head injury

head injury

Preliminary

Approximately 40% of patients will experience multiple cedara central nervous system injury. This group will experience a death rate twice as high (35% vs. 17%) compared with the group without CNS injury. Head injuries included 25% of all deaths from trauma and covers half of the death of a motorcycle accident where the other injuries, a thorough evaluation and penataalaksanaan and soon will provide a better possibility of recovery. To continue with the effective management of head injury, need to understand the basic anatomy and physiology is good about the head and brain. Head injuries that occur can be bruising of brain tissue followed by 'swelling' and increased intra-cranial pressure, injury to blood vessels accompanied by bleeding and increased intra-cranial pressure or penetrating injury that damage brain tissue. Selalau must be remembered that in severe head injury should always be assumed to also be accompanied by cedara cervical and spinal cord.

Anatomy of the head

Head (excluding face and facial structures) covers parts:

Scalp Ö

Bone Ö tenkorak

Ö membrane covering the brain (meningens)

Ö brain Network

Cerebrospinal fluid Ö

Ö Vascular Compartment

Scalp has vascularities rich and cause a lot of bleeding if injured, as many small blood vessels located in the matrix of elastic connective tissue.

Normal protective Vasospasme that should occur to reduce the bleeding does not function, causing bleeding continued and significant blood loss. Skull serves as a closed box, the only exit door where the pressure can continue is through foramen magnum is located at the base of the skull where there is a transition between the brainstem and spinal cord. The skull is rigid and narrow in several mechanisms contribute to head injuries.

Because the location of the brain in the head so that more movement at the peak of the brain basis of disbanding. This is an important determinant of the damage. Temporal bones thinner and prone to fracture. Membrane covering the whole brain, thinner layer of Pia arachnoid which lies below duramater and is home to the arteries and veins, the most thin layer piamater located directly below the arachnoid and the brain surface coating. Were found in the cerebrospinal fluid and arachnoid layer piamater.

The brain fills the entire cavity of the skull, which really does not have the adaptation of brain swelling. This has considerable importance in the pathophysiology of head injury.

Cerebrospinal fluid (CSF) is a liquid nutrition menyeliputi brain and spinal cord. This fluid is continuously produced in the ventricles of the brain with a speed of 1 / 3 ml / min. This fluid reabsorbed by the arachnoid membrane covering the brain and spinal cord. Anything that inhibits the flow of CSF will cause this fluid buildup in the brain and will cause increased intracranial pressure.

Pathophysiology of head injuries

Most brain injuries are not caused by direct injury to brain tissue, but occurred as a result of outside forces who hit the outer side of the skull or the brain itself from movements in the skull cavity. On deceleration injury, the head usually hit an object like a car windshield, resulting in deceleration that lasted skull suddenly. The brain keeps moving towards the front, hit the inside tengorak just below the point hit a bump and then turned toward the side opposite the point of initial bump. Therefore, the injury can occur in conflict areas (coup) or on the opposite side (contra coup).

Side of the skull is uneven surfaces. Friction tehadap this region of brain tissue can cause a variety of damage to brain tissue and blood vessels.

Initial response of the brain that have cedra is "swelling". Bruising on the brain caused vasoliditasi with increased blood flow to the area, causing the accumulation of blood and cause suppression of the surrounding brain tissue. Because there is no more space in the skull, the 'swelling' and the injured brain area will increase intracerebral pressure and reduce blood flow to the brain. Increased content of brain fluid (edema) does not occur immediately but began to flourish after 24 hours up to 48 hours. Early efforts to maintain brain perfusion is a life saving action.

CO2 concentration in the blood affect cerebral blood flow. Normal level of CO2 is 35-40 mmHg. Elevated levels of CO2 (hypoventilation) causes vasodilatation and swelling of the brain, while decreasing levels of CO2 (hyperventilation) causes vasokontruksi and cerebral ischemia. At the time of the past, it is estimated that by decreasing the concentration of CO2 (hyperventilation) in patients with head injuries will reduce brain swelling and improve brain blood flow. Recently demonstrated that hyperventilation gives only a small role against brain swelling, but a large effect in reducing cerebral blood flow due to vasoconstriction. This causes cerebral hypoxia. Brain injury are unable to tolerate hypoxia.

Hypoventilation or hypoxia increase the death rate by maintaining good ventilation at the breathing frequency range from 15 times a minute and adequate oxygen flow is very important. Prophylactic hyperventilation in head injury is not recommended.

