Nursing Management of Low Back Pain

Definition of Low Back Pain

Low Back Pain (LBP) or lower back pain is a sensation of pain that is felt in the intervertebral discs, are generally lower lumbar, L4-L5 and L5-S1.

Etiology of Low Back Pain

Most lower back pain caused by any of a variety of musculoskeletal problems (eg, acute lumbosacral strain, lumbosacral ligament instability and muscle weakness, osteoarthritis spine, spinal stenosis, intervertebral disc problems, leg length inequality). Other causes include obesity, kidney disorders, pelvic problems, retroperitoneal tumors, abdominal aneurysms and psychosomatic problems. Most back pain due to musculoskeletal disorders will be aggravated by activity, whereas the pain due to other circumstances is not affected by the activity.

Clinical Manifestations of Low Back Pain

Patients usually complain of back pain is acute or chronic back pain and weakness. During the initial interview, review the location of pain, its nature and how to spread along nerve fibers (sciatica), also evaluated the patient's gait, mobility of the spine, reflexes, leg length, motor strength and sensory perception along with the degree of discomfort. Straight leg raising in the circumstances that resulted in pain suggests irritation of nerve fibers.

Physical examination can be found, the para-vertebral muscle spasm (increased postural muscle tone back the excessive bone) with loss of normal lumbar curvature lordotik and there may be deformity of the spine. If the patient is examined in a state of stomach, paraspinal muscles will relax and deformity caused by a spasm will disappear.

Sometimes the organic basis of back pain can not be found. Anxiety and stress can evoke muscle spasm and pain. Lower back pain can be a manifestation of depression or mental conflict or reaction to environmental stressors and life. When we examined patients with low back pain, nurses need to revisit the family relationships, environment and work situation variables.

Nursing Management of Low Back Pain

Most back pain can go away and will heal in 6 weeks with bed rest, stress reduction and relaxation. The patient must remain in bed with a mattress that padatl for 2 to 3 days. The position of the patient are such that the larger lumbar flexion which may reduce pressure on spinal nerve fibers. The head of the bed elevated 30 degrees and the patient slightly flexed knees or lying on her side with Lutu and pelvis and legs bent and a pillow placed under the head. The prone position be avoided because it will aggravate the lordosis. Sometimes patients need to be admitted to the handling of "active conservative" and physiotherapy. Intermittent pelvic traction with 7 to 13 kg load traction. Traction allows the addition of lumbar flexion and muscle relaxation.

Physiotherapy should be given to reduce pain and muscle spasms. Therapy may include cooling (eg with ice), infrared heating, moist compresses and hot, turbulent pool and traction. Circulatory disorders, trauma disorders, and touching a hot compress is contraindicated. Turbulent pool therapy is contraindicated for patients with cardiovascular problems due to inability to tolerate the resulting massive peripheral vasodilatation. Ultra heat wave will lead to increased discomfort due to swelling in the acute stage.
Medications may be needed to treat acute pain.

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Self-Care Requisites - Dorothea Orem

Terms of self-care is the goal to be achieved through a variety of nursing. (The purpose to be Attained through the Kinds of actions termed self care).

Divided into three categories:

1. Universal Self-Care requisites
Universal self-care requisites are present in humans and including the balance of air, water, food, elimination, activity and rest and solitude and social interaction, prevention of accidents and improve the function of the individual.

2. Developmental Self-Care requisites
Self-care needs in accordance with the process of development and maturity of a person to function optimally to prevent conditions that may hinder the development and maturation as well as conformance with these developments.
Example: adjustment for age and body shape changes.

2. Health Deviation Self-Care requisites
Health deviation (Deviation health) such as illness, injury or accident can reduce an individual's ability to meet the needs of self-carenya, either permanently or temporarily. These needs include:
1) Finding the right treatment and safe
2) Recognizing the impact of the disease pathology
3) Choosing a diagnostic procedure, therapeutic and rehabilitative appropriate and effective.
4) Understand and realize the uncomfortable effects of the treatment program
5) Modify the concept of self in order to receive their health status.
6) Learning to live with limitations.

