tag:blogger.com,1999:blog-17171297592330645182024-03-14T13:34:17.904+08:00My Nursing Box .comWishing all a good magical day.Spreading happy thoughts and positive vibes!Peace + Harmony!misibbhttp://www.blogger.com/profile/14827173537467932982noreply@blogger.comBlogger23125tag:blogger.com,1999:blog-1717129759233064518.post-54182183808063218072014-05-18T21:49:00.001+08:002014-05-18T21:49:52.252+08:00Apakah Masalah Biasa Bayi Yang Baru Lahir? | My Nursing Box .com<a href="http://mynursingbox.blogspot.com/2010/03/apakah-masalah-biasa-bayi-yang-baru.html">Apakah Masalah Biasa Bayi Yang Baru Lahir? | My Nursing Box .com</a><br />
<br />
<span class="fullpost"></span><script type="text/javascript">adv_username = "misibb";adv_gid = "misibb_default";adtype = "180x150";</script><script src="http://www.advertlets.com/_/js/advertlets_lite.js" type="text/javascript"></script>misibbhttp://www.blogger.com/profile/14827173537467932982noreply@blogger.com0tag:blogger.com,1999:blog-1717129759233064518.post-6946361344260703922010-11-28T00:20:00.003+08:002010-11-28T00:56:30.260+08:00Intimate Talk!It's easy to put if off, but there are huge benefits for you - and your man. So make sex a regular daily routine... just like brushing your teeth!<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://3.bp.blogspot.com/_StW9Y6v_f4I/TPE3u6iEmHI/AAAAAAAAAJw/l10Z_63APfc/s1600/intimate.jpg"><img style="margin: 0pt 10px 10px 0pt; float: left; cursor: pointer; width: 400px; height: 300px;" src="http://3.bp.blogspot.com/_StW9Y6v_f4I/TPE3u6iEmHI/AAAAAAAAAJw/l10Z_63APfc/s400/intimate.jpg" alt="" id="BLOGGER_PHOTO_ID_5544273895395465330" border="0" /></a><br /><div style="text-align: center;">Good sex is truly wonderful. The warmth of his skin, his smell, the whisper of his mouth across yours. It's a meeting of minds, bodies and souls, a mutual, profound bonding that penetrates us to our very core. The only problem is, long-term relationships can be a kiss of death to regular sex. Ask anyone who's been married for years. No one seems to have time for it anymore. It's so difficult to muster up the interest or the energy to regard sex as a normal part of life. Other important things seem to take precedent - like our work, house chores and, er the telly.<br /><div style="text-align: left;"><span style="font-weight: bold; color: rgb(153, 0, 0);font-size:180%;" ><br />8</span> <span style="color: rgb(153, 0, 0); font-weight: bold;">(Quick) sizzling moves to jump-start your sex life</span><br /><div style="text-align: right;">Realise there's probably nothing wrong with the relationship if the sight of your partner's body doesn't always send you into a frenzy. Sex requires effort. Try something new. Take turns giving each other massages. Stop blaming each other or your work for your low desire. Making love means making time. Pick a day(s) when you want to get physical and stick to it. Studies show the more you anticipate sex, the higher your pleasure factor. Talk each other up. Low self-esteem and sex don't mix. You need to feel good about yourself - and you can help each other with this. Also define your sexual needs, share your findings - and try fulfilling them.<br /></div><div style="text-align: right;">If you're simmering because he hasn't helped with the household chores, you aren't going to feel especially loving towards him. Thrash it out - then trash it out. Love, like everything, needs to be balanced.Your partner should be as committed as you are in the relationship. Clear your mind and make space for sex. Why worry about work at 10.30pm? They're not paying you for that. Get your priorities right. Turn off the phone, clear a space, and then concentrate on your lover and you. Relocate. Bring back early days of lust - the sofa, shower, kitchen table, and car. When the urge strikes, don't think. Just do it. Set the alarm a little earlier and make love first thing in the morning. Testosterone levels are highest when we first wake up and decreases as the day progresses. Remember, sex is one of life's challenges. It's supposed to be fun and one of the few areas where adults can play. So turn off the TV and turn on each other! </div></div></div><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://3.bp.blogspot.com/_StW9Y6v_f4I/TPEwRHfHCXI/AAAAAAAAAJo/P_9J_okc6os/s1600/fairylove.jpg"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 300px;" src="http://3.bp.blogspot.com/_StW9Y6v_f4I/TPEwRHfHCXI/AAAAAAAAAJo/P_9J_okc6os/s400/fairylove.jpg" alt="" id="BLOGGER_PHOTO_ID_5544265686895233394" border="0" /></a><br /><span class="fullpost"></span><script type="text/javascript">adv_username = "misibb";adv_gid = "misibb_default";adtype = "180x150";</script><script type="text/javascript" src="http://www.advertlets.com/_/js/advertlets_lite.js"></script>misibbhttp://www.blogger.com/profile/14827173537467932982noreply@blogger.com0tag:blogger.com,1999:blog-1717129759233064518.post-90741303394939180462010-11-24T01:37:00.005+08:002010-11-24T02:28:45.680+08:00BABY, Behave!<span style="color: rgb(0, 0, 153); font-weight: bold;">Your child needs your guidance to learn good behaviour, so knowing when to say ' no ' is crucial</span><br /><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://1.bp.blogspot.com/_StW9Y6v_f4I/TOwGweatqYI/AAAAAAAAAJg/60E4l2Z1lAY/s1600/babyandmother.jpg"><img style="margin: 0pt 10px 10px 0pt; float: left; cursor: pointer; width: 400px; height: 268px;" src="http://1.bp.blogspot.com/_StW9Y6v_f4I/TOwGweatqYI/AAAAAAAAAJg/60E4l2Z1lAY/s400/babyandmother.jpg" alt="" id="BLOGGER_PHOTO_ID_5542812671254833538" border="0" /></a><br /><span style="color: rgb(204, 0, 0); font-weight: bold;">AGES and STAGES : What your child understands ?</span><br /><ul><li>6 - 12 months - There's no dubt that at this age your child begins to understand the words 'yes' and 'no' and also to recognise when you're annoyed with her. However, this doesn't mean you can expect her to do what you ask.</li><li>18 months - The typical toddler likes to draw the line herself and rejects attempts to do this for her. Resistance to rules can be fierce, and many parents feel they face a constant struggle.<br /></li></ul><ul><li>2 years - She's full of her own importance and expects you do as she wants, not the other way round. Because she lacks patience, she can explode with frustration the instant she hears 'no'.</li><li>3 years - Your child now realises she isn't the only one who is expected to behave properly - everyone at home needs to think of others, too. She tries harder to conform as she's keen to please you.</li><li>4 years - She may become something of a disciplinarian now, and ready to tell you off for putting your feet on the chair or for leaving a used mug on the floor. She realises the rules apply to everybody, not only to her.</li><li>5 years + ; By now, your child is so aware of the way she's expected to behave that she can usually do this without a reminder from mum or dad. In fact, your child often draws the line herself now.<br /></li></ul><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://2.bp.blogspot.com/_StW9Y6v_f4I/TOwCSLLT06I/AAAAAAAAAJY/eYvvXs8xABI/s1600/mother.jpg"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 170px;" src="http://2.bp.blogspot.com/_StW9Y6v_f4I/TOwCSLLT06I/AAAAAAAAAJY/eYvvXs8xABI/s400/mother.jpg" alt="" id="BLOGGER_PHOTO_ID_5542807752647365538" border="0" /></a><br /><span style="color: rgb(51, 0, 51); font-weight: bold;">GOOD BEHAVIOUR YOUR 10 - POINT ACTION PLAN</span><br />It's never easy to draw the line in a confrontation with your child. Know when to stand your ground, and how to do so effectively.<br /><br /><ol><li><span style="color: rgb(0, 0, 153);">ALWAYS PRAISE GOOD BEHAVIOUR.</span> A cuddle when your child does what you ask him to will encourage him to do the same next time. Praise for good behaviour is always more effective than punishment for naughty behaviour.<br /></li><li><span style="color: rgb(0, 0, 153);">EXPLAIN YOUR RULES. </span>He's more likely to do as you ask if he understands why. Use terms he can understand, for example, "Don't touch that because it could hurt you and make you cry".</li><li><span style="color: rgb(0, 0, 153);">HAVE CONFIDENCE. </span>You're the parent, after all. Even though he still challenges you , trust yourself to know that you're being reasonable and sensible.</li><li><span style="color: rgb(0, 0, 153);">USE DIVERSIONS.</span> Rather than saying an outright "no" , try to distract your child, or find a different way round the problem.</li><li><span style="color: rgb(0, 0, 153);">GIVE LOTS OF ATTENTION.</span> Make sure to spend as much time as you possibly can with your child, so that he doesn't feel the need to misbehave just to get noticed.</li><li><span style="color: rgb(0, 0, 153);">STAY IN CONTROL.</span> Children can sometimes create a fuss just for the sake of getting a heated reaction. It's important to keep calm when provoked. Say firmly, "I'm not going to talk to you until you stop being silly."</li><li><span style="color: rgb(0, 0, 153);">KEEP LOOKING FORWARD. </span>You'll feel terrible at the end of a day in which you spent most of the time reprimanding your child. Everybody has days like that. Put it behind you and look forward positively to tomorrow.</li><li><span style="color: rgb(0, 0, 153);">ANTICIPATE YOUR CHILD'S BEHAVIOUR. </span>If you know your three-year-old becomes irritable in the hour before bedtime because he's so tired, think about bringing bedtime forward a little, or reading him an extra story, to avoid a crists altogether.</li><li>WALK AWAY. There may be times when you're so fed up with constant battles that you feel ready to explode. That's normal. Instead of shouting, walk into another room for a couple of minutes until you calm down.</li><li><span style="color: rgb(0, 0, 153);">DEAL WITH INCIDENTS AS THEY HAPPEN.</span> You can't expect a young child to remember what he's done wrong hours after it's happened. Deal with it immediately - then let it go.<br /></li></ol><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://1.bp.blogspot.com/_StW9Y6v_f4I/TOv79LDfRLI/AAAAAAAAAJQ/YKcgPjpJZlk/s1600/waitingfordaddyyellow.jpg"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 300px;" src="http://1.bp.blogspot.com/_StW9Y6v_f4I/TOv79LDfRLI/AAAAAAAAAJQ/YKcgPjpJZlk/s400/waitingfordaddyyellow.jpg" alt="" id="BLOGGER_PHOTO_ID_5542800794767541426" border="0" /></a><br /><span class="fullpost"></span><script type="text/javascript">adv_username = "misibb";adv_gid = "misibb_default";adtype = "180x150";</script><script type="text/javascript" src="http://www.advertlets.com/_/js/advertlets_lite.js"></script>misibbhttp://www.blogger.com/profile/14827173537467932982noreply@blogger.com0tag:blogger.com,1999:blog-1717129759233064518.post-76423838265910815432010-10-11T02:05:00.002+08:002010-10-11T02:46:15.053+08:00STUTTER ! Something Serious?<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://3.bp.blogspot.com/_StW9Y6v_f4I/TLIDIc3xBLI/AAAAAAAAAII/b501nAZFjAs/s1600/candhstutter.jpg"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 314px; height: 371px;" src="http://3.bp.blogspot.com/_StW9Y6v_f4I/TLIDIc3xBLI/AAAAAAAAAII/b501nAZFjAs/s400/candhstutter.jpg" alt="" id="BLOGGER_PHOTO_ID_5526483136460948658" border="0" /></a>When is that STUTTER SOMETHING SERIOUS?<br />When her tot started stuttering, people said it would go away. But this mother was not willing to ignore it. She shares how she helped her son talk confidently again.<br />" Don't worry", said friends and family when my three-year-old started to stutter. " He's just learning new words". But after a few weeks of " I-I-I want's" and " L-l-like's ", one particular incident made me decide to take action.<br />We were in the middle of our usual bedtime story and my little fellow was stuck on the word "spot". All that was coming out of his mouth was " S-s-s..."<br />I wanted patiently, but suddenly my son clamped his hands over his mouth and said himself, "S-s-s..stop it. Sp-sp-speak properly. T-t-talk like a big boy."<br />It chilled my heart to see my little boy so frustrated and angry with himself.<br />Over the next few weeks, my paediatrician monitored my son's stuttering pattern. I also requested his pre-school teachers for regular updates about his stuttering, and implemented a zero-tolerance policy on any teasing.<br />Thankfully, my older six-year-old son showed restraint towards his little brother. My younger son's teachers also kept an eye on his classmates.<br />At home, my husband and I spent time reading to our son, encouraging him to tell stories at his own pace. After about three months of all this, to my relief, the stutter had gone.<br />During that time I researched the topic of stuttering in children, and found that the crucial time for diagnosis and treatment is between the eges of two and five. And the signs are easy to miss.<br /><br />So what are the signs to watch out for? Make a note if you observe the following symptoms in your child :<br /><ul><li>Excessively repeats words and phrases. For example, "I-I-I want that..."</li><li>Stretches syllables. For example, " Sssshhow me how..."</li><li>Shows facial tension, blinks,grimaces or jerks his or her head.</li><li>The child struggles with speech and avoids situations where he or she will have a talk.</li><li>Has blocks in speech . This indicates that the child is trying to speak but cannot get the sound out.</li></ul>TIME IT RIGHT ( ^__^)<br /><script type="text/javascript">adv_username = "misibb";adv_gid = "misibb_default";adtype = "180x150";</script><script type="text/javascript" src="http://www.advertlets.com/_/js/advertlets_lite.js"></script>misibbhttp://www.blogger.com/profile/14827173537467932982noreply@blogger.com0tag:blogger.com,1999:blog-1717129759233064518.post-52414892253473335572010-08-24T13:13:00.004+08:002010-08-24T14:26:32.864+08:00PENJAGAAN ~ untuk Ibu Hamil ketika Berpuasa<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://2.bp.blogspot.com/_StW9Y6v_f4I/THNl970ZYoI/AAAAAAAAAH4/jZrjIzshuxY/s1600/23127-muslimah.jpg"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 400px; height: 297px;" src="http://2.bp.blogspot.com/_StW9Y6v_f4I/THNl970ZYoI/AAAAAAAAAH4/jZrjIzshuxY/s400/23127-muslimah.jpg" border="0" alt="" id="BLOGGER_PHOTO_ID_5508858883908133506" /></a><br /><b><span class="Apple-style-span" style="color:#003300;">HIKMAH BERPUASA DAN KELEBIHAN RAMADHAN</span></b><div style="text-align: left;"><br /></div><div style="text-align: left;">Kelebihan Ramadan, umat Islam di seluruh pelusuk dunia serentak mengerjakan puasa dalam satu masa tertentu. <span class="Apple-style-span" style="color:#003333;"><b>Kesatuan Hati</b></span> dan <span class="Apple-style-span" style="color:#003300;"><b>niat tulus Ikhlas</b></span> ini di lakukan semata-mata untuk mengabdikan diri terhadap Allah SWT. Dengan diwajibkan berpuasa, semua golongan Islam, kaya dan miskin, berada dan tidak berada terpaksa menempuh <span class="Apple-style-span" style="color:#003333;"><b>ujian yang sama</b></span>. Dengan berpusa menimbulkan <span class="Apple-style-span" style="color:#003333;"><b>keinsafan</b></span> dan perasaan bertimbang rasa serta kasih-mengasihi sesama umat Islam. Amalan berpuasa melahirkan jiwa insan yang selalu <span class="Apple-style-span" style="color:#003333;"><b>taat kepada Allah</b></span>, justeru itu akan lahir pula ketenangan jiwa dan ketakwaan. </div><div style="text-align: left;"><br /></div><div style="text-align: left;">Dari segi <span class="Apple-style-span" style="color:#003300;"><b>kesihatan</b></span>, perut yang melalui proses berpuasa dapat dibersihkan, sekali gus beberapa penyakit yang terdapat di dalam tubuh badan manusia dapat diatasi. Dalam istilah perubatan berpuasa amat digalakkan bagi membuat ujian darah sebelum mendapat langkah-langkah perubatan pengamalan yang lain dilakukan. Contoh pembedahan atau ujian penyakit.</div><div style="text-align: left;"><br /></div><div style="text-align: left;">Puasa itu disifatkan oleh Rasulullah SAW sebagai <span class="Apple-style-span" style="color:#003333;"><b>separuh daripada kesabaran</b></span>. Orang yang berpuasa lebih disayangi Allah, <span class="Apple-style-span" style="color:#003333;"><b>selamat daripada api neraka</b></span> dan menghapuskan dosa-dosa kecil. Kedatangan Ramadan ada keistimewaannya kerana dianjurkan <span class="Apple-style-span" style="color:#003333;"><b>ibadah solat Tarawih</b></span>, di samping itu diwajibkan juga <span class="Apple-style-span" style="color:#003333;"><b>zakat fitrah </b></span>(badan) ke atas golongan yang mampu sebagai satu kewajipan membantu insan Muslim yang lain, khususnya mereka yang daif. Ketibaan Ramadan menandakan<span class="Apple-style-span" style="color:#003333;"><b> terbukanya pintu-pintu syurga</b></span>, <span class="Apple-style-span" style="color:#003333;"><b>ditutup pintu-pintu neraka</b></span> dan dirantaikan syaitan. Malam <span class="Apple-style-span" style="color:#003333;"><b>Nuzul al-Quran</b></span> (17 Ramadan) merupakan saat penting </div><div style="text-align: left;"><span class="Apple-style-span" style="color:#003333;"><b>al-Quran diturunkan</b></span> dari langit ke dunia untuk menjadi pedoman manusia hingga ke akhir zaman. Terdapat <span class="Apple-style-span" style="color:#003333;"><b>Lailatul Qadar</b></span> iaitu satu malam yang padanya terdapat saat penuh keberkatan menyamai 1000 bulan (83 tahun 3 bulan) ganjaran pahalanya daripada Allah SWT. Rugilah kita sekiranya kita ketinggalan di dalam bulan puasa ini...</div><div style="text-align: left;"><br /></div><div style="text-align: left;"><span class="Apple-style-span" style="color:#003333;"><b>Tiada kemudaratan Untuk Ibu Mengandung Berpuasa.</b></span></div><div style="text-align: left;"><span class="Apple-style-span" style="color:#003333;"><b><br /></b></span></div><div style="text-align: left;"><span class="Apple-style-span" style="color:#003333;">Kita sebenarnya juga berpuasa sewaktu tidur setiap malam, cuma tempoh tidur mungkin tidak selama tempoh berpuasa Ramadan. Waktu makan pada siang hari boleh diganti dengan waktu makan pada malam hari iaitu berbuka, selepas solat Maghrib , waktu sahur dan mengambil minuman berkalori sebelum tidur. Eloklah mengamalkan bersahur lewat dan segera berbuka apabila masuk waktunya. Memahami perubahan normal yang berlaku dalam kehamilan meyakinkan seseorang untuk meneruskan berpuasa, tetapi dengan mengambil langkah berkaitan. Secara amnya , perubahan yang berlaku dalam kehamilan boleh dibahagikan kepada 3 fasa atau trimester.</span></div><div style="text-align: left;"><span class="Apple-style-span" style="color:#003333;"><br /></span></div><div style="text-align: left;"><span class="Apple-style-span" style="color:#003333;"><b>Trimester 1 (bulan pertama hingga ketiga)</b></span></div><div style="text-align: left;"><span class="Apple-style-span" style="color:#003333;">~loya , muntah , pening , pedih ulu hati sering berlaku "morning sickness".</span></div><div style="text-align: left;"><span class="Apple-style-span" style="color:#003333;">~kehilangan cecair badan daripada muntah kadangkala tidak cukup diganti dengan makan dan minum bagi wanita yang terganggu seleranya. hingga tidak bermaya . Tambahan pula bau pil supplement sperti folic acid dan zat besi boleh tambah loya sehingga menjangkau bulan keempat kehamilan.</span></div><div style="text-align: left;"><span class="Apple-style-span" style="color:#003333;"><br /></span></div><div style="text-align: left;"><span class="Apple-style-span" style="color:#003333;"><b>Trimester 2 ( bulan keempat, kelima dan keenam kehamilan)</b></span></div><div style="text-align: left;"><span class="Apple-style-span" style="color:#003333;">~tempoh yang paling selesa. Selera makan kembali normal dan bertambah.</span></div><div style="text-align: left;"><span class="Apple-style-span" style="color:#003333;">~mempengaruhi psikologi si ibu menjadi positif untuk berpuasa tanpa gangguan..amat menyeronokan waktu ini.</span></div><div style="text-align: left;"><span class="Apple-style-span" style="color:#003333;">~lebihkan minum air kerana mudah dehidrasi pada waktu ini. Elak berdiri terlalu lama. Tekanan Darah menjadi lebih rendah daripada biasa. Elak perubahan posisi yang mendadak apabila hendak bangun. Seeloknya daripada berbaring, anda duduk sebentar , kemudian bangun perlahan-lahan sebelum mula melangkah. Kurangkan aktiviti yang tidak penting untuk simpan tenaga contoh berjalan-jalan ( shopping) boleh mengurangkan gula dalam darah dan dehidrasi.</span></div><div style="text-align: left;"><span class="Apple-style-span" style="color:#003333;"><br /></span></div><div style="text-align: left;"><span class="Apple-style-span" style="color:#003333;"><b>Trimester 3 ( bulan ketujuh hingga lahir)</b></span></div><div style="text-align: left;"><span class="Apple-style-span" style="color:#003333;">~mudah penat saiz kandungan semakin besar dan berat.</span></div><div style="text-align: left;"><span class="Apple-style-span" style="color:#003333;">~mudah rasa mengah,sakit pada bahagian ari-ari, pedih ulu hati, sembelit, ketegangan akibat kontraksi Braxton Hicks boleh menjadikan anda tidak selesa dan mudah keletihan.</span></div><div style="text-align: left;"><span class="Apple-style-span" style="color:#003333;">~selain penjagaan aktiviti ; memakai pakaian yan selesa dan tidak ketat, tidak memakai kasut tumit tinggi serta berhati-hati sewaktu berjalan agat tidak jatuh. serta berhati-hati sewaktu berkenderaan di jalan raya - kemalangan lebih kerap berlaku. Semoga semuanya dapat membantu menghadapi kehamilan dengan jayanya.</span></div><div style="text-align: left;"><span class="Apple-style-span" style="color:#003333;"><br /></span></div><div style="text-align: left;"><span class="Apple-style-span" style="color:#003333;"><br /></span></div>misibbhttp://www.blogger.com/profile/14827173537467932982noreply@blogger.com0tag:blogger.com,1999:blog-1717129759233064518.post-43475150282668700532010-08-10T00:23:00.006+08:002010-08-10T01:20:48.753+08:00WATER WORKS !<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://3.bp.blogspot.com/_StW9Y6v_f4I/TGAt2Y-LYuI/AAAAAAAAAHw/qhxukWXKncU/s1600/frogfunnyicon2.jpg"><img style="float:left; margin:0 10px 10px 0;cursor:pointer; cursor:hand;width: 250px; height: 250px;" src="http://3.bp.blogspot.com/_StW9Y6v_f4I/TGAt2Y-LYuI/AAAAAAAAAHw/qhxukWXKncU/s400/frogfunnyicon2.jpg" border="0" alt="" id="BLOGGER_PHOTO_ID_5503449157086175970" /></a>
<br /><span class="Apple-style-span" style="font-size:large;"><b>Did you know there's a difference between dehydrated skin and dry skin?<span class="fullpost"></span></b></span><script type="text/javascript">adv_username = "misibb";adv_gid = "misibb_default";</script><div><span class="Apple-style-span" style="font-size:large;"><b>Or that there's a difference between hydration and moisturisation?</b></span></div><div><span class="Apple-style-span" style="font-size:large;"><b>If you've been in the dark, grab a glass of water and find out why you need to give hydration some serious </b></span></div><div><span class="Apple-style-span" style="font-size:large;"><b>attention !</b></span></div><div>
<br /></div><div>
<br /></div><div>
<br /></div><div>
<br /></div><div><b>
<br /></b></div><div><b>
