Bahan Ajar Ibu ErLY

7/30/2019 Bahan Ajar Ibu ErLY

1/22

BAHAN AJAR

Komunikasi efektif dalam hubungandokter/drg-pasien

dr erly SpMK

Mengatasi kendala keduapihak,pasien dan dokter

Opini lama: mengembangkan

komunikasi dengan pasienmenyita waktuharus diluruskan!

Komunikasi efektif dokter pasienmenghindari hal negatif

Dokter dapat mengetahui dengan baik kondisipasien dan keluarganya

Pasien percaya sepenuhnya kepada dokter

berpengaruh pada proses penyembuhan pasien Pasien merasa tenang dan aman ditangani oleh

dokterpatuh menjalankan petunjuk dannasihat dokter

Pasien percaya dokter tersebut dapat membantumenyelesaikan masalah kesehatannya


2/22

KURTZ(1998)Komunikasi efektif tidak memerlukan waktulamadokter terampil mengenali kebutuhanpasien.

Pelayanan medis dengan komunikasi efektif

dokter melakukan manajemen pengelolaan

masalah kesehatan bersama pasien

berdasarkan kebutuhan pasien

Pemahaman tentang komunikasi efektifdokter-pasiendiharapkan terjadi perubahansikap dalam hubungan dokter-pasien


3/22

Dua pendekatan komunikasi(KURTZ)

1. Doctor centered communication styleKomunikasi berdasarkan kepentingan dokter

diagnosis penyakit

2. Patient centered communication style.

Komunikasi berdasarkan apa yg dirasakanpasien tentang penyakitnya

Termasuk pendapat pasien,kekhawatirannya,

harapannya,serta apa yg dipikirkannya.

Kemampuan dokter memahamiharapan,kepentingan,kecemasan,sertakebutuhan pasien, pendekatan no 2 tidakperlu waktu lebih lama dari pada no 1.


4/22

Keberhasilan komunikasi dokter-pasienkenyamanan dan kepuasan bagi kedua pihak

empati

Empati dapat dikembangkan apabila doktermemiliki ketrampilan mendengarkan danberbicara (dapat dilatih).

Emphatic Communication in Physician-

Patient Encounter(Bylund&Makoul2002)

Pentingnya empati ini di komunikasikan.

EMPATI:

1. Kemampuan kognitigf dokter dalammengerti kebutuhan pasien

2. Menunjukkan sensitifitas dokter terhadap

perasaan pasien

3. Kemampuan perilaku dokter dalammemperlihatkan empatinya kepada pasien


5/22

The Emphaty Communication CodingSystem(ECCS)levelsBylund&Macoul

Level 0 :dokter menolak sudut pandangpasien

Level 1 :mengenali sudut pandang pasien

sambil lalu

Level 2 :mengenali sudut pandang pasien

secara implisit

Level 3 :dokter menghargai pendapat pasien

Level 4 :dokter mengkonfirmasi pada pasien

Level 5 :dokter berbagi perasaan danpengalaman dengan pasien

Level 3 sampai 5 :dokter mengenal sudut

pandang pasien tentang penyakitnya secaraeksplisit


6/22

Host Defenses Againts ViralInfection

erly

Objectives

Describe three mechanisms ofimmune responses to viral infection.

Human are protected from viral infection by:

1. Natural barriers

2. Non spesific immune defenses

3. Antigen-spesific immune responses


7/22

The ultimate goal of the immune response to eliminate . The virus

. The cells harboring

. Replicating the virus

The immune responsethe best ofcontrolling a virus infection

Humoral and cellular immune responses areimportant for antiviral immunity

Non spesific Immune Defenses Fever and body temp

Infected cells and macrophages

- IFN

- other cytokine

MN Phagocyte system

NK cellls

Local rapid response to viral infectionActivated the spesific immune responses


8/22

IFNtrigger local and systemic responses Fever can limit the replication viruses

MN Phagocyte phagocytize virus and celldebris

Kuppfers cells and spleen rapidly clearmany viruses from the blood

Antibody and Complemen opsonization

Macrophages present antigen to T cellIL1&

IFNinitiate the antigen spesific immuneresponse

NK cells to kill viral-infected cells


9/22

Biological Effects of IFN

Inhibition of multiplication of viruses Inhibition of cell division

Immunomodulation

Increased MHC antigens & Fc receptors

NK cellActivation and maturation

T cell Proliferation ,suppressed lymphokinerelease

DTH(CD4)modulation of DTH

CTL(CD8) cytotoxicity

Macrophage activation


10/22

Antigen-Spesific Immunity

Humoral and CMI play different roles inresolving viral infection

Antibody act mainly on extracellular virions

CMI directed at the virus-producing cells

Humoral Immunity

Viral proteins immunogenic(eliciting anantibody response),but not all

Protective humoral immunity antigen at thesurface of the virus(proteincapsid,glycoproteins)