Therapeutic Self-Care Demand is the totality of self-care measures that are formed in a span of time in order to find her care needs using valid methods.

Self Care Agency is a person's ability to be able to take into account the ability to care for himself. There are three related terms, namely:
• Agent: a person who does the
• Self care agent: a self-care providers
• Dependent care agent: is a provider of child care, child care or elder care

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Model and Theory of Nursing by JEAN WATSON

Model and Theory of Nursing by JEAN WATSON

Jean Watson's philosophy, which is known as "JW", seeks to define the outcomes of nursing activities associated with the humanistic aspects of life. Watson, (1979). Nursing actions that refer directly to the understanding of the relationship between health, illness and human behavior. Nursing attention to the improvement and restore health, and prevention of disease.

Model of Watson, was formed surrounding the Nursing Process, provide assistance to clients in attaining or maintaining or achieving health and a peaceful death. Nursing interventions related to human care process. The process requires human care nurse who is able to understand human behavior and response to the problem of actual or potential health, human needs, and how people respond to others, as well as the advantages and disadvantages of the client and his family, as well as an understanding with himself. In addition, nurses also provide comfort and attention, and empathy for clients and their families.

Orphanage care is reflected in all the factors used by nurses in providing nursing services to clients and their families.

JW in understanding the concept of nursing, is famous for its theory of human knowledge and human caring. Benchmark is based on the JW outlook on the human element of the theory. JW theory is to understand that humans have four branches of the needs that are interconnected, diantaraanya:

1. Basic biophysical needs (need for life), which includes eating and fluid needs, elimination needs, and Ventilation Needs
2. Psycho-physical basic needs (Needs Funsional) which includes the need for activity and rest, and the need for sexuality.
3. Psychosocial basic needs (need for Integration), which includes the need for Achievement and Organize
4. Intrapersonal and Interpersonal basic needs (Requirements for Development) is the need for self actualization.

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Physical Examination and Treatment for Marasmus

Assessment for Marasmus

The assessment consists of: initial assessment and follow-up assessment.

1. Initial assessment (for emergencies):

• Incidence of sunken eyes that had just appeared
• The duration and frequency of diarrhea and vomiting as well as the appearance of materials vomiting and diarrhea (watery / blood / mucus)
• When was the last urination
• Since when did the hands and feet felt cold.

When found on the above, it is likely the child is dehydrated and / or shock, and must be addressed immediately.

2. Follow-up assessment (to find the causes and subsequent management of the plan, carried out after the emergency is handled):

• Diet / eating habits before the illness
• History of breastfeeding
• Intake of foods and beverages consumed the last few days
• Loss of appetite
• Contact with measles or tuberculosis patients
• Ever measles in the last 3 months
• Chronic cough
• Incidence and cause of death of siblings
• Birth weight
• History of growth and development: sitting, standing, talking, etc.
• Immunization history
• Does were weighed every month
• Family environment (to understand the social background of the child)
• Known or suspected HIV infection

Physical Examination for Marasmus


Is the child looked very thin,


Is there edema on both back legs.

• Determine the nutritional status.
• Signs of dehydration: thirst appears, sunken eyes, poor turgor (be careful to determine the status of dehydration).
• Are there any signs of shock (cold hands, capillary refill time is slow, weak and rapid pulse), decreased consciousness.
• Fever (axillary temperature ≥ 37.5 ° C) or hypothermia (axillary temperature <35.5 ° C). The frequency and type of respiratory: pneumonia or heart failure Very pale Enlarged liver and jaundice Is there abdominal distention, bowel sounds fell / rose, a sign of ascites, or a sound like a blow on the water surface (abdominal splash)

Treatment for Marasmus

1. Sign of vitamin A deficiency on the eye:

• Conjunctival or corneal dryness,
• Bitot spots; Corneal ulcers;
• Keratomalasia
  

2. Ulcers in the mouth --> Focus infections: ear, throat, lungs, skinSkin

3. Lesions in kwashiorkor:

• hypo / hyperpigmentation;
• desquamation;
• ulceration (legs, thighs, genitals, groin, behind the ears);
• exudative lesions (resembling severe burns) often with secondary infections (including yeast).

