HOLISTIC MODULE

PROBLEM BASED LEARNING

SCENARIO 2

TUTOR
dr. Danti Nur Indiastuti, M.ked
SCENARIO COMPOSER
Dr. Sri Umijati,dr.,MS
Dr. Sulistiawati,dr,Mkes
EDITOR
Prof. Dr. N. Margarita Rehatta, dr., Sp.AnKIC., KNA

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COMPOSED BY
4B GROUP

LEADER
Muhammad Bagas Pratista

(011511133066)

SECRETARY
Elvin Nuzulistina

(011511133068)

NOTULEN
Hanifa Imansari

(011511133064)

MEMBERS
Cholifatin Nur Ardhiyah

(011511133056)

Nur Imroatul Mursyidah

(011511133058)

Ismi Masyithah

(011511133060)

Arinda Agung Katritama

(011511133062)

Erlyta Zulfaizah

(011511133070)

Risnanda Putri Rasyda

(011511133072)

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CONTENTS
Cover..1
Group member...2
Contents.3
Chapter I: Brain Storming.5
1.1 Scenario.....5
1.2 Main Problem....5
1.3 Keywords..5
1.4 First Hypothesis....5
1.5 Learning Issues I...6
Chapter II: Problem Analysis7
2.1 Answer..7
2.1.1 How is holistic approach?..........7
2.1.2 Causes and Symptoms of Tuberculosis, Asthma, Pneumonia,
Emphysema and Lung Cancer...8
2.1.3 What is cement and cotton containing?............11
2.1.4 How is a holistic approach based on the scenario?............14
2.1.5 How can happen the problem of medical based on holistic
approach?......................15
2.2 Method and Steps to Find Information...18
2.3 First Mind Mapping....19
Chapter III : Tutorial Conclusion....20
3.1 Data Analysis .....20
3.2 Final Hypothesis.22
3.3 Concept Mapping....23
3.4 Pathophysiologic Dyspnea;;;.......24
3.5 Problem Solving......26
Reference.29
Journal Appraisal.31
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Critical Appraisal.34

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CHAPTER I
BRAIN STORMING
1.1 Scenario
Nia is 23rd years old girl come from Jakarta. She feel that, she always cough and
sometimes dyspnea in 3 month after she move to X city. She boarding in house that
have religious people . That boarding house rather dusty because it near to semen
factory.
1.2 Main Problem
Nia has cough and dyspnea after she move to X city.
1.3 Keywords
From the scenario and main problem, we use 3 keywords for it. They are :
1. 23rd years old girl
2. Move to X city
3. Religious environmet.
4. The boarding house near to Semen factory
1.4 First Hypothesis
From the scenario and a main problem that we choose. We hypothesize :
1. Dust allergic
2. Tuberculosis
3. Asthma
4. Pneumonia
5. Emfisema
6. Lung Cancer
1.5 Learning Issues 1
From all above, there are many learning issues that we state. For the learning
issues there are:
1. What is cough and dyspnea ?
2. What are the causes and symptoms of tuberculosis, asthma, pneumonia,
emphysema and lung cancer?
3. What is cement and cotton containing ?
4. How is holistic approach?
5. How is holistic approach based on the scenario?
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6. How can happen the problem of medical based on holistic approach?

CHAPTER II
PROBLEM ANALYSIS
2.1 Answers
2.1.1 Cough and Dyspnea
Cough
The cough is a natural response body to clean mucus or irritation factor causes, like
dust, smoke. Usually So it can go out from the respiratory system. An irritant stimulates
nerves there to send a cough impulse to the brain. Then, the brain gives the signal to abdomen
and chest wall. Abdomen and chest wall will give a push the air to the lungs and expel the
irritant.
Cough is the symptom of some diseases either acute or chronic. The chronic diseases
like allergies, asthma, bronchitis, GERD, and postnasal drip. The acute diseases like
influenza, common cold, pneumonia, and COPD. Cough can be acute if it lasts than three
weeks while cough can be chronic if it lasts longer than eight weeks (Mayo Clinic, 2013).
Dyspnea
Dyspnea is a feeling difficult to breathe. Usually it happen when physical activity.
Dyspnea has many causes affecting either the breathing passages and lungs or the heart. The
dyspnea can occurs gradually or all of a sudden. The causes of dyspnea can be asthma,