<br /></b></div><div><b>Dehydration </b></div><div>As we know , the majority of our body is made up of water, contributing about 60% of the body's weight. Most of it is found within the cells of the body ( intracellular space ). The rest is found in extracellular space, consisting of blood vessels ( intravascular space ) and the spaces between cells ( interstitial space ).</div><div>
<br /></div><div>The skin alone accounts for 20% of water. We lose about 2.5 litres of water each day via sweat, urine and bowel movements and cell processes.</div><div>We lose water even when we think we don't - When we breathe, humidified air leaves the body. When the amount of water leaving the body is greater than the amount being taken in, dehydration sets in and shows on our skin ( the body's largest organ ), making it look dull, dry,tight and uncomfortable, with superficial lines. The skin cells lose water and their plumpness reduces with insufficient hydration of the stratum corneum, the outer most layer of the epidermis, dehydration renders the skin an ineffective barrier against environmental aggressors. This is not a good thing.</div><div>
<br /></div><div><span class="Apple-style-span" style="color:#000099;"><b><i>Causes of Moisture Loss</i></b></span></div><div><span class="Apple-style-span" style="color:#000099;"><b><i>
<br /></i></b></span></div><div>Dehydration is caused by external and internal factors.</div><div>
<br /></div><div><ul><li><span class="Apple-style-span" style="color:#000099;"><b><i>Externally </i></b></span>--> there's rapid water evaporation - caused by environmental factors, incorrect skincare routine, diet, lifestyle and sun exposure.</li><li><span class="Apple-style-span" style="color:#000099;"><i><b>Internally</b></i></span> --> it's all about insufficient internal hydration - caused by abnormalities in bodily functions, illness, medication and ageing.</li></ul><div>So it can't be blamed solely on not drinking sufficient water. Staying out in the sun reduces water and makes the skin diarrhoea and vomitting.</div></div><div>Poor cleansing habits and products like soap, dry out skin. Harsh acne treatments, like hydrogen peroxide, alter the keratinisation process and weaken the skin.</div><div>Cigarette smoking is directly associated with wrinkle formation.</div><div>Regular use of scrubs can break down cell cohesion in certain skin types.</div><div>Air conditioning causes moisture to evaporate quickly.</div><div>Hot showers remove sebum from the skins surface.</div><div>Excessive table salt intake can have a dehydrating effect.</div><div>Coffee, too, can contribute to dehydration.</div><div>
<br /></div><div><span class="Apple-style-span" style="font-size: large;"><i><span class="Apple-style-span" style="font-family:'lucida grande';">Q :Dehydrated skin vs dry skin.....!!?</span></i></span></div><div>
<br /></div><div><span class="Apple-style-span" style="color:#006600;">>></span><i><span class="Apple-style-span" style="font-family:'lucida grande';"><span class="Apple-style-span" style="color:#006600;">" Selamat Berpuasa Kepada Rakan-rakan, Rakan Blogger dan Tetamu Pembaca"</span></span></i><span class="Apple-style-span" style="color:#006600;"><<</span></div>misibbhttp://www.blogger.com/profile/14827173537467932982noreply@blogger.com0tag:blogger.com,1999:blog-1717129759233064518.post-54343000031925887042010-07-30T01:56:00.007+08:002010-07-30T02:18:10.178+08:00CLINICAL CARE GUIDELINE<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://4.bp.blogspot.com/_StW9Y6v_f4I/TFHD3nfqwSI/AAAAAAAAAHo/gt5qUOTtTOY/s1600/CARDIO+(2).jpg"><img style="float:left; margin:0 10px 10px 0;cursor:pointer; cursor:hand;width: 259px; height: 400px;" src="http://4.bp.blogspot.com/_StW9Y6v_f4I/TFHD3nfqwSI/AAAAAAAAAHo/gt5qUOTtTOY/s400/CARDIO+(2).jpg" border="0" alt="" id="BLOGGER_PHOTO_ID_5499391980258115874" /></a>
<br /><div><p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in;page-break-after:avoid"><b><span style="font-family:Arial;color:red;"><span class="Apple-style-span" style="font-size: x-large;">CHEST PAIN AND ACUTE CORONARY SYNDROME</span></span></b></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="color:black;"> <o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="color:black;"> <o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">These systematically developed statements have been created to assist the practitioner in the formulation of health care decisions in specific clinical circumstances. They are not to be construed as an inflexible set of correct procedures or protocols.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">In each clinical circumstance the exercise of individual judgment is essential.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">Guidelines are based upon statistical averages and opinions of practicing clinicians. Variation from these guidelines does not constitute improper care or improper professional judgment. Evaluation of these variations requires detailed analysis of the facts and circumstances surrounding the individual patient’s care.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">SUBJECT: Chest Pain and Acute Coronary Syndromes</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="color:black;"> <o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in;page-break-after:avoid"><span style="font-family:Arial;color:black;"><span class="Apple-style-span" style="font-size: large;">
<br /></span></span></p><p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in;page-break-after:avoid"><span style="font-family:Arial;color:black;"><span class="Apple-style-span" style="font-size: large;">
<br /></span></span></p><p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in;page-break-after:avoid"><span style="font-family:Arial;color:black;"><span class="Apple-style-span" style="font-size: x-large;"><b>OBJECTIVE</b></span></span><span style="color:black;"><span class="Apple-style-span" style="font-size: large;"><o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in;page-break-after:avoid"><span style="color:black;"><span class="Apple-style-span" style="font-size: large;"> <o:p></o:p></span></span></p> <p class="MsoNormal"><span class="apple-style-span"><span style="font-family:Arial;color:black;"><span class="Apple-style-span" style="font-size: large;">The goal of these guidelines is to improve the quality and efficiency of management of adult patients with acute coronary syndromes in accordance with the ACC/AHA Acute Coronary Syndromes Clinical Practice Guidelines. Specifically:</span></span></span><span class="apple-style-span"><span style="font-size:13.5pt;"><o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">1. Provide management and diagnostic guidelines for patients assigned to these categories: chest pain, unstable angina, acute myocardial infarction, Non-ST Segment Elevation myocardial infarction (NSTEMI), and ST-Segment Elevation myocardial infarction (STEMI).</span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">2. Provide recommendations and supporting evidence for the continued management of patients with these conditions in both inpatient and outpatient settings.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">3. Provide critical pathway as standard for rapid ACS risk assessment and rapid comprehensive therapy for optimal patient care and cost-effectiveness.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">4. Rapid initiation of therapy aimed at achieving reperfusion for patients with ST-segment elevation myocardial infarction (STEMI) with goal of door to PCI (percutaneous coronary intervention) of 120 minutes.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">5. Reduce the risk of cardiac damage and death in patients who present with symptoms suggestive of unstable angina and Non-ST Segment Elevation myocardial infarction (NSTEMI).</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">6. Provide standard discharge treatment plan based on Cardiac Hospitalization Atherosclerosis Management Program (CHAMP).</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">7. Provide recommendations for ambulatory setting for post discharge patients with chest pain, unstable angina, and acute myocardial infarction.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="color:black;"> <o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in;page-break-after:avoid"><span style="font-family:Arial;color:black;"><span class="Apple-style-span" style="font-size: x-large;"><b>DEFINITIONS</b></span></span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in;page-break-after:avoid"><span style="color:black;"> <o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">For the purpose of this guideline, the following definitions apply:</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><b><span style="font-family:Arial;color:maroon;">Chest pain</span></b><span style="mso-bidi-font-weight:bold;font-family:Arial;color:black;"> - Patients without evidence of acute myocardial infarction or active myocardial ischemia on ECG with chest pain that is not definite angina. These patients are defined as not having features that give them an intermediate or high likelihood of significant coronary artery disease.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><b><span style="font-family:Arial;color:maroon;">Unstable Angina</span></b><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;"> - Patients without evidence of acute myocardial infarction who have chest pain and are felt to have an intermediate or high likelihood of significant coronary artery disease.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><b><span style="font-family:Arial;color:maroon;">Non ST-Segment Myocardial Infarction</span></b><span style=" mso-bidi-font-weight:bold;font-family:Arial;color:black;"> - Patients with clinical presentations similar to unstable angina with detectable quantities of markers of myocardial injury in circulation, most commonly troponin I or CK-MB. ECG ST-segment or T-wave changes may be persistent.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><b><span style="font-family:Arial;color:maroon;">ST-Segment Myocardial Infarction</span></b><span style=" mso-bidi-font-weight:bold;font-family:Arial;color:black;"> - Patients with symptoms suggestive of myocardial infarction and an ECG with ST elevation of 1mm or left bundle branch block. Patients with medically refractory chest pain associated with ischemic ECG changes that persist for greater than 20 minutes (refractory unstable angina/non Q-wave myocardial infarction) are included in this category.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in;page-break-after:avoid"><span style=" mso-bidi-font-weight:bold;font-family:Arial;font-size:24.0pt;color:black;"><o:p> </o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in;page-break-after:avoid"><span style="font-family:Arial;color:black;"><span class="Apple-style-span" style="font-size: x-large;"><b>
<br /></b></span></span></p><p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in;page-break-after:avoid"><span style="font-family:Arial;color:black;"><span class="Apple-style-span" style="font-size: x-large;"><b>POSITION STATEMENTS</b></span></span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in;page-break-after:avoid"><span style="color:black;"> <o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">Patients with acute myocardial infarction require rapid initiation of therapy aimed at achieving reperfusion.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">All patients with acute coronary syndrome require appropriate risk stratification to determine optimal choice and timing of therapies.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">Discharge planning and education should include emphasis on secondary prevention to alter the natural history of underlying cardiac disease and prolong long-term survival outcomes.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="color:black;"> <o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;"> </span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in;page-break-after:avoid"><span style="font-family:Arial;color:black;"><span class="Apple-style-span" style="font-size: x-large;"><b>
<br /></b></span></span></p><p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in;page-break-after:avoid"><span style="font-family:Arial;color:black;"><span class="Apple-style-span" style="font-size: x-large;"><b>PROCEDURE</b></span></span><span style="color:black;"><span class="Apple-style-span" style="font-size: x-large;"><b><o:p></o:p></b></span></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in;page-break-after:avoid"><span style="color:black;"><span class="Apple-style-span" style="font-size: x-large;"><b> <o:p></o:p></b></span></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in;page-break-after:avoid"><span style="font-family:Arial;color:black;"><span class="Apple-style-span" style="font-size: x-large;"><b>Emergency Department</b></span></span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="color:black;"> <o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">I. Assessment/Diagnosis (Early Risk Stratification)</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">A. History (likelihood of ischemia due to CAD)</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">1. Nature of anginal symptoms (definite angina, probable angina, probably not angina, and not angina).</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">2. Prior history of CAD or myocardial infarction.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">3. Sex.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">4. Age.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">5. Number of traditional risk factors: smoking, hyperlipidemia, diabetes mellitus, family history, cocaine use, hypertension, post menopausal.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">6. Special considerations.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">a. Women may present more frequently than men with atypical chest pain and symptoms.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">b. Diabetics and elderly may have atypical symptoms.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">B. Electrocardiogram – 12 lead ECG should be obtained and reviewed immediately within 10 minutes in patients with ongoing chest discomfort or as rapidly as possible in patients with history of chest discomfort consistent with ACS, but has resolved by time of evaluation.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">1. Diagnostic criteria for STEMI.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">a. 1mm ST elevation in 2 or more contiguous limb or precordial lead left bundle branch block, not known to be old.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">2. ECG findings useful for establishing the likelihood of CAD NSTEMI, unstable angina.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">a. ST segment depression >1mm.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">b. Inverted T-waves > 1mm in two or more contiguous leads.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">C. Physical Examination</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">1. Goal: to identify potential precipitating causes of myocardial ischemia (e.g., hypertension, thyrotoxicosis).</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">2. Complete a thorough cardiovascular and chest examination.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">3. Sign of left ventricular dysfunction is single strongest predictor of subsequent cardiac death in patients with CAD: cardiogenic shock, sustained ventricular arrhythmia, complete heart block, pulmonary edema.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">D. Biochemical Cardiac Markers (see Table 1)</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">1. For initial MI rule out, Cardiac labs (CK-MB, Troponin I, and total CPK).</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">2. Labs to be drawn q6 hours x 3, and then at physician’s discretion.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">E. Conclusion of Initial Evaluation with Documentation Using Risk Stratification Guideline (see Table 2)</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">1. Focused history with symptom characteristics, response to nitroglycerin.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">2. Presence of coronary artery disease risk factors.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">3. ECG findings.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">4. Physical Exam: presence of pulmonary edema, hypotension, or ventricular arrhythmia.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">5. Document risk stratification with appropriate diagnosis.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">a. Possible ACS.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">b. Likely or definite ACS (without continuing ischemic pain or high-risk features).</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">c. Definite ACS with continuing ischemic pain, other high-risk features, or planned intervention.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">II. Care Treatment Plan</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">A. ST-Segment Elevation Myocardial Infarction (STEMI) (see Addendum 1)</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">1. Goal: rapid initiation of therapy aimed at reperfusion, time from door to percutaneous coronary intervention (PCI) of 120 minutes.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">a. Contact Interventional Attending and CCU fellow immediately.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">b. All patients should receive regular ASA 325mg as soon as possible. (Definite contraindications: evidence of life-threatening hemorrhage or clear history of severe hypersensitivity to ASA.)</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">c. All patients should be given intravenous bolus of heparin and started on heparin drip. (Definite contraindications: acute pericarditis, aortic dissection, heparin allergy, major life threatening hemorrhage.)</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">d. Patients should be treated with intravenous beta-blocker, followed by oral beta-blockers. (Definite contraindications: cardiogenic shock, hypotension, severe COPD/asthma, AV block > 1<sup>st</sup><span class="apple-converted-space"> </span>degree.)</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">e. Patients with ongoing chest pain despite SL NTG and beta-blockers, with SBP >90 mmHg should be started on intravenous nitroglycerin drip.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">B. Unstable Angina/Non-ST Elevation MI (NSTEMI)</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">1. Goal: medical therapy or revascularization to prevent the evolution to MI and diagnostic testing (coronary angiography or physiologic stress testing) to assess coronary risk.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">C. Chest Pain</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">1. Patients who are pain free, have either normal or non-diagnostic ECG, and have a normal set of initial cardiac marker should be considered for further evaluation to screen for non-ischemic discomfort versus low risk ACS.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">2. Patients will be observed in the ED with continuous cardiac monitoring.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">3. Follow up at 2 hours with ECG and cardiac markers (CK, CK-MB, Troponin-I).</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">4. An increase in CK-MB level of +1.5 ng/mL or greater, or cardiac troponin I level of +0.2ng/mL or greater is defined as significant and an abnormal marker.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">a. Patients who develop recurrent pain during observation, new ECG changes, or abnormal cardiac markers should be admitted.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">5. If no interval change in ECG, symptoms, or change in delta CK-MB and troponin-I at 2 hour follow up period, patients may be discharged from the ED and return for stress test as outpatient within 72 hours.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">6. In the following situations, patients will be provided with a cardiology referral for outpatient follow-up of a cardiology workup and/or stress test.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">a. Completion of the accelerated chest pain protocol, and following clearance for discharge from the ED (NOTE: excluding cocaine chest pain).</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">b. Patients with a likelihood of coronary heart disease as determined by cardiac risk factors and clinical assessment.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">III. Discharge Education and Planning</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">A. Patients should be given written discharge instructions with review of treatments, and symptoms that would require contact of their physician.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">B. Patients should be instructed to call their primary care physician to arrange a follow-up appointment within 72 hours of discharge.</span><span style="color:black;"><o:p></o:p></span></p></div>
<br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://1.bp.blogspot.com/_StW9Y6v_f4I/TFHDGLnZ15I/AAAAAAAAAHg/ZH-MbekuCT0/s1600/cardio.jpg"><img style="text-align: center;float: left; margin-top: 0px; margin-right: 10px; margin-bottom: 10px; margin-left: 0px; cursor: pointer; width: 150px; height: 150px; " src="http://1.bp.blogspot.com/_StW9Y6v_f4I/TFHDGLnZ15I/AAAAAAAAAHg/ZH-MbekuCT0/s400/cardio.jpg" border="0" alt="" id="BLOGGER_PHOTO_ID_5499391130960779154" /></a>
<br />
<br /><div><p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in;page-break-after:avoid"><span style=" mso-bidi-font-weight:bold;font-family:Arial;font-size:24.0pt;color:black;">
<br /></span></p><p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in;page-break-after:avoid"><span style=" mso-bidi-font-weight:bold;font-family:Arial;font-size:24.0pt;color:black;">