4. Display stools (consistency, blood, mucus).

5. Signs and symptoms of HIV infection.

Note:

• Children with vitamin A deficiency is often photophobia. Important to examine the eye carefully to avoid tearing of the cornea.
• Laboratory examinations and hemoglobin or hematocrit, if the kids get very pale.

Marasmus - Pathophysiology, Causes, Signs and Symptoms

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Marasmus - Pathophysiology, Causes, Signs and Symptoms

Marasmus is a condition caused by malnutrition due to low energy consumption of calories and protein in the daily diet resulting in an inadequate intake of calories needed by the body.

Causes of Marasmus

According to Behrman (1999: 122) causes of marasmus are:

1. Inadequate caloric intake, as a result of deficiencies in the arrangement of food.
2. Food habits are not feasible, as contained in the parent-child relationship is disrupted or as a result of metabolic disorders or congenital malformations.
3. Each body system disorder that can lead to severe malnutrition.
4. Caused by the negative influence of socioeconomic factors and cultural events that contribute to general malnutrition, negative nitrogen balance can be caused by chronic diarrhea, malabsorption of protein, urine protein loss (neprofit syndrome), chronic infections, burns and heart disease.

Signs and Symptoms of Marasmus

1. Child's whiny, cranky, and not excited.
2. Diarrhea.
3. Eyes large and deep.
4. Acral cyanosis and looks cool.
5. Face as parents.
6. Impaired growth and development.
7. Occur begi ass, because there is muscle atrophy.
8. Fatty tissue under the skin will disappear, the skin wrinkles and poor skin turgor ..
9. Belly bulge or concave with a clear picture of the intestine.
10. Slow pulse and decreased basal metabolism.
11. Superficial veins are more apparent.
12. Large fontanel sunken.
13. Cheekbones and chin stand out.
14. Anorexia.
15. Frequent night waking.

Pathophysiology of Marasmus

Growth with less or stop muscle atrophy and lose fat under the skin. At first this is prosesn physiological abnormalities. For the survival of tissue the body requires energy, but does not come alone and protein reserves are used also to meet the energy needs. Tissue destruction in calorie deficiency not only help meet energy needs, but also to allow the synthesis of glucose and other metabolites such as amino acids essential for the homeostatic component. Therefore, in severe marasmus are sometimes still found a normal amino acid, so that the liver is still able to form enough albumin.

Physical Examination and Treatment for Marasmus

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The Role of Family Health Care in Tuberculosis

The Role of Family Health Care in Tuberculosis. Associated with the family's ability to implement The Role of Family in Tuberculosis Health Care, namely:

a. Know the family health issues

Health is a family needs that should not be ignored because without health, everything is meaningless, and because sometimes the entire health care resources and the power of family funds depleted.

Inability of the family in identifying health problems in the family one of which is caused by a lack of knowledge. Lack of knowledge about the understanding of the family, signs and symptoms, treatment and prevention of tuberculosis.

b. Decide what is right for family health

This task is a major effort for families seeking help appropriate to their family circumstances, to consider who among families who have decided to determine the ability of the family action. Health measures undertaken by the family of the right to expect health problems can be reduced even resolved.

Family's inability to take decisions in doing the right thing, because the family did not understand the nature, weight and extent of the problem and did not feel the prominence of the issue.

c. Caring for families experiencing health problems

Families can take appropriate action and correct, but the family has its limitations. The inability of families caring for a sick family member due to not knowing how to care on the disease. If so, family members who experienced health problems need to obtain follow-up or maintenance can be performed in health care institutions.

d. Modify the family environment to ensure the health of family

Maintaining a good environment will improve the health of families and assist healing. The inability of the family in modifying the environment can be caused due to limited family resources such as financial, physical condition of the home who are not eligible.

e. Utilize health care facilities in the vicinity of the family

Family's ability to utilize health care facilities will help family members who are sick get help and get treatment immediately so the problem is resolved.