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bronchitis, pneumonia, pneumothorax, anemia, lung cancer, inhalation injury, pulmonary

embolism, congestive heart failure, allergic reaction, anaphylaxis, interstitial lung disease,
obesity, tuberculosis, emphysema, pulmonary artery hypertension, and aerobic exercise.
Dyspnea can be associated with symptoms of chest pain, dizziness, fainting, cough,
wheezing, neck pain, and chest injury (Longo, 2011 cited in William, 2015)

2.1.2 Causes and Symptoms of Tuberculosis, Asthma, Pneumonia,

Emphysema and Lung Cancer
A. Tuberculosis
Tuberculosis is a disease that caused by infection of mycobacterium
tuberculosis. This disease can transmitted to the other human through saliva.
And the symptom is a cough with sputum about 3 weeks, bloody cough, high
bodys temperature, sweat in a night day, decrease satiety.
B. Asthma
Asthma is a disease in which the airways narrow excessively in response to
various stimuli in the presence of airway hyperresponsiveness (AHR) and
eosinophilic airway inflammation. In classic asthma (CA) variable airflow
obstruction typically leads to symptoms such as wheeze, dyspnea and cough.
(Niimi.2011)
Asthma caused by 3 factors, first is genetic factor. Genetic factor is big role
how asthma occurred, if there is our family that suffer asthma, so we have probability
suffer asthma. Second is allergic, like allergic of dust, temperature, and humidity.
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Allergic can trigger reaction in respirational tract, and it will produce excessive
sputum and respirational tract become narrow, and asthma occurred. Third is a
psychologic, emotion and stressed can cause asthma.
Asthmas symptoms are dyspnea with a wheezing sound. For the prevention,
asthma sufferer have to clean their environment like clean their bed from dust, avoid
high humidity room, pets and food that trigger allergic.
C. Pneumonia
Pneumonia is a infectious disease that occurred in lung tissue and caused by
bacteria, virus and fungi. Streptococcus bacteria, mycoplasma pneumonia are a
common bacteria that can occurred pneumonia. The symptoms are a cough with
sputum, chest pain, and dyspnea with high temperature.
D. Emphysema
Chronic obstructive pulmonary disease (COPD) is a disease characterized by
airflow limitation that is not fully reversible. The pathogenesis of COPD is thought to
be chronic inflammation throughout the airways, parenchyma, and pulmonary
vasculature. Pathologic changes characteristic of COPD occur in all these respiratory
structures. Among these changes, destruction of the lung parenchyma is commonly
referred to as pulmonary emphysema, defined as an abnormal permanent
enlargement of the air space distal to the terminal bronchioles, accompanied by
destruction of the alveolar walls, and without obvious fibrosis

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Emphysema cause by smoke from cigarettes, and lack of apha-1-atitripsin

enzyme, because of that alveolus lost its elasticity. The symptoms are dyspnea in a
long period and cannot cure by salve medicine. The decrease of satiety, and lost
bodys weight is an example of emphysemas symptoms.
E. Lung Cancer
Lung cancer is the most frequently diagnosed cancer and the leading cause of
cancer-related deaths worldwide. Evidence suggests that there is a relationship
between previous respiratory disease (PRD), including chronic bronchitis,
emphysema, tuberculosis, and pneumonia, and lung cancer diagnoses. Tobacco is a
shared risk factor of PRD and lung cancer.
Main causes of lung cancer in the world is smoke from cigarettes, it contain
many toxic substances and if we inhales it, it will accumulate in our lung for many
years and trigger a cell mutation that can cause lung cancer. The other cause of lung
cancer is radiation, other toxic chemical substances and genetic factor.
The symptoms of lung cancer are cough, chest pain, dyspnea, bloody cough,
tired and decrease of bodys weight. But, like the other cancer, the common symptom
of cancer will showed when the cancer has growth for along time and has spread all
over the body.
2.1.2 Cement and Cotton Contain
Cement
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Cement is an essential ingredient and many connective used in physical

