reached the end of the screen, the experiment will
automatically stop. Note the data in the displays below the oscilloscope screen:
The BPM display gives you the breaths per minute - the rate at which
respiration occurred.
Blood pH tells you the pH value of the blood.
PC02 (shown as PCO2 in the text) tells you the partial pressure of carbon
dioxide in the blood.
H+ and HC03~ tell you the levels of each of these ions.
Click Record Data.
Click Tools Print Graph and choose Adobe PDF as the printer to save the
data in PDF format (attach the data in your lab report).
How did respiration change with respect to BPM and tidal volume?
How did blood pH change?
How did PCO2 change?
How did [H+] change?
How did [HCO3-] change?
Explain why these changes took place as metabolic rate increased.
Hint: Start with the formation of excess CO 2 waste and explain the
changes.
Which metabolic rates caused pH levels to decrease to a condition of
metabolic acidosis?
What were the pH values at each of these rates?
By the time the respiratory system fully compensated for acidosis, how
would you expect the pH values to change?
7.
5.
6.
Click Tools Print Graph and choose Adobe PDF as the printer to save the
data in PDF format (attach the data in your lab report).
Repeat steps 1 through 5 with the Metabolic Rate set at 30, and then 20.
As the bodys metabolic rate decreased:
Click Tools Print Data and choose Adobe PDF as the printer to save the data in PDF
format (attach the data in your lab report).S P I R O M E T R I
TUJUAN
Tujuan Instruksional Umum
Menguraikan cara melakukan pencatatan spirogram dengan menggunakan spirometer
Collins.
Menguraikan cara melakukan pencatatan spirogram dengan menggunakan spirometer
elektronik (Spirometer Koko Legend)
Menganalisis pelbagai volume dan kapasitas paru pada sebuah spirogram.
Tujuan Perilaku Khusus
1.1. Melakukan langkah-langkah persiapan alat spirometer mekanik Collins.
1.2. Menghubungkan OP dengan alat spirometer Collins untuk memperoleh pencatatan
spirogram.
1.3. Memberi instruksi kepada OP agar dapat dilakukan pencatatan spirogram pada
pelbagai sikap pernapasan (tenang, dalam, paksa dan sebagainya).
1.4. Melakukan pencatatan spirogram dengan spirometer Collins pada pelbagai sikap
pernapasan.
2.1. Melakukan langkah-langkah persiapan alat spirometer elektronik (Spirometer Koko
Legend).
2.2. Memberi instruksi kepada OP sehingga dapat dilakukan pencatatan spirogram.
2.3. Melakukan pencatatan spirogram dengan spirometer elektronik.
3.1.
3.2.
3.3.
3.4.
3.5.
3.6.
3.7.
3.8.
3.9.
3.10.
3.11.
3.12.
TATA KERJA
A. SPIROMETER MEKANIK (COLLINS)
Pada percobaan ini digunakan spirometer tanpa soda lime.
1.
2.
3.
4.
5.
6.
7.
8.
Putar kran 3 jalan ke posisi A dan keluarkan sisa udara yang masih terdapat di dalam
alat dengan cara menekan-mengangkat sungkup spirometer 3 kali. Isilah spirometer
dengan udara biasa secukupnya dengan cara mengangkat sungkup. Tutuplah
spirometer dengan cara memutar kran 3 jalan ke posisi B.
Bersihkan mouthpiece yang terdapat pada ujung pipa penghubung karet spirometer
dengan kapas dan alkohol, biarkan sebentar sampai kering.
Suruh OP berdiri menghadap alat.
Hubungkan OP dengan alat, dengan cara menyuruh OP memasukkan mouthpiece ke
dalam mulutnya dan tutuplah hidung OP dengan penjepit hidung.
Biarkan OP bernapas tenang dengan udara luar untuk beberapa waktu.
Siapkan alat pencatat spirometer untuk dapat mencatat gerakan pernapasan OP.
Bila pernapasan OP sudah terlihat tenang dan teratur, putarlah kran 3 jalan ke posisi
A. OP sekarang bernapas ke dalam spirometer dan pena spirometer terlihat turunnaik mengikuti irama pernapasan.
Jalankan kimograf dengan kecepatan rendah (skakelar didorong ke S) dan catatlah 5
gerakan pernapasan.
P-SP.1.
9.
10. Putar kran ke posisi B dan dengan hidung tetap tertutup, suruh OP melatih diri untuk
melakukan inspirasi dan ekspirasi maksimal secepat-cepatnya.