Family Nursing Care Plan for Tuberculosis

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Examples of Guidelines - Nurse Patient Relationship

1. Pre-interaction Phase

• Collecting data on client
• Explore feelings, fantasies, and fears away.
• Make a planned meeting with a client (events, time, place).

2. Orientation Phase

• Greetings and a smile on a client
• Validate (cognitive, psychomotor, affective) (typically at a further meeting to introduce the name of nurse)
• Asking the client's favorite nicknames
• Explain the role of nurses and since lien
• Explain the activities to be conducted
• explain the purpose
• Explain the time required to perform activities
• explain confidentiality

3. Work Phase

• Provide an opportunity for clients to ask
• Asks the chief complaints / complaints that may be related to the smooth implementation of activities
• Initiate activities in a good way
• Carried out in accordance with the plans

4. Termination Phase

• Summing up the results of activities: the evaluation process and results
• Provide positive reinforcement
• Planning a follow-up with clients
• Contracts for the next meeting (time, place, topic)
• Terminate the activities in a good way

Dimensions of response / non-verbal behavior that needs to be demonstrated at least:

• Face to face
• Maintain eye contact
• Smiling at the right time
• Bent towards the client at the time it takes
• Maintaining an open attitude (no arms, put his hand into a bag or folding legs)

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The Nurse's Role in Security Needs

The nurse's role in meeting the security needs can contribute directly or indirectly. Nurses can perform direct nursing care to clients experiencing problems associated with unmet security needs. The role of nurses in meeting the security requirements are as follows:

1. Direct care givers; nurses providing direct assistance to clients and families experiencing problems related to security needs.

2. Educators, nurses need to provide health education to clients and families, so that the client and family to family health care program, linked to the security needs independently, and are responsible for family security issues.

3. Health watchdog, the nurse must do "home visit" or a regular home visits to identify or carry out a review of the security needs of clients and families.

4. Consultants, nurses as a resource for families in addressing the security concerns of the family. In order for families to ask for advice to the nurse the nurse-family relationships should be nurtured well, nurses must be open and trustworthy.

5. Collaboration, nurses must also work with various programs and across sectors in meeting the security needs of families to achieve health and safety of the optimal family.

6. Facilitator, the nurse should be able to bridge the well to the client's security needs and risk factors in keuarga so ketidakpemenuhan security needs can be addressed.

7. Inventor of the case / problem, the nurse identify safety problems early, so there is no risk of injury or falls on the clients who are unable to meet its security needs.

8. Modification of the environment, nurses must be able to modify the environment both home and community environments in order to create a healthy environment to support the fulfillment of security needs.

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Predisposing Factors and Types of Schizophrenia

Schizophrenia? What is meant by schizophrenia? Maybe some people are still unfamiliar with this word. But it is possible for families in which one family member diagnosed with this disease often hear.

Schizophrenia is a persistent and serious brain disease that lead to psychotic behavior, concrete thinking, and difficulty in information processing, interpersonal relationships, and solve problems (Stuart, 2006).

Of several studies found a variety of factors that cause a person was suffering from schizophrenia. According to a source book of nursing spirit of "Iyus Joseph" (2007), that causes the disease of schizophrenia include: genetic factors, viral, auto-antibodies, and the state of malnutrition. The study says that despite the abnormal gene, but the disease does not appear if not accompanied by the factors mentioned above, or the so-called epigenetic. He said the disease also would be at great risk, if someone with epigenetic factors and psychosocial stressors experienced.

According to research from sources J.C. Coleman (1970), people who may have schizophrenia is a disease that has a relationship of twins from one egg (monozygotic) 86.2% suffered from schizophrenia, while the twins from two eggs (heterozygous) 14.5%, 14.2% of siblings, siblings stepdaughter 7.1% and 0.85% general public

Predisposing factors of schizophrenia, the first is the somatic factor or organo-biological. That including the Neuro-anatomy, neuro-physiology, neuro-chemical, organic level of maturity and development, pre and perinatal factors. The second factor is the psycho-educative namely: mother and child interactions, the role of father, competition between siblings, intelligence, relationships within the family, work, play, and society, loss of which causes anxiety or depression, self-concept, skill, talent and creativity , the pattern of adaptation and defense in response to danger, the level of emotional development. Three sociocultural factors include family stability, parenting children, economic level, housing: residential versus rural. (Joseph, 2007)