development in the civil construction sector. If plus water, cement would be the
cement paste. If the plus fine aggregate, cement paste will be the mortar that if
coupled with the coarse aggregate will be a mixture of concrete Fresh after the
concrete hardens will be hard (concrete).
Portland cement made from fine powder minerals crystalline composition is
primarily calcium and aluminum silicate. The addition of this mineral water produces
a pasta that if it dries will is as strong as a rock. Density produced ranges between
3:12 and 3:16 and the heavy volume about 1500 kg cm3 (Nawy, 1985: 9). The main
ingredient forming portland cement is lime (CaO), silica (SiO3), alumina (Al2O3), a
little magnesia (MgO), and sometimes slightly alkaline. To control the composition,
sometimes add iron oxide, while gypsum (CaSO4.H2O) was added to set the timing
belt cement.
Semen that one can be distinguished with cement other based on their chemical
composition and fineness butimya. Comparison of main constituent materials
portland cement is lime (CaO) of about 60% -65%, silica (SiO2) of about 20% -25%,
and iron oxide as well as alumina (Fe2O3 and Al2O3) approximately 7% -12%.
There are four (4) compound The main chemicals that make portland cement,
namely:
1.
2.
3.
4.

Tricalcium Silicate (3CaO. SiO2) which is abbreviated be C3S.

Dicalcium Silicate (2CaO. SiO2) which is abbreviated be C2S.
Tricalcium aluminate (3CaO. Al2O3) are inbriefly became C3A.
Tertrakalsium aluminoferrit (4CaO. AL2O3.Fe2O3) is shortened to C4AF.

Cotton
Cotton comes from randu trees. Many people think that sleep on the kapuk is
more comfortable and not hot (cooler). But a bed of cotton can flat after being used
for a long time. Bed from cotton is not being suggested for people who have allergic.

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Because catton keep the dust inside bed. Kapuk has smooth piecess that can inhale
on repiratory system.
2.1.3 Definition of Holistic Approach
Holism is derived from the Greek, holos, which means whole, was first used by South
African philosopher Jan Christian Smuts (1926) in Holism and Evolution (Daniel and
Equlinet, 2006). Holistic approach to medicine is we can see the whole person. The whole
person means their body, mind, and spirit. The concept of holistic approach is a link between
physical health and the close interrelation with that physical health like biological,
psychological, social, and cultural. An holistic approach is not only treating the syptoms but
also thinking about the causes of those symptoms. It is usually called the story behind the
story. Daniel Mengistu and Equlinet Misganaw. 2006. Community Health Nursing. Page 12
Holisic Approach divide into 3 part :

AGENT
Agent is factor outside the body that have ability to causes, triggers, or worsen
disease. Agent can be from physical hazard, Biological Hazard, Chemical Hazard or
Psychosocial Hazard. Each Hazard described below (Comcare.gov.au, 2014).
1. Physical Hazard
A physical hazard is defined as a factor within the environment that can harm
the body without necessarily touching it. Vibration and noise are examples of
physical hazards". Physical hazards include but aren't limited to electricity, radiation,
pressure, noise, heights and vibration amongst many others.
2. Biologycal Hazard
Biological hazards are organic substances that pose a threat to the health
of humans and other living organisms. Biological hazards include pathogenic
micro-organisms, viruses, toxins (from biological sources), spores, fungi and bioactive substances. Biological hazards can also be considered to include biological
vectors or transmitters of disease.
Biological hazards pose risks for many people in a wide variety of ways.
For example, workers in health care professions are exposed to biological hazards
via contact with human bodily matter, such as blood, tissues, saliva, mucous,
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urine and faeces, because these substances have a high risk of containing viral or
bacterial diseases. Likewise, people who work with live animals or animal
products (blood, tissue, milk, eggs) are exposed to animal diseases and infections,
some of which (zoonoses) have the potential to infect humans (for example, Qfever, avian flu or Hendra virus) or cause serious allergy via sensitisation.
3. Chemical Hazard
Hazardous chemicals in the workplace are substances, mixtures and
materials that can be classified according to their health and physicochemical
risks and dangers.
Health hazards include skin irritants, carcinogens or respiratory sensitisers that
have an adverse effect on a worker's health as a result of direct contact with or
exposure to the chemical, usually through inhalation, skin contact or ingestion.
Physicochemical hazards generally result from a substance's physical and
chemical properties, as is the case with flammable, corrosive, oxidising or
explosive substances.
4. Social Hazard
Psychosocial hazards include but arent limited to stress, violence and
other workplace stressors.
There are circumstances, however, in which work can have adverse
consequences for health and wellbeing. Risks to psychological health at work
may arise from organizational or personal factors, with the major factors being
poor design of work and jobs, poor communication and interpersonal
relationships, bullying, occupational violence and fatigue. Risks to psychological
health due to work should be viewed in the same way as other health and safety
risks and a commitment to prevention of work-related stress should be included in
an organizations health and safety policies.
ENVIRONMENT
Environment is factor that can affect on health. Environment including
(Umijati, 2015) :
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1. Family
Including parents, dietary habit, lifestyle, family culture, familys economic,
health and nutritional status, and Spiritual.
2. Home Environment
Including home sanitation.
3. Health Services
Including policies and programs of nutrition and company health services.
4. Work Environment
Including work place sanitation, labor compensation, bio-psycho-socioculture hazard, and social and cultural conditions of society.
2.1.4 Holistic Approach Based on Scenario
We know that holistic approach divide into 3, based on scenario that is :
1. HOST
a.
b.
c.
d.
e.