<br /></span></p><p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in;page-break-after:avoid"><span style=" mso-bidi-font-weight:bold;font-family:Arial;font-size:24.0pt;color:black;">Inpatient Care</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in;page-break-after:avoid"><span style="color:black;"> <o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">I. Assessment/Diagnosis</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">A. The CCU fellow and the cardiology team shall determine whether patient will be monitored on 6WSD or CCU based on risk stratification.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">B. Nursing staff shall notify the CCU resident of patient’s arrival on the unit, tele-monitor assigned, and nursing admission database to be completed.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">C. Nursing staff shall notify the CCU resident of any changes in patient’s clinical condition, any arrhythmias recorded on telemetry monitor, and any abnormal lab values.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">II. Care Treatment Plan</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><b><span style="font-family:Arial;color:black;"><o:p> </o:p></span></b></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><b><span style="font-family:Arial;color:black;">A. ST-Elevation Myocardial Infarction (STEMI) (see Addendum 1)</span></b><b style="mso-bidi-font-weight: normal"><span style="color:black;"><o:p></o:p></span></b></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">1. Goal: rapid initiation of therapy aimed at reperfusion, initiation of thrombolytic therapy within 30 minutes or time from door to PCI (direct catheterization) of 120 minutes.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">2. Initial Therapy.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">a. Notify CCU fellow and cardiac cath team immediately with determination of diagnosis.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">b. All patients should receive regular ASA 325 mg as soon as possible. (Definite contraindication: evidence of life-threatening hemorrhage or clear history of severe hypersensitivity to ASA.)</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">c. All patients should be given intravenous bolus of heparin at 5000 units or 65 units/kg and started on heparin drip at 12units/kg/hr (1000 units/ml) or 1000 units/hr. (Definite contraindications: acute pericarditis, aortic dissection, heparin allergy, major life threatening hemorrhage.)</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">d. Patients should be treated with intravenous beta-blockers, followed by oral beta-blockers. Initiate intravenous Metoprolol 5mg x 3 every 5 minutes, followed by 50mg Q6hours x 8 doses and then 50-100mg BID. (Definite contraindications: cardiogenic shock, hypotension, severe COPD/asthma, AV block > first degree.)</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">e. Patients with ongoing chest pain despite SL NTG and beta-blockers, with SBP >90 mmHg should be started on intravenous nitroglycerin drip (follow Nitroglycerin protocol).</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">f. Patients should be taken immediately to cath lab for catheter based intervention.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">g. Glycoprotein IIb/IIIa inhibitor (Abciximab, Eptifibatide) should be strongly in conjunction with catheter based intervention. (see Addendum 3)</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">h. Thrombolytic Therapy - per interventional attending’s discretion - is indicated for chest pain <><span style="color:black;"><o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">i. Oxygen therapy: maintain pulse oximeter saturation > 92%.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">3. Sub-acute Therapy</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">a. Patients should be continuously monitored on ECG for 48-72 hours in uncomplicated myocardial infarction (MI).</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">b. Continue ASA 325mg po qd on all patients.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">c. Continue beta-blocker on all patients unless contraindicated.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">d. All MI patients without contraindications should be started on ACE inhibitors within two weeks of acute myocardial infarction onset, even if blood pressure and ejection fraction are normal.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">e. ACE Inhibitors should be started on all patients with <st1:city st="on">LV</st1:city> dysfunction (<st1:city st="on"><st1:place st="on">LV</st1:place></st1:city> function <><span style="color:black;"><o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">f. Statins or other lipid lowering agents should be started on all patients.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">g. Anticoagulation with Warfarin is indicated for a trial fibrillation or <st1:city st="on"><st1:place st="on">LV</st1:place></st1:city> thrombus post myocardial infarction.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">h. Consultations ordered for cardiac rehab, social worker, dietitian, or chaplain.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">i. Initially bed rest is recommended followed by an advance with ambulation on day 2 or 3.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">j. Patients should be placed on a cardiac diet.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><b><span style="font-family:Arial;color:black;"><o:p> </o:p></span></b></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><b><span style="font-family:Arial;color:black;">B. Unstable Angina/Non-ST Elevation Myocardial Infarction (NSTEMI) (see Addendum 2)</span></b><b style="mso-bidi-font-weight:normal"><span style="color:black;"><o:p></o:p></span></b></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><b><span style="font-family:Arial;color:blue;">1. Treatment Strategies</span></b><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">a. Early conservative strategy: coronary angiography is reserved for patients with evidence of recurrent ischemia or chest pain, congestive heart failure or depressed <st1:city st="on"><st1:place st="on">LV</st1:place></st1:city> function, malignant ventricular arrhythmias, or a strongly positive stress test.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">b. Early invasive strategy: coronary angiography is the initial diagnostic strategy for unstable angina patients with persistent chest pain/ischemia despite anti-ischemic therapy, elevated troponin I level, new or presumable new ST-segment depression, symptoms of congestive heart failure or depressed LV systolic function, high-risk findings on noninvasive testing, hemodynamicin stability, sustained ventricular arrhythmias, prior PCI (within 6 months), and prior CABG.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><b><span style="font-family:Arial;color:blue;">2. General Care</span></b><b style="mso-bidi-font-weight:normal"><span style="color:blue;"><o:p></o:p></span></b></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">a. Patients should remain on continuous ECG monitoring for ischemia and arrhythmia detection.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">b. Maintain pulse oximeter saturation <><span style="color:black;"><o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">c. Patients should be placed on bed rest during initial phase of management.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">d. Patients should remain NPO except meds until clinical stability is demonstrated and cardiac catheterization need and timing is determined.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">e. Consider and initiate consultations as needed: cardiac rehab, dietitian, social worker, and chaplain.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><b><span style="font-family:Arial;color:blue;">3. Pharmacologic Treatment</span></b><b style="mso-bidi-font-weight:normal"><span style="color:blue;"><o:p></o:p></span></b></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">a. All patients should receive ASA 325mg as soon as possible, unless contraindicated.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">b. Patients risk stratified at intermediate or high likelihood ACS should be on anticoagulation with heparin, bolus (follow hospital Normogram or Lovenox at 1mg/kg sq q12); Continue Heparin 2 - 4 days or until revascularization is performed.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">c. Beta-blockers should be started on all patients unless contraindicated. Initiate with IV metoprolol 5mg x 3 every 5 minutes to total dose of 15mg, followed in 2 hours by 25-50mg PO every 6hr. (Definite contraindications: cardiogenic shock, hypotension, AV block > 1<sup>st</sup><span class="apple-converted-space"> </span>degree, severe COPD/Asthma.)</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">d. Patients where beta-blockers are contraindicated, consider calcium channel blockers (Diltiazem or Verapamil).</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">e. Patients with definite ACS, positive cardiac markers, should be started on Glycoprotein IIb/IIIa Inhibitor: 180mcg/kg Eptifibatide (Integrillin) IV bolus, followed by 2.0mcg/kg/min Eptifibatide IV infusion; If Creatinine is 2.0 - 4.0, infuse 1.0mcg/kg/min. (Hold Eptifibatide if patient is on dialysis.) (see Addendum 3)</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">f. Nitroglycerin 0.4mg SL should be given promptly with presentation of chest pain every 5 minutes x 3 or until pain relief or SBP <><span style="color:black;"><o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">g. Morphine sulfate can be considered for patients whose symptoms are not relieved with nitroglycerin and beta-blockers. (Definite contraindications: hypotension, respiratory insufficiency, intolerance.)</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><b><span style="font-family:Arial;color:black;"><o:p> </o:p></span></b></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><b><span style="font-family:Arial;color:black;">C. Chest Pain</span></b><b style="mso-bidi-font-weight:normal"><span style="color:black;"><o:p></o:p></span></b></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">1. Patients admitted with diagnosis of chest pain should be placed on R/O MI protocol with EKG and cardiac markers (CPK, CK-MB, Troponin I) every 6 hours x 3. The CCU resident or fellow should be notified with every EKG readings and any abnormal lab values.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">2. All patients should receive 325mg aspirin.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">3. Patients should be given nitroglycerin SL and assessed for pain relief.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">4. Decision for noninvasive stress testing will be based on patient’s history.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">a. Exercise treadmill with additional imaging.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">b. Pharmacologic stress testing with imaging for patients unable to exercise due to physical limitations.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">III. Discharge Education and Planning</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">A. Patients should be sent home on aspirin 81mg to 325mg indefinitely.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">B. Patients should be sent home on clopidogrel (plavix) 75mg qd if post stent, brachytherapy, or unable to tolerate aspirin.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">C. Patients should be sent home on statin or lipid lowering agent, goal of LDL<><span style="color:black;"><o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">D. If LVSF <><span style="color:black;"><o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">E. Within two weeks of discharge, all post PCI, <st1:place st="on"><st1:city st="on">UA</st1:city>, <st1:state st="on">MI</st1:state></st1:place>, stable CAD, PVD, CVD and diabetic patients should receive an ACE inhibitor.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">F. Patients should be sent home on beta-blocker, unless contraindicated.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">G. Calcium channel blockers (Diltiazem or Verapamil) are indicated if beta-blockers are contraindicated.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">H. Nitrates should be considered as a second line after beta-blocker for symptomatic control of angina.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">I. Patients should be instructed to complete and aerobic exercise program on minimum of 3-5 times per week; Post MI patients should be referred to cardiac rehab program.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">J. Patients with current tobacco use who are ready to quit should be referred to smoking cessation clinic, and this should be clearly documented.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">K. Patients should receive dietary counseling on the National Cholesterol Education Program Step 2 Diet during hospitalization (refer to dietitian as need).</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">L. Patients and family should receive education throughout the hospitalization course on all the above treatment plans, monitoring of symptoms, and follow up.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">M. Acute MI education folder should be given to all post MI patients with appropriate documentation.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">N. Continuation of the above targeted therapies is pertinent with continued education.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">O. The discharge planner assigned to the specific location or unit should be involved in the discharge plan throughout the hospitalization course with proper communication and documentation.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">P. Patients should have a follow up appointment with their Primary Care Physician (PCP) within 2 weeks.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">Q. Patients should have a follow up appointment with the Cardiologist in 1-2 weeks.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">R. Patients should be instructed to bring their ACS discharge instruction sheet to their first follow up appointments with their PCP and Cardiologist.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">S. Other follow up appointments should also be given and documented in Gemini by physician.</span><span style="color:black;"><o:p></o:p></span></p></div><div>
<br /></div>
<br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://4.bp.blogspot.com/_StW9Y6v_f4I/TFHCfyt5fHI/AAAAAAAAAHY/dAt2nsq3Zzk/s1600/pr_cardio.jpg"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 320px; height: 150px;" src="http://4.bp.blogspot.com/_StW9Y6v_f4I/TFHCfyt5fHI/AAAAAAAAAHY/dAt2nsq3Zzk/s320/pr_cardio.jpg" border="0" alt="" id="BLOGGER_PHOTO_ID_5499390471442103410" /></a>
<br /><p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in;page-break-after:avoid"><span class="Apple-style-span" style="font-family:Arial;"><span class="Apple-style-span" style="font-size: x-large;"><b>Outpatient Clinic </b></span></span><span class="Apple-style-span" style="font-family:Arial;font-size:-webkit-xxx-large;"><b>Follow Up Care</b></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in;page-break-after:avoid"><span style="color:black;"> <o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">I. Assessment/Diagnosis</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">A. Cardiovascular and anginal symptoms.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">B. Compliance with medications, diet, exercise program, smoking cessation follow up.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">C. Physical examination, including groin exam for patients post coronary angiography.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">D. EKG as needed.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;"><o:p> </o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">II. Care Treatment Plan</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;"><o:p> </o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">A. Chest pain.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">1. Patients considered low risk, was ruled out for MI, should undergo exercise or pharmacologic stress testing.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">2. Follow the guideline for risk stratification and treatment plan for noninvasive stress testing.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">3. Patients with positive stress testing should be referred for cardiac catheterization.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;"><o:p> </o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">B. Unstable Angina</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">1. Aggressive risk factor modifications and reinforcement of lifestyle changes, including AHA step II diet, exercise program or cardiac rehab, smoking cessation.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">2. Continued medical management with aspirin, beta-blockers, ace-inhibitors, nitrates, and cholesterol-lowering agents.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">3. Management and referral to appropriate care for co-morbid conditions (i.e., hypertension, diabetes, heart failure).</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;"><o:p> </o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">C. Acute Myocardial Infarction (STEMI and NSTEMI)</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">1. Continue targeted therapy as outline in Cardiovascular Hospitalization Atherosclerosis Management Program (CHAMP).</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">a) Aspirin.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">b) Beta-blockers.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">c) Statins or cholesterol-lowering agent with target LDL <><span style="color:black;"><o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">d) Ace-Inhibitors.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">e) Clopidogrel (plavix) for post PTCA/stent, Drug-Eluting stent, brachytherapy.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">f) Exercise program or cardiac rehab.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">g) Smoking cessation.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">h) AHA step II diet.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">2. Management and referral to appropriate care for co-morbid conditions (i.e., hypertension, diabetes, heart failure).</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;"><o:p> </o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">III. Discharge Education and Planning</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">A. Patients and family should be educated on all of the above targeted therapies and also monitoring of symptoms.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">B. Education on warning signs of a heart attack and plan of action should be included.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">Table 1: Biochemical cardiac markers for evaluation and management of patients with suspected ACS but without ST-Segment elevation on 12-Lead.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="color:black;"> <o:p></o:p></span></p> <table class="MsoNormalTable" border="0" cellspacing="0" cellpadding="0" style="margin-left:1.15pt;border-collapse:collapse;mso-padding-alt:0in 0in 0in 0in"> <tbody><tr style="mso-yfti-irow:0;mso-yfti-firstrow:yes"> <td width="139" valign="top" style="width:104.25pt;border:ridge windowtext 2.25pt; mso-border-alt:three-d-emboss windowtext 2.25pt;padding:0in 0in 0in 0in"> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><b><span style="font-family:Arial;color:navy;">Marker</span></b><b style="mso-bidi-font-weight:normal"><span style="color:navy;"><o:p></o:p></span></b></p> </td> <td width="144" valign="top" style="width:1.5in;border:ridge windowtext 2.25pt; border-left:none;mso-border-top-alt:three-d-emboss windowtext 2.25pt; mso-border-bottom-alt:three-d-emboss windowtext 2.25pt;mso-border-right-alt: three-d-emboss windowtext 2.25pt;padding:0in 0in 0in 0in"> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><b><span style="font-family:Arial;color:navy;">Advantages</span></b><b style="mso-bidi-font-weight:normal"><span style="color:navy;"><o:p></o:p></span></b></p> </td> <td width="144" valign="top" style="width:1.5in;border:ridge windowtext 2.25pt; border-left:none;mso-border-top-alt:three-d-emboss windowtext 2.25pt; mso-border-bottom-alt:three-d-emboss windowtext 2.25pt;mso-border-right-alt: three-d-emboss windowtext 2.25pt;padding:0in 0in 0in 0in"> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><b><span style="font-family:Arial;color:navy;">Disadvantages</span></b><b style="mso-bidi-font-weight:normal"><span style="color:navy;"><o:p></o:p></span></b></p> </td> <td width="163" valign="top" style="width:122.25pt;border:ridge windowtext 2.25pt; border-left:none;mso-border-top-alt:three-d-emboss windowtext 2.25pt; mso-border-bottom-alt:three-d-emboss windowtext 2.25pt;mso-border-right-alt: three-d-emboss windowtext 2.25pt;padding:0in 0in 0in 0in"> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><b><span style="font-family:Arial;color:navy;">Clinical Recommendations</span></b><b style="mso-bidi-font-weight:normal"><span style="color:navy;"><o:p></o:p></span></b></p> </td> </tr> <tr style="mso-yfti-irow:1"> <td width="139" valign="top" style="width:104.25pt;border:ridge windowtext 2.25pt; border-top:none;mso-border-left-alt:three-d-emboss windowtext 2.25pt; mso-border-bottom-alt:three-d-emboss windowtext 2.25pt;mso-border-right-alt: three-d-emboss windowtext 2.25pt;padding:0in 0in 0in 0in"> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">CK-MB</span><span style="color:blue;"><o:p></o:p></span></p> </td> <td width="144" valign="top" style="width:1.5in;border-top:none;border-left:none; border-bottom:ridge windowtext 2.25pt;border-right:ridge windowtext 2.25pt; mso-border-bottom-alt:three-d-emboss windowtext 2.25pt;mso-border-right-alt: three-d-emboss windowtext 2.25pt;padding:0in 0in 0in 0in"> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">§ Rapid, cost-efficient, accurate assays.</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">§ Ability to detect early reinfarction.</span><span style="color:blue;"><o:p></o:p></span></p> </td> <td width="144" valign="top" style="width:1.5in;border-top:none;border-left:none; border-bottom:ridge windowtext 2.25pt;border-right:ridge windowtext 2.25pt; mso-border-bottom-alt:three-d-emboss windowtext 2.25pt;mso-border-right-alt: three-d-emboss windowtext 2.25pt;padding:0in 0in 0in 0in"> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">§ Loss of specificity in setting of skeletal muscle disease or injury, including surgery.</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">§ Low sensitivity during early MI (6h after symptom onset); or</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">§ Later after symptom onset (36h) and for minor myocardial damage (detectable with troponins).</span><span style="color:blue;"><o:p></o:p></span></p> </td> <td width="163" valign="top" style="width:122.25pt;border-top:none;border-left: none;border-bottom:ridge windowtext 2.25pt;border-right:ridge windowtext 2.25pt; mso-border-bottom-alt:three-d-emboss windowtext 2.25pt;mso-border-right-alt: three-d-emboss windowtext 2.25pt;padding:0in 0in 0in 0in"> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">Prior standard and still acceptable diagnostic test in most clinical circumstances.</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">Normal lab values:</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">Male: 8 ng/ml</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">Female: 6 ng/ml</span><span style="color:blue;"><o:p></o:p></span></p> </td> </tr> <tr style="mso-yfti-irow:2;mso-yfti-lastrow:yes"> <td width="139" valign="top" style="width:104.25pt;border:ridge windowtext 2.25pt; border-top:none;mso-border-left-alt:three-d-emboss windowtext 2.25pt; mso-border-bottom-alt:three-d-emboss windowtext 2.25pt;mso-border-right-alt: three-d-emboss windowtext 2.25pt;padding:0in 0in 0in 0in"> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">Cardiac Troponins</span><span style="color:blue;"><o:p></o:p></span></p> </td> <td width="144" valign="top" style="width:1.5in;border-top:none;border-left:none; border-bottom:ridge windowtext 2.25pt;border-right:ridge windowtext 2.25pt; mso-border-bottom-alt:three-d-emboss windowtext 2.25pt;mso-border-right-alt: three-d-emboss windowtext 2.25pt;padding:0in 0in 0in 0in"> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">§ Powerful tool for risk stratification.