Intracranial pressure

In the cavity of the skull and the membranes enveloping the brain are the brain tissue, cerebrospinal liquor. And blood volume increase in one component will be followed by a reduction or suppression of each volume of the other components because the adult skull (a rigid box) can not be expanded (enlarged). Although CSF provides tolerance, but the space given is not able to tolerate brain swelling occurs quickly. Blood flow must not be disturbed because the brain needs a constant blood supply (oxygen and glucose) to survive. None of the components that support the brain can mentoloransi this case, therefore, the brain swelling that occurs will quickly cause death. The pressure generated by the contents of the skull known as intracranial pressure (ICP). This pressure is usually very low. Intra-cranial pressure is considered dangerous when it increased to 15mmHg, and the herniation occurs at pressures above 25 mmHg. Blood pressure in the brain called the cerebral perfusion pressure (the CPP). CPP was obtained by subtracting the value of ICP MABP. Perfusion pressure must be maintained 70 mmHg or more. When the brain swells or bleeding within the skull, increased intracranial pressure and perfusion pressure decreases. The body has a protective reflex (response / Cushing reflex) are trying to maintain a constant perfusion pressure of circumstances. We increased intracerebral pressure, increased systemic blood pressure to try to maintain the blood flow of the brain. When conditions become more critical, decreased pulse rate (bradycardia) and even reduced the frequency of respiration. Intracranial pressure continued to increase until a certain critical point where all the head injury worsened and disrupted vital signs, and ended with the death of patients. If there was an increased intracranial hypotension will exacerbate the situation. Perfusion pressure must be maintained for at least 70 mmHg, which requires 100-110 mm Hg systolic pressure in patients with head injuries.

Herniation syndromes

When the brain swells, especially after the collision on the head, increased intracranial pressure can occur suddenly. This can encourage the brain towards the bottom, blocking the flow of CSF and cause great pressure on the brain stem. This is a life-threatening condition marked by decreased level of consciousness progressively into a coma, dilated pupils and eye deviation toward the bottom and lateral sides of the eye injury suffered head, leg and arm weakness on the opposite side of the injured side , and posture deserebrasi (explained below) then the patient will lose all movement, stopped breathing and died. This syndrome often occurs after an acute subdural hemorrhage. Herniation syndrome is the only state in which hyperventilation was still an indication.

Anoksia brain injury

Injury to the brain due to lack of oxygen (eg cardiac arrest, airway obstruction) seriously affects the brain. If the brain does not receive oxygen for four to six minutes, irreversible damage is almost always the case. After the episode anoksia, perfusion will be disrupted due to spasm of the cortex that occurs in small cerebral arteries. After anoksia 4 to 6 minutes, improved oxygenation and blood pressure will not improve cortical perfusion (no reflow phenomenon) and will continue anoksia injury in brain cells. Looks like hypothermia can protect the brain against the effects and there are case reports of patients who resuscitated after suffering hypothermia hypoxia for 1 hour.

Research is currently indicated for drug discovery that is able to overcome the persistent arterial spasm after anoksia situation or protect the cells against injury anoksia.

HEAD INJURY

Ä Scalp Injury

Vascularities Scalp has a rich and often bloody much after laceration, quickly generate a lot of blood loss. It is extremely important in children who have bleeding like adults but have different blood volume.

Unlike in adults who rarely went into shock because Scalp laceration, shock can occur in children after Scalp laceration, it must be sought other sources of bleeding (such as bleeding from the inside). However, do not underestimate the bleeding wounds of Scalp. Most of the Scalp hemorrhage can be stopped easily use the direct suppression.

Ä Skull Injury

The skull may have a non-displaced linear fracture, depressed fracture or open fracture should be suspected of skull fractures in adults if there is a large contusions or swelling and bruising on the Scalp. Very little that can be done against this injury in the field (the scene) but avoid direct pressure on the obvious depressed fracture or fracture open. Translucent objects left on the skull (not revoked) and the patient immediately elevated to the emergency room. If the patient suffered a gunshot wound to the head, without any obvious entrance wound and exit wound located strip, must be assumed that the bullet can be shifted and trapped in the neck near the spinal cord.

Suspect the existence of child abuse if the child suffered head injuries without adequate explanation for. Give attention to the scene where the child is helped and requested police assistance or social services from the scene if there is suspicion of child abuse.

BRAIN INJURY

Ä Concussion

Concussion showed no structural brain injury there is usually a history of head trauma with a period of fainting or disorientation different then back in normal consciousness. There is the possibility of amnesia due to injury. Amnesia typically include some time before the injury (retrograde amnesia is short) so that people usually forget when the incidence of injury. Short-term memory is often involved and the patient usually repeat-ngulang questions such as if patients do not notice you provide the answers. Can be accompanied by dizziness, headaches, ear buzzing and / or vomiting.

Ä cerebral contusions

Patients with cerebral contusions (bruises brain tissue) can have a longer history, or unconscious level of awareness of a serious disorder (such as the heavy orienta disorder, amnesia persistem, abnormal behavior). Swelling of the brain can be swift and severe. Patients may exhibit neurological signs or visible focal cerebrovascular attack (stroke). Depending upon the location of cerebral contusions, the patient may experience changes in personality such as rude behavior

Ä Intracranial Hemorrhage

Bleeding can occur between the skull and duramater (connective tissue membranes covering the brain) between dura and arachnoid, between the arachnoid and the brain, or directly into brain tissue.