Age : Woman, 23 years old.

Education : S1 Bachelor of Economy
Work : Accountant
Hygiene : Have a habit of coming home late at night after work
Health Status :
- Disease Profile: 1. Past: Experienced a dust allergy at 12 years old
2. Now: Have cough and shortness (ronki) and fever
(Temperature 37,5)
- Family Profile: Her father and aunt suffered bronchial asthma and
allergic rhinitis
f. Life Style : Have a habit buying food from outside/restaurant
g. Family and social roles :Female workers who go abroad
2. AGENT
a. Biological Hazard: fungi and bacteria
b. Chemical Hazard:
c. Physical Hazard: Cement dust, humidity
d. Social Hazard: Boarding nearby friends also have cough and shortness
3. ENVIRONMENT
a. Kost
The size is 20 m x 5 m
Wide House
Only has 3 opened-windows with size 2 m x 1 m
ventilation
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b. Work

Lived by 6 person
too many person in a house
Bed were built by kapok
Humidity 85 %
too high
Live with religious family
Her friend has cough and asthma too
Located near cement factory
Machine Company
As acountant

2.1.5 Medical Problem basen on holistic approach

In this case according to the holistic approach, we can not directly diagnose
the disease suffered by the woman, which we can do is how the woman may
experience medical problems seen from a holistic approach. As explained previously,
a holistic approach can be divided into 3 parts in advance, namely Host, Agent and
Environment. Through 3 of them, we can analyze how a medical problem occurs in a
woman .
If we look from the Host, we can divided again into several small parts such
as age, sex, occupation, lifestyle, hygiene, life status and medical history. We can take
some parts and we can make the analysis of why women may experience medical
problems. These things are lifestyle, occupation and medical history. As our
discussion, this woman has a job as an accountant in a machine company. For us, an
accountant must have worked just focus on the task and regardless of the work
environment so that her health is less well preserved. The second is her lifestyle, if we
look more deeply about her lifestyle, he often ate outside and often go home at night,
often eat outside that enabling reduced hygiene and food eaten can contain dangerous
microorganisms that can adversely affect the body and cause a medical problem such
as in this case. Often go home the evening can also cause a medical problem such as
in this case. The fourth is the history of the disease, it is very important because by
knowing how the medical history we can certainly know what she was exposed to
medical problems. As we know at the age of 12 years, he is allergic to dust, and it is
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in line with how the disease occurs because of the home environment that is close to a
cement plant and a large housing conditions without air circulation .

Job

Host

Often hanging out at

evening
Eat outside

Cough and
shortness of
breath

causes

Medical history

If we look at the second aspect , namely agents, it is increasingly obvious

influence. Agent can be seen in four parts, namely the threat of biological , chemical ,
physical and social . Of the biological threat , we can menngetahui humidity level of
the house of the woman is very high . Causing his house to be a place that is very
good for the growth of fungi and other microorganisms that can cause medical
problems . Besides the mattress he used made of cotton that can cause coughing and
breathing difficulties if inhaled.
Both are part of a chemical threat , as the information we know , the
environment around the house is a cement factory which will inevitably happen
deployment of substances derived from cement and very dangerous if it gets inhaled
by the woman. Chemicals such as silicates in cement by inhalation would be very
harmful to the human body . The silicate can also cause a disease that is one of the
symptoms of cough and shortness of breath . The third is the physical threat in the
form of dust in the house of the woman , as the information we receive , the home of
the woman is quite large but has a very slight amount of ventilation . So that the
circulation becomes very less and the dust would be harmful if inhaled , can cause
tightness and coughing . The fourth is a social threat , boarding a friend 's woman has
the same disease with the woman , which means there is a possibility that a friend of
his boarding can transmit the disease in women.
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Biological
Physical
Agent
Chemical
Social