11. Putar lagi kran ke posisi A, jalankan kimograf dengan kecepatan rendah dan catat
lagi pernapasan tenang OP.
12. Suruh sekarang OP melakukan inspirasi maksimal dan menahan napasnya sesaat.
Setelah kecepatan kimograf diubah dari rendah menjadi cepat (skakelar didorong ke
F), suruh OP ekspirasi secara kuat, maksimal dan secepat-cepatnya.
Hentikan kimograf.
P-SP.5.
13. Lepaskan mouthpiece dari mulut OP. Bersihkan udara di dalam spirometer dan isilah
kembali dengan udara luar, menurut cara butir 1.
14. Hubungkan kembali OP dengan spirometer, jepit hidungnya, jalankan kimograf
dengan kecepatan seperti rendah dan catat kembali pernapasan tenang OP untuk 34 gerakan pernapasan.
15. Suruh OP bernapas sedalam-dalamnya dan secepat-cepatnya minimal selama 12
detik (hiperventilasi maksimal).
Hentikan kimograf.
P-SP.11. Pencatatan apa yang telah dilakukan?
1.
j.
a. FEV1
b. Estimated Maximum Voluntary Ventilation (MVVest)
P-SP.18. Bangaimana cara menghitung MVVest?
c. FEV1/FVC
d. FEF 25-75%
P-SP.19. Apakah definisi dari FEF 25-75%?
e. Peak Expiratory Flow Rate (PEFR)
P-SP.21. Apakah definisi dari PEFR?
f.
3. RPR Antigen
Tujuan: mendeteksi antibodi pada serum pasien yang terinfeksi sifilis
Alat dan Bahan
Alat
1. Mikroskop
2. RPR card test
3. Pipet tetes
4. Sarung tangan
1.
2.
3.
4.
Bahan
1. Reagen RPR
2. Kontrol positif dan negatif
3. Serum
4. Antigen karbon
Cara Kerja
Teteskan 1 tetes kontrol positif pada kertas pemeriksaan pada lingkaran 1
Teteskan 1 tetes kontrol negatif pada kertas pemeriksaan pada lingkaran 2
Teteskan 1 tetes serum atau sampel plasma pada lingkaran 3 pada kertas pemeriksaan
Lebarkan sampel pada lingkaran
5. Teteskan antigen karbon diatas sampel dengan cara meneteskan karbon dalam posisi
tegak lurus dan tidak menyentuh sampel, jangan dicampurkan
6. Goyangkan kertas pemeriksaan baca 8 menit kemudian
Interprestasi hasil positif: agregasi
PENDAHULUAN
Buku praktikum ini dibuat untuk mempelajari morfologi parasit dan hasil uji
diagnostik spesifik dari parasit yang dapat menyebabkan kelainan saluran nafas, sehingga
mahasiswa dapat lebih memahami dan mengingat kembali teori parasit penyebab
gangguan saluran pernafasan yang telah diterima.
Waktu
Tempat
PJ
Tujuan Umum:
Mahasiswa diharapkan mengetahui dan memahami parasit penyebab infeksi pada saluran
pernafasan dan cara menegakkan diagnosisnya.
Tujuan Khusus:
Setelah mengikuti praktikum mahasiswa diharapkan:
a. Memahami beberapa parasit penyebab infeksi pada saluran pernafasan (House dust
mite/ Dermatophagoides pteronyssimus, Microphilaria/ Filaria larvae Wuchereria
bancrofti dan Entamoeba histolytica)
b. Memahami stadium dan morfologi parasit penyebab infeksi pada saluran pernafasan
c. Dapat mengidentifikasi bentuk parasit dan menghubungkannya dengan manifestasi
klinis
d. Mengetahui pemeriksaan serologi untuk menegakkan diagnosis dari parasit penyebab
infeksi saluran pernafasan
Aktivitas :
1.Kuliah pendahuluan
2.Demonstrasi slide
3.Diskusi dengan tutor
1. Dermatophagoides pteronyssimus
Tungau debu
Stadium: dewasa
Perhatikan:
Ukuran: 0,34 mm (betina), 0,28 mm (Jantan)
Bentuk badan: seperti kantong
Empat pasang kaki, dua pasang kaki depan
dan dua pasang kaki belakang
Mikroskop
2. Dermatophagoides pteronyssimus
Tungau debu
4. Filaria
Mikroskop
6. Entamoeba histolytica
(pewarnaan lugol)
Perhatikan :
Mikroskop
bentuk kista
besar kista
7. Entamoeba histolytica (stadium trofozoit)
Mikroskop
Perhatikan :
bentuk trofozoit
endoplasma
ektoplasma
Mikroskop
Perhatikan :
dinding kista
ektoplasma tidak tampak jelas
inti
ventilasinya.