While the originator of the stressor in schizophrenia may be biological factors associated with neuro-biologist maladaptive responses such as poor nutrition, lack of sleep, circadian rhythms out of balance, fatigue, infection, central nervous system drugs, lack of exercise, barriers in accessing health services. Environmental factors can also trigger this disease is an environment full of criticism, interpersonal difficulties, impaired interpersonal relationships, social isolation, job stress, poverty, etc.. Attitudes and behavioral factors can be triggers as well as low self-concept, lack of self-confidence, social skills are lacking, aggressive behavior, violent behavior, etc.. (Stuart, 2006)

Apparently there are several types of schizophrenia, the first type of paranoid schizophrenia, Hebephrenic Schizophrenic, catatonic, schizophrenia is not classified (undiffentiated), post-schizophrenic depression, residual schizophrenia and other schizophrenia (Maslim, 1998 & Issacs, 2004).
Paranoid schizophrenia is the main characteristic of systematic delusions or auditory hallucinations. These individuals can be suspicious, argumentative, rude, and aggressive. Less regressive behavior, less social damage, and a better prognosis than other types.

Schizophrenic Hebephrenic main characteristics of the chaotic conversation and behavior, as well as flat affect or is not appropriate, the association also prevalent disorders. Individuals also have a strange attitude, demonstrate social withdrawal behavior to the extreme, ignoring hygiene and personal appearance. Onset usually occurs before 25 years and can be chronic. Regressive behavior, with social interaction and contact with the reality that bad.

Catatonic schizophrenia is its main characteristic is characterized by psychomotor disturbance, which would involve immobility or excessive activity. Catatonic stupor. Individuals can show inactivity, negativism, and excessive body flexibility (abnormal posture). Catatonic excitement involve extreme agitation and can be accompanied by ekolalia and ekopraksia.

Schizophrenia is not classified as main characteristics of delusions, hallucinations, conversations that are not coherent and chaotic behavior. This classification is used when the criteria for other types are not met.

Schizophrenia residual main characteristics is the absence of acute symptoms at this time, but occurred in the past. Can occur negative symptoms, such as real social isolation, withdrawal and impaired role functioning.

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Ineffective Individual Coping and Knowledge Deficient

Nursing Interventions for Headaches

Ineffective individual coping related to situations of crisis, personal vulnerability, inadequate support systems, excessive workload, inadequate relaxation, coping methods is inadequate, severe pain, excessive threat to himself.

Nursing Interventions ineffective individual Coping:

1. Approach the patient with a friendly and attentive. Take advantage of activities that can be taught.
2. Aids patients in understanding the changes in the concept of body image.
3. Instruct the patient to express their feelings and discuss how the headaches that interfere with work and the pleasures of this life.
4. Make sure the impact of illness on sexual needs.
5. Provide information about the cause of headaches, treatment, and expected results.
6. Collaboration : Refer to counseling and / or family therapy or assertiveness training classes where indicated.

Knowledge deficient: the condition and treatment needs related to lack of recall, did not know the information, cognitive keterbatasab.

Nursing Interventions for Knowledge deficient

1. Discuss the individual etiology of headache if known.
2. Assist patients in identifying possible predisposing factors, such as emotional stress, excessive temperature, food allergy / particular environment.
3. Talk about drugs and their side effects. The return value is the need to reduce / stop the treatment as indicated
4. Instruct the patient / person nearest in conducting program activities / exercise, food intake, and that raises a sense of comfort measures, such as massage and so on.
5. Talk about the position / location of a normal body.
6. Instruct the patient / person nearby to provide time to relax and have fun.
7. Recommend to use the right brain activity, love and laughter / smiling.
8. Recommend the use of fun music.
9. Instruct the patient to pay attention to that experienced headache and associated factors or factors presipitasinya.
10. Provide written information / instructions such records
11. Identify and discuss the emergence of a hazard that is not real and / or therapy instead of medical therapy

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Quick Ways To Sleep at Night

Quick Ways To Sleep at Night. Not everyone is lucky to fall asleep at some time, many of them are like an owl, stay awake while others sleep. Sleeping disorders can be caused by various factors, but primarily due to stress.