Microorganisms
and fungus
Houses dust

Cough, and
Shortness of
breath
causes

Silica in Portland
Semen
house mate

The third is part of the environment , this is very important because most
diseases of the human body definitely has a direct relationship with the environment.
As in the environment section is divided into two, namely the workplace and home
environments . The first is the environment of the working environment , the working
environment of women is related to the engine , which means he often interact with
machines which can cause respiratory problems . Both are part of the home
environment , as described earlier , again and again from the rooming house is a big
woman but with little meaningful ventilation air flow is not smooth in the house and
will accumulate dust and pollution cement are in the neighborhood .
Job environment

In

ac
h

Environmen
t
environtment

ll
Sma

in
e

co
m
pa
ny

Cough, and
shortness of
breath

n
ilatio
vent

Viewed from the third exposure above , between these three aspects can we
analissi well and get how the disease can strike women . So if we draw the third part
in a table is as follows

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Job

Host

Often hang
out
Eat
outside
Medical
history
Biologi
cal

HOLISTIK

Agent

Physic
al
Chemi
cal
Social
Biologi
cal

Agent

Physic
al
Chemic
a.l
Social

cause

Microorganis
ms and
fungus

Cough and
shortness of
breath

dust
Silica in
portland semen
House
mate
Microorganism
s and fungus
dust
Silica in
portland
semen
House mate

2.2.1 Open web browser and type the keywords, such as : holistic approach, holistic,
holistic approach to medicine,physical hazard etc.
2.2.2 Search engine and web address that we used are :
www.google.com
www.scholar.google.com
www.gopubmed.org/web/gopubmed/
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www.ncbi.nlm.nih.gov/pubmed/

2.3 First Mind Mapping

DISEASE
(COUGH AND DYSPNEA)

HOST

AGENT

Age

ENVIRONMET

Biological Hazard
Kost

Education

Chemical Hazard

Work Place
Work

Physical Hazard
(Machine Company)

Hygiene

Social Hazard

Family and social roles

Life Style
Health Status
Hospital sheet

Family
HOLISTIC

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CHAPTER 3
TUTORIAL CONCLUSION
3.1 Data Analysis
Cough and dyspnea are common symptoms of some diseases related to
lung or cardiac. We dont discuss about what the disease host suffered but we just
can analyze about why cough and dyspnea happened. In this modul, we use the
holistic approach. It is like knowing the story behind the story.
Based on holistic approach, we can use a model called epidemiology triangle.
It is a model usually used to study about the health problems (cough and dyspnea).
These health problems can be associated with three major factors. These factors are :
1. Host (the person with the health problems)
The host is a woman 23 years old. She is an accountant in a company
based machine. She has past medical history, had experienced dust allergy
since 12 years old. Her families (her father and aunt) have rhinitis allergic and
bronchiale asthma. She moves from her domicile to city X. She lives in a
kos which is owned by religious people. After three months she lives in her
new domicile, she has the health problems (cough and dyspnea)
2. Agent (hazards in the environment)
Biological hazard
: Microorganims
Chemical hazard
: The composition of cement dust, SiO2 (Silicon
dioxide)
Physical hazard
Social hazard

: 85% humidity in the house

: people around the host

3. Environment (place in which the host and the agent interact)

The environment can be divided into:
1. Micro environment
: Her new domicile
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2. Meso environment

: Her new domicile is near the cement

factory, her work environmen

The new domicile of the host changes the environment of the host. From the
data we got, there are micro and meso environment changes. The micro environment
is the place where the host lives. It has size20 m X 5 m but with minimum
ventilation. There are only 3 windows in that house. The meso environment is the
environment around the host living. It is near the cement factory. The meso
environment can be the place where the host works. It is a machine company. The
changes of the environment mean the changes of the agent. From micro environment,
so many agents yang didapatkan. The physical agent is the 85% humidity in that
house. It can be caused by that house which has minimum ventilation and windows.
The dust in the house is also the physical agent. The host bed is made from cotton.
Actually, cotton is soft and comfortable for sleeping. But, cotton is not recommended
for people who have dust allergy because cotton can accumulate dust around it so it
can be inhaled while sleeping. From the meso environment, there is cement dust
exposure. The biological agent is there will be very big probability of microorganisms
live in that house because of the abnormal houses humidity. The chemical agent is
from the composition of cement dust like SiO 2 (Silicon dioxide). It is tiny particles
can enter into small air sacs in the lungs. If it is often inhaled, it can cause cough,
dyspnea, and wheezing.
The social agent can be analyzed from the people around the host. The host
lives in the house which is owned by religious people. The host can get the pressure
from them because of Nia habit who often go home at night. In addition, when
viewed from the side of the host's role in the family, she is a woman who works and
migrated out of the city, this may trigger psychological host. Stress can occur because
she is a woman who must work and also to adapt to the new ligkungan and should far
from her family. And the last, it is about the hosts medical history and her familys
medical history. It can make the probability of the host to has cough and dyspnea. The