11/22

Antibody block the progression of diseaseby: netralization&opsonization of cell-freevirus

- binding viral attachment proteins

- preventing interaction with target cells

- destabilizing the virus

- degradation

Antiviral role of antibodypreventing a viremia

Antibody most effective at resolving cytolytic

infections.

Resolution occure because:

-The virus kills the cell factory and

-Antibody eliminate the extracellular virus

Antibody is the primary defense initiated byvaccination


12/22

T-cell Immunity

Promote Antibody ,inflamatory responsesand kills infected cells

CMI.

- especially important for resolving infections

by: . Syncytia-forming viruses

. Non cytolytic viruses

. Controlling latent viruses

Immune response to viral challengeNatural immune response to infection is

determined by :

Host,viral and other factors

Host: - genetic

- immunity

- age

- general health


13/22

Viral: - strain

- infectious dose

- route of entry

Viral Escaping the Immune response

Evading detection

Preventing activation

Blocking immune response

Suppress the immune response


14/22

Viral Immunopathogenesis Flu-like symptoms (IFN)

DTH and inflamation(T cell)

Immune-complex disease

Hemorrhagic disease

Post infection cytolysis

Immunosuppression


15/22

1.Medical Mcrobiology

2. Medical Microbiology and Immunology


16/22

Fungal infectionerly

Focus point:

Describe some of the virulencedeterminants of fungi

Pathogenesis of fungi involve :

colonization

evasion of host defenses,and damage to thehost

The mechanisms,however,are generally not

well understood.


17/22

Eukaryotic Parasites

Attach to host cells via spesific receptors

Use a variety mechanisms to avoid antibodies

Some can produce enzymes that digest hosttissue,causing direct damage

Damage is due to the immune response

Classification Fungal Infection

1. Superficial fungal infection

2. Cutaneus fungal infection

3. Deep/systemic fungal infection


18/22

In general ,intact skin and mucosal surfacebarrier to infection

- Fatty acid

- pH

-Turn over of the skin

- Normal bacterial flora

Pityriasis versicolor =Tinea versicolor

Causal: Malassezia furfur ,yeast like

Lipophilic

Generally harmless

In some people,cause scally face rash,dandruff

Common skin disease patchy scallines and

increased or decrease in pigment in skinpeople.


19/22

Skin scrapping: yeast form and short filaments

mi bakso

Unknown factors,probably relating to the host

Tinea nigra

Piedra

The infections cosmetic problems

Easily diagnosed and treated

Infections of the skin are limited to the outer

most layers of str. CorneumDo not elicit a cellular response


20/22

Cutaneus mycoses

Disease of the skin,hair and nailkeratinizedlayers

Cellular immune response may be evoke in

cutaneous infectionspathological changes

expressed in the deeper tissues of the skin

Clinical manifestation ring worm or tinea

Tinea capitis,corpooris,cruris,manus,pedis andunguium

Favus

Tokelau

Tinea snake like and annularlesions


21/22

Dermatophytes

1. Microsporum2. Trichophyton

3. Epidermophyton

Geophilic (soil)

Zoophilic( animal and birds)

Anthropophilic(human)

Anthropophilic chronic infectiondificult to

cure

Geophilic and zoophilic respons well totherapy and healm spontaneously


22/22

Adelicate balance between host and fungi

keratophilic fungi

Keratinases have been isolated from someof these fungi

Unable to invade organs other than thekeratinazed layers of the skin,hair and nails

The bacteria invade the epithelium aretransported by M cells

Invasion of and multiplication withinintestinal epithelial cells

Death of cells ,intense inflamation and

ulcerations of intestinal lining Bloody and mucus diarrhea

Bahan Ajar Ibu ErLY

Documents

Transcript of Bahan Ajar Ibu ErLY