</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">§ Greater sensitivity and specificity than CK-MB.</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">§ Detection of recent MI up to 2 weeks after onset.</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">§ Useful for selection of therapy.</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">§ Detection of reperfusion.</span><span style="color:blue;"><o:p></o:p></span></p> </td> <td width="144" valign="top" style="width:1.5in;border-top:none;border-left:none; border-bottom:ridge windowtext 2.25pt;border-right:ridge windowtext 2.25pt; mso-border-bottom-alt:three-d-emboss windowtext 2.25pt;mso-border-right-alt: three-d-emboss windowtext 2.25pt;padding:0in 0in 0in 0in"> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">§ Low sensitivity in very early phase of MI (<6><span style="color:blue;"><o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">§ Limited ability to detect late minor reinfarction.</span><span style="color:blue;"><o:p></o:p></span></p> </td> <td width="163" valign="top" style="width:122.25pt;border-top:none;border-left: none;border-bottom:ridge windowtext 2.25pt;border-right:ridge windowtext 2.25pt; mso-border-bottom-alt:three-d-emboss windowtext 2.25pt;mso-border-right-alt: three-d-emboss windowtext 2.25pt;padding:0in 0in 0in 0in"> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">Useful as a single test to efficiently diagnose NSTEMI, with serial measurements. Know diagnostic “cutoffs”.</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">Normal lab values:</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;"><2.0><span style="color:blue;"><o:p></o:p></span></span></p> </td> </tr> </tbody></table> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="color:black;"> <o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">Table 2: Risk Stratification: Likelihood that signs and symptoms represent ACS secondary to CAD.</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="color:black;"> <o:p></o:p></span></p> <table class="MsoNormalTable" border="0" cellspacing="0" cellpadding="0" style="margin-left:1.15pt;border-collapse:collapse;mso-padding-alt:0in 0in 0in 0in"> <tbody><tr style="mso-yfti-irow:0;mso-yfti-firstrow:yes"> <td width="148" valign="top" style="width:111.0pt;border:ridge windowtext 2.25pt; mso-border-alt:three-d-emboss windowtext 2.25pt;padding:0in 0in 0in 0in"> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><a name="_Toc75743275"><b><span style="font-family:Arial;color:navy;">Feature</span></b></a><b style="mso-bidi-font-weight:normal"><span style="color:navy;"><o:p></o:p></span></b></p> </td> <td width="148" valign="top" style="width:111.0pt;border:ridge windowtext 2.25pt; border-left:none;mso-border-top-alt:three-d-emboss windowtext 2.25pt; mso-border-bottom-alt:three-d-emboss windowtext 2.25pt;mso-border-right-alt: three-d-emboss windowtext 2.25pt;padding:0in 0in 0in 0in"> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><b><span style="font-family:Arial;color:navy;">High Likelihood</span></b><b style="mso-bidi-font-weight:normal"><span style="color:navy;"><o:p></o:p></span></b></p> </td> <td width="148" valign="top" style="width:111.0pt;border:ridge windowtext 2.25pt; border-left:none;mso-border-top-alt:three-d-emboss windowtext 2.25pt; mso-border-bottom-alt:three-d-emboss windowtext 2.25pt;mso-border-right-alt: three-d-emboss windowtext 2.25pt;padding:0in 0in 0in 0in"> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><b><span style="font-family:Arial;color:navy;">Intermediate Likelihood</span></b><b style="mso-bidi-font-weight:normal"><span style="color:navy;"><o:p></o:p></span></b></p> </td> <td width="148" valign="top" style="width:111.0pt;border:ridge windowtext 2.25pt; border-left:none;mso-border-top-alt:three-d-emboss windowtext 2.25pt; mso-border-bottom-alt:three-d-emboss windowtext 2.25pt;mso-border-right-alt: three-d-emboss windowtext 2.25pt;padding:0in 0in 0in 0in"> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><b><span style="font-family:Arial;color:navy;">Low Likelihood</span></b><b style="mso-bidi-font-weight:normal"><span style="color:navy;"><o:p></o:p></span></b></p> </td> </tr> <tr style="mso-yfti-irow:1"> <td width="148" valign="top" style="width:111.0pt;border:ridge windowtext 2.25pt; border-top:none;mso-border-left-alt:three-d-emboss windowtext 2.25pt; mso-border-bottom-alt:three-d-emboss windowtext 2.25pt;mso-border-right-alt: three-d-emboss windowtext 2.25pt;padding:0in 0in 0in 0in"> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">History</span><span style="color:blue;"><o:p></o:p></span></p> </td> <td width="148" valign="top" style="width:111.0pt;border-top:none;border-left: none;border-bottom:ridge windowtext 2.25pt;border-right:ridge windowtext 2.25pt; mso-border-bottom-alt:three-d-emboss windowtext 2.25pt;mso-border-right-alt: three-d-emboss windowtext 2.25pt;padding:0in 0in 0in 0in"> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">§ Chest or left arm pain or discomfort as chief symptom reproducing prior documented angina.</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">§ Known history of CAD, including MI.</span><span style="color:blue;"><o:p></o:p></span></p> </td> <td width="148" valign="top" style="width:111.0pt;border-top:none;border-left: none;border-bottom:ridge windowtext 2.25pt;border-right:ridge windowtext 2.25pt; mso-border-bottom-alt:three-d-emboss windowtext 2.25pt;mso-border-right-alt: three-d-emboss windowtext 2.25pt;padding:0in 0in 0in 0in"> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">§ Chest or left arm pain or discomfort as chief symptom.</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">§ Age > 70 years.</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">§ Male sex.</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">§ Diabetes mellitus.</span><span style="color:blue;"><o:p></o:p></span></p> </td> <td width="148" valign="top" style="width:111.0pt;border-top:none;border-left: none;border-bottom:ridge windowtext 2.25pt;border-right:ridge windowtext 2.25pt; mso-border-bottom-alt:three-d-emboss windowtext 2.25pt;mso-border-right-alt: three-d-emboss windowtext 2.25pt;padding:0in 0in 0in 0in"> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">§ Probable ischemic symptoms in absence of any of the intermediate likelihood characteristics.</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">§ Recent cocaine use.</span><span style="color:blue;"><o:p></o:p></span></p> </td> </tr> <tr style="mso-yfti-irow:2"> <td width="148" valign="top" style="width:111.0pt;border:ridge windowtext 2.25pt; border-top:none;mso-border-left-alt:three-d-emboss windowtext 2.25pt; mso-border-bottom-alt:three-d-emboss windowtext 2.25pt;mso-border-right-alt: three-d-emboss windowtext 2.25pt;padding:0in 0in 0in 0in"> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">Examination</span><span style="color:blue;"><o:p></o:p></span></p> </td> <td width="148" valign="top" style="width:111.0pt;border-top:none;border-left: none;border-bottom:ridge windowtext 2.25pt;border-right:ridge windowtext 2.25pt; mso-border-bottom-alt:three-d-emboss windowtext 2.25pt;mso-border-right-alt: three-d-emboss windowtext 2.25pt;padding:0in 0in 0in 0in"> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">§ Transient MR.</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">§ Hypotension.</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">§ Diaphoresis.</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">§ Pulmonary edema.</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">§ Rales.</span><span style="color:blue;"><o:p></o:p></span></p> </td> <td width="148" valign="top" style="width:111.0pt;border-top:none;border-left: none;border-bottom:ridge windowtext 2.25pt;border-right:ridge windowtext 2.25pt; mso-border-bottom-alt:three-d-emboss windowtext 2.25pt;mso-border-right-alt: three-d-emboss windowtext 2.25pt;padding:0in 0in 0in 0in"> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">§ Extracardiac vascular disease.</span><span style="color:blue;"><o:p></o:p></span></p> </td> <td width="148" valign="top" style="width:111.0pt;border-top:none;border-left: none;border-bottom:ridge windowtext 2.25pt;border-right:ridge windowtext 2.25pt; mso-border-bottom-alt:three-d-emboss windowtext 2.25pt;mso-border-right-alt: three-d-emboss windowtext 2.25pt;padding:0in 0in 0in 0in"> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">§ Chest discomfort reproduced by palpation.</span><span style="color:blue;"><o:p></o:p></span></p> </td> </tr> <tr style="mso-yfti-irow:3"> <td width="148" valign="top" style="width:111.0pt;border:ridge windowtext 2.25pt; border-top:none;mso-border-left-alt:three-d-emboss windowtext 2.25pt; mso-border-bottom-alt:three-d-emboss windowtext 2.25pt;mso-border-right-alt: three-d-emboss windowtext 2.25pt;padding:0in 0in 0in 0in"> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">ECG</span><span style="color:blue;"><o:p></o:p></span></p> </td> <td width="148" valign="top" style="width:111.0pt;border-top:none;border-left: none;border-bottom:ridge windowtext 2.25pt;border-right:ridge windowtext 2.25pt; mso-border-bottom-alt:three-d-emboss windowtext 2.25pt;mso-border-right-alt: three-d-emboss windowtext 2.25pt;padding:0in 0in 0in 0in"> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">§ New, or presumably new transient ST-segment deviation (>0.05 mV); or</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">§ T-wave inversion (>0.2 mV) with symptoms.</span><span style="color:blue;"><o:p></o:p></span></p> </td> <td width="148" valign="top" style="width:111.0pt;border-top:none;border-left: none;border-bottom:ridge windowtext 2.25pt;border-right:ridge windowtext 2.25pt; mso-border-bottom-alt:three-d-emboss windowtext 2.25pt;mso-border-right-alt: three-d-emboss windowtext 2.25pt;padding:0in 0in 0in 0in"> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">§ Fixed Q waves.</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">§ Abnormal ST segment; or</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">§ T waves not documented to be new.</span><span style="color:blue;"><o:p></o:p></span></p> </td> <td width="148" valign="top" style="width:111.0pt;border-top:none;border-left: none;border-bottom:ridge windowtext 2.25pt;border-right:ridge windowtext 2.25pt; mso-border-bottom-alt:three-d-emboss windowtext 2.25pt;mso-border-right-alt: three-d-emboss windowtext 2.25pt;padding:0in 0in 0in 0in"> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">§ T-wave flattening; or</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">§ Inversion in leads with dominant R waves.</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">§ Normal ECG.</span><span style="color:blue;"><o:p></o:p></span></p> </td> </tr> <tr style="mso-yfti-irow:4;mso-yfti-lastrow:yes"> <td width="148" valign="top" style="width:111.0pt;border:ridge windowtext 2.25pt; border-top:none;mso-border-left-alt:three-d-emboss windowtext 2.25pt; mso-border-bottom-alt:three-d-emboss windowtext 2.25pt;mso-border-right-alt: three-d-emboss windowtext 2.25pt;padding:0in 0in 0in 0in"> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">Cardiac Markers</span><span style="color:blue;"><o:p></o:p></span></p> </td> <td width="148" valign="top" style="width:111.0pt;border-top:none;border-left: none;border-bottom:ridge windowtext 2.25pt;border-right:ridge windowtext 2.25pt; mso-border-bottom-alt:three-d-emboss windowtext 2.25pt;mso-border-right-alt: three-d-emboss windowtext 2.25pt;padding:0in 0in 0in 0in"> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">§ Elevated cardiac TnI or CK-MB.</span><span style="color:blue;"><o:p></o:p></span></p> </td> <td width="148" valign="top" style="width:111.0pt;border-top:none;border-left: none;border-bottom:ridge windowtext 2.25pt;border-right:ridge windowtext 2.25pt; mso-border-bottom-alt:three-d-emboss windowtext 2.25pt;mso-border-right-alt: three-d-emboss windowtext 2.25pt;padding:0in 0in 0in 0in"> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">§ <st1:city st="on"><st1:place st="on">Normal</st1:place></st1:city>.</span><span style="color:blue;"><o:p></o:p></span></p> </td> <td width="148" valign="top" style="width:111.0pt;border-top:none;border-left: none;border-bottom:ridge windowtext 2.25pt;border-right:ridge windowtext 2.25pt; mso-border-bottom-alt:three-d-emboss windowtext 2.25pt;mso-border-right-alt: three-d-emboss windowtext 2.25pt;padding:0in 0in 0in 0in"> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">§ <st1:city st="on"><st1:place st="on">Normal</st1:place></st1:city>.</span><span style="color:blue;"><o:p></o:p></span></p> </td> </tr> </tbody></table> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="color:black;"> <o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">Table 3: Noninvasive Risk Stratification</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="color:black;"> <o:p></o:p></span></p> <table class="MsoNormalTable" border="0" cellspacing="0" cellpadding="0" style="margin-left:1.15pt;border-collapse:collapse;mso-padding-alt:0in 0in 0in 0in"> <tbody><tr style="mso-yfti-irow:0;mso-yfti-firstrow:yes"> <td width="638" valign="top" style="width:478.5pt;border:ridge windowtext 2.25pt; mso-border-alt:three-d-emboss windowtext 2.25pt;padding:0in 0in 0in 0in"> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="font-family:Arial;"><span class="Apple-style-span" style="font-size: x-large;"><span class="Apple-style-span" style="color:#990000;">Coronary Angiography</span></span></span></p> </td> </tr> <tr style="mso-yfti-irow:1"> <td width="638" valign="top" style="width:478.5pt;border:ridge windowtext 2.25pt; border-top:none;mso-border-left-alt:three-d-emboss windowtext 2.25pt; mso-border-bottom-alt:three-d-emboss windowtext 2.25pt;mso-border-right-alt: three-d-emboss windowtext 2.25pt;padding:0in 0in 0in 0in"> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;">High risk (>3% annual mortality rate)</span></p> </td> </tr> <tr style="mso-yfti-irow:2"> <td width="638" valign="top" style="width:478.5pt;border:ridge windowtext 2.25pt; border-top:none;mso-border-left-alt:three-d-emboss windowtext 2.25pt; mso-border-bottom-alt:three-d-emboss windowtext 2.25pt;mso-border-right-alt: three-d-emboss windowtext 2.25pt;padding:0in 0in 0in 0in"> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;">Severe resting <st1:city st="on"><st1:place st="on">LV</st1:place></st1:city> dysfunction (LVEF <0.35)</span></p> </td> </tr> <tr style="mso-yfti-irow:3"> <td width="638" valign="top" style="width:478.5pt;border:ridge windowtext 2.25pt; border-top:none;mso-border-left-alt:three-d-emboss windowtext 2.25pt; mso-border-bottom-alt:three-d-emboss windowtext 2.25pt;mso-border-right-alt: three-d-emboss windowtext 2.25pt;padding:0in 0in 0in 0in"> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;">High-risk treadmill score (score < -11)</span></p> </td> </tr> <tr style="mso-yfti-irow:4"> <td width="638" valign="top" style="width:478.5pt;border:ridge windowtext 2.25pt; border-top:none;mso-border-left-alt:three-d-emboss windowtext 2.25pt; mso-border-bottom-alt:three-d-emboss windowtext 2.25pt;mso-border-right-alt: three-d-emboss windowtext 2.25pt;padding:0in 0in 0in 0in"> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;">Severe exercise <st1:city st="on"><st1:place st="on">LV</st1:place></st1:city> dysfunction (exercise LVEF <0.35)</span></p> </td> </tr> <tr style="mso-yfti-irow:5"> <td width="638" valign="top" style="width:478.5pt;border:ridge windowtext 2.25pt; border-top:none;mso-border-left-alt:three-d-emboss windowtext 2.25pt; mso-border-bottom-alt:three-d-emboss windowtext 2.25pt;mso-border-right-alt: three-d-emboss windowtext 2.25pt;padding:0in 0in 0in 0in"> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;">Stress-induced large perfusion defect (particularly if anterior)</span></p> </td> </tr> <tr style="mso-yfti-irow:6"> <td width="638" valign="top" style="width:478.5pt;border:ridge windowtext 2.25pt; border-top:none;mso-border-left-alt:three-d-emboss windowtext 2.25pt; mso-border-bottom-alt:three-d-emboss windowtext 2.25pt;mso-border-right-alt: three-d-emboss windowtext 2.25pt;padding:0in 0in 0in 0in"> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;">Stress-induced multiple perfusion defects of moderate size</span></p> </td> </tr> <tr style="mso-yfti-irow:7"> <td width="638" valign="top" style="width:478.5pt;border:ridge windowtext 2.25pt; border-top:none;mso-border-left-alt:three-d-emboss windowtext 2.25pt; mso-border-bottom-alt:three-d-emboss windowtext 2.25pt;mso-border-right-alt: three-d-emboss windowtext 2.25pt;padding:0in 0in 0in 0in"> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;">Large, fixed perfusion defect with <st1:city st="on"><st1:place st="on">LV</st1:place></st1:city> dilation or increased lung uptake (thallium-201)</span></p> </td> </tr> <tr style="mso-yfti-irow:8"> <td width="638" valign="top" style="width:478.5pt;border:ridge windowtext 2.25pt; border-top:none;mso-border-left-alt:three-d-emboss windowtext 2.25pt; mso-border-bottom-alt:three-d-emboss windowtext 2.25pt;mso-border-right-alt: three-d-emboss windowtext 2.25pt;padding:0in 0in 0in 0in"> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;">Stress-induced moderate perfusion defect with <st1:city st="on"><st1:place st="on">LV</st1:place></st1:city> dilation or increased lung uptake (thallium-201)</span></p> </td> </tr> <tr style="mso-yfti-irow:9"> <td width="638" valign="top" style="width:478.5pt;border:ridge windowtext 2.25pt; border-top:none;mso-border-left-alt:three-d-emboss windowtext 2.25pt; mso-border-bottom-alt:three-d-emboss windowtext 2.25pt;mso-border-right-alt: three-d-emboss windowtext 2.25pt;padding:0in 0in 0in 0in"> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;">Echocardiographic wall motion abnormality</span></p> </td> </tr> <tr style="mso-yfti-irow:10"> <td width="638" valign="top" style="width:478.5pt;border:ridge windowtext 2.25pt; border-top:none;mso-border-left-alt:three-d-emboss windowtext 2.25pt; mso-border-bottom-alt:three-d-emboss windowtext 2.25pt;mso-border-right-alt: three-d-emboss windowtext 2.25pt;padding:0in 0in 0in 0in"> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;">Stress echocardiographic evidence of extensive ischemia</span></p> </td> </tr> <tr style="mso-yfti-irow:11"> <td width="638" valign="top" style="width:478.5pt;border:ridge windowtext 2.25pt; border-top:none;mso-border-left-alt:three-d-emboss windowtext 2.25pt; mso-border-bottom-alt:three-d-emboss windowtext 2.25pt;mso-border-right-alt: three-d-emboss windowtext 2.25pt;padding:0in 0in 0in 0in"> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="font-family:Arial;"><span class="Apple-style-span" style="font-size: x-large;"><b><span class="Apple-style-span" style="color:#990000;">Coronary Angiograph or Medical Management</span></b></span></span></p> </td> </tr> <tr style="mso-yfti-irow:12"> <td width="638" valign="top" style="width:478.5pt;border:ridge windowtext 2.25pt; border-top:none;mso-border-left-alt:three-d-emboss windowtext 2.25pt; mso-border-bottom-alt:three-d-emboss windowtext 2.25pt;mso-border-right-alt: three-d-emboss windowtext 2.25pt;padding:0in 0in 0in 0in"> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;">Intermediate risk (1-3% annual mortality rate)</span></p> </td> </tr> <tr style="mso-yfti-irow:13"> <td width="638" valign="top" style="width:478.5pt;border:ridge windowtext 2.25pt; border-top:none;mso-border-left-alt:three-d-emboss windowtext 2.25pt; mso-border-bottom-alt:three-d-emboss windowtext 2.25pt;mso-border-right-alt: three-d-emboss windowtext 2.25pt;padding:0in 0in 0in 0in"> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;">Mild/moderate resting <st1:city st="on"><st1:place st="on">LV</st1:place></st1:city> dysfunction (LVEF 0.35-0.49)</span></p> </td> </tr> <tr style="mso-yfti-irow:14"> <td width="638" valign="top" style="width:478.5pt;border:ridge windowtext 2.25pt; border-top:none;mso-border-left-alt:three-d-emboss windowtext 2.25pt; mso-border-bottom-alt:three-d-emboss windowtext 2.25pt;mso-border-right-alt: three-d-emboss windowtext 2.25pt;padding:0in 0in 0in 0in"> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;">Intermediate-risk treadmill score (-11<score><5)</score></span></p> </td> </tr> <tr style="mso-yfti-irow:15"> <td width="638" valign="top" style="width:478.5pt;border:ridge windowtext 2.25pt; border-top:none;mso-border-left-alt:three-d-emboss windowtext 2.25pt; mso-border-bottom-alt:three-d-emboss windowtext 2.25pt;mso-border-right-alt: three-d-emboss windowtext 2.25pt;padding:0in 0in 0in 0in"> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;">Stress-induced moderate perfusion defect without <st1:city st="on"><st1:place st="on">LV</st1:place></st1:city> dilation or increased lung intake (thallium-201)</span></p> </td> </tr> <tr style="mso-yfti-irow:16"> <td width="638" valign="top" style="width:478.5pt;border:ridge windowtext 2.25pt; border-top:none;mso-border-left-alt:three-d-emboss windowtext 2.25pt; mso-border-bottom-alt:three-d-emboss windowtext 2.25pt;mso-border-right-alt: three-d-emboss windowtext 2.25pt;padding:0in 0in 0in 0in"> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;">Limited stress echocardiographic ischemia with a wall motion abnormality only at higher doses of dobutamine involving <></span></p> </td> </tr> <tr style="mso-yfti-irow:17"> <td width="638" valign="top" style="width:478.5pt;border:ridge windowtext 2.25pt; border-top:none;mso-border-left-alt:three-d-emboss windowtext 2.25pt; mso-border-bottom-alt:three-d-emboss windowtext 2.25pt;mso-border-right-alt: three-d-emboss windowtext 2.25pt;padding:0in 0in 0in 0in"> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="font-family:Arial;"><span class="Apple-style-span" style="font-size: x-large;"><b><span class="Apple-style-span" style="color:#990000;">Medical Management</span></b></span></span></p> </td> </tr> <tr style="mso-yfti-irow:18"> <td width="638" valign="top" style="width:478.5pt;border:ridge windowtext 2.25pt; border-top:none;mso-border-left-alt:three-d-emboss windowtext 2.25pt; mso-border-bottom-alt:three-d-emboss windowtext 2.25pt;mso-border-right-alt: three-d-emboss windowtext 2.25pt;padding:0in 0in 0in 0in"> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;">Low risk (<></span></p> </td> </tr> <tr style="mso-yfti-irow:19"> <td width="638" valign="top" style="width:478.5pt;border:ridge windowtext 2.25pt; border-top:none;mso-border-left-alt:three-d-emboss windowtext 2.25pt; mso-border-bottom-alt:three-d-emboss windowtext 2.25pt;mso-border-right-alt: three-d-emboss windowtext 2.25pt;padding:0in 0in 0in 0in"> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;">Low risk-treadmill score (score > 5)</span></p> </td> </tr> <tr style="mso-yfti-irow:20"> <td width="638" valign="top" style="width:478.5pt;border:ridge windowtext 2.25pt; border-top:none;mso-border-left-alt:three-d-emboss windowtext 2.25pt; mso-border-bottom-alt:three-d-emboss windowtext 2.25pt;mso-border-right-alt: three-d-emboss windowtext 2.25pt;padding:0in 0in 0in 0in"> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;">Normal or small myocardial perfusion defect at rest or with stress</span></p> </td> </tr> <tr style="mso-yfti-irow:21;mso-yfti-lastrow:yes"> <td width="638" valign="top" style="width:478.5pt;border:ridge windowtext 2.25pt; border-top:none;mso-border-left-alt:three-d-emboss windowtext 2.25pt; mso-border-bottom-alt:three-d-emboss windowtext 2.25pt;mso-border-right-alt: three-d-emboss windowtext 2.25pt;padding:0in 0in 0in 0in"> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;">Normal stress echocardiographic wall motion or no change of limited resting wall motion abnormalities during stress</span></p> </td> </tr> </tbody></table> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in;page-break-after:avoid"><span style="color:black;"> <o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in;page-break-after:avoid"><span style="font-family:Arial;color:black;"><span class="Apple-style-span" style="font-size: medium;">Addenda</span></span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">ST-Elevation MI (STEMI) Order Set</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">Suspected Unstable Angina/Non-ST-Elevation MI: (NSTEMI) Order Set</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:black;">Glycoprotein IIB/ IIIA Inhibitors</span><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in;page-break-after:avoid"><span color="black"> <o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in;page-break-after:avoid"><b style="mso-bidi-font-weight:normal"><span style="color:red;"> ((NOTE: IMPORTANT!!))<o:p></o:p></span></b></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in;page-break-after:avoid"><span style="font-family:Arial;color:blue;"><span class="Apple-style-span" style="font-size: large;">Addendum #1:
<br />ST-Elevation MI (STEMI) Order</span></span><span style=" mso-bidi-font-weight:bold;font-family:Arial;font-size:24.0pt;color:blue;"> </span><span style="font-family:Arial;color:blue;"><span class="Apple-style-span" style="font-size: large;">Set</span></span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">Initial Orders</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">DIAGNOSTICS</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">¨ Stat ECG, obtain old ECG record</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">¨ Labs to be drawn stat: CMP, CBC/diff, PT/PTT/INR, CK and CK-MB (site specific), Troponin-I</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">¨ Lipid panel</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">¨ Stat portable CXR</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">¨ Cardiac monitor and SaO<sub>2</sub><span class="apple-converted-space"> </span>monitors</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">¨ Other_____________________________________________________</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">ANTI-ISCHEMIC THERAPY</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">¨ Oxygen 2L/min Nasal Cannula (titrate to keep pulse oximetry saturations >94%)</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">¨ IV 0.9NS _____ml/hr</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">¨ Morphine Sulfate</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">NITROGLYCERIN THERAPY (Hold if patient has taken Sildenafil (Viagara) within 24 hours)</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">¨ Nitroglycerin 0.4mg SL q5 min x 3 doses or until pain relief or SBP <><span style="color:blue;"><o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">¨ Nitroglycerin paste _____ inch(es) topically x 1</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">¨ IV – start Nitroglycerin infusion at 10mcg/min, then titrate to chest pain relief</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">B-BLOCKER THERAPY</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">¨ Metoprolol (Lopressor) 5mg IV q 5min x 3 doses (Hold for SBP <90),> 1<sup>st</sup><span class="apple-converted-space"> </span>degree, decompensated CHF, severe COPD/Asthma)</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">ANTI-THROMBOTIC THERAPY</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">¨ Aspirin 162 mg po (2 chewable 81 mg tablets)</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">FIBRINOLYTIC THERAPY (Per discretion of Interventional Attending)</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">Indications: chest pain <><span style="color:blue;"><o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">1. History of hemorrhagic stroke at any time; other stroke or cerebrovascular event within 1 year.</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">2. Known intra-cranial neoplasm.</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">3. Active internal bleeding.</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">4. Suspected aortic dissection (consider CT of chest).</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">TPA (Per interventional attending)</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">¨ Full dose:15mg IVP, then 0.75mg/kg (maximum 50mg) over 30 min, then 0.5mg/kg (maximum 35mg) over 60 min</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">¨ Facilitated PCI (per interventional attending discretion)- Alteplase plus Eptifibatide</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">¨ Patient eligibility- <75yo><span style="color:blue;"><o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">¨ Serum Creatinine <2.0><span style="color:blue;"><o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">All Patients shall receive:</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">¨ ASA 160mg –325mg STAT</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">¨ Heparin - 60Units/KG (max 4000 Units) followed by 12/units/kg/hr (max 800units/hr titrated to aPTT 50-70)</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">¨ Alteplase Dose (should precede GPIIb IIIa inhibitors) - 15mg IVP followed by .75mg/kg (max 35mg) over 60 minutes</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">¨ Eptifibatide Dose - 180mcg/kg IVP, followed by 2mcg/kg/mininfusion. Second bolus -90mcg/kg IVP thirty minutes after first bolus. Infusion continues x 18-24 hours post PCI or max of 48 hours</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">HEPARIN THERAPY</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">May be administered simultaneously with TPA or given alone</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">¨ Unfractionated heparin: 5000 units IV bolus or 60 units/kg bolus (1000units/ml), then 1000 units/hr IV or 12units/kg/hr IV</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">¨ Follow Heparin Normogram per hospital protocol</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">¨ Goal of PTT 60-80</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="color:blue;"> <o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in;page-break-after:avoid"><span style="font-family:Arial;color:blue;"><span class="Apple-style-span" style="font-size: x-large;">Addendum # 2:
<br />Suspected Unstable Angina/Non-ST- Elevation MI: (NSTEMI) Order Set</span></span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">Initial Orders</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">DIAGNOSTICS</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">¨ Stat ECG, obtain old ECG record</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">¨ Stat labs: CMP, CBC/diff, PT/PTT/INR, CK and CK-MB (site specific), Troponin I</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">¨ Lipid Panel</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">¨ Stat portable CXR</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">¨ Cardiac monitor and SaO2 monitors</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">¨ Other ___________________________________________________________</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">ANTI-ISCHEMIC THERAPY</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">¨ Oxygen 2L/min Nasal Cannula (titrate to keep pulse oximetry saturations >94%)</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">¨ IV 0.9NS _____ml/hr</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">¨ Morphine Sulfate</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">NITROGLYCERIN THERAPY</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">¨ Hold if patient has taken Sildenfil (Viagara) within 24 hours</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">¨ Nitroglycerin 0.4mg SL q 5min x 3 doses or until pain relief or SBP <><span style="color:blue;"><o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">¨ Nitroglycerin paste ____ inch(es) topically x 1</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">¨ Start IV infusion of Nitroglycerin at 10mcg/min, then titrate for pain relief</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">B-BLOCKER THERAPY</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">¨ Metoprolol (Lopressor) 5mg IV q 5 min x 3 (Hold SBP <90,> 1<sup>st</sup><span class="apple-converted-space"> </span>degree, decompensated CHF, severe COPD/Asthma)</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">ACS ANTI-THROMBOTIC TREATMENT GUIDE</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">Possible ACS:</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">¨ Aspirin 162 mg (2 chewable 81 mg tablets)</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">Likely/Definite ACS (without continuing ischemic pain or high risk features)</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">§ Chief symptom: chest or left arm discomfort</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">§ Prior MI, History of CAD, extra-cardiac vascular disease, age >70 years</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">§ ECG: fixed Q waves, presumed old abnormal ST segments or T waves</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">¨ Aspirin 162 mg po (2 chewable 81 mg tablets)</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">¨ Noxaparin (Lovenox) ___mg SQ x 1 (1mg/kg dose) or</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">¨ Unfractionated heparin ____ units IV bolus (1000units/ml), followed by ______ units/hr (Follow Heparin Normogram per hospital protocol)</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">Definite ACS with any of the following features:</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">§ Continuing ischemic pain (despite ASA, clopidigrel, IV NTG, heparin)</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">§ High-risk (of death or non-fatal MI) features: positive cardiac enzymes, new or transient ST-segment changes, chest pain at rest >20minutes, diabetes, pulmonary edema, recent MI, age >75 years, hypotension</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">§ Planned intervention</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">¨ Aspirin 162mg (2 chewable 81 mg tablets)</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">¨ Eptifibatide (Integrillin) - See Micromedex for details</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">______180mcg/kg Eptifibatide IV bolus</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">______2.0mcg/kg/min Eptifibatide IV infusion</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">§ (NOTE: Half infusion rate if serum creatinine is between 2-4 mg/dl, hold if patient is on hemodialysis)</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">¨ Unfractionated heparin _____ units IV bolus (1000units/ml), then ____units/hr IV infusion (Follow Heparin Normogram per hospital protocol)</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="color:blue;"> <o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in;page-break-after:avoid"><span style="font-family:Arial;color:blue;"><span class="Apple-style-span" style="font-size: x-large;">Addendum #3:
<br />Glycoprotein IIB/ IIIA Inhibitors</span></span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in;page-break-after:avoid"><span style="color:blue;"> <o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in;page-break-after:avoid"><span style=" mso-bidi-font-weight:bold;font-family:Arial;color:blue;">Medication Pharmacokinetics/Pharmacodynamics</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in;page-break-after:avoid"><span style="color:blue;"> <o:p></o:p></span></p> <table class="MsoNormalTable" border="0" cellspacing="0" cellpadding="0" style="margin-left:1.15pt;border-collapse:collapse;mso-padding-alt:0in 0in 0in 0in"> <tbody><tr style="mso-yfti-irow:0;mso-yfti-firstrow:yes"> <td width="209" valign="top" style="width:156.75pt;border:ridge windowtext 2.25pt; mso-border-alt:three-d-emboss windowtext 2.25pt;padding:0in 0in 0in 0in"> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;"> </span><span style="color:blue;"><o:p></o:p></span></p> </td> <td width="209" valign="top" style="width:156.75pt;border:ridge windowtext 2.25pt; border-left:none;mso-border-top-alt:three-d-emboss windowtext 2.25pt; mso-border-bottom-alt:three-d-emboss windowtext 2.25pt;mso-border-right-alt: three-d-emboss windowtext 2.25pt;padding:0in 0in 0in 0in"> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">Eptifibatide</span><span style="color:blue;"><o:p></o:p></span></p> </td> <td width="209" valign="top" style="width:156.75pt;border:ridge windowtext 2.25pt; border-left:none;mso-border-top-alt:three-d-emboss windowtext 2.25pt; mso-border-bottom-alt:three-d-emboss windowtext 2.25pt;mso-border-right-alt: three-d-emboss windowtext 2.25pt;padding:0in 0in 0in 0in"> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">Abciximab</span><span style="color:blue;"><o:p></o:p></span></p> </td> </tr> <tr style="mso-yfti-irow:1"> <td width="209" valign="top" style="width:156.75pt;border:ridge windowtext 2.25pt; border-top:none;mso-border-left-alt:three-d-emboss windowtext 2.25pt; mso-border-bottom-alt:three-d-emboss windowtext 2.25pt;mso-border-right-alt: three-d-emboss windowtext 2.25pt;padding:0in 0in 0in 0in"> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">Mechanism of Action</span><span style="color:blue;"><o:p></o:p></span></p> </td> <td width="209" valign="top" style="width:156.75pt;border-top:none;border-left: none;border-bottom:ridge windowtext 2.25pt;border-right:ridge windowtext 2.25pt; mso-border-bottom-alt:three-d-emboss windowtext 2.25pt;mso-border-right-alt: three-d-emboss windowtext 2.25pt;padding:0in 0in 0in 0in"> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">Reversible inhibitor of receptor</span><span style="color:blue;"><o:p></o:p></span></p> </td> <td width="209" valign="top" style="width:156.75pt;border-top:none;border-left: none;border-bottom:ridge windowtext 2.25pt;border-right:ridge windowtext 2.25pt; mso-border-bottom-alt:three-d-emboss windowtext 2.25pt;mso-border-right-alt: three-d-emboss windowtext 2.25pt;padding:0in 0in 0in 0in"> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">Monoclonal antibody that irreversibly inhibits receptor</span><span style="color:blue;"><o:p></o:p></span></p> </td> </tr> <tr style="mso-yfti-irow:2"> <td width="209" valign="top" style="width:156.75pt;border:ridge windowtext 2.25pt; border-top:none;mso-border-left-alt:three-d-emboss windowtext 2.25pt; mso-border-bottom-alt:three-d-emboss windowtext 2.25pt;mso-border-right-alt: three-d-emboss windowtext 2.25pt;padding:0in 0in 0in 0in"> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">Half life</span><span style="color:blue;"><o:p></o:p></span></p> </td> <td width="209" valign="top" style="width:156.75pt;border-top:none;border-left: none;border-bottom:ridge windowtext 2.25pt;border-right:ridge windowtext 2.25pt; mso-border-bottom-alt:three-d-emboss windowtext 2.25pt;mso-border-right-alt: three-d-emboss windowtext 2.25pt;padding:0in 0in 0in 0in"> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">1.5 – 2.5 hours</span><span style="color:blue;"><o:p></o:p></span></p> </td> <td width="209" valign="top" style="width:156.75pt;border-top:none;border-left: none;border-bottom:ridge windowtext 2.25pt;border-right:ridge windowtext 2.25pt; mso-border-bottom-alt:three-d-emboss windowtext 2.25pt;mso-border-right-alt: three-d-emboss windowtext 2.25pt;padding:0in 0in 0in 0in"> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">a: <><span style="color:blue;"><o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">b: 30 minutes *</span><span style="color:blue;"><o:p></o:p></span></p> </td> </tr> <tr style="mso-yfti-irow:3;mso-yfti-lastrow:yes"> <td width="209" valign="top" style="width:156.75pt;border:ridge windowtext 2.25pt; border-top:none;mso-border-left-alt:three-d-emboss windowtext 2.25pt; mso-border-bottom-alt:three-d-emboss windowtext 2.25pt;mso-border-right-alt: three-d-emboss windowtext 2.25pt;padding:0in 0in 0in 0in"> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">Duration of Action</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">§ Platelet aggregation</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">§ Bleeding time</span><span style="color:blue;"><o:p></o:p></span></p> </td> <td width="209" valign="top" style="width:156.75pt;border-top:none;border-left: none;border-bottom:ridge windowtext 2.25pt;border-right:ridge windowtext 2.25pt; mso-border-bottom-alt:three-d-emboss windowtext 2.25pt;mso-border-right-alt: three-d-emboss windowtext 2.25pt;padding:0in 0in 0in 0in"> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">2 – 4 hours</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">15 – 30 minutes</span><span style="color:blue;"><o:p></o:p></span></p> </td> <td width="209" valign="top" style="width:156.75pt;border-top:none;border-left: none;border-bottom:ridge windowtext 2.25pt;border-right:ridge windowtext 2.25pt; mso-border-bottom-alt:three-d-emboss windowtext 2.25pt;mso-border-right-alt: three-d-emboss windowtext 2.25pt;padding:0in 0in 0in 0in"> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">~ 48 hours</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">~ 24 hours</span><span style="color:blue;"><o:p></o:p></span></p> </td> </tr> </tbody></table> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">*NOTE: Half-life is deceiving. Applies to free drug in serum, drug still bound to receptor at 15 days.</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="color:blue;"> <o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">Dosing (eptifibatide used in most cases, abciximab is used sparingly in Cath lab):</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="color:blue;"> <o:p></o:p></span></p> <table class="MsoNormalTable" border="0" cellspacing="0" cellpadding="0" style="margin-left:1.15pt;border-collapse:collapse;mso-padding-alt:0in 0in 0in 0in"> <tbody><tr style="mso-yfti-irow:0;mso-yfti-firstrow:yes"> <td width="115" valign="top" style="width:86.25pt;border:ridge windowtext 2.25pt; mso-border-alt:three-d-emboss windowtext 2.25pt;padding:0in 0in 0in 0in"> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;"> </span><span style="color:blue;"><o:p></o:p></span></p> </td> <td width="310" valign="top" style="width:232.5pt;border:ridge windowtext 2.25pt; border-left:none;mso-border-top-alt:three-d-emboss windowtext 2.25pt; mso-border-bottom-alt:three-d-emboss windowtext 2.25pt;mso-border-right-alt: three-d-emboss windowtext 2.25pt;padding:0in 0in 0in 0in"> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">Eptifibatide</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">(Dosing charts available in pharmacy, cath lab, and CCU)</span><span style="color:blue;"><o:p></o:p></span></p> </td> <td width="213" valign="top" style="width:159.75pt;border:ridge windowtext 2.25pt; border-left:none;mso-border-top-alt:three-d-emboss windowtext 2.25pt; mso-border-bottom-alt:three-d-emboss windowtext 2.25pt;mso-border-right-alt: three-d-emboss windowtext 2.25pt;padding:0in 0in 0in 0in"> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">Abciximab</span><span style="color:blue;"><o:p></o:p></span></p> </td> </tr> <tr style="mso-yfti-irow:1"> <td width="115" valign="top" style="width:86.25pt;border:ridge windowtext 2.25pt; border-top:none;mso-border-left-alt:three-d-emboss windowtext 2.25pt; mso-border-bottom-alt:three-d-emboss windowtext 2.25pt;mso-border-right-alt: three-d-emboss windowtext 2.25pt;padding:0in 0in 0in 0in"> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">Acute Coronary Syndrome</span><span style="color:blue;"><o:p></o:p></span></p> </td> <td width="310" valign="top" style="width:232.5pt;border-top:none;border-left: none;border-bottom:ridge windowtext 2.25pt;border-right:ridge windowtext 2.25pt; mso-border-bottom-alt:three-d-emboss windowtext 2.25pt;mso-border-right-alt: three-d-emboss windowtext 2.25pt;padding:0in 0in 0in 0in"> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">180 mcg/kg IVP, plus 2 mcg/kg/min [generally continued x 24 hrs after PCI (if performed), may give up to 96 hrs total]</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">**For pt’s with SCr 2.0 - 4.0mg/dl, reduce maintenance infusion rate to 1.0 mcg/kg/min**</span><span style="color:blue;"><o:p></o:p></span></p> </td> <td width="213" valign="top" style="width:159.75pt;border-top:none;border-left: none;border-bottom:ridge windowtext 2.25pt;border-right:ridge windowtext 2.25pt; mso-border-bottom-alt:three-d-emboss windowtext 2.25pt;mso-border-right-alt: three-d-emboss windowtext 2.25pt;padding:0in 0in 0in 0in"> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">0.25 mg/kg IVP, then 0.125 mcg/kg/min (max 10 mcg/min)</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">x 18 – 24 hrs (for pts undergoing PCI w/in 24hrs)</span><span style="color:blue;"><o:p></o:p></span></p> </td> </tr> <tr style="mso-yfti-irow:2;mso-yfti-lastrow:yes"> <td width="115" valign="top" style="width:86.25pt;border:ridge windowtext 2.25pt; border-top:none;mso-border-left-alt:three-d-emboss windowtext 2.25pt; mso-border-bottom-alt:three-d-emboss windowtext 2.25pt;mso-border-right-alt: three-d-emboss windowtext 2.25pt;padding:0in 0in 0in 0in"> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">Percutaneous Coronary Intervention</span><span style="color:blue;"><o:p></o:p></span></p> </td> <td width="310" valign="top" style="width:232.5pt;border-top:none;border-left: none;border-bottom:ridge windowtext 2.25pt;border-right:ridge windowtext 2.25pt; mso-border-bottom-alt:three-d-emboss windowtext 2.25pt;mso-border-right-alt: three-d-emboss windowtext 2.25pt;padding:0in 0in 0in 0in"> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">180 mcg/kg IVP x 2 (10 minutes apart), plus</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">2 mcg/kg/min x 20 – 24 hrs</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">**For pt’s with SCr 2.0 - 4.0mg/dl, reduce maintenance infusion rate to 1.0 mcg/kg/min**</span><span style="color:blue;"><o:p></o:p></span></p> </td> <td width="213" valign="top" style="width:159.75pt;border-top:none;border-left: none;border-bottom:ridge windowtext 2.25pt;border-right:ridge windowtext 2.25pt; mso-border-bottom-alt:three-d-emboss windowtext 2.25pt;mso-border-right-alt: three-d-emboss windowtext 2.25pt;padding:0in 0in 0in 0in"> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">0.25 mg/kg IVP, then 0.125 mcg/kg/min (max 10 mcg/min)</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">x 12 hrs</span><span style="color:blue;"><o:p></o:p></span></p> </td> </tr> </tbody></table> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="color:blue;"> <o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">Adverse Drug Reactions/Monitoring Parameters:</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="color:blue;"> <o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">§ Bleeding [vascular access site (usually groin) most common].</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">§ CBC baseline, QD, and if bleed suspected.</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">§ PTT as appropriate (in most cases due to concomitant heparin therapy).</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">§ 50 – 70 seconds [goal may be higher (60 – 80 seconds) if PCI performed].</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">§ For PCI, may use activated clotting time (ACT) with goal of 200 – 300 seconds.</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">§ Thrombocytopenia (primarily with abciximab, rare with eptifibatide).</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">§ May be given concomitantly with IV heparin and ASA.</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">University of <st1:placename st="on">Illinois</st1:placename> <st1:placename st="on">Medical</st1:placename> <st1:placetype st="on">Center</st1:placetype> at <st1:city st="on"><st1:place st="on">Chicago</st1:place></st1:city> Procedures for Integrilin™ Use</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">I. Requires cardiology approval.</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">II. Screen for appropriate use and contraindications.</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">III. Verify patient weight.</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">IV. Patient selection.</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">A. Ischemic chest pain at rest > 10 minutes within last 12 hours.</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">AND</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">B.</span><span style="color:blue;"><o:p></o:p></span></p> <table class="MsoNormalTable" border="0" cellspacing="0" cellpadding="0" style="border-collapse:collapse;mso-padding-alt:0in 0in 0in 0in"> <tbody><tr style="mso-yfti-irow:0;mso-yfti-firstrow:yes;mso-yfti-lastrow:yes"> <td width="624" style="width:6.5in;padding:0in 0in 0in 0in"> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom: 5.0pt;margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;"> </span><span style="color:blue;"><o:p></o:p></span></p> </td> </tr> </tbody></table> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">ECG changes consistent with ischemia.</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">1. ST depression.</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">2. T wave inversion.</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">3. Normalization of previously abnormal T waves.</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">OR</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">C. Positive Troponin I or CPK-MB.</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">OR</span><span style="color:blue;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt; margin-left:0in"><span style="mso-bidi-font-weight: bold;font-family:Arial;color:blue;">D. Recurrent chest pain on medical therapy (ASA, heparin, nitrates, beta-blocker).</span><span style="color:blue;"><o:p></o:p></span></p>