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host has past medical history, had experienced dust allergy since 12 years old. Her
families (her father and aunt) have rhinitis allergic and bronchiale asthma.
If all three sections are connected to the host, agent and environment as the
cause medical problems, it can be found links between each other. Changes in the
environment on the host would cause changes to the agent, so there will be many
factors that affect the health of the host. It is not only host, agent, or environment
itself. But, all of those are linked each other.
First Host
3.2 Final Hypothesis
The environment
Medical
change
dan Medical
will be follow
Familyby
History
the agent changes that will affect
the host so that arose symptoms such as cough and dyspnea. According holistic
approach, asthma is a disease that
has most likely suffered by the host.
Domicile
Movement
Causing a change
to

AGENT

Biological Hazard :
3.3 Concept Mapping
Mold
Chemical Hazard :
Cement dust
Psychological Hazard :
dust
Social Hazard : stress
about work

HOS
T

Life Style

ENVIRONMEN
T

Kost
Workplace

Pstology
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3.4 Pathophysiologic mapping

Respiratory centers
(Respiratory drive)

Sensory Cortex
Corollary
Pathophysiology of Dyspnea
Chemoreceptors
Feedback
Motor
discharge
A. Decreased tissue oxygenation
Cortex of
Disease or acutely certain circumstances can cause the speed of delivery
Mechanoreceptors
Feed-forward
oxygen
to all tissues decreases . A decrease in tissue oxygenation will improve
Metaboreceptors
Error Signal
shortness of breath . Oxygen depends
on transport because of the circulation
of blood
Error Signal
Ventilatory
and hemoglobin levels , then some circumstances such as bleedingMuscles
, anemia
Dyspnea intensity and
( hemolysis ) , change in hemoglobin
( sulfhemoglobin , methemoglobin ,
quality
carboxyhemoglobin ) may cause shortness of breath .
Parenchyma lung disease that causes intrapulmonary shunt , ventilation
disorders also cause asphyxiation . So , shortness of breath can be caused by diseases
of bronchial asthma, bronchitis and pulmonary blood vessels disease group such as
emboli , vasculitis and primary pulmonary hypertension .
B. The need of oxygen increases
Disease or condition suddenly increased oxygen requirement would give the
sensation of shortness of breath . For example , acute infection will require more
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oxygen due to increased metabolism . Increase in body temperature due to material