Jangan mengumpulkan sputum di dalam ruangan laboratorium, kamar kecil, ruang
tunggu, ruang pendaftaran atau ruang dengan ventilasi buruk; sebaiknya dilakukan
di luar bangunan yang jauh dari pengunjung
Petugas jangan berdiri di depan penderita pada waktu pengambilan spesimen
Sebelum mengeluarkan sputum, sebaiknya kumur dengan air matang untuk
menghindari kontaminasi dari flora normal mulut
Bila memakai gigi palsu, lepaskan sebelum berkumur
Tarik nafas dalam 2 3 kali dan setiap kali hembuskan nafas dengan kuat
Letakkan pot yang sudah dibuka dan diberi label nama, tanggal serta waktu
pengambilan sputum dekat dengan mulut dan batukkan sputum kedalam pot
Batukkan dengan keras dari dalam dada
Tutup pot dengan rapat dengan cara memutar tutupnya
Setelah mengeluarkan dahak, bersihkan mulut dengan tissue dan buang tissue di
tempat sampah yang tertutup, kemudian cuci tangan
Bila perlu hal-hal diatas dapat diulang beberapa kali untuk mendapatkan sputum
yang berkualitas baik dengan volume yang cukup (3-5 ml)
Bila sputum sulit dikeluarkan, lakukan olah raga ringan kemudian menarik nafas
dalam beberapa kali sampai terasa akan batuk, nafas ditahan selama mungkin
kemudian batukkan. Malam sebelum tidur dianjurkan banyak minum air atau
menelan 1 tablet gliseril guaiakolat 200 mg
c. Sputum yang berkualitas baik adalah :
Sputum yang mukoid, purulen atau bercampur darah
Dengan pewarnaan Gram dan pembesaran objektif 10x sesuai dengan kriteria
dimana jumlah sel lekosit lebih banyak dibandingkan dengan sel epitel (sel epitel <
10 dan sel lekosit PMN > 25 untuk 20 30 lapang pandang yang berbeda).
d. Pengumpulan sputum perlu diulang apabila :
Spesimen jelas merupakan air liur (encer seperti air atau sebagian besar terdiri dari
gelembung-gelembung)
Data pada pot tidak sesuai dengan formulir permohonan pemeriksaan
Spesimen dikumpulkan pada wadah yang tidak memenuhi persyaratan (pot pecah
atau retak, tidak bersih atau steril, kertas tissue, kantong plastik dsb)
Spesimen diberi pengawet, seperti formalin dsb.
Kualitas sputum tidak memenuhi syarat berdasarkan pemeriksaan mikroskop
TUJUAN PRAKTIKUM
Setelah mengikuti kegiatan ini, mahasiswa diharapkan dapat :
1.
2.
3.
4.
5.
pemeriksaan
mikrobiologik
untuk
mendeteksi
keberadaan
3.
4.
5.
6.
Cara Kerja
Pengambilan bahan usap tenggorok:
1. Lidah dijulurkan dan ditekan dengan spatel. Usapkan kapas steril pada tonsil dan bagian
belakang faring. Hindarkan sentuhan pada lidah dan gigi. Untuk mencegah kekeringan
sebaiknya bahan yang diambil dimasukkan dalam perbenihan tioglikolat atau
medium
transpor lain
2. Bahan pemeriksaan ditanam pada lempeng agar darah dan perbenihan tioglikot.
3. Inkubasi pada suhu 35 C selama 18 24 jam.
4. Buat pewarnaan Gram (preparat langsung).
Interpretasi hasil
Berbagai mikroorganisme yang dapat ditemukan pada tenggorok tumbuh subur
pada lempeng medium biakan agar darah dan dapat dilihat di bawah mikroskop setelah
sediaan diwarnai dengan pewarnaan Gram.