<br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://2.bp.blogspot.com/_StW9Y6v_f4I/TFHBlUrZqsI/AAAAAAAAAHQ/bQSP0lyP3JY/s1600/cardio+(1).jpg"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 305px; height: 320px;" src="http://2.bp.blogspot.com/_StW9Y6v_f4I/TFHBlUrZqsI/AAAAAAAAAHQ/bQSP0lyP3JY/s320/cardio+(1).jpg" border="0" alt="" id="BLOGGER_PHOTO_ID_5499389466946153154" /></a>
<br /><span class="fullpost"></span><script type="text/javascript">adv_username = "misibb";adv_gid = "misibb_default";adtype = "180x150";</script><script type="text/javascript" src="http://www.advertlets.com/_/js/advertlets_lite.js"></script>misibbhttp://www.blogger.com/profile/14827173537467932982noreply@blogger.com0tag:blogger.com,1999:blog-1717129759233064518.post-40164855662741787662010-07-22T09:53:00.011+08:002010-07-22T11:02:05.612+08:00MMRV<span class="Apple-style-span" style="color:#660000;"><b>MEASLES, MUMPS, RUBELLA & VARICELLA ( chickenpox )</b></span><span class="Apple-style-span" style="color:#006600;"> TARGET INNOCENT CHILDREN.</span> <span class="Apple-style-span" style="color:#990000;"><b>Get Them Before They Get Close.</b></span><div><br /></div><div><span class="Apple-style-span" style="color:#990000;">KNOW THESE</span> <b><span class="Apple-style-span" style="color:#006600;">THREATS</span></b><span class="Apple-style-span" style="color:#006600;"> <b>AND PROTECT</b></span> <span class="Apple-style-span" style="color:#990000;">YOUR CHILDREN FROM THEM</span>.</div><div>They are <span class="Apple-style-span" style="color:#990000;">Measles, Mumps, Rubella and Varicella (chickenpox)</span> who appear as harmless illnesses in children. However, infections from <span class="Apple-style-span" style="color:#000099;">MMRV</span> viruses can lead to serious complications that may involve hospitalisation and burden the family. Because <span class="Apple-style-span" style="color:#000099;">MMRV</span> viruses are highly contagious and mainly targets children, it is vital to prevent them from harming your child.<br /><br /></div><div><b><span class="Apple-style-span" style="color:#660000;"><br /></span></b></div><div><b><span class="Apple-style-span" style="color:#660000;"><br /></span></b></div><div><b><span class="Apple-style-span" style="color:#660000;">MEASLES</span></b><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://2.bp.blogspot.com/_StW9Y6v_f4I/TEewfqoiPxI/AAAAAAAAAHI/_gC5NBO5V-o/s1600/measles.jpg"><img style="float:left; margin:0 10px 10px 0;cursor:pointer; cursor:hand;width: 320px; height: 213px;" src="http://2.bp.blogspot.com/_StW9Y6v_f4I/TEewfqoiPxI/AAAAAAAAAHI/_gC5NBO5V-o/s320/measles.jpg" border="0" alt="" id="BLOGGER_PHOTO_ID_5496555928295718674" /></a><br /><div><br /></div>Most contagious vaccine~preventable infection in humans.<div>Spread by airborne or droplet exposure.</div><div>Symptoms include fever, cough, runny nose, conjunctivitis ( red eyes ) and a rash.</div><div>May result in complications of the ear and pneumonia.<br /><br /><span class="Apple-style-span" style="color:#660000;"><b><br /></b></span></div><div><span class="Apple-style-span" style="color:#660000;"><b><br /></b></span></div><div><span class="Apple-style-span" style="color:#660000;"><b><br /></b></span></div><div><span class="Apple-style-span" style="color:#660000;"><b><br /></b></span></div><div><span class="Apple-style-span" style="color:#660000;"><b>MUMPS</b></span><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://2.bp.blogspot.com/_StW9Y6v_f4I/TEevZgfqNGI/AAAAAAAAAHA/GINpaRHMDyI/s1600/M-mumps.png"><img style="float:left; margin:0 10px 10px 0;cursor:pointer; cursor:hand;width: 320px; height: 240px;" src="http://2.bp.blogspot.com/_StW9Y6v_f4I/TEevZgfqNGI/AAAAAAAAAHA/GINpaRHMDyI/s320/M-mumps.png" border="0" alt="" id="BLOGGER_PHOTO_ID_5496554722983294050" /></a><br /><br /><ul><li>Acute infectious disease caused by the mumps virus.</li><li>May cause inflammation of brain and/or tissue covering the brain and spinal cord.</li><li>Common symptoms include swelling of salivary glands (near jaw line ) and pain particularly when chewing, fever and headache.</li><li>Known complications include permanent deafness, infection of other organ systems and sterility.</li></ul><br /><span class="Apple-style-span" style="color:#660000;"><b><br /></b></span></div><div><span class="Apple-style-span" style="color:#660000;"><b><br /></b></span></div><div><span class="Apple-style-span" style="color:#660000;"><b>RUBELLA</b></span><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://1.bp.blogspot.com/_StW9Y6v_f4I/TEet0u41QfI/AAAAAAAAAG4/q7P9_knGSKI/s1600/rubella.jpg"><img style="float:left; margin:0 10px 10px 0;cursor:pointer; cursor:hand;width: 105px; height: 159px;" src="http://1.bp.blogspot.com/_StW9Y6v_f4I/TEet0u41QfI/AAAAAAAAAG4/q7P9_knGSKI/s320/rubella.jpg" border="0" alt="" id="BLOGGER_PHOTO_ID_5496552991680184818" /></a><br /><br /></div><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div><div><ul><li>A common childhood disease also known as German measles.</li><li>Virus is spread by airborne or droplet exposure and may be present in urine, feces and skin.</li><li>Birth defects if acquired by a pregnant women: deafness, cataracts, heart defects and mental retardation.</li></ul></div><div><span class="Apple-style-span" style="color: rgb(102, 0, 0); "><b><br /></b></span></div><div><span class="Apple-style-span" style="color: rgb(102, 0, 0); "><b><br /></b></span></div><div><span class="Apple-style-span" style="color: rgb(102, 0, 0); "><b><br /></b></span></div><div><span class="Apple-style-span" style="color: rgb(102, 0, 0); "><b>VARICELLA ( chickenpox )</b></span></div><div><ul><li>The primary cause of chickenpox , a highly contagious illness.</li><li>Children may have as many as 200 to 500 spots, which occur in waves. High temperatures can reach up to 38.9oC.</li><li>The virus is easily spread through coughs, sneezes or direct contact with secretion from the rash.</li><li>May result in scarring, shingles (reactivation of varicella zoster virus ) and the central nervous system being affected.</li></ul></div><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://4.bp.blogspot.com/_StW9Y6v_f4I/TEeqzkqE_hI/AAAAAAAAAGw/l96L67LZb_8/s1600/varicella.jpg"><img style="float:left; margin:0 10px 10px 0;cursor:pointer; cursor:hand;width: 300px; height: 200px;" src="http://4.bp.blogspot.com/_StW9Y6v_f4I/TEeqzkqE_hI/AAAAAAAAAGw/l96L67LZb_8/s320/varicella.jpg" border="0" alt="" id="BLOGGER_PHOTO_ID_5496549673219194386" /></a><br /><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://1.bp.blogspot.com/_StW9Y6v_f4I/TEeqps-FK5I/AAAAAAAAAGo/2JQvfCTe3RA/s1600/varicella5.jpg"><img style="float:left; margin:0 10px 10px 0;cursor:pointer; cursor:hand;width: 300px; height: 200px;" src="http://1.bp.blogspot.com/_StW9Y6v_f4I/TEeqps-FK5I/AAAAAAAAAGo/2JQvfCTe3RA/s320/varicella5.jpg" border="0" alt="" id="BLOGGER_PHOTO_ID_5496549503651883922" /></a><br /><br /><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://1.bp.blogspot.com/_StW9Y6v_f4I/TEeqeaOe4lI/AAAAAAAAAGg/baXCT8-3geA/s1600/Varicella+(1).jpg"><img style="float:left; margin:0 10px 10px 0;cursor:pointer; cursor:hand;width: 200px; height: 199px;" src="http://1.bp.blogspot.com/_StW9Y6v_f4I/TEeqeaOe4lI/AAAAAAAAAGg/baXCT8-3geA/s320/Varicella+(1).jpg" border="0" alt="" id="BLOGGER_PHOTO_ID_5496549309641843282" /></a><br /><span class="Apple-style-span" style="color:#000099;"><b><div><span class="Apple-style-span" style="color:#000099;"><b><br /></b></span></div><div><span class="Apple-style-span" style="color:#000099;"><b><br /></b></span></div><div><span class="Apple-style-span" style="color:#000099;"><b><br /></b></span></div><div><span class="Apple-style-span" style="color:#000099;"><b><br /></b></span></div><div><span class="Apple-style-span" style="color:#000099;"><b><br /></b></span></div><div><span class="Apple-style-span" style="color:#000099;"><b><br /></b></span></div><div><span class="Apple-style-span" style="color:#000099;"><b><br /></b></span></div><div><span class="Apple-style-span" style="color:#000099;"><b><br /></b></span></div><div><span class="Apple-style-span" style="color:#000099;"><b><br /></b></span></div><div><span class="Apple-style-span" style="color:#000099;"><b><br /></b></span></div><div><span class="Apple-style-span" style="color:#000099;"><b><br /></b></span></div><div><span class="Apple-style-span" style="color:#000099;"><b><br /></b></span></div><div><span class="Apple-style-span" style="color:#000099;"><b><br /></b></span></div><div><span class="Apple-style-span" style="color:#000099;"><b><br /></b></span></div><div><span class="Apple-style-span" style="color:#000099;"><b><br /></b></span></div><div><span class="Apple-style-span" style="color:#000099;"><b><br /></b></span></div><div><span class="Apple-style-span" style="color:#000099;"><b><br /></b></span></div><div><span class="Apple-style-span" style="color:#000099;"><b><br /></b></span></div><div><span class="Apple-style-span" style="color:#000099;"><b><br /></b></span></div><div><span class="Apple-style-span" style="color:#000099;"><b><br /></b></span></div>CHICKENPOX IS COMMON</b></span> as everyone has a 95% chance of having it something in life. It occurs in almost 90% of children below the age of 12.<div><span class="Apple-style-span" style="color: rgb(0, 0, 153); "><b><br /></b></span></div><div><span class="Apple-style-span" style="color: rgb(0, 0, 153); "><b>But , did you know the various complications chickenpox can bring ?</b></span></div><div><ul><li>Brain swelling and inflammation ( encephalitis; headaches, unsteadiness while walking, seizures )</li><li>Lung infection (pneumonia; cough, difficulty breathing)</li><li>Bacterial infection of the skin (cellulitis; painful,red and swollen skin )</li><li>Bone infection ( osteomyelitis; pain in infected area, difficulty in moving )</li><li>Joint infection ( arthritis , join pain )</li></ul>There are chances that these complications will result in hospitalisation and in some cases , lose of life.<br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://4.bp.blogspot.com/_StW9Y6v_f4I/TEeoCHPi0yI/AAAAAAAAAGY/-lw7kmyJkjI/s1600/varicella_virus.jpg"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 298px; height: 320px;" src="http://4.bp.blogspot.com/_StW9Y6v_f4I/TEeoCHPi0yI/AAAAAAAAAGY/-lw7kmyJkjI/s320/varicella_virus.jpg" border="0" alt="" id="BLOGGER_PHOTO_ID_5496546624486429474" /></a><br /><span class="Apple-style-span" style="color:#000099;"><b><div><span class="Apple-style-span" style="color:#000099;"><b><br /></b></span></div><div><span class="Apple-style-span" style="color:#000099;"><b><br /></b></span></div>PREVENTING MMR + V ( Measles , Mumps, Rubella ) + ( Chickenpox )</b></span><div><br /></div><div>Remember, contagious MMRV viruses mean higher infection risks for your child. An infection may spread to other family members plus burden parents who have to miss work to care for a sick child.</div><div>Now , additional protection from the VARICELLA ( chickenpox ) virus alongside the compulsory MMR vaccinations is available. You can spare your child from extra pain and injections by protecting against 4 threats at 1 go.<br /><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://2.bp.blogspot.com/_StW9Y6v_f4I/TEelsel3ylI/AAAAAAAAAGQ/RX5BpohgT_A/s1600/brufolona.jpg"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 190px; height: 260px;" src="http://2.bp.blogspot.com/_StW9Y6v_f4I/TEelsel3ylI/AAAAAAAAAGQ/RX5BpohgT_A/s320/brufolona.jpg" border="0" alt="" id="BLOGGER_PHOTO_ID_5496544053773716050" /></a><div style="text-align: center;">Ask your doctor how 1 vaccine protects your child from 4 deadly diseases.</div><br /></div></div></div></div>misibbhttp://www.blogger.com/profile/14827173537467932982noreply@blogger.com1tag:blogger.com,1999:blog-1717129759233064518.post-63031782307010656042010-07-02T10:18:00.010+08:002010-07-02T11:22:54.813+08:00BERSENAM SECARA BETUL DAN SELAMAT<b>Pandauan Senaman Penting</b><br /><div><br /></div><b>Untuk Pesakit DIABETES </b><div><br /></div><div><ul><li>Bawa gula-gula/manisan bersama anda. Makan sekiranya anda berasa pening kerana keadaan hipoglisemia ( paras glukos rendah ).</li><li>Pakai kasut yang berlapik dan selesa, bersarung kaki untuk mengelakkan dari kecederaan kaki.</li><li>Jangan melakukan senaman semasa lapar atau kenyang. * Perlu seimbangkan waktu lepas 20 minit makan.<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://3.bp.blogspot.com/_StW9Y6v_f4I/TC1Yc2tEhpI/AAAAAAAAAF4/gmo4NXY3JIQ/s1600/exercise2.gif"><img style="float:left; margin:0 10px 10px 0;cursor:pointer; cursor:hand;width: 238px; height: 320px;" src="http://3.bp.blogspot.com/_StW9Y6v_f4I/TC1Yc2tEhpI/AAAAAAAAAF4/gmo4NXY3JIQ/s320/exercise2.gif" border="0" alt="" id="BLOGGER_PHOTO_ID_5489140773578638994" /></a><br /></li></ul><div><b>Untuk Pesakit Hipertensi? Tekanan Darah Tinggi</b></div><div><ul><li>Berhenti bersenam jika pening, sakit dada dan sukar bernafas.</li></ul><div><b>Untuk anda yang GEMUK</b></div></div><div><ul><li>Jangan lakukan senaman yang terlalu agresif dan cuba minimakan pergerakan yang berimpak tinggi bagi mengelakkan kecederaan pada otot-otot.</li></ul><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div><b>KEMAMPUAN BERSENAM</b></div></div><div><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://3.bp.blogspot.com/_StW9Y6v_f4I/TC1XyVLG9PI/AAAAAAAAAFw/uTbIFkFhduw/s1600/Exercise.jpg"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 320px; height: 268px;" src="http://3.bp.blogspot.com/_StW9Y6v_f4I/TC1XyVLG9PI/AAAAAAAAAFw/uTbIFkFhduw/s320/Exercise.jpg" border="0" alt="" id="BLOGGER_PHOTO_ID_5489140043023316210" /></a><br /></div><div><ol><li>Ujian Percakapan : Perlahankan intensiti anda sekiranya anda sesak nafas bila bercakap semasa bersenam. Tingkatkan intensiti anda sekiranya anda masih mampu bergelak semasa bersenam.</li><li>Kira Sasaran Denyutan Jantung Anda:-</li></ol></div><div><ul><li>220 - umur x 60% Denyutan Jantung ; contoh Jika umur anda 70tahun</li></ul><div> 220 - 70 = 150</div></div><div> 150 x 0.60 = 90</div><div> 150 x 0.90 = 135</div><div><ul><li>Cuba kekalkan denyutan jantung di antara 90 dan 135 seminit.</li><li>Dapatkan nasihat doktor jika: Denyutan jantung semasa berehat berdekatan atau melebihi sasran denyutan jantung anda.</li><li>Anda sedang mengambil rawatan ubatan yang boleh memperlahankan denyutan jantung.</li><li>untuk mendapatkan denyutan jantung anda. Mempalpat jantung nadi di pergelangan tangan selari dengan pangkal ibu jari.</li><li>Untuk mengira denyutan jantung anda, mempalpat denyutan nadi selama 10 saat. Keputusannya digandakan dengan 6.</li><li><br /></li><li><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://4.bp.blogspot.com/_StW9Y6v_f4I/TC1ZNNC03lI/AAAAAAAAAGA/UyV_K5se59Y/s1600/Exercise+(1).jpg"><img style="float:left; margin:0 10px 10px 0;cursor:pointer; cursor:hand;width: 219px; height: 320px;" src="http://4.bp.blogspot.com/_StW9Y6v_f4I/TC1ZNNC03lI/AAAAAAAAAGA/UyV_K5se59Y/s320/Exercise+(1).jpg" border="0" alt="" id="BLOGGER_PHOTO_ID_5489141604209188434" /></a></li></ul><div><b>Garis Panduan di sajikan supaya anda bersenam secara menyeronokkan.</b></div></div><div><ul><li>Dapatkan nasihat doktor sebelum memulakan program senaman kecergasan.</li><li>Mulakan senaman dengan perlahan dan tingkatkan secara beransur-ansur untuk beberapa minggu bila anda semakin lebih cergas.</li><li>Mulakan senaman berselang seli 2-3 minit, dengan 2-3 minit berehat selama 15 minit. Aktiviti senaman perlu ditambah 2-3 minit setiap minggu sehingga mencapai 30 minit.</li><li>Mulakan dengan aktiviti memanaskan badan untuk mengelakan rasa sakit dan kesakitan selepas senaman.</li><li>Menyejukkan badan dengan membuat aktivit ringan seperti berjalan atau melakukan regangan bagi mengelakkan pening dan sakit.</li><li>Perlahankan aktiviti anda jika anda mengalami kesukaran bernafas semasa melakukan senaman.</li><li>Berhenti dengan serta merta jika anda mengalami ketidakselesaan, sakit dan pening.</li><li>Pakaian mestilah bersesuaian, longgar dan selesa serta pakai kasut yang sesuai.</li><li>Masa yang paling sesuai untuk melakukan senaman: setiap pagi ( sebelum 9.30 pagi waktu Malaysia) ; Petang ( selepas pukul 6 petang ).</li><li>Persekitaran tempat senaman : permukaan yang rata. Suhu dan kelembapan udara terkawal. Kawasan redup/ teduh. Tempat yang cukup terang.</li><li>Pastikan anda mengambil minuman yang secukupnya , sebelum , semasa dan selepas bersenam untuk menggantikan kehilangan peluh.</li></ul></div><div><br /></div><div><br /><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://3.bp.blogspot.com/_StW9Y6v_f4I/TC1Z5sKJFsI/AAAAAAAAAGI/3xJ-YPDwRTM/s1600/ex1.gif"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 320px; height: 88px;" src="http://3.bp.blogspot.com/_StW9Y6v_f4I/TC1Z5sKJFsI/AAAAAAAAAGI/3xJ-YPDwRTM/s320/ex1.gif" border="0" alt="" id="BLOGGER_PHOTO_ID_5489142368475616962" /></a><span class="fullpost"></span><script type="text/javascript">adv_username = "misibb";adv_gid = "misibb_default";adtype = "180x150";</script><script type="text/javascript" src="http://www.advertlets.com/_/js/advertlets_lite.js"></script></div></div><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://4.bp.blogspot.com/_StW9Y6v_f4I/TC1XIhOOy-I/AAAAAAAAAFg/LPhVTCmUd7g/s1600/mousexercis.jpg"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 271px; height: 204px;" src="http://4.bp.blogspot.com/_StW9Y6v_f4I/TC1XIhOOy-I/AAAAAAAAAFg/LPhVTCmUd7g/s320/mousexercis.jpg" border="0" alt="" id="BLOGGER_PHOTO_ID_5489139324703132642" /></a>misibbhttp://www.blogger.com/profile/14827173537467932982noreply@blogger.com0tag:blogger.com,1999:blog-1717129759233064518.post-10187106290885674892010-06-22T16:12:00.005+08:002010-06-22T16:39:19.411+08:00ALAHAN MAKANAN<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://1.bp.blogspot.com/_StW9Y6v_f4I/TCB2U5qT9GI/AAAAAAAAAFY/ySwOSRAexUI/s1600/food10.jpg"><img style="float: left; margin: 0pt 10px 10px 0pt; cursor: pointer; width: 400px; height: 288px;" src="http://1.bp.blogspot.com/_StW9Y6v_f4I/TCB2U5qT9GI/AAAAAAAAAFY/ySwOSRAexUI/s400/food10.jpg" alt="" id="BLOGGER_PHOTO_ID_5485514447585014882" border="0" /></a><span style="color: rgb(102, 0, 0); font-weight: bold;">ELAKKAN ALAHAN MAKANAN</span><br /><br />Gejala alahan makanan termasuklah rasa seperti dicucuk-cucuk pada mulut, ruam hives, kesukaran bernafas, pening serta bengkak pada bibir, muka , lidah dan tekak. Jika alahan berkenaan teruk, gejala lain akan muncul seperti laluan udara terhalang kerana tekak membengkak, denyutan nadi yang laju serta rasa pening dan tidak sedarkan diri.<br /><br />Langkah-langkah jika mengalami alahan:-<br /><br /><ul><li>Ketahui apa yang anda makan dan minum. Pastikan baca label makanan dengan teliti.</li><li>Pastikan ahli keluarga terdekat atau rakan sekerja anda tahu mengenai alahan yang anda alami.</li><li>Bincang dengan doktor sekiranya mahu membawa epinephrine kecemasan.</li><li>Jika anda menghidapi asma, pastikan jika makan di luar pastikan makanan berkenaan tidak mengandungi sulfites.</li><li>Baca label pada bungkusan makanan mengandungi <span style="font-weight: bold; color: rgb(51, 0, 0);">sodium bisulfite, potassium bisulfite, sodium sulfite, sulfur dioxide dan potassium metabisulfite.</span></li></ul><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://1.bp.blogspot.com/_StW9Y6v_f4I/TCBz_bKdxiI/AAAAAAAAAFQ/8UlSgzFqCHk/s1600/food20.jpg"><img style="display: block; margin: 0px auto 10px; text-align: center; cursor: pointer; width: 300px; height: 217px;" src="http://1.bp.blogspot.com/_StW9Y6v_f4I/TCBz_bKdxiI/AAAAAAAAAFQ/8UlSgzFqCHk/s400/food20.jpg" alt="" id="BLOGGER_PHOTO_ID_5485511879597868578" border="0" /></a><br /><br /><br />Alahan makanan adalah reaksi yang tercetus melalui sistem imun. Hampir enam peratus kanak-kanak dan dua peratus dewasa mengalami masalah alahan terhadap makanan dan angka lebih besar dicatatkan untuk golongan yang tidak tahan dengan makanan.