pyrogens or stimuli in the central nervous causing increased oxygen demand and
eventually lead to shortness of breath . Likewise with thyrotoxicosis disease , basal
metabolic rate is increased so that the oxygen demand is also increasing . Physical
activity also requires more oxygen , causing suffocation .
C. The work of breathing increases
Parenchym lung disease such as pneumonia , swollen lungs which causes reduced
lung elasticity and disease that causes narrowing of the airways such as bronchial
asthma, bronchitis and bronchiolitis can lead to decreased lung ventilation . To
compensate for this situation and that the oxygen demand also remains can be met ,
the respiratory muscles are forced to work harder , or in other words the increased
work of breathing . This situation raises the metabolism increases and eventually
metabolites that are in the blood stream increases. Metabolites consisting of lactic
acid and pyruvic acid will stimulate the central nervous system . Oxygen demand
increases in obesity also leads to increased work of breathing .
D. Stimulate In Central Nervous System
A disease that attacks the central nervous system can lead to an attack of shortness of
breath suddenly . How to attack this , until now unclear , such as meningitis ,
cerebrovascular accident and others . Idiopathic hyperventilation also found ,
although the mechanism is unclear .
E. Neuromuscular diseases
Quite a lot of diseases that can cause disorders of the respiratory system , especially if
the disease was about diaphragms , such as myasthenia gravis and amyotrophic been
literally sclerosis . The mechanism that causes shortness of breath due to
neuromuscular disease is as yet unclear .
3.5 Problem Solving
Solutions Based On Holistic
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Symptoms of health problem that was taken by host is caused by some factors
depends on holistic. In every part of host, agent, and environment can support hosts
health problem. Therefore, to solve this health problem, we should fix every part of
host, agent, and environment depends on holistic.
In holistic, the solution of factors that support health problem are :
a. Host
In host, part that support health problem are education, life style, medical history,
and social roles. The education means host with s1 bachelor of economics maybe has
less health education. So, by increasing health education also can increase hosts
health level.
The second is life style, someones bad habit will influence hosts health
condition. In this scenario, host often going home late until night, this condition gives
bad impact to host because night wind has low temperature. By this low temperature,
maybe hosts immunity can not control it or maybe host has night-wind allergic.
Moreover, this condition can trigger pneumonia. Therefore, host should decrease her
bad habit not to going home late at night often.
The third is medical history, medical history are medical history in the past and
family. For disease history, host was ever taken allergic to dust at 12 years old.
Allergy can appear for the second time if there are some triggers.
The last is social roles. In this scenario, social roles means host roles as female
who works outside town far from her family, this condition can build stress to host.
So, the solution are decreasing work portion and fixing her communication with her
family.
b. Agent
In agent, there are some factors that support this health problem. There are
biological hazard, physical and social hazard. Biological hazard is about
microorganism and fungi that cause this health problem based on the condition in

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scenario. So, ways to solve and prevent this health problem are adding more
ventilation in the kost and cleaning kost regularly.
Second is physical hazard. Physical hazard based on scenario means the dust that
was inhaled by host then flew in host respiratory system and humidity. Level
humidity in scenario is too high, so it can triggers cough and dyspnea. To balancing
humidity, host should keep the kost dry and setting air circulation. Then, to decrease
the dust, host should keep the ventilation only open when wind outside kost is calm.
c. Environment
In environment, some factors that cause symptom of cough and sesak are house
environment and workplace. In house environment based on scenario, hosts kost
located near cement company with less ventilation and kost area is too wide. Hosts
workplace based on scenario is machine company. To prevent new health problem,
host must clean kost and workplace where she often spend her most time there
regularly and maybe host needs use masker in kost or at work.
Solution Of Cough And Dyspnea In Common
A medical problem suffered by host is cough and dyspnea. Dsypnea can cause
lack of oxygen in the body, it happened because of trouble in breathing. Thus, the
solutions are plant more trees, daily exercise and live in a clean and wide
environment.
Chronic dyspnea sufferer have to avoid a food and drink that contain a high
sugar like milk, white sugar, candy, wheat, and rice. Beside unhealthy food and
drinks, sufferer must consume fruit and vegetable, and also enough mineral water.
Dyspnea can be prevented and cured by a daily exercise, the funcion of the
exercise are to increase movement of back and chest that can train muscle around
lung, diaphragm and blood circulation. Best exercise is swimming because all of the
body move in swimming.

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Medicines that can cure dyspnea is a kind of drug that can enlarge respiratory
tract. The main reaseon why dyspnea can occur in human body is a psychologic
pressure that trigger dyspnea. Thud, we have to enjoy our life and dont think to much.
Sigit Nugroho (2009) cited in Wara Kushartanti (2002) said that breathing
exercise must be done everyday in few minutes. These are the direction :
a. Exhale air through nose until mucus is pulled up.
b. Take short inhale pass through nose and take long exhale through mouth so it
can produces voice.
c. Loose clothes or pants then setting air breath. Tell someone if there is ngik
voices during first few minutes from diaphragm breathing.
d. Drink a glass of water before and after take an exercise.

References
C. Shiel Jr., William. 2015. Shorness of Breath (Dyspnea). MedicineNet, Inc.
http://www.medicinenet.com/script/main/mobileart.asp?articlekey=34434 (online)
[Accessed 22 Nov. 2015].
Comcare.gov.au,

(2014).

Managing

hazards.

[online]

Available

at:

http://www.comcare.go-v.au/preventing/hazards/ [Accessed 22 Nov. 2015].