Acute epidural hematoma th. (Acute EDH)

These injuries most often caused by a tear in an artery that runs along the media meningea surface of the skull at sisitem poral. Injury to the artery is often caused by a linear skull fracture in the temporal and parietal regions. Because the source of bleeding is of arterial (although sometimes it can be derived from one of the sinus dura), bleeding and pressure can develop rapidly, so that death occurs rapidly. Surgery to remove blood clots and ligation of the torn artery often gives a perfect repair if not lower section of brain tissue injury. Symptoms of acute epidural hematoma include a history of head injury accompanied by fainting during the event, followed by a state patients become aware of either orientation (Lucid interval). After 30 minutes to two hours later, the patient showed signs:

Ý increases in intracranial pressure (vomiting, headache, impaired mental status),

Ý weaknesses in the side opposite the side of the head injury

Ý often accompanied with a dilated pupil and terfiksir (no response to bright light) on the injured side of the head, usually it will soon be followed by death. Classic example is a boxer who collapsed from a stroke, then conscious and allowed to go home, and was found dead in bed the next day.

th acute subdural hematomas (SDH)

This is caused by bleeding between the arachnoid and durameter and connect with the surrounding brain tissue injury because perdarahn comes from a vein, pressures grow more slowly and often a new diagnosis ditegakan hours or days and after injury.

Symptoms and signs include:

Ý headache,

Ý fluctuations,

Ý level of consciousness and focal neurological signs (cth.kelemahan on one limb or one side of the body, tendon reflex changes in the talk pelo).

Because of the underlying brain injury, the prognosis is often unfavorable. Mortality is very high (60-90%) in patients with a comma when checked. Always suspect the existence of subdural in alcoholic patients with a mental status changes after a fall.

Bleeding th intraserebal (ICH)

This bleeding occurs in brain tissue. Traumatika intraserebal bleeding is always associated with penetrating injuries to the head and often associated with blunt impact to the head. Unfortunately, surgery is not always helpful. Symptoms and signs depend on the locations involved and the level of injury, with pattern resembling yamg stroke.

EVALUATION OF HEAD INJURY PATIENTS

Treatment of patients with head injury can be difficult because generally they are rarely cooperative and often under the influence of alcohol or drugs. As a helper, you must give more attention to detail matters and do not give up the patience for uncooperative patients. Remember always preliminary assessment of each patient following the sequence as follows:

th Perform comprehensive initial observations on the situation your patients as early pemerksaan

th Exempt airway in line with cervical spinal stabilization and do preliminary assessment of the level of awareness

Assessment of respiratory th

th Assessment of circulation and control major bleeding

Determine th patient transport decisions and critical intervention

th Perform secondary assessment

Ý vital signs

Ý SAMPLE History:

ü Symptoms (symptoms),

ü allergies,

ü Medications (drugs),

ü Past medical history (other diseases),

ü Last oral intake (time to eat or drink the last one),

ü Events preceding the accidents (events or circumstances prior to the accident)

Ý examination from head to toe

Ý dressing and further pembidaian

Monitor Ý further

Perform th re-examination

PRIMARY checks

Airway supervision must receive primary attention. Patients who received sedation lay, and was not aware of a tendency to airway obstruction due to tongue, blood, vomit or secret. Vomiting often occurs in the first hours after head injury. Airway should be protected by endotracheal intubation or by placing a protective oral or nasal breathing and positioning the patient on one side (in this case there is no suspicion of cervical fracture), and "suction" sustainable. Endoktrakheal intubation in patients with head injury should be done quickly and gently to avoid suffering from agitation, tense and hold your breath so that an increase in intracranial pressure. Before starting intubation, ventilation do (do not hyperventilate) with high oxygen. Avoid head injury from hypoxia. Even with a single episode of hypoxia can cause a significant effect on mortality.

In general, the evaluation of head injury begins with preliminary assessment of the level of consciousness of patients with neurological patients to speak with penderita.pemeriksaan more detail dilakuakn on secondary survey. Clearly patients with a history and examination results showed an epidural hematoma should be sent faster compared with conscious patients after undergoing brain gagar. It is important to note senua observation and examination results because treatment is often determined by changes in the stability of the clinical state of patients. The purpose of evaluation is to immediately determine whether the patient suffered a brain ceera, if so, if things deteriorate? Level of awareness is the most sensitive indicator of brain function.

It is important to know the overall history of injury if possible circumstances of head injuries is very important for the management of patients and represents an important prognostic factor in connection with the final result (out come), give special attention to patients who nearly drowned, electrical burns, lightning, abuse drugs, smoke inhalation, hypothermia, and seizures always ask about the behavior of patients with head injuries from the time of the incident until the moment you arrive.