<br /><br />Tidak tahan laktosa adalah satu contoh tidak tahan makanan. Mereka yang mengalami masalah ini akan menyebabkan kekurangan enzime laktase yang diperlukan untuk mencerna gula, susu atau laktosa dalam susu dan produk tenusu lain. Akibatnya , mereka boleh diserang sakit perut, kembung perut, angin atau cirit-birit.<br /><br />Dalam alahan makanan, sistem imun anda tersalah mengenal pasti makanan tertentu atau kompenen makanan yang bertindak sebagai bahan bahaya. Sistem imun manusia mencetuskan sel tertentu bagi menghasilkan antibodi immunoglobulin E (IgE) bagi menentang makanan yang membawa masalah. Antibodi berkenaan akan mengesan makanan yang bermasalah dan memberi isyarat kepada sistem imun untuk melepaskan histamin dan beberapa kimia ke saluran darah.<br />Kebanyakan alahan makanan dicetuskan protein tertentu seperti yang terdapat dalam telur, kekacang, ikan dan makanan laut bercengkerang.<br /><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://4.bp.blogspot.com/_StW9Y6v_f4I/TCBw3YR8JNI/AAAAAAAAAFI/52nJMbosl2E/s1600/food18.jpg"><img style="display: block; margin: 0px auto 10px; text-align: center; cursor: pointer; width: 300px; height: 396px;" src="http://4.bp.blogspot.com/_StW9Y6v_f4I/TCBw3YR8JNI/AAAAAAAAAFI/52nJMbosl2E/s400/food18.jpg" alt="" id="BLOGGER_PHOTO_ID_5485508442850075858" border="0" /></a><br /><span class="fullpost"></span><script type="text/javascript">adv_username = "misibb";adv_gid = "misibb_default";adtype = "180x150";</script><script type="text/javascript" src="http://www.advertlets.com/_/js/advertlets_lite.js"></script>misibbhttp://www.blogger.com/profile/14827173537467932982noreply@blogger.com1tag:blogger.com,1999:blog-1717129759233064518.post-89346916773104182252010-05-25T12:47:00.005+08:002010-05-25T17:44:49.816+08:00PASTIKAN ANAK ANDA MEMPUNYAI<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://1.bp.blogspot.com/_StW9Y6v_f4I/S_ubzez2R8I/AAAAAAAAAEg/UkZDW5VAD5w/s1600/food21.jpg"><img style="float: left; margin: 0pt 10px 10px 0pt; cursor: pointer; width: 300px; height: 347px;" src="http://1.bp.blogspot.com/_StW9Y6v_f4I/S_ubzez2R8I/AAAAAAAAAEg/UkZDW5VAD5w/s400/food21.jpg" alt="" id="BLOGGER_PHOTO_ID_5475141080745134018" border="0" /></a><br />BERAT DAN KETINGGIAN NORMAL<br /><br />Bagi ibu bapa yang ada anak terlalu kurus, sebaik-baiknya dapatkan nasihat doktor atau pakar pemakanan supaya mereka boleh merancang program pemakanan khusus untuk mengatasi maslah itu. Pada masa sama, panduan di bawah mungkin boleh membantu<br /><ul><li>Masak makanan kegermarannya. Jika dia tidak suka sayur, hiris halus atau kisar sayur untuk dicampurkan dalam makanan berkenaan.<br /></li></ul><ul><li>Dengar keinginan selera anak. Sebaik-baiknya bincang dengan anak apa hidangan yang dia mahu makan (asalkan ia berkhasiat) dan minta bantuan anak untuk menyediakan makanan itu bersama-sama<br /></li></ul><ul><li>Sediakan hidangan seimbang yang mengandungi protein, kaborhidrat dan lemak ( lemak tidak tepu dan monotaktepu.) Untuk anak yang terlalu kurus, pakar pemakanan menyarankan supaya hidangannya membabitkan karbohidrat ( 60 hingga 70%). Protein ( 10 hingga 15%) dan sedikit lemak<br /></li></ul><ul><li>Galak anak makan makanan yang tinggi kandungan kalori, vitamin dan mineral<br /></li></ul><ul><li>Anda juga boleh menyediakan makanan berkalori tinggi tetapi berkhasiat seperti mencampurkan telur jika membuat kentang lenyek, masukkan ayam ke dalam sup atau keju ke dalam bubur nasi<br /></li></ul><ul><li>Galakkan anak minum susu. Beli perisa yang digemarinya</li></ul><ul><li>Elak menyediakan minuman atau snek setengah jam sebelum waktu makan kerana ia menjejaskan selera anak dan membuatkan mereka tidak mahu makan<br /></li></ul><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://4.bp.blogspot.com/_StW9Y6v_f4I/S_uYxNdO3_I/AAAAAAAAAEY/bpQwXypQzic/s1600/food15.jpg"><img style="display: block; margin: 0px auto 10px; text-align: center; cursor: pointer; width: 300px; height: 400px;" src="http://4.bp.blogspot.com/_StW9Y6v_f4I/S_uYxNdO3_I/AAAAAAAAAEY/bpQwXypQzic/s400/food15.jpg" alt="" id="BLOGGER_PHOTO_ID_5475137743192252402" border="0" /></a><br /><br /><ul><li>Jus buah juga baik untuk menambah pengambilan kalori anak. Lebih baik jika anda dapat mencampur beberapa jenis buah ( jus buah campur)<br /></li></ul><ul><li>Sediakan snek berkhasiat seperti kekacang , buah-buahan kering atau segar. Sesekali, anda boleh beri anak makan aiskrim yang bercampur buah-buahan dan kekacang<br /></li></ul><ul><li>Rangsang anak untuk makan yogurt. Ia bukan saja enak, tetapi juga kaya dengan probiotik untuk merangsang pertumbuhan bakteria baik dalam usus.<br /></li></ul><ul><li>Ajak anak untuk beriadah, sebaik-baiknya setiap hari. Aktiviti fizikal dan cergas juga boleh merangsang selera anak.</li></ul><br /><ul><li>Pastikan anda sekeluarga makan bersama. Jadikan waktu makan bersama ini menyeronokkan dan antara cara yang boleh anda lakukan ialah bertanya mengenai peristiwa yang berlaku di sekolah.<br /></li></ul><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://3.bp.blogspot.com/_StW9Y6v_f4I/S_uWNILd_VI/AAAAAAAAAEQ/ufSFfsXEhng/s1600/food8.jpg"><img style="display: block; margin: 0px auto 10px; text-align: center; cursor: pointer; width: 400px; height: 245px;" src="http://3.bp.blogspot.com/_StW9Y6v_f4I/S_uWNILd_VI/AAAAAAAAAEQ/ufSFfsXEhng/s400/food8.jpg" alt="" id="BLOGGER_PHOTO_ID_5475134924277022034" border="0" /></a><br /><ul><li>Sesekali ubah selera dengan makan di luar atau membuat barbeku di halaman rumah. Ia juga akan merangsang anak untuk makan lebih banyak.<br /></li></ul><ul><li>Kurangkan gangguan. Tutup televisyen ketika makan kerana keinginan menonton rancangan yang digemari akan membuat anak anda makan sedikit dan tergesa-gesa.<br /></li></ul><ul><li>Pastikan rumah anda bebas daripada snek yang tidak berkhasiat. Ini termasuk gula-gula dan minuman berkarbonat. Kajian mendapati snek yang tidak berkhasiat ini boleh membuatkan mereka tidak berasa lapar terhadap makanan berkhasiat.</li><li>Pelbagaikan menu sarapan. Sarapan adalah sajian paling penting dalam kehidupan seseorang, termasuk kanak-kanak. Kanak-kanak yang bersarapan mempunyai daya tumpuan lebih baik di dalam bilik darjah.<br /></li></ul><ul><li>Jadilah ibu yang kreatif dalam menyediakan makanan. Makanan yang cantik akan lebih mudah menarik selera anak. Tidak salah jika meniru cara hidangan di restoran atau hotel untuk menjadikan makanan yang biasa tampak menyelerakan.<br /></li></ul><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://4.bp.blogspot.com/_StW9Y6v_f4I/S_tX0E4aUfI/AAAAAAAAAEI/6B33YU9gZ_Y/s1600/food6.jpg"><img style="display: block; margin: 0px auto 10px; text-align: center; cursor: pointer; width: 400px; height: 374px;" src="http://4.bp.blogspot.com/_StW9Y6v_f4I/S_tX0E4aUfI/AAAAAAAAAEI/6B33YU9gZ_Y/s400/food6.jpg" alt="" id="BLOGGER_PHOTO_ID_5475066324174131698" border="0" /></a><br /><span class="fullpost"></span><script type="text/javascript">adv_username = "misibb";adv_gid = "misibb_default";adtype = "180x150";</script><script type="text/javascript" src="http://www.advertlets.com/_/js/advertlets_lite.js"></script>misibbhttp://www.blogger.com/profile/14827173537467932982noreply@blogger.com0tag:blogger.com,1999:blog-1717129759233064518.post-90313487298569577382010-05-20T10:07:00.008+08:002010-05-20T11:01:21.536+08:00TANGANI STRESS<div style="text-align: center;"><span style="color: rgb(0, 0, 102); font-weight: bold;font-size:130%;" >SiHAt SepAnJaNg HayAT</span><br /><br /></div><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://1.bp.blogspot.com/_StW9Y6v_f4I/S_Sj6rz06EI/AAAAAAAAAEA/kLjdCLd03HQ/s1600/emoticonsedit.gif"><img style="display: block; margin: 0px auto 10px; text-align: center; cursor: pointer; width: 250px; height: 250px;" src="http://1.bp.blogspot.com/_StW9Y6v_f4I/S_Sj6rz06EI/AAAAAAAAAEA/kLjdCLd03HQ/s400/emoticonsedit.gif" alt="" id="BLOGGER_PHOTO_ID_5473179675749836866" border="0" /></a><br /><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://3.bp.blogspot.com/_StW9Y6v_f4I/S_SjqVjvb1I/AAAAAAAAAD4/DGqrA4dgecs/s1600/morning2.gif"><img style="float: left; margin: 0pt 10px 10px 0pt; cursor: pointer; width: 341px; height: 400px;" src="http://3.bp.blogspot.com/_StW9Y6v_f4I/S_SjqVjvb1I/AAAAAAAAAD4/DGqrA4dgecs/s400/morning2.gif" alt="" id="BLOGGER_PHOTO_ID_5473179394898882386" border="0" /></a><br />Kemarahan adalah satu masalah utama emosi akibat stress.<br />Stress ialah tindakbalas fizikal, emosi dan mental kepada perubahan. Kita semua mengalami stress di rumah, sekolah atau tempat kerja. Kita perlu sedikit stress untuk berfungsi secara berkesan. Adakalanya stress boleh juga menjadi faktor motivasi terhadap perkembangan hidup seseorang. Stress yang keterlaluan boleh menjejaskan kesihatan.<br /><br /><span style="color: rgb(102, 0, 0);">KENAPA ANDA STRESS?</span> <ul><li style="color: rgb(102, 0, 0);">Diri sendiri ( contoh : Anda kecewa, anda tidak dapat apa yang anda mahu )</li><li style="color: rgb(102, 0, 0);">Keluarga anda ( contoh : Masalah dengan suami/isteri dan anak, pindah rumah, masalah kewangan )</li><li style="color: rgb(102, 0, 0);">Pekerjaan anda ( contoh : Anda tidak cemerlang dalam kerja, ketua anda tidak berpuas hati dengan kerja anda, anda tidak dinaikkan pangkat, tukar kerja, dibuang kerja )</li><li><span style="color: rgb(102, 0, 0);">Komuniti anda ( contoh : Jiran dan komuniti tidak ramah )</span><br /></li></ul><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://3.bp.blogspot.com/_StW9Y6v_f4I/S_Sg9bkD-CI/AAAAAAAAADw/hSYIMQhhukI/s1600/stressed-cats-5341-tn.jpg"><img style="display: block; margin: 0px auto 10px; text-align: center; cursor: pointer; width: 141px; height: 149px;" src="http://3.bp.blogspot.com/_StW9Y6v_f4I/S_Sg9bkD-CI/AAAAAAAAADw/hSYIMQhhukI/s400/stressed-cats-5341-tn.jpg" alt="" id="BLOGGER_PHOTO_ID_5473176424393472034" border="0" /></a><br /><span style="color: rgb(0, 0, 102); font-weight: bold;"></span><span style="color: rgb(102, 0, 0); font-weight: bold;"><span style="font-weight: bold;"><span style="font-weight: bold;"><span style="font-weight: bold;"></span></span></span></span><span style="color: rgb(102, 0, 0);"></span><span style="color: rgb(102, 0, 0); font-weight: bold;"><span style="font-weight: bold;"><span style="font-weight: bold;"><span style="font-weight: bold;"><span style="font-weight: bold;"><br />Bila anda Stress...<br /></span></span></span></span></span><ul><li>Jantung anda berdegup kencang dan sukar bernafas</li><li>Anda cepat marah</li><li>Anda rasa tidak gembira</li><li>Anda kehilangan selera makan</li><li>Anda hilang minat bekerja</li><li>Anda tidak lagi menikmati hobi</li><li>Anda tidak cukup tidur</li><li>Anda menengking-nengking</li><li>Anda ingin membaling sesuatu</li><li>Anda cuba menjauhkan diri<br /></li></ul><span style="color: rgb(102, 0, 0); font-weight: bold;"><span style="font-weight: bold;"><span style="font-weight: bold;">A</span></span></span><span style="color: rgb(102, 0, 0);"><span style="color: rgb(0, 0, 0);">pa yang harus dilakukan apabila anda marah ??:<br /></span></span><ul><li>Menyedari yang anda sedang marah... Katakan : " Saya sedang marah ".</li><li>Bertenang... kira hingga 10, tarik nafas panjang dan mengucap</li><li>Kenal pasti kenapa anda marah</li><li>Cuba dengar penjelasan orang lain</li><li>Jangan berkata sesuatu untuk menyakitkan hati atau menghukum orang lain</li><li>Anda perlu beredar jika tidak dapat mengawal kemarahan<br /></li><li>Berbincang dengan orang lain jika tidak mampu mengendalikan kemarahan<br /></li><li>Membinasakan diri memaafkan - menerima kenyataan bahawa manusia juga melakukan kesalahan.<br /></li></ul><span style="color: rgb(102, 0, 0); font-weight: bold;">Kuasai Kemahiran untuk menyelesaikan masalah cara IDEAL</span> <span style="color: rgb(102, 0, 0);"><br /><br /></span><ul><li><span style="color: rgb(102, 0, 0);">I - Kenal pasti masalah ( Identify the problem )</span></li></ul> <span style="color: rgb(102, 0, 0);"><br /></span><ul><li><span style="color: rgb(102, 0, 0);">D - Jelaskan pilihan yang boleh diambil ( Describe possible options )</span></li></ul><br /><ul><li><span style="color: rgb(102, 0, 0);">E - Buat penilaian bagi setiap cadangan - baik dan buruknya ( Evaluate consequences of each option - the pro's and con's )</span></li></ul> <span style="color: rgb(102, 0, 0);"><br /></span><ul><li><span style="color: rgb(102, 0, 0);">A - Bertindak - pilih satu cara untuk bertindak ( Act )</span></li></ul> <span style="color: rgb(102, 0, 0);"><br /></span><ul><li><span style="color: rgb(102, 0, 0);">L - Berlajar dari pengalaman sama ada hasilnya berjaya atau tidak ( Learn )</span></li></ul><br />Cara mengurangkan kemungkinan untuk marah<br /><br /><ul><li>Berfikir secara positif<br /></li><li>Jangan salahkan orang lain apabila berlaku kesilapan</li><li>Belajar menyukai diri sendiri<br /></li><li>Usahakan yang terbaik daripada apa yang anda ada</li><li>Belajar menerima apa yang tidak dapat diubah</li><li>Jangan risau tentang kekurangan yang ada</li><li>Bertenang</li><li>Lakukan senaman selalu</li><li>Adakan hobi</li><li>Luangkan masa untuk keluarga , kerja dan beriadah</li><li>Dapatkan tidur yang cukup</li><li>Dapatkan teman untuk meluahkan masalah</li><li>Bersifat asertif. Berani berkata "TIDAK" untuk kegiatan luar, jemputan atau temu janji yang anda tiada masa untuk hadiri</li><li>Tetapkan matlamat yang realistik untuk diri anda. Tidak semua anda dapat kecapi. Sedarilah bahawa tidak semua perkara penting seperti yang anda sangkakan.<br /></li></ul><br /><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://2.bp.blogspot.com/_StW9Y6v_f4I/S_SZw6bgT4I/AAAAAAAAADo/o3Toou-SQ0Q/s1600/frogfunnyicon2.jpg"><img style="display: block; margin: 0px auto 10px; text-align: center; cursor: pointer; width: 273px; height: 250px;" src="http://2.bp.blogspot.com/_StW9Y6v_f4I/S_SZw6bgT4I/AAAAAAAAADo/o3Toou-SQ0Q/s320/frogfunnyicon2.jpg" alt="" id="BLOGGER_PHOTO_ID_5473168512759385986" border="0" /></a><br /><br /><span class="fullpost"></span><script type="text/javascript">adv_username = "misibb";adv_gid = "misibb_default";adtype = "180x150";</script><script type="text/javascript" src="http://www.advertlets.com/_/js/advertlets_lite.js"></script>misibbhttp://www.blogger.com/profile/14827173537467932982noreply@blogger.com0tag:blogger.com,1999:blog-1717129759233064518.post-60842131313519956932010-03-30T12:27:00.004+08:002010-03-30T12:35:45.694+08:00Perkembangan mental & social<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://4.bp.blogspot.com/_StW9Y6v_f4I/S7F_StMqYPI/AAAAAAAAADg/drPXfohCYXw/s1600/P2160219.JPG"><img style="display: block; margin: 0px auto 10px; text-align: center; cursor: pointer; width: 400px; height: 300px;" src="http://4.bp.blogspot.com/_StW9Y6v_f4I/S7F_StMqYPI/AAAAAAAAADg/drPXfohCYXw/s400/P2160219.JPG" alt="" id="BLOGGER_PHOTO_ID_5454280583069458674" border="0" /></a>
<br /><meta equiv="Content-Type" content="text/html; charset=utf-8"><meta name="ProgId" content="Word.Document"><meta name="Generator" content="Microsoft Word 11"><meta name="Originator" content="Microsoft Word 11"><link rel="File-List" href="file:///C:%5CUsers%5CADMIN%5CAppData%5CLocal%5CTemp%5Cmsohtml1%5C01%5Cclip_filelist.xml"><o:smarttagtype namespaceuri="urn:schemas-microsoft-com:office:smarttags" name="country-region"></o:smarttagtype><o:smarttagtype namespaceuri="urn:schemas-microsoft-com:office:smarttags" name="place"></o:smarttagtype><!--[if gte mso 9]><xml> <w:worddocument> <w:view>Normal</w:View> <w:zoom>0</w:Zoom> <w:punctuationkerning/> <w:validateagainstschemas/> <w:saveifxmlinvalid>false</w:SaveIfXMLInvalid> <w:ignoremixedcontent>false</w:IgnoreMixedContent> <w:alwaysshowplaceholdertext>false</w:AlwaysShowPlaceholderText> <w:compatibility> <w:breakwrappedtables/> <w:snaptogridincell/> <w:wraptextwithpunct/> <w:useasianbreakrules/> <w:dontgrowautofit/> </w:Compatibility> <w:browserlevel>MicrosoftInternetExplorer4</w:BrowserLevel> </w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:latentstyles deflockedstate="false" latentstylecount="156"> </w:LatentStyles> </xml><![endif]--><!--[if !mso]><object classid="clsid:38481807-CA0E-42D2-BF39-B33AF135CC4D" id="ieooui"></object> <style> st1\:*{behavior:url(#ieooui) } </style> <![endif]--><style> <!-- /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-parent:""; margin:0in; margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-fareast-font-family:"Times New Roman";} @page Section1 {size:8.5in 11.0in; margin:1.0in 1.25in 1.0in 1.25in; mso-header-margin:.5in; mso-footer-margin:.5in; mso-paper-source:0;} div.Section1 {page:Section1;} --> </style><!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} table.MsoTableGrid {mso-style-name:"Table Grid"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; border:solid windowtext 1.0pt; mso-border-alt:solid windowtext .5pt; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-border-insideh:.5pt solid windowtext; mso-border-insidev:.5pt solid windowtext; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} </style> <![endif]--> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal">Seoarang bayi merupakan pelajar yang paling bijak dan mudah menerima sesuat yang diajar kepadanya. Anak anda tidak seharusnya dianggap terlalu mentah untuk memahami atau belajar tentang sesuatu. Malah, dia perlu diajar mengikut peringkat usia yang bersesuaian dengan dirinya. Namun, setiap kanak-kanak itu mempunyai kadar perkembangan yang berbeza. Anda tidak seharusnya terlalu tegas atau garang dalam mendidik anak-anak dan terlalu berharap agar dia dapat belajar atau memahami sesuatu dengan cepat atau di luar kemampuannya. Ini akan menyebabkan anda berasa kecewa, hilang keyakinan dan mungkin berputus asa.</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal"><b style=""><u>Kemahiran belajar<o:p></o:p></u></b></p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal">Pada awalnya, orang yang paling penting dalam kehidupannya adalah orang yang sentiasa berada disisinya atau menjaganya sepanjang masa, di mana selalunya orang tersebut adalah ibunya sendiri. Maka, anda adalah guru yang paling penting dalam kehidupan anak anda. Sesungguhnya, anda perlu memberitahunya mengenai cerita/sesuatu yang menarik yang terjadi dalam kehidupan sehariannya. Ceritakan tentang pengalaman baru yang dialaminya, terangkan segala yang anda lihat atau Nampak dan sentiasa melakukan aktiviti bersamanya. Sentiasa berikan banyak galakan dan pujian walaupun pencapaiannya tidak seperti yang anda harapkan. Namun, anda harus terus memberikan dorongan walaupun bayi anda gagal melakukannya.</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal"><b style=""><u>Kemahiran bertutur<o:p></o:p></u></b></p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal">Pakar-pakar kesihatan percaya bahawa beberapa hari setelah bayi dilahirkan, dia sudah mula dapat bertindakbalas terhadap bunyi orang yang sedang bercakap berbanding dengan bunyi-bunyi lain di sekelilingnya. Malah, bayi yang masih kecil dapat membezakan antara bunyi dan bahasa orang yang sedang bercakap, di mana ini merupakan sebahagian daripada asas untuk mempelajari sesuatu bahasa.</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal">Bayi anda lebih mudah mempelajari sesuatu bahasa berbanding dengan orang lain. Beberapa cara untuk membantu bayi belajar adalah melabelkan sesuatu objek. Ketika anda sedang berbual-bual dengannya, sebut nama objek tersebut dan ulanginya dengan lebih kerap. Namun, janganlah anda terlalu mengharap agar bayi anda dapat menyebut perkataan-perkataan tersebut dengan tepat. Berusahalah untuk memahami perkataan yang disebutnya untuk membantu kemahirannya bertutur. Bayi anda pasti akan berasa seronok dapat berkomunikasi dengan anda, jadi sentiasalah memberi sokongan dan galakkan kepadanya untuk terus mencuba.</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal"><b style=""><u>Kemahiran social<o:p></o:p></u></b></p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal">Daripada seorang bayi yang pasif semasa lahir, lambat laun bayi anda akan mula mengajuk tingkah laku orang di sekelilingnya. Pada awalnya, bayi akan mengajuk mimic muka dan tindak-tanduk atau pergerakan badan anda, seterusnya dia akan mengajuk cara nada bercakap dan akhirnya perbuatan anda. Bayi yang mempunyai hbungan yang rapat, manja dan mesra apabila berada di sisi ibunya akan lebih bermotivasi untuk menjalinkan hubungan yang mesra dengan orang lain. Adalah penting untuk bayi menyertai aktiviti bersama dengan ahli keluarganya. Ini akan membri bayi peluang untuk belajar mengenai kehidupan dan orang di sekeliling secara amnya terutamanya adab dan adapt masyarakatnya.</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal" style="text-align: center;" align="center"><b style="">Perkembangan mental & social<o:p></o:p></b></p> <p class="MsoNormal"><o:p> </o:p></p> <table class="MsoTableGrid" style="border-collapse: collapse; border: medium none;" border="1" cellpadding="0" cellspacing="0"> <tbody><tr style=""> <td style="width: 2.05in; border: 1pt solid windowtext; padding: 0in 5.4pt;" valign="top" width="197"> <p class="MsoNormal" style="text-align: center;" align="center"><b style="">Kemahiran belajar<o:p></o:p></b></p> <p class="MsoNormal" style="text-align: center;" align="center"><b style="">(Apa yang bayi anda fahami?)<o:p></o:p></b></p> </td> <td style="width: 2.05in; border-width: 1pt 1pt 1pt medium; border-style: solid solid solid none; border-color: windowtext windowtext windowtext -moz-use-text-color; padding: 0in 5.4pt;" valign="top" width="197"> <p class="MsoNormal" style="text-align: center;" align="center"><b style="">Kemahiran bertutur<o:p></o:p></b></p> <p class="MsoNormal" style="text-align: center;" align="center"><b style="">( Bagaimana bayi belajar bertutur ?)<o:p></o:p></b></p> </td> <td style="width: 2.05in; border-width: 1pt 1pt 1pt medium; border-style: solid solid solid none; border-color: windowtext windowtext windowtext -moz-use-text-color; padding: 0in 5.4pt;" valign="top" width="197"> <p class="MsoNormal" style="text-align: center;" align="center"><b style="">Kemahiran social<o:p></o:p></b></p> <p class="MsoNormal" style="text-align: center;" align="center"><b style="">( Tingkah laku / Cara pergaulan bayi )<o:p></o:p></b></p> </td> </tr> </tbody></table> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal" style="text-align: center;" align="center"><b style="">0 hingga 3 Bulan<o:p></o:p></b></p> <p class="MsoNormal" style="text-align: center;" align="center"><o:p> </o:p></p> <table class="MsoTableGrid" style="border-collapse: collapse; border: medium none;" border="1" cellpadding="0" cellspacing="0"> <tbody><tr style=""> <td style="width: 2.05in; border: 1pt solid windowtext; padding: 0in 5.4pt;" valign="top" width="197"> <p class="MsoNormal">Dapat mengenali wajah anda jika anda merapatkan muka anda kea rah bayi kurang daripada 12 inci (30 sm0</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal">Apabila dia berusia sebulan, dia dapat mnegajuk mimic muka anda.</p> </td> <td style="width: 2.05in; border-width: 1pt 1pt 1pt medium; border-style: solid solid solid none; border-color: windowtext windowtext windowtext -moz-use-text-color; padding: 0in 5.4pt;" valign="top" width="197"> <p class="MsoNormal">Bayi anda akan menangis sebaik sahaja dia dilahirkan. Pada peringkat permulaan, bayi anda hanya tahu menangis sahaja, lambat laun dia akan pandai mengagah sebagai tanda dia berasa seronok dan gembira.