What did we do before bed is very influential on-quality sleep. One study found that drowsiness did not come, could be due to a strained mind. Therefore, relaxation techniques can help overcome mild insomnia. Here are some tips that may help you fall asleep faster:



1. Bath.
Bath before bed is good for your sleep. Fill the tub with salt or lavender oil, this can make the muscles more relaxed so it can sleep more sleep.

2. Avoid caffeine.
Beverages containing caffeine, especially if taken in the afternoon or evening before bed should be avoided. Caffeine is included in the stimulants can increase brain activity and spirit.

3. Do not watch TV or play computer before bed.
We tend to cover day-to-day activities as "relax" in front of a computer or TV. Yet the light of the computer screen will make your body think it was daytime. As a result, sleep did not come.

4. Avoid napping.
In order to fall asleep faster at night, avoiding naps.
But if you ever need a nap, go to sleep only for 15 minutes. Longer naps can make it more difficult closed at night.

5. Listening to music.
Music does make the body more relaxed. Listen to the slow and rhythmic music that will help you fall asleep.

6. Remove anxiety.
Excessive worry on something or things that we can not control is a useless thing. One that can help you unravel the tangled mind is to write down one by one the things that burdened mind.

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Headaches Nursing Care Plan Interventions

Headaches is one of the most important human physical complaints. Headache in fact is a symptom not a disease and may indicate organic disease (neurological or other disease), stress response, vasodilation (migraine), skeletal muscle tension (tension headache) or a combination of these responses (Brunner & Suddan).

Headaches classification of the most recently issued by the Headache Classification Comitte of the International Headache Society as follows:

1. Migraine (with or without aura)
2. Tension headaches
3. Cluster headache and paroxysmal hemikranial
4. A variety of headaches associated with structural lesions.
5. Headache associated with head trauma.
6. Headache associated with vascular disorders (eg, subarachnoid hemorrhage).
7. Headache associated with non-vascular intracranial disorders (eg brain tumors)
8. Headaches associated with the use of chemicals tau drug withdrawal.
9. Headache associated with non-cephalic infection.
10. Headache associated with metabolic disorders (hypoglycemia).
11. Headache or facial pain associated with disorders of the head, neck or head around the structure (eg, acute glaucoma)
12. Cranial neuralgia (persistent pain from cranial nerves)
    

Nursing Care Plans for Headaches

Acute pain r/t stess and tension, irritation / nerve pressure, vasospasm, increased intracranial pressures.

Nursing Interventions for Headaces

1. Make sure the duration / episode problems, who have been consulted, and drug and / or what therapy has been used
2. Thorough complaints of pain, record itensitasnya (on a scale 0-10), characteristics (eg, heavy, throbbing, constant) location, duration, factors that aggravate or relieve.
3. Note the possible pathophysiological characteristic, such as brain / meningeal / sinus infection, cervical trauma, hypertension, or trauma.
4. Observe for nonverbal signs of pain, are like: facial expression, posture, restlessness, crying / grimacing, withdrawal, diaphoresis, changes in heart rate / breathing, blood pressure.
5. Assess the relationship of physical factors / emotional state of a person
6. Evaluation of pain behavior
7. Note the influence of pain such as: loss of interest in life, decreased activity, weight loss.
8. Assess the degree of making a false step in person from the patient, such as isolating themselves.
9. Determine the issue of a second party to the patient / significant others, such as insurance, spouse / family
10. Discuss the physiological dynamics of tension / anxiety with the patient / person nearest
11. Instruct patient to report pain immediately if the pain arises.
12. Place on a rather dark room according to the indication.
13. Suggest to rest in a quiet room.
14. Give cold compress on the head.
15. Massage the head / neck / arm if the patient can tolerate the touch.
16. Use the techniques of therapeutic touch, visualization, biofeedback, hypnosis itself, and stress reduction and relaxation techniques to another.
17. Instruct the patient to use a positive statement "I am cured, I'm relaxing, I love this life". Instruct the patient to be aware of the external-internal dialogue and say "stop" or "delay" if it comes up negative thoughts.
18. Observe for nausea / vomiting. Give the ice, drinks containing carbonate as indicated.