All patients with head injuries and injuries to the face will cervical spine injury until proven not. Cervical spine stabilization must be accompanied by management of the airway and breathing. During the primary survey, neurological examination ranged only between levels of consciousness and motor weakness are obvious, change in level of consciousness, a sign of brain injury or increased intracranial pressure. Continue your evaluation and report results simply so that others can understand you.

AVPU method quite adequate:

Ä A: patient conscious

Ä V: patients react to sound stimuli

Ä P: patient reacted to pain stimuli

Ä U: patient did not react

SECONDARY EXAMINATION

After the primary inspection complete and on record, began with a Scalp and quickly and carefully, do the inspection for the presence of obvious injuries such as lacerations or fractures terbuka.ukuran depressed or injury estimates are often wrong because of injuries tetutup by dirty hair and blood. Feel Scalp carefully to find the existence of an unstable region of the skull. If you can not find a safe place swathe press or directly pressing the bandage to stop bleeding wounds.

Cranial base fracture can be characterized by bleeding from the ears or nose, the clear liquid out of the nose, swollen and / or discoloration behind the ear (Battle's sign), and / or swelling and discoloration around both eyes (raccoon eyes)

Pupil is controlled by some third nerve. This nerve has a long journey in the skull and brain prone to compression by the swollen, so this nerve can be affected by high intracranial pressure. After head injury, if both pupils are dilated and unresponsive to light, the patient may have suffered brain stem injuries and poor prognosis. If the pupil is dilated but still react to light, the injury is still reversible, so any attempt to make the sufferer soon arrive at a place that can treat a head injury, should be done immediately. Pupillary dilatation unilaterial which still reactive to light may be an early sign increased intracranial pressure. Unilateral pupillary dilatation that developed at the time of your observation is very emergency situation and requires immediate transportation.

Other causes of dilated pupils, whether that react to light or not, include:

Ý hypothermia,

Ý struck by lightning,

Ý anoksia,

Ý optic nerve injury,

Ý drug effects (such as atropine),

Y or direct injury to the eye.

Pupils are dilated and terfiksir have meaning in a head injury, only in patients with decreased levels of consciousness. If the patient has a normal level of consciousness, dilated pupils did not come from head injury.

Eyelid blink are often found on the hysterical. Slow eyelid closure is rarely found on the hysterical. If the brain stem is still good, the eye will remain synchronized (conjugate gaze) when the head rotated to the left and right. Eyes will be moving the opposite direction to head movements. Because the state is like the movement eyeball dolls when moved, this inspection is called reflex doll's eyes "(reflex okulosefalik) This test was never performed on patients with trauma who may suffer injury to the cervical, since turning his head from side to side can cause injury to the spinal cord is irreversible .

Inspection blink reflex (corneal reflex) with corneal touch and / or by examination of reaction to pain in patients with a technique that can not be trusted and are not essential for 'prehospital care'.

Limb, do the inspection and monorik sensory function in extremities. Can the patient felt the touch of the hands and feet? If patients are not aware, check the excitatory or leg pain sufferers indicate roughly still has sensory and motor function yanga good. This usually indicates cortical function was normal or slightly disturbed

Dekortikasi good posture (flexion of arm and leg extension) and deserebrasi (arm and leg extension) is a sign of disturbance or injury to the cerebral hemispheres of the brain stem top. Flaccid paralysis usually indicates spinal cord injury.

To be consistent with the 'revised trauma score' and the other scoring system used in the field, you should be familiar with the GCS (Glasgow Coma Scale), which is easy to use, simple, and has prognostic value when evaluating patients. In trauma patients, GSC 8 or less indicates severe head injury.

VITAL SIGNS, very important vital sign in patients with head injuries. Called very important because it may reflect changes in intracranial pressure. You must do the observation and recording vital signs obtained during the secondary survey and any time you do re-examination.

Ý blood pressure. pengkatan intracranial pressure causes increased blood pressure. Another cause of hypertension, including fear and pain. Hypotension associated with head injuries are usually caused by bleeding or spinal shock and must be addressed as where the bleeding. Head injury patients can not tolerate hypotension. One-time occurrence of hypotension (tek.Darah <90 mmHg) in adult mortality will increase by 150%. Give IV fluids to maintain systolic blood pressure of 100-110 in patients with head injury

Ý Nadi, causing increased intracranial pressure pulse decreases

Ý respiration, increased intracranial pressure caused breathing frequency increased, decreased, and / or become irregular. Irregular breathing pattern indicates the level of the brain or brain stem injury shortly before the death of the patient will menglami rapid respiration, is called central neurogenic hyperventilation. Because respiration is affected by many factors (such as fear, hysteria, thoracic injuries, spinal cord injuries, diabetes), its usefulness as an indicator is not as important as other vital signs in the supervision of head injury travel
shock head injury with increased intracranial pressure
Decreasing Blood Pressure Rising
Decreasing the pulse rise
respiration increased Varies but generally declining
Decreased level of consciousness decreased

Glascow Coma Scale (GCS)

To obtain uniformity of quantitative assessment of consciousness level (previously carried out a qualitative assessment of consciousness such as apathy, somnolen, coma and measurement results are not uniform between the examiner with one another) then was examined with a GCS scale, where there are three indkator who examined the eye reaction , verbal and motor.