1. Pada sediaan sputum penderita tuberkulosis yang telah direkatkan, tuangkan fukhsinkarbol 0,3 % sampai menutupi seluruh permukaan sediaan
2. Panaskan dengan api kecil hingga keluar uap (tidak boleh mendidih), apabila mendidih
atau kering fukhsin karbol akan membentuk partikel kecil yang akan terlihat seperti
BTA (positif palsu), diamkan selama 5 menit
3. Cuci dengan air sampai zat warna hilang
4. Tuang sediaan dengan asam alkohol (HCl alkohol 3 %) sampai warna merah fukhsinkarbol hilang atau selama 2 detik
5. Cuci kembali dengan air mengalir perlahan
6. Tuangkan larutan biru metilen 0,3 % pada sediaan , diamkan selama 10 20 detik
7. Cuci dengan air, kemudian keringkan di udara terbuka, jangan terkena sinar matahari
langsung
8. Periksa di bawah mikroskop dengan pembesaran 100 x 10, menggunakan minyak
emersi
Cara pembacaan
1. Cari lebih dahulu lapang pandang dengan lensa okuler 10x dan lensa objektif 10x
2. Teteskan 1 tetes minyak emersi diatas sediaan (aplikator minyak emersi tidak boleh
menyentuh kaca objek!)
3. Periksa dengan menggunakan lensa okuler 10x dan lensa objektif 100x ( jangan sekalikali lensa menyentuh kaca sediaan !)
4. Carilah Basil Tahan Asam (BTA) berbentuk batang berwarna merah
5. Periksa sedikitnya 100 lapang pandang dengan cara menggeserkan sediaan menurut
arah sebagai berikut:
3 cm
2 cm
6. Mencatat setiap temuan BTA dalam 1 lapang pandang sebanyak 100 lapang
pandang
Penghitungan BTA
1.
11.
21.
31.
41.
51.
61.
71.
81.
91
Interpretasi hasil
Skala IUATLD (International Union Against Tuberculosis and Lung Diseases),
yaitu pembacaan hasil yang digunakan oleh Departemen Kesehatan RI dalam buku
Pedoman Nasional Penanggulangan Tuberkulosis tahun 2008, yaitu :
dipergunakan,
Sediaan apus dan pewarnaan Ziehl Neelsen yang baik
Biakan Streptococcus -haemolyticus,
yang dapat
ditemukan pada infeksi saluran napas pada medium yang sesuai dan hasil pemeriksaan
mikroskopik dengan pewarnaan Gram/khusus.
HASIL KERJA PEWARNAAN PEWARNAAN ZIEHL NEELSEN
Hasil pewarnaan Ziehl Neelsen
Contoh spesimen sputum dalam pot yang benar Alat yang dibutuhkan dalam pemeriksaan
mikroskopis tuberculosis
Macam-macam media :
No
Nama Media
.
1.
Agar darah
2.
Tellurit
3.
Agar coklat
4.
Lowenstein Jensen
5.
Middlebrook 7H10
6.
Agar Sabouroud
7.
Manitol Salt Agar (MSA)
Kegunaan
Bakteri
Bakteri
Bakter
Streptococcus pneumoniae
Pewarnaan Gram
Pewarnaan Gins-Burry
Corynebacterium diphteriae
Pewarnaan Neisser
Haemophilus influenzae
Biakan pada lempeng agar
coklat
Satellite formation
Staphylococcus aureus
Pewarnaan Gram
Staphylococcus non-aureus
Klebsiella pneumoniae
Pewarnaan Gram
Pseudomonas aeruginosa
Pewarnaan Gram
Aspergillus
Pewarnaan LPBC
Candida albicans
Germ tube pada pewarnaan Gram
I : Photochromogen
A
Warna koloni
Hasil
Contoh
II : Scotocromogen
A
Warna koloni
Hasil
Contoh
III : Non
chromogen
A
B
IV : Rapid
grower
Warna koloni
Hasil
Contoh
Warna koloni
Hasil
Contoh
A:
B:
A:
B:
Uji PNB
A
A:
B:
Skala
4+
3+
2+
1+
Tulis jumlah koloni
Negatif
OAT
Interpretasi hasil :
RESISTEN: isolat dengan jumlah koloni yang tumbuh
dibandingkan LJ tanpa OAT
SENSITIF : isolate dengan jumlah koloni
> 1 %
dengan OAT
dengan OAT
Indicator Tube)
C
adalah
Streptomycin :
INH
:
Rifampicin :
Ethambutol :
INH
0.2
10
INH
0.1
9
RIP
0.2
15
RIP
0.1
14
PAS
1
20
25
11
17
RIP
0.5
16
ETB
2
22
STR
5
INH
0.5
RIP
1
ETB
5
23
STR
10
12
18
Control
INH
1
RIP
2
ETB
10
24
STR
20
13
19
control
1/100
INH
2
RIP
5
ETB
20
AMK
5
ETB
1
21
STR
2
STR
1
Pembacaan dari arah bawah plat DSCP; konsentrasi OAT dalam mg/ml);
AMK : amikacin
< 5 resisten
INH : isoniazid
< 0,2 resisten ; 0,5 0,1 intermediate
RIP : rifampicin
< 1 resisten
PAS : p-aminosalicyl acid < 1 resisten
ETB : ethambutol
< 5 resisten; 10 intermediate
STR : streptomycin
< 5 resisten; 10 intermediate
Cut-off concentration
1.