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Family Nursing Care Plan for Tuberculosis

Family nursing care is a series of activities provided through the practice of nursing, family to help resolve the issue using the family health nursing process approach.

The nursing process is a scientific method that is used systematically to assess and determine the issues of health and family nursing, nursing care plan and carry out nursing interventions to families that have been prepared according to plan and evaluate the quality of nursing care is carried on the family.



Assessment

Five stages of the nursing process consists of: an assessment of the family, family problems and individual identification (nursing diagnoses), nursing care plan, implementation, deployment plans and evaluation of sources of care.

The nursing process has stages that are interdependent and structured systematically to describe the progression from one stage to another stage.

According to Friedman (1998:56) the process of nursing assessment by collecting information on an ongoing basis to the meaning attached to such information being collected. The assessment includes the collection of information is done in a systematic way, it means analyzed classified.

Data Collection

Data collection can be done by interview, observation, study and documentation of physical examination.

Data collected includes:

a. Family identity, which examined the age, occupation and residence.
Be at risk of tuberculosis patients are: individuals without adequate health care (homeless, prisoners), under the age of 15 years and young adults between 15-44 years old, rundown and stay in place under standard housing and jobs.

b. Cultural background or family practice
• Eating habits
In patients with tuberculosis had decreased appetite when it occurs continuously will cause the patient to be weak. Diet recommended for patients with tuberculosis: High Calorie High Protein.

• utilization of health facilities
Family's ability to utilize health services are very influential in the treatment of tuberculosis both for information and treatment. Some places that provide health services for tuberculosis is a health center, hospital and doctor.

• Socio-Economic Status
Low education levels influence patterns of thought and action in addressing family issues in the family. In contrast, families with higher education levels will be able to recognize problems and be able to take decisions to resolve the issue.

• Work and Income
Employment and income is very related. Family income will determine the ability of existing health problems. Ability to provide healthy housing, the ability of the ill treatment of family members and the ability to provide food with balanced nutrition.

• Activities
In addition to food, rest needs must also be considered. For patients with tuberculosis is recommended break of at least 8 hours per day.

• The development and family history
Level of development at this stage of family formation will be found to problems with low socioeconomic having to learn to adapt to the needs that must be met. New families learn to solve problems. In that situation, influence the level of family health. Low socioeconomic generally closely associated with health problems that they face due to ignorance and inability to overcome the problems they face. The absence of family history of health problems that have no effect on the health status of the family.

Environmental data

1. Characteristics of home
State of the narrow house, less ventilation, humidity, including home health condition under the standards. One factor that can cause tuberculosis bacteria survive the conditions of the humid air.

a. Characteristics of the environment
A clean home environment, waste disposal and proper waste disposal can reduce the transmission of tuberculosis and inhibit the growth of tuberculosis bacteria. TB is closely related to the condition of the slum environment.

b. Family gatherings and interaction with the community
Tuberculosis germs can be transmitted from the person through the air. The more frequent direct contact with patients infected with tuberculosis bereksiko once. Especially at home caring for the opportunity to contract tuberculosis than those located in public places.

2. Family structure

a. communication patterns
When the family communication that occurs in an open and two-way will be very supportive for people with tuberculosis. Remind each other and motivate patients to continue to take medication can speed up the healing process.

b. The role of family structure
When family members can receive and carry out its role properly will make family members happy and avoid any conflict in the family and society.

c. The structure of the family
Family members' ability to influence and control others to change behaviors that support healthy families. Problem solving and decision-making by consensus will be able to create a family atmosphere. Will arise in the family feel appreciated.

d. Family values ​​or norms
Individual behavior of each family member who ditampakan a picture of the prevailing values ​​and norms in the family.