1. 1. Eye-opening reaction:
1. Opens eyes spontaneously: 4
2. Opening eyes with excitatory vote: 3
3. Opens eyes with pain stimulation: 2
4. Not opening eyes with painful stimuli: a
2. 2. Verbal reactions:
1. Answered correctly: 5
2. Confusion, disorientation of time, place and space: 4
3. Get out the word with pain stimulation: 3
4. Exit the voice does not form words: 2
5. Not out words with any stimuli: 1
3. 3. Motor reactions:
1. Following orders: 6
2. Localizing pain stimuli: 5
3. Pulling the body when there is pain stimuli: 4
4. Abnormal flexion reaction to pain stimuli: 3
5. Abnormal extension reaction with painful stimuli: 2
6. No movement with pain stimulation: a

Based on scale of Glascow Coma Scale (GCS), then the head injury can be divided into three levels, namely:

1. Mild head injury: GCS: 13-15
2. Head injuries are: GCS: 9-12
3. Severe head injury: GCS: 3-8

In patients who can not be checking the valuation is labeled X. For example in cases where there is periorbital edema eyes given the reaction Ex nila, in patients with aphasia, the verbal reaction of VX was rated if the patient is tracheostomy performed intubation or the VT rated verbal reaction

ASSESSMENT REVIEW

Each time you do a reassessment, record the level of consciousness, pupil size and pupillary reaction to light. This is in line with the vital state of patients will provide sufficient information to initiate the condition of patients with head injury

The decision in the management of patients with head injury is made on the basis of changes in all parameters of physical and neurological examination. You make an initial assessment to be the basis for subsequent decision-making, record your observations

Management of HEAD INJURY PATIENTS

No special actions you can do to penderit head injuries at the scene. It is important to carry out checks quickly and send the patient to a center that has facilities capable of handling patients with head injuries before arriving at the hospital among others:

Exempt Ý airway and provide good oxygenation. The brain is not able to tolerate hypoxia, thus oxygenation are absolute requirements. If patients in a coma, intubation endotrakheal installation must be done. This prevents aspiration and allows oxygenation and ventilation is better because penderit head injuries tend to experience vomiting, preparation for immobilization 'log-roll "to the patient and suction the oropharynx lakuakn, particularly if it is not placed endotracheal tube.

Ý Stabilization patients with spine boards. The neck should diimmobilisasi with kollar rigid immobilization and equipment that a footstool head

Ý Perform initial recording observations. Record the blood pressure, respiration (frequency and pattern), pupils (size and reaction to light), sensation and spontaneous motor activity, also noted the value of GCS. If patients experienced hypotension, suspected the existence of bleeding or spinal injury

Ý often do repeated observations and record sequentially

Ý Put two iv infusion with a large catheter. There used to be thought to restrict liquids on penderit head injury. Already proved that the danger of more frequent occurrence of brain swelling caused by fluid administration of hypotension compared

POTENTIAL PROBLEMS

Always anticipate the existence of spinal injury in patients with head injury

Ý seizures. Head injuries, especially intracranial bleeding, may cause seizures. The patient became hypoxic seizures and hyperthermia, so seizures may exacerbate the ongoing situation. You can give intravenous medications to control seizures. Not infrequently that the seizures associated with bad breath, so must always be that oxygenation and ventilation is very important.

Ý Vomiting. Almost all patients will experience vomiting head injury. You must always be vigilant to prevent aspiration. If patients are not aware, should the intubation. Besides the mechanical suction ready and prepare patients for the log-roll to one side (keep immobilization of the cervical spine)

Ý rapidly worsening situation. Patients showed a rapid worsening of vital signs, or progressive worsening brain injury (eg dilated pupil, or deserebrasi dekortikasi posture) should be immediately sent to the trauma center. This is a situation where hyperventilation is still an indication of hyperventilation, although known to cause ischemia, can reduce brain swelling temporarily. although this is a futile effort but this can give the time to take the patient to the operating table as the act of saving lives. You can also give intravenous mannitol or furosemide. Make notification to the hospital intended to prepare neurosurgeons and operating room so that everything is ready when you arrive

Ý Shock. Think of bleeding or spinal shock

Ý metabolic disorders. Remember granting naloxon (narcan) in patients with mental status disorder, if suspected of using narcotic drugs. Recall of thiamine, and dextrose in diabetic patients with impaired consciousness, alcoholics, or patients who might be experiencing hypoglycemia.