Denholm, Rachel, et al. "Is previous respiratory disease a risk factor for lung
cancer?." American journal of respiratory and critical care medicine 190.5 (2014):
549-559.
Google.co.id, (2015). Semen. [online] Available at: https://www.google.co.id/url?
sa=t&rct=j&q=&esrc=s&source=web&cd=2&cad=rja&uact=8&ved=0ahUKEwiR5Y
L9xKjJAhVRbY4KHZx5BI0QFgggMAE&url=http%3A%2F
%2Fkk.mercubuana.ac.id%2Felearning%2Ffiles_modul%2F11004-7PBL Group 4B Faculty of Medicine Airlangga University
Holistic Module

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901570378753.pdf&usg=AFQjCNG6w6TC46xn7ewYhXuiOlBQuzuSsw&sig2=eU8
sGo8q97RQXrlmKOGmZA [Accessed 24 Nov. 2015].
Longo, D.L., et al. 2011. Harrisons Principles of Internal Medicine., 18th ed. United
States: McGraw-Hill Professional
Mengistu Daniel and Equlinet Misganaw. 2006. Community Health Nursing. Page 12
(PDF) [Accessed 24 Nov. 2015]
Ober, Carole, and TsungChieh Yao. "The genetics of asthma and allergic disease: a
21st century perspective." Immunological reviews 242.1 (2011): 10-30.
Nugroho, Sigit, Dosen Pendidikan Olahraga Kesehatan Fakultas Ilmu, and
Keolahragan Universitas Negeri. "Terapi Pernapasan Pada Penderita Asma." (2008).
Prescott, Hallie C., Michael W. Sjoding, and Theodore J. Iwashyna. "Diagnoses of
Early and Late Readmissions after Hospitalization for Pneumonia. A Systematic
Review." Annals of the American Thoracic Society 11.7 (2014): 1091-1100.
Umijati, Sri. 'Modul Pendekatan Holistik Manusia Dan Lingkungan'. 2015. Lecture.
LINK :
http://mitaunair-fk12.web.unair.ac.id/
http://www.alodokter.com/batuk-batuk/
http://www.mayoclinic.org/diseases-conditions/barretts-esophagus/multimedia/vid-20078526
http://artikel.co/72/sesak-nafas-dan-solusinya.html
http://www.medicinenet.com/script/main/mobileart.asp?articlekey=34434

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JOURNAL APPRAISAL
Grup : 4B
Title

: Hazard potential ranking of hazardous waste landfill sites and risk of

congenital anomalies

1. THE COMPLETENESS OF PAPER FORMAT

Appraisal Item

:
Avaibility

Title

Yes (page 1)

Abstract and or Summary

Yes (page 1)

Introduction, background

Yes (page 1)

Method

Yes (page 2)

Result

Yes (page 4)

Discussion

Yes (page 6)

Acknowledgement

Yes (page 8)

Reference

Yes (page 8)

Conclusion : The format is complete / not complete

2. STUDY RESEARCH VALIDITY

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a. Purpose of research : To develop and evaluate an expert panel scoring method

of the hazard potential of EUROHAZCON landfill sites, and to investigate
whether sites classified as posing a greater potential hazard.
a. Research method
Item

Result

Design

Case-Control Study

hierarchy of evidence

Sample

The sample is landfill sites which

contained
hazardous waste of non-domestic
origin (as defined in the
EC directive 91/689 on Hazardous
Waste13) in the regions covered
by the participating centres

Sample Size

20 landfill sites in 14 study

areas

Exclusion Criteria

geographic site coordinates used in initial

analyses proved
incorrect

Sampling Frame

Random Sampling

Measurement and or assessment

And Final hazard scores (after changes

were made) of the four
experts were averaged to form the final
overall, water, and air
hazard scoring. High, medium, and low
hazard categories were created using
tertiles of the hazard scores as cut off
points.

Instrument

questionnaires

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Randomization

Intervention

Analysis Method

In order to assess the agreement between

experts in both initial
and final scores, intraclass correlation
coefficients (ICC)
were calculated by analysis of variance.
In addition, the
reliability of the average expert scores
(ICCk) was calculated.

a) Compatibility of The Design and The Objective of The Study

compatible
b) Compatibility of The Measurement & The instruments

compatible
Consclusion : Valid / Not Valid

3.

IMPORTANCE OF RESEARCH
A. P
= 0.06, if the research was reheld 100 times, 6 among of them didnt
give results as this research.
OR
= 0,79 (0.511.21) in the low hazard category, 1.43 (1.101.86) in the
medium, to 1.60 (1.162.21) in the high water hazard category.
B. Conclusion : Importance/Not Importance.

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