3. Family Function

a. Affective Function
Family, loving and caring for sick family members tuberculosis will speed up the healing process. Because of the participation of family members in caring for a sick family member.

b. Socialization and Social Function Place
Family functions to develop and train social berkehidupan before leaving the house to relate to others.
There is no limit to socialize for people with the environment will affect the recovery of patients as long as people still consider her condition. Socialization is necessary because it can reduce stress for patients.

c. Function Care / Health Care
Associated with the ability to implement the 5 families in family duties in the health sector, namely:

• Identify family health issues
Health is a family needs that should not be ignored because of everything without health is meaningless because of health and sometimes the whole strength and resources depleted family funds. Inability of the family in identifying health problems in the family one of which is caused by a lack of knowledge. Lack of knowledge about the understanding of the family, signs and symptoms, consequences, prevention, care and treatment of tuberculosis.

• Decide on appropriate health measures for families
This task is a major effort for families seeking help appropriate to their family circumstances, to consider who among families who have decided to determine the ability of the family action. Health measures undertaken by the family of the right to expect health problems can be reduced even resolved. Family's inability to take decisions in doing the right thing, because the family did not understand the nature, weight and extent of the problem and did not feel the prominence of the issue.

• Taking care of families experiencing health problems.
Families can take appropriate action and correct, but the family has its limitations. The inability of families caring for a sick family member due to not knowing how to care on the disease. If so, family members who experienced health problems need to obtain follow-up or maintenance can be performed in health care institutions.

• Modifying the family environment to ensure the health of family
Maintaining a good environment will improve the health of families and assist healing. The inability of the family in modifying the environment can be caused due to limited family resources such as financial, physical condition of the home who are not eligible
.
• Make use of health care facilities in the vicinity of the family
Family's ability to utilize health care facilities will help family members who are sick get help and get treatment immediately so the problem is resolved.

4. Reproductive Function
Generation of the family serves to maintain and sustain the family. And also a place to develop a universal reproductive functions, including: sexual health and quality sex education to children is very important.

5. Economic Functions
Family functioning to meet the needs of families, such as the need for food, clothing and a place of refuge (home). And a place to develop the individual's ability to meet the income needs of families.

6. Family coping
If ineffective family coping to stressors that will cause stress that this berkepanjangan.Hal will affect the immune system.

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Home Health Care Patients with Hypertension

Home health care is one type of long-term care, which can be given by professionals and non professionals who have received training. Home health care, which is one form of health care is a component of a continuous range of health services and comprehensive given to individuals and families in their homes that aim to enhance, maintain or restore health and maximize independence and minimize the consequences of diseases including terminals. Services that fit the needs of individual patients and families, planned, coordinated and provided by service providers who are organized to provide home care staff or through contractual arrangements or a combination of both (C Warhola, 1980).

According Sherwen (1991), home health care as an integral part of nursing services performed by nurses to help individuals, families and communities to achieve self-reliance in solving health problems that exist. Meanwhile, Stuart (1998) describe the home health care as part of the nursing process in the hospital, which is a continuation of the repatriation plan (discharge planning), for clients who have time to go home from the hospital. Home treatment is usually done by nurses from the hospital initially, carried out by community nurses where the client is located, or carried out by special teams who deal with home care.

Purpose of Health Care

Home health care aims to:

1. Help clients maintain or improve health status and quality of life,
2. Improve the adequacy and effectiveness of care in family members with health problems and disabilities,
3. Strengthen family functioning and closeness among family,
4. Helping clients stay or return home and get the necessary treatment, rehabilitation or palliative care,
5. Health care costs will be more controllable.

Equipment required - Home Health Care Patients with Hypertension :

1. Tensimeter
2. Stethoscope
3. Scale
4. Syringe
5. Infusion set
6. Drugs

Etc. ...............................

Evaluation

1. Evaluation of nurse
2. Evaluation of patient / family

Inform Concern

Consent of the patient and family
Approval of financing and participation in care
Approval of the system of salary / wages of home care personnel.

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