Application of Levine’s Model in Nursing Care of Patient with Diabetic Foot: A Case Study

Diabetic foot is such a life threatening condition for people with Diabetes Mellitus which it can be result in hemodynamic instability and loss of consciousness. In order to improve quality of nursing care in patient with diabetic foot, nurses should apply a nursing model approach. Levine conservation theoretical model is one of comprehensive model theory that can be applied in patients with critical diabetic foot in Emergency Department (ED). This case study describes a nursing care using Levine's Conservation Model to care for a patient with diabetic foot. This study was a case study with a single case design. Data were collected using physical assessment, written communications with the patient, interviews patient family members, and observing the patient during intensive care in the ED of Lawang General Hospital on December 21th, 2015. Levine's Conservation Model used as the nursing guideline successfully identified patient issues including ineffective breathing pattern as a major priority of energy conservation problem and damage tissue integrity as a problem of structural conservation. Both of conservation problem were caused by patient's personal integrity conservation maladaptive that caused by ineffective therapeutic regimen management. Levine’s conservation model is useful to investigate nursing problem and applicable to solve the emergency condition of damage tissue integrity in patients with diabetic foot. Index Terms— diabetic foot, nursing care, levine’s conservation model.

HISTOPATOLOGI INSANG, HATI DAN USUS IKAN LELE (Clarias gariepinus) DI KOTA KUPANG, NUSA TENGGARA TIMUR (Gill, Liver and Gut’s Histopathology of Catfish (Clarias gariepinus) in Kota Kupang, East West Nusa)

Peningkatan konsumsi ikan air tawar di Kota Kupang menstimulasi para pembudidaya ikan untuk berlomba-lomba meningkatkan produksi usahanya. Mengingat cara budidaya ikan yang dilakukan di Kota Kupang adalah dengan padat tebar tinggi dan tanpa pergantian air, maka dapat menyebabkan kualitas media air menjadi buruk karena adanya dekomposisi dari hasil sisa pakan sehingga memungkinkan perkembangbiakan mikroba patogen. Penelitian ini bertujuan untuk mengetahui gambaran histopatologi pada organ insang, hati dan usus ikan lele di Kota Kupang. Ikan lele sebanyak 100 ekor yang diambil dari Pasar Oeba kemudian diukur berat dan panjang serta diamati kondisi morfologinya. Organ insang, hati dan usus diambil dan dilakukan fiksasi menggunakan larutan formalin 4%. Preparasi histopatologi dan analisisnya dilakukan di laboratorium. Spesimen diwarnai dengan menggunakan hematoxylin dan eosin. Hasil penelitian menunjukkan adanya abnormalitas dan kerusakan jaringan pada organ-organ tersebut. Abnormalitas yang terjadi adalah adanya sungut patah, sirip dada panjang sebelah, sirip perut besar sebelah, jumlah sirip dada dan perut hanya satu, ukuran hati kecil, hati terdapat bercak kuning, hati berumbai dan pucat. Kerusakan jaringan organ insang yang terjadi adalah telangeaktasis, nekrosis, edema, hiperplasia, perhimpitan lamela sekunder, fusi, hemoragi, kongesti dan jaringan yang lepas. Sedangkan pada hati adalah fibrosis, hemoragi, kongesti, terbentuknya vakuola-vakuola, adanya degerasi lemak, kumpulan makrofag yang ditandai dengan adanya MMC, hiperplasi, piknotik dan nekrosis. Dan pada usus adalah nekrosis, edema dan hemoragi. The enhancement of freshwater fish consumption in Kota Kupang has stimulated fish farmer to increase their production. The cultivation’s system of fish conducted in Kota Kupang is carried out with high density and whithout water circulation wich decreases water quality caused leftover feed decomposition so as that possible to pathogenic microbes breeding. The aim of this research was observe the description of gill, liver and gut’s histopathology of Catfish in Kota Kupang. One hundred Catfish was taken from Oeba Market which be measured the weight, length and observation of morphological condition. Gills, liver and gut was taken and fixatived with 4% of formalin. Histopathological preparation and their analysis was done in laboratory. The specimens were stained with hematoxylin and eosin. The result of this research showed abnormalities and tissue damage on the organs. The abnormalities showed the presence of flesh grows near the reproductive organ, the size of pectoral vins and ventral vins were not same, only one was pectoral vins and ventral vins, small liver, yellow liver, tassel-shaped and pale liver. The gill’s damage tissue was telangeaktasis, necrosis, edema, hyperplasia, coincide of secondary lamela, fussion, hemorage, congestion and lifting tissue. Liver’s damage was fibrosist, hemorage, congestion,vacuolas, fat degeneration, melano macrophages centre, hyperplasia, picnotic and necrosis. And for the gut’s damage was necrosis, edema and hemorage.hereas, R. mucronata, L. racemosa and S. caseolaris has strength relation with gastropoda T. palustris, N. planospira and M. puella.

Effects of summer and fall applications of foliar boron on fruit bud winter injury in wild blueberry (Vaccinium angustifolium Ait.)

The effects of single and multiple applications of foliar B to two commercial wild blueberry sites during 1999 to 2001 were determined. The effects on tissue B concentrations and winter injury to developing fruit buds was evaluated. At one site, applications of foliar B in summer or fall or in both seasons increased tissue B levels in the first crop fruit buds, but the increases were not observed 1 yr later in the second crop fruit buds. At the other site, applications of foliar B in both the summer and fall of two successive cropping cycles reduced winter injury compared with untreated controls, indicating that multiple foliar B applications may be required to reduce winter injury to developing buds of wild blueberry. Key words: Extractable boron, bud damage, tissue boron concentration, Vaccinium angustifolium Ait.

The Benefit of Force Feedback in Surgery: Examination of Blunt Dissection

Force feedback is widely assumed to enhance performance in robotic surgery, but its benefits have not yet been systematically assessed. In this study we examine the effects of force feedback on a blunt dissection task. Twenty subjects used a telerobotic system to expose an artery in a synthetic model while viewing the operative site with a video laparoscope. Subjects were drawn from a range of surgical backgrounds, from inexperienced to attending surgeons. Performance was compared between three force feedback gains: 0% (no force feedback), 37%, and 75%. The absence of force feedback increased the average force magnitude applied to the tissue by at least 50%, and increased the peak force magnitude by at least 100%. The number of errors that damage tissue increased by over a factor of 3. The rate and precision of dissection were not significantly enhanced with force feedback. These results hold across all levels of previous surgical experience. We hypothesize that force feedback is helpful in this blunt dissection task because the artery is stiffer than the surrounding tissue. This mechanical contrast serves to constrain the subject's hand from commanding inappropriate motions that generate large forces.