CONCLUSION

Head injury is a serious complication of trauma. In order to provide the best for the patient to recover, you must be familiar with the anatomy important in the head and central nervous system, and understand how the main clinical presentation in different parts of the body. The most important thing in the management of head injury is a quick examination, the good management of the airway, prevention of hypotension, immediate referral to a trauma center, and the examination repeated. As well as recording the results of such examination is important for decision making in the management of patients. .

Article by:

Dr.M.Z.Arifin, sp.BS

Part / SMF.Bedah nerve FKUP perjan R.S. Hasan Sadikin

Virginia Henderson's conceptual model

Virginia Henderson's conceptual model

Preliminary

Virginia Henderson was born in 1897, fifth child of eight siblings in the family. He is native of Kansas City, Mo. Henderson spent growing up in Virginia because his father practiced law in Washington D, C.

During World War I Henderson interested in the science of care. Then in 1918 he entered the Military School in Washington DC Nurses Henderson graduated in 1921 and occupies a position as a staff nurse at the Henry Street Visiting Nurse Service in New York. In 1922 Henderson began teaching science in the treatment of Prostetan Hospital in Norfolk, Virginia. Five years later he entered the Teacher, Äôs college at the University of Colombia in a row where he consecutively won his BS and MA in education care. In 1929 Henderson became supervisor of clinical teaching at Strong Memorial Hospital in Rochester, New York. He returned to the Teacher, Äôs college in 1930 as an instructor, providing training analytical process of clinical care and practice until 1948.

Henderson enjoyed a long career as a writer of researchers. While teaching at the Teacher, Äôs college he rewrote the fourth edition of the writings Bertha Harmer Textbook of the Principles and Practice of Nursing and Practice of Nursing after the death of the author. This edition published in 1939. The fifth edition of the book was published in 1955 and includes maintenance work of Henderson's definition of science. Hnderson joined Yale University since the early 1950s and have done much to research further treatment through this association. Beginning in 1959 until 1971. Henderson heads the Nursing Studies Index Project, sponsored Yale. Nursing Studies Index into the four-volume biography completed with the index maintenance, analysis, and literature, history since 1900 until 1959.

In 1980 Henderson was still active as a Research Associate Emeritus at Yale. Henderson's achievements and influence in the profession of nursing has provided more than tuujh doctoral degree and Christiane Reimann Award for her first time.

Central Concept Description

1. Human:

Creature intact, complete and independent who has 14 basic human needs which include:

1. Breathing
2. Eating and drinking
3. Elimination
4. Mobilization
5. Sleep Rest
6. Dress
7. Maintaining body temperature
8. Police
9. Avoiding hazards
10. Communicate
11. Work
12. Play
13. Worshipping
14. Study

2. Community / environment:

All the external conditions that affect the lives and development of organisms

3. Health:

Viewed as the ability of individuals to perform 14 components of nursing care without assistance (eg, breathing normally). Health is the quality of basic life needs to function and independence and interdependence. So more to the quality of life than life itself, which allows humans to work effectively and achieve or maintain their health if they have the power, desire or knowledge required.

4. Nursing:

Unique function is to help clients better nurse healthy or sick, in carrying out activities that contribute to the health, recovery or die in peace. Activities to be undertaken without the assistance if the strength / capability, desire or knowledge. Also do so in such a way as to help clients independently as soon as possible.

MAIN ELEMENT GOALS

1. The purpose of nursing care:

14 gratification of self-sufficiency in basic needs

2. Client:

Complete human being, complete and autonomous components that have 14 basic needs

3. The role of nurses:

Role-complementary addition to maintaining or restoring self-sufficiency in basic needs satisfaction 14

4. Source difficulties / problems:

Not having the ability / strength, willpower or knowledge

5. Focus of intervention:

Deficit which is the source of client difficulties

6. Ways of intervention:

Action to replace, complement, add, generate or increase the strength, willpower or knowledge

7. Consequence

1. Increased self-sufficiency in satisfying basic human needs 14
2. Died peacefully

THEORETICAL assertions

- Nurse Patient Relationship

Three levels of nurse patient relationship can be recognized:

1. nurse as a substitute (replacement) for the patient.
2. nurse as a helper (helper)
3. nurse as a partner (partner) with the patient. In moments of severe illness, the nurse looked like, what Äúpengganti patients lacking to make it a complete, intact, or free due to reduced physical strength, willpower or pengatahuan.

During the recovery condition (convalescence), nurses helping patients achieve or regain independence. Henderson states, Äúkemandirian is all relative. None of these words does not depend on the other, but we strive to achieve health are interdependent, not dependent in the hospital.