b.
c.
a.
2.
b.
Daftar pustaka
1. A Fujiki. Bacteriology examination to stop TB. The Research Institute of Tuberculosis
Japan. 2001
2. Direktorat Jenderal Pengendalian Penyakit dan Penyehatan Lingkungan Departemen
Kesehatan RI. Pemeriksaan mikroskopik tuberculosis. Panduan bagi petugas
laboratorium. 2006.
3. Departemen Kesehatan RI. Buku Pedoman Nasional Tuberkulosis. 2008
4. Cappucino, J.G and Sherman, N. Microbiology A Laboratory Manual, 7 ed, Pearson
Education Inc., New York, 2005, p. 321
5. IN de Kantor. Laboratory services in tuberculosis control. Culture (Part III). World
Health Organization. Geneve. 1998
6. Jawetz, Melnick & Adelbergs. Medical Microbiology, ed. 22. California: Appleton
and Lange, 2001
7. JM Miller. A guide to specimen management in clinical microbiology. ASM Press.
Washington DC. 1996.
8. Knapp JS, Rice RJ. Manual of Clinical Microbiology, ed. 6. Washington, DC: ASM
Press, 1995
9. bKwong Chung, KJ and Bennet, JE : Medical Microbiology, Lea and Febiger,
Philadelphia, 1982. p.201
10. P Hawkey, D Lewis. Medical bacteriology, A practical approach. 2 nd Ed. Oxford
University Press. New York. 2004.
11. PR Murray, EJ Baron, MA Pfaller, FC Tenover, RH Yolken. Manual of clinical
Microbiology 8th Ed. ASM Press. Washington DC.2007.
12. Staf pengajar Departemen Mikrobiologi FKUI. Penuntun Praktikum Mikrobiologi
Kedokteran, PT Medical Multimedia Indonesia, Kramat raya 31 Jakarta Pusat., 2005
13. WHO. New technologies for tuberculosis control : A framework for their adoption,
introduction and implementation. 2007.
14. WHO. Recommendations and laboratory procedures for detection of avian influenza A
(H5N1) virus in specimens from suspected human cases. Amendment 30 August 2007.
15. Working Manual Mycobacterial Department.Determination of the Minimal Inhibitory
Concentration (MIC) of the anti-mycobacterial drugs. SOP/LYS/MYC/M113.
National Institute of Public Health (RIVM).Bilthoven. The Netherlands.
.....................................................................................................................................
Otot-otot intrinsik larynx :
M. cricoarytaenoideus posterior
M. arytaenoideus transversus
M. cricothyreoideus
M. cricoarytaenoideus lateralis
Carilah bangunan-bangunan lainnya :
Plica vocalis
Plica ventricularis
Conus elasticus laryngis
Ventriculus laryngis Morgagni
M.intercostalis internus
M.transversus thoracis
F. PARU-PARU
Paru kanan terdiri atas tiga lobus,
yaitu
,..,
..
Paru kiri terdiri atas dua lobus, yaitu ,..
1. Paru kanan
Carilah :
Sulcus esophageus
Sulcus v.cava superior
Sulcus v. axygos
Impressio cardiaca
Bronchus segmentalis :
Apicalis, posterior, anterior
Lateralis, medialis
Apicalis, anterobasal, mediobasal, laterobasal, posterobasal.
2. Paru kiri
Carilah :
Lingula pulmonis
Sulcus aorticus
Sulcus A.carptis communis sinistra
Sulcus A.subclavia sinistra
Impressio cardiaca
Bronchus segmentalis :
Apicoposterior, anterior
Lingularis superior, lingularis inferior
Apicalis, anteromediobasal, laterobasal, posterobasal