Nurses should be able to observe not only the needs of patients, but also those conditions and pathological conditions to change it.

Nurses can change the environment in which he considers necessary. Henderson believes in every situation the nurses who know the physiological reactions and psychological Dadan temperature, light and color.

Nurses and patients are always trying to reach one goal, whether in the form of healing or a peaceful death. One goal nurses must maintain patient days as normal as possible. Making healthy is an important goal alinnya by the nurse.

- Physician Nurse Relations

Henderson demanded that the unique task of the doctors have nurses. Care plan, which formulated by perawt and patients together, must be executed with a way to propose a treatment plan that is determined doctor.

Nurses as members of the medical team. Nurse jobs hang together with other health workers. Nurses and other team members help each other run a full treatment program, but they should not do the works of others. Henderson reminds us, Äùtidak one in the team giving weight to other members, where anyone they can not afford to do these particular tasks.

FORM LOGIC

Henderson seems to use a form of reasoning deductive logic to construct a definition of science to maintain. He pulled the definition of science interesting conclusions treatment and 14 the needs of the principles of physiological and psychological. Someone should study the assumptions of the definition of Henderson's work to assess the adequacy of such logic.

ACCEPTANCE BY THE COMMUNITY Nursing

Henderson's definition of science as it relates to treatment care practices showed that nurses who see their main task as giving direct care to the patient will find immediate benefits to the patient's progress from dependent to independent conditions. Henderson believes the process of care is a process of problem-sloving and not only specific maintenance problems.

conceptual model ROY

conceptual model ROY

History Calista Roy

Sister Calista Roy is one of the sisters of Saint Joseph of Carondelet. Roy was born on 14 october 1939 in Los Angeles, California. Roy received a Bachelor of Art in Nursing in 1963 from Mount Saint Marys College and a Master's Degree in Pediatric Nursing Saint in 1966 at the University of California Los Angeles.

Roy started the job with the adaptation theory of nursing in 1964 when he graduated from the University of California Los Angeles. In a seminar with Dorrothy E. Johnson, Roy being challenged to develop a concept model of nursing. The concept of adaptation within the framework of Roy's influence is in accordance with the concept of nursing. Starting with the systems theory approach. Roy added an adaptation of the work Helsen (1964), an expert in physiology - psychology. To begin to build understanding of the concept. Helsen interpret the adaptive response as a function of the arrival of the stimulus until the achievement of the degree of adaptation to the needs of individuals. The degree of adaptation is formed by three types of stimulus drive are: focal stimuli, konsektual stimuli and residual stimuli.

Roy's adaptation theory Helson combining with the definitions and views of humans as adaptive systems. In addition to these concepts, Roy also adapted the value of "Humanism" in the conceptual model derived from the concept AH Maslow to explore the beliefs and values of humans. According to Roy humanism in nursing is the belief, against human coping ability can improve health status.

As the model evolved, Roy describes the work of other experts from other experts in areas such as adaptation Dohrenwend (1961), Lazarus (1966), Mechanic (1970) and Selye (1978). After several years, this model developed into a framework of nursing education, nursing practice and research. By 1970, the adaptation model of nursing is implemented as a basic baccalaureate nursing curriculum at Mount Saint Mary's College. Since then it is more than 1500 faculty and students helped to clarify, refine, and expand the model. The use of model practices also play an important role for further clarifications and screening models.

A research study in 1971, and survey research in the year 1976 to 1977 showed some temporary assertion of the model adaptation. Development of adaptation model of nursing was influenced by Roy's background and professionalism. In the philosophy of Roy trust their innate abilities, goals, and humanitarian values, clinical experience have fostered the belief in the harmony of body and spirit manausia. Roy philosophical beliefs more clearly in his new job on the adaptation model of nursing.

Major Definitions and Concepts

Major concepts that build a conceptual framework roy adaptation model is:

1.Sistem is the unity of several units that are interconnected and form one unified whole with a marked presence of input, controls, processes, outputs, and feedback.

2.Derajat adaptation is a change in equipment as a result of focal stimuli, contextual and residual individual standards, so that humans can respond adaptively own.

3.Problem adaptation are events or situations that are not adequate to the decrease or increase in demand.

4.Stimulus is the degree of change or focal stimulus that directly require that humans respond adaptively. Focal stimulus is the precipitation changes in behavior.

Contextual 5.Stimulus are all other stimuli that accompany and contribute to changes in behavior caused or triggered by a focal stimulus.

6.Stimulus residuals are all factors that may contribute to changes in behavior, but has yet to be validated.

7.Regulator is a subsystem of an automatic mechanism for coping with the neural response, cemikal, and endocrine processes.

8.Kognator is a subsystem of the mechanisms of coping with the response through a complex process of perception of information, taking, making and learning.

9.Model adaptive effector is kognator namely; Fisiologikal, Pean function, interdependence and self-concept.

10.Respon adaptive response is the increase of human integrity in achieving its goal to sustain human life, reproductive growth.

11.Fisiologis are physiological needs, including basic needs and how the adaptation process conducted for the regulation of fluid and electrolytes, aktivits and rest, elimination, nutrition, circulation and temperature regulation, sensation, and endocrine processes.

12.Konsep self-confidence and feelings are all adopted by individuals within a single time in the form: perceptions, participation of other people's reactions and behavior directly. Including the views of the physical (body image and self sensation) to produce the consistency of personality self, ideal self, or self-expectations, morals and personal ethics.

13.Penampilan role is the role of appearance-related functions of his job in a social environment.

14.Interdependensi is an individual relationship with others is important and as a support system. Within this model, including how to maintain the physical integrity with maintenance and influence learning.

Conceptual Model of Adaptation roy

Four key elements are included in the adaptation model of nursing are: (1) human, (2) Environment, (3) health, (4) nursing. Elements of nursing consists of two parts, namely tujua nursing and nursing activities, is also included in elememn important to the concept of adaptation.

1.Manusia

Roy suggested that the human being as an adaptive system. As an adaptive system, humans can be described holistically as a single unit having input, control, output, and feedback processes. Process control is a coping mechanism that is manifested by way of adaptation. More specifically human is defined sabagai an adaptive system with kognator activity and regulators to maintain adaptation adaptation in four ways, namely: physiological function, self concept, role function and interdependence.

In the adaptation model of nursing, human beings are described as a living system, open and adaptive to experience the power and substances with environmental changes. As the human adaptive system can be described in terms of system characteristics, so humans are seen as an integral and interconnected between the functional units as a whole or several functional units for some purposes. As a human system can also be described in terms of input, process control and feedback and output.

Added on humans as an adaptation system is to receive input from the external environment and the environment within the individual itself. Input or stimulus, including variable satandar opposite that feedback can be compared. This is the standard variable internal stimuli that have a level of adaptation and represent the range of human stimulus that can be tolerated by those businesses which are usually done.

The process of human beings as a system of controls is a coping mechanism of adaptation that has been identified as follows: subsystem regulator and subsystem kognator. Kognator regulators and is described as the action of an effector hubunganya of four ways of adaptation, namely: physiological function, self concept, role function and interdependence.

Human

1. Humans are defined as recipients of nursing care. Human beings as living systems that are in constant interaction with the environment is marked by changes of internal and external
2. These changes require that humans maintain its integrity, ie continuous adaptation
3. Roy identified the unit as a stimulus. Stimulus is a unit of
4. information materials or energy from the environment or herself as a response.
5. along with the stimulus, the level of adaptation is the reach of human stimulus that can adapt its response with reasonable effort.
6. Levels of adaptation and human systems are influenced by individual growth and usage of coping mechanisms
7. Roy categorize the results as an adaptive response system and inefektif
8. Adaptive response is all that refers to human integrity is all behavior that looks as human beings can understand the purpose of life, growth, production and power
9. Response inefektif not support these goals
10. Roy uses the term coping mechanism to explain the process of human control as adaptive systems

Adaptation response diagram
PROCESS

1. Coping
2. Regulatory mechanisms and kognator

INPUT

1. Stimulus
2. Rate adaptation

OUTPUT

1. Adaptation
2. Response inefekti

Effector is described by Roy as follows:

1. Physiological adaptation model

Physiological adaptation model consists of: Oxygenation

1.
1. Nutrition
2. Elimination
3. Activity and rest
4. Sensory
5. Fluids and electrolytes
6. Skin integrity
7. Nerve function
8. Endocrine function

1. Self concept

Referring to the values, beliefs, emotions, ideals, and the attention given to overcome such physical conditions

Role function

Describes the relationship of individual interaction with others who reflected on the role of the first, second and so on.

1. Model dependence

Identifying the human values, love and seriousness. This process occurs in human relationships with individuals and groups.

Nursing

Roy identified the goal of nursing as an increase of the adaptation process. Adaptation level is determined by the size of both focal stimuli, contextual or residual

Model planned maintenance activities as an increase in adaptation responses of healthy or sick situation. As the restriction is an approach that represents nurses to manipulate action focal stimuli, contextual and residual that deviates in humans. Focal stimuli can be modified and nurses can improve the adaptation response by manipulating the contextual and residual stimuli. Nurses can anticipate the possibility of a secondary response which is not effective on the same stimuli in certain circumstances.

Nurses can also prepare for the anticipated human being by strengthening the regulator kognator and coping mechanisms.

HEALTH

Roy identifies as the status and the combined processes of the human condition, expressed as the ability to set goals, live, grow, growing, producing and directing

ENVIRONMENT

Roy identifies the specific circumstances of all the circumstances, conditions and around and feeling the effects of environment and behavior of individuals and groups