</p> </td> <td style="width: 2.05in; border-width: 1pt 1pt 1pt medium; border-style: solid solid solid none; border-color: windowtext windowtext windowtext -moz-use-text-color; padding: 0in 5.4pt;" valign="top" width="197"> <p class="MsoNormal">( Beberapa minggu pertama) Tidak berupaya untuk bertindabalas pada dunia luar.</p> <p class="MsoNormal" style="text-align: center;" align="center"><o:p> </o:p></p> </td> </tr> <tr style=""> <td style="width: 2.05in; border-width: medium 1pt 1pt; border-style: none solid solid; border-color: -moz-use-text-color windowtext windowtext; padding: 0in 5.4pt;" valign="top" width="197"> <p class="MsoNormal">Matanya akan mengekori objek yang bergerak apabila berusia 2 bulan</p> <p class="MsoNormal"><o:p> </o:p></p> </td> <td style="width: 2.05in; border-width: medium 1pt 1pt medium; border-style: none solid solid none; border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; padding: 0in 5.4pt;" valign="top" width="197"> <p class="MsoNormal">Mula membalas senyuman anda dan pandai mengagah. Walaupun dia masih tidak tahu untuk bercakap, ini merupakan salah satu isyarat yang bayi sedang belajar untuk berkomunikasi dengan anda.</p> </td> <td style="width: 2.05in; border-width: medium 1pt 1pt medium; border-style: none solid solid none; border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; padding: 0in 5.4pt;" valign="top" width="197"> <p class="MsoNormal">Mengenali wajah ibunya dan orang-orang yang biasa berada di sekelilingnya. Kelihatan takut jika ternampak orang asing dengan memalingkan mukanya ataupun mungkin akan menangis.</p> </td> </tr> <tr style=""> <td style="width: 2.05in; border-width: medium 1pt 1pt; border-style: none solid solid; border-color: -moz-use-text-color windowtext windowtext; padding: 0in 5.4pt;" valign="top" width="197"> <p class="MsoNormal">(3 bulan) Akan membalas percakapan anda dengan senyumannya dan mengagah dengan kuat.</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal">Menunjukkan minat ingin tahu dengan keadaan di sekelilingnya.</p> </td> <td style="width: 2.05in; border-width: medium 1pt 1pt medium; border-style: none solid solid none; border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; padding: 0in 5.4pt;" valign="top" width="197"> <p class="MsoNormal">Dapat membezakan bunyi percakapan dan bunyi-bunyi yang lain.</p> <p class="MsoNormal">Menoleh ke arah bunyi.</p> </td> <td style="width: 2.05in; border-width: medium 1pt 1pt medium; border-style: none solid solid none; border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; padding: 0in 5.4pt;" valign="top" width="197"> <p class="MsoNormal" style="text-align: center;" align="center"><o:p> </o:p></p> </td> </tr> </tbody></table> <p class="MsoNormal" style="text-align: center;" align="center"><o:p> </o:p></p> <p class="MsoNormal" style="text-align: center;" align="center"><b style="">4 hingga 6 Bulan<o:p></o:p></b></p> <p class="MsoNormal" style="text-align: center;" align="center"><o:p> </o:p></p> <table class="MsoTableGrid" style="border-collapse: collapse; border: medium none;" border="1" cellpadding="0" cellspacing="0"> <tbody><tr style=""> <td style="width: 2.05in; border: 1pt solid windowtext; padding: 0in 5.4pt;" valign="top" width="197"> <p class="MsoNormal">Akan ketawa kecil apabila anda bermain dengannya.</p> <p class="MsoNormal">Akan menoleh kea rah sebarang bunyi dan suka jika diletakkan dalam keadaan duduk.</p> </td> <td style="width: 2.05in; border-width: 1pt 1pt 1pt medium; border-style: solid solid solid none; border-color: windowtext windowtext windowtext -moz-use-text-color; padding: 0in 5.4pt;" valign="top" width="197"> <p class="MsoNormal">Suka membuat bunyi-bunyi bising dan menyebut beberapa perkataan seperti bunyi Bah, Maa, Paa, Moo,Dah.</p> </td> <td style="width: 2.05in; border-width: 1pt 1pt 1pt medium; border-style: solid solid solid none; border-color: windowtext windowtext windowtext -moz-use-text-color; padding: 0in 5.4pt;" valign="top" width="197"> <p class="MsoNormal">Suka diberi perhatian.</p> </td> </tr> <tr style=""> <td style="width: 2.05in; border-width: medium 1pt 1pt; border-style: none solid solid; border-color: -moz-use-text-color windowtext windowtext; padding: 0in 5.4pt;" valign="top" width="197"> <p class="MsoNormal">Muka menyedari keadaan yang asing bagi dirinya, dapat meluahkan perasaan takut, tidak suka dan marah.</p> </td> <td style="width: 2.05in; border-width: medium 1pt 1pt medium; border-style: none solid solid none; border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; padding: 0in 5.4pt;" valign="top" width="197"> <p class="MsoNormal" style="text-align: center;" align="center"><o:p> </o:p></p> </td> <td style="width: 2.05in; border-width: medium 1pt 1pt medium; border-style: none solid solid none; border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; padding: 0in 5.4pt;" valign="top" width="197"> <p class="MsoNormal" style="text-align: center;" align="center"><o:p> </o:p></p> </td> </tr> <tr style=""> <td style="width: 2.05in; border-width: medium 1pt 1pt; border-style: none solid solid; border-color: -moz-use-text-color windowtext windowtext; padding: 0in 5.4pt;" valign="top" width="197"> <p class="MsoNormal" style="text-align: center;" align="center">Mula pandai untuk memilih makanan.</p> <p class="MsoNormal" style="text-align: center;" align="center">Amat berminat untuk melihat dirinya di cermin.</p> </td> <td style="width: 2.05in; border-width: medium 1pt 1pt medium; border-style: none solid solid none; border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; padding: 0in 5.4pt;" valign="top" width="197"> <p class="MsoNormal" style="text-align: center;" align="center">Terus berkomunikasi dengan orang dewasa, membuat pelbagai bunyi dan menunggu sehingga seseorang membalas kelakuannya sebelum dia melakukan semula.</p> </td> <td style="width: 2.05in; border-width: medium 1pt 1pt medium; border-style: none solid solid none; border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; padding: 0in 5.4pt;" valign="top" width="197"> <p class="MsoNormal" style="text-align: center;" align="center">Pandai membuat mimic muka.</p> </td> </tr> </tbody></table> <p class="MsoNormal" style="text-align: center;" align="center"><o:p> </o:p></p> <p class="MsoNormal" style="text-align: center;" align="center"><o:p> </o:p></p> <p class="MsoNormal" style="text-align: center;" align="center"><o:p> </o:p></p> <p class="MsoNormal" style="text-align: center;" align="center"><o:p> </o:p></p> <p class="MsoNormal" style="text-align: center;" align="center"><b style="">7 hingga 9 Bulan<o:p></o:p></b></p> <p class="MsoNormal" style="text-align: center;" align="center"><b style=""><o:p> </o:p></b></p> <table class="MsoTableGrid" style="border-collapse: collapse; border: medium none;" border="1" cellpadding="0" cellspacing="0"> <tbody><tr style=""> <td style="width: 2.05in; border: 1pt solid windowtext; padding: 0in 5.4pt;" valign="top" width="197"> <p class="MsoNormal" style="text-align: center;" align="center">Mula pandai untuk memilih makanan.</p> <p class="MsoNormal" style="text-align: center;" align="center">Amat berminat untuk melihat dirinya di cermin.</p> </td> <td style="width: 2.05in; border-width: 1pt 1pt 1pt medium; border-style: solid solid solid none; border-color: windowtext windowtext windowtext -moz-use-text-color; padding: 0in 5.4pt;" valign="top" width="197"> <p class="MsoNormal" style="text-align: center;" align="center">Bertindakbalas dengan lebih baik kea rah bunyi, sama ada suara manusia atau nada muzik.</p> <p class="MsoNormal" style="text-align: center;" align="center"><o:p> </o:p></p> <p class="MsoNormal" style="text-align: center;" align="center">Dapat menyebut 2 patah perkataan hujung kepada perkataan penuh contohnya Maama, Aabaah.</p> </td> <td style="width: 2.05in; border-width: 1pt 1pt 1pt medium; border-style: solid solid solid none; border-color: windowtext windowtext windowtext -moz-use-text-color; padding: 0in 5.4pt;" valign="top" width="197"> <p class="MsoNormal" style="text-align: center;" align="center">Lebih aktif dan lebih bijak berinteraktif.</p> <p class="MsoNormal" style="text-align: center;" align="center"><o:p> </o:p></p> <p class="MsoNormal" style="text-align: center;" align="center">Suka bermainan “ cak – cak”</p> </td> </tr> <tr style=""> <td style="width: 2.05in; border-width: medium 1pt 1pt; border-style: none solid solid; border-color: -moz-use-text-color windowtext windowtext; padding: 0in 5.4pt;" valign="top" width="197"> <p class="MsoNormal" style="text-align: center;" align="center">Mengenali namanya sendiri apabila dipanggil.</p> <p class="MsoNormal" style="text-align: center;" align="center"><o:p> </o:p></p> <p class="MsoNormal" style="text-align: center;" align="center">Pandai membuat pelbagai jenis bunyi untuk menarik perhatian.</p> </td> <td style="width: 2.05in; border-width: medium 1pt 1pt medium; border-style: none solid solid none; border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; padding: 0in 5.4pt;" valign="top" width="197"> <p class="MsoNormal" style="text-align: center;" align="center">Bermain dengan bibirnya dengan menyebut perkataan yang mudah dengan berulang kali seperti </p> <p class="MsoNormal" style="text-align: center;" align="center">Abababa.</p> <p class="MsoNormal" style="text-align: center;" align="center"><o:p> </o:p></p> <p class="MsoNormal" style="text-align: center;" align="center">Belajar untuk menarik perhatian orang ramai. Berminat dalam perbualan orang dewasa.</p> </td> <td style="width: 2.05in; border-width: medium 1pt 1pt medium; border-style: none solid solid none; border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; padding: 0in 5.4pt;" valign="top" width="197"> <p class="MsoNormal" style="text-align: center;" align="center"><o:p> </o:p></p> </td> </tr> <tr style=""> <td style="width: 2.05in; border-width: medium 1pt 1pt; border-style: none solid solid; border-color: -moz-use-text-color windowtext windowtext; padding: 0in 5.4pt;" valign="top" width="197"> <p class="MsoNormal" style="text-align: center;" align="center">Mula memperlihatkan “ kuasanya’ , misalnya akan menghalang anda dari melakukan sesuatu, <st1:country-region st="on"><st1:place st="on">cuba</st1:place></st1:country-region> mengelak daripada anda membasuh mukanya. Memberi sepenuh perhatian terhadap barang permainannya dan membelek-beleknya seolah-olah ingin memeriksanya dengan teliti. Mencari objek yang tersembunyi.</p> </td> <td style="width: 2.05in; border-width: medium 1pt 1pt medium; border-style: none solid solid none; border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; padding: 0in 5.4pt;" valign="top" width="197"> <p class="MsoNormal" style="text-align: center;" align="center">Pertuturan menjadi lebih baik kerana bayi akan <st1:country-region st="on"><st1:place st="on">cuba</st1:place></st1:country-region> menyambung beberapa patah perkataan dan mnyebutnya seperti sepotong ayat. Anda akan tahu bila bayi anda akan mula hendak bercakap.</p> </td> <td style="width: 2.05in; border-width: medium 1pt 1pt medium; border-style: none solid solid none; border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; padding: 0in 5.4pt;" valign="top" width="197"> <p class="MsoNormal" style="text-align: center;" align="center">Bergaul dengan mengajuk bunyi percakapan dan tindak-tanduk orang lain.</p> <p class="MsoNormal" style="text-align: center;" align="center">Memahami beberapa perkataan mudah contohnya jangan, “ bye – bye”.</p> </td> </tr> </tbody></table> <p class="MsoNormal" style="text-align: center;" align="center"><o:p> </o:p></p> <p class="MsoNormal" style="text-align: center;" align="center"><b style="">10 bulan hingga 12 bulan<o:p></o:p></b></p> <p class="MsoNormal" style="text-align: center;" align="center"><o:p> </o:p></p> <table class="MsoTableGrid" style="border-collapse: collapse; border: medium none;" border="1" cellpadding="0" cellspacing="0"> <tbody><tr style=""> <td style="width: 2.05in; border: 1pt solid windowtext; padding: 0in 5.4pt;" valign="top" width="197"> <p class="MsoNormal" style="text-align: center;" align="center">Memahami perkataan pendek dan ayat –ayat mudah</p> <p class="MsoNormal" style="text-align: center;" align="center"><o:p> </o:p></p> <p class="MsoNormal" style="text-align: center;" align="center"><o:p> </o:p></p> </td> <td style="width: 2.05in; border-width: 1pt 1pt 1pt medium; border-style: solid solid solid none; border-color: windowtext windowtext windowtext -moz-use-text-color; padding: 0in 5.4pt;" valign="top" width="197"> <p class="MsoNormal" style="text-align: center;" align="center">Pertuturan menjadi lebih baik kerana bayi akan <st1:country-region st="on"><st1:place st="on">cuba</st1:place></st1:country-region> menyambung beberapa patah perkataan dan menyebutnya seperti sepotong ayat. Anda akan tahu bila bayi anda akan mula hendak bercakap.</p> </td> <td style="width: 2.05in; border-width: 1pt 1pt 1pt medium; border-style: solid solid solid none; border-color: windowtext windowtext windowtext -moz-use-text-color; padding: 0in 5.4pt;" valign="top" width="197"> <p class="MsoNormal" style="text-align: center;" align="center">Bargaul denga mengajuk bunyi percakapan dan tindak-tanduk orang lain. Memahami beberapa perkataan mdah contohnya jangan, “ bye – bye”</p> </td> </tr> <tr style=""> <td style="width: 2.05in; border-width: medium 1pt 1pt; border-style: none solid solid; border-color: -moz-use-text-color windowtext windowtext; padding: 0in 5.4pt;" valign="top" width="197"> <p class="MsoNormal" style="text-align: center;" align="center">Bayi anda akan suka membuat bunyi bising, ingin menggoyang, mengetuk, memukul apa sahaja yang boleh mengeluarkan bunyi.</p> <p class="MsoNormal" style="text-align: center;" align="center"><o:p> </o:p></p> <p class="MsoNormal" style="text-align: center;" align="center">Suka melemparkan atau menjatuhkan barang dengan sengaja dan menyurh anda mengutipnya semula.</p> </td> <td style="width: 2.05in; border-width: medium 1pt 1pt medium; border-style: none solid solid none; border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; padding: 0in 5.4pt;" valign="top" width="197"> <p class="MsoNormal" style="text-align: center;" align="center"><o:p> </o:p></p> </td> <td style="width: 2.05in; border-width: medium 1pt 1pt medium; border-style: none solid solid none; border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; padding: 0in 5.4pt;" valign="top" width="197"> <p class="MsoNormal" style="text-align: center;" align="center"><o:p> </o:p></p> </td> </tr> <tr style=""> <td style="width: 2.05in; border-width: medium 1pt 1pt; border-style: none solid solid; border-color: -moz-use-text-color windowtext windowtext; padding: 0in 5.4pt;" valign="top" width="197"> <p class="MsoNormal" style="text-align: center;" align="center">Anak anda membuat apa sahaja supaya anda ketawa dan mengulanginya beberapa kali.</p> <p class="MsoNormal" style="text-align: center;" align="center"><o:p> </o:p></p> <p class="MsoNormal" style="text-align: center;" align="center">Mungkin mengetahui beberapa patah perkataan yang mudah.</p> </td> <td style="width: 2.05in; border-width: medium 1pt 1pt medium; border-style: none solid solid none; border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; padding: 0in 5.4pt;" valign="top" width="197"> <p class="MsoNormal" style="text-align: center;" align="center">Menyebut dan menggunakan perkataan pertamanya. Perkataan pilihannya adalah nama benda yang penting baginya, contohnya oraang ( nama, abah), objek ( bola,jam)</p> </td> <td style="width: 2.05in; border-width: medium 1pt 1pt medium; border-style: none solid solid none; border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; padding: 0in 5.4pt;" valign="top" width="197"> <p class="MsoNormal" style="text-align: center;" align="center">Memahami dan patuh kepada arahan mudah seperti “ jangan “</p> <p class="MsoNormal" style="text-align: center;" align="center"><o:p> </o:p></p> <p class="MsoNormal" style="text-align: center;" align="center">Memahami keadaan yang berbeza; berupaya meluahkan perasaannya dengan lebih baik.</p> <p class="MsoNormal" style="text-align: center;" align="center"><o:p> </o:p></p> <p class="MsoNormal" style="text-align: center;" align="center">Mungkin pada peringkat ini, tidak boleh berenggang dengan anda.</p> </td> </tr> </tbody></table> <p class="MsoNormal" style="text-align: center;" align="center"><o:p> </o:p></p> <p class="MsoNormal" style="text-align: center;" align="center">Saya ucapakan terima kasih kerana anda meluangkan masa dengan membaca ruangan ini. Saya berharap segala maklumat yang saya kongsikan dapat memberi panduan kepada anda disamping dapat merealisasikan impian menjadi kenyataan…InsyaAllah!</p> <p class="MsoNormal" style="text-align: center;" align="center">Semoga Berjaya!</p>
<br />
<br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://4.bp.blogspot.com/_StW9Y6v_f4I/S7F91GJQsJI/AAAAAAAAADY/jX_l8iYEwdI/s1600/babyangelbutterfly.jpg"><img style="display: block; margin: 0px auto 10px; text-align: center; cursor: pointer; width: 303px; height: 400px;" src="http://4.bp.blogspot.com/_StW9Y6v_f4I/S7F91GJQsJI/AAAAAAAAADY/jX_l8iYEwdI/s400/babyangelbutterfly.jpg" alt="" id="BLOGGER_PHOTO_ID_5454278974858375314" border="0" /></a>
<br /><span class="fullpost"></span>misibbhttp://www.blogger.com/profile/14827173537467932982noreply@blogger.com0tag:blogger.com,1999:blog-1717129759233064518.post-14545266227053943342010-03-28T14:23:00.004+08:002010-03-28T15:03:46.459+08:00Apakah Perkembangan Awal Bayi?<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://3.bp.blogspot.com/_StW9Y6v_f4I/S673HvBwJrI/AAAAAAAAADA/ZlnzRMK28gA/s1600/baby4.jpg"><img style="display: block; margin: 0px auto 10px; text-align: center; cursor: pointer; width: 264px; height: 400px;" src="http://3.bp.blogspot.com/_StW9Y6v_f4I/S673HvBwJrI/AAAAAAAAADA/ZlnzRMK28gA/s400/baby4.jpg" alt="" id="BLOGGER_PHOTO_ID_5453567911047210674" border="0" /></a>
<br /><meta equiv="Content-Type" content="text/html; charset=utf-8"><meta name="ProgId" content="Word.Document"><meta name="Generator" content="Microsoft Word 11"><meta name="Originator" content="Microsoft Word 11"><link rel="File-List" href="file:///C:%5CUsers%5CADMIN%5CAppData%5CLocal%5CTemp%5Cmsohtml1%5C01%5Cclip_filelist.xml"><link rel="Edit-Time-Data" href="file:///C:%5CUsers%5CADMIN%5CAppData%5CLocal%5CTemp%5Cmsohtml1%5C01%5Cclip_editdata.mso"><!--[if !mso]> <style> v\:* {behavior:url(#default#VML);} o\:* {behavior:url(#default#VML);} w\:* {behavior:url(#default#VML);} .shape {behavior:url(#default#VML);} </style> <![endif]--><o:smarttagtype namespaceuri="urn:schemas-microsoft-com:office:smarttags" name="place"></o:smarttagtype><o:smarttagtype namespaceuri="urn:schemas-microsoft-com:office:smarttags" name="country-region"></o:smarttagtype><!--[if gte mso 9]><xml> <w:worddocument> <w:view>Normal</w:View> <w:zoom>0</w:Zoom> <w:punctuationkerning/> <w:validateagainstschemas/> <w:saveifxmlinvalid>false</w:SaveIfXMLInvalid> <w:ignoremixedcontent>false</w:IgnoreMixedContent> <w:alwaysshowplaceholdertext>false</w:AlwaysShowPlaceholderText> <w:compatibility> <w:breakwrappedtables/> <w:snaptogridincell/> <w:wraptextwithpunct/> <w:useasianbreakrules/> <w:dontgrowautofit/> </w:Compatibility> <w:browserlevel>MicrosoftInternetExplorer4</w:BrowserLevel> </w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:latentstyles deflockedstate="false" latentstylecount="156"> </w:LatentStyles> </xml><![endif]--><!--[if !mso]><object classid="clsid:38481807-CA0E-42D2-BF39-B33AF135CC4D" id="ieooui"></object> <style> st1\:*{behavior:url(#ieooui) } </style> <![endif]--><style> <!-- /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-parent:""; margin:0in; margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-fareast-font-family:"Times New Roman";} @page Section1 {size:8.5in 11.0in; margin:1.0in 1.25in 1.0in 1.25in; mso-header-margin:.5in; mso-footer-margin:.5in; mso-paper-source:0;} div.Section1 {page:Section1;} --> </style><!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} table.MsoTableGrid {mso-style-name:"Table Grid"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; border:solid windowtext 1.0pt; mso-border-alt:solid windowtext .5pt; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-border-insideh:.5pt solid windowtext; mso-border-insidev:.5pt solid windowtext; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} </style> <![endif]--> <p class="MsoNormal"><b style="">BAB 3 <o:p></o:p></b></p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal"><b style="">
<br /></b></p><p class="MsoNormal"><b style="">PERKEMBANGAN AWAL BAYI<o:p></o:p></b></p> <p class="MsoNormal" style="text-align: center;" align="center"><o:p> </o:p></p> <p class="MsoNormal" style="text-align: center;" align="center"><o:p> </o:p></p> <p class="MsoNormal" style="text-align: center;" align="center"><o:p> </o:p></p> <p class="MsoNormal"><b style="">
<br /></b></p><p class="MsoNormal"><b style="">Perkembangan Fizikal<o:p></o:p></b></p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal">
<br /></p><p class="MsoNormal">Sebagai seorang ibu atau bapa, melihat anak anda membesar dan berkembang dengan sihat adalah suatu pengalaman yang paling menggembirakan. Dalam tempoh 12 bulan pertamanya, anda pasti akan berasa kagum melihat bagaimana dia membesar dengan cepat. Bahkan, tempoh ini juga, beberapa peristiwa penting akan berlaku di mana dia akan menguasai beberapa kemahiran dari segi fizikal, mental dan social.</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal">Beberapa kemahiran ini biasanya dapat dikuasai oleh kebanyakan bayi yang sedang membesar dan secara tidak langsung anda mungkin dapat meramalkan waktu yang tepat bila ia akan berlaku. Kemahiran yang telah dikuasainya bukan hanya diukur dari segi apa yang dia telah lakukan tetapi bagaimana dia melakukannya. Dalam erti kata lain, bayi akan membesar serentak dengan kemampuannya untuk menguasai kemahiran tersebut. Biarkan bayi anda menguasai beberapa kemahiran mengikut kemampuannya serta berilah dia peluang untuk melakukannya mengikut kadar kebolehannya sendiri.</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal">Sementara itu, anda hanya perlu memberikannya sepenuh kasih sayang, sokongan dan dorongan yang berterusan serta membantunya dalam menguasai kemahiran- kemahiran tersebut pada peringkat yang berbeza terutamanya dalam tempoh satu tahun ini. Anak anda pasti akan berasa seronok berdamping dengan anda ketika menempuh pelbagai dugaan dalam menguasai kemahiran- kemahiran seperti yang telah disenaraikan di bab seterusnya. Adalah diingatkan bahawa setiap bayi mempunyai kadar perkembangan yang berbeza. Maka , saya menyediakan bahagian seterusnya, seharusnya dijadikan sebagai panduan untuk anda semata – semata.</p> <p class="MsoNormal"><span style=""> </span></p> <p class="MsoNormal"><span style=""> </span><span style=""> </span><span style="color:black;"><span style=""> </span><a href="javascript:;"><span style="color: rgb(120, 120, 120); text-decoration: none;"><!--[if gte vml 1]><v:shapetype id="_x0000_t75" coordsize="21600,21600" spt="75" preferrelative="t" path="m@4@5l@4@11@9@11@9@5xe" filled="f" stroked="f"> <v:stroke joinstyle="miter"> <v:formulas> <v:f eqn="if lineDrawn pixelLineWidth 0"> <v:f eqn="sum @0 1 0"> <v:f eqn="sum 0 0 @1"> <v:f eqn="prod @2 1 2"> <v:f eqn="prod @3 21600 pixelWidth"> <v:f eqn="prod @3 21600 pixelHeight"> <v:f eqn="sum @0 0 1"> <v:f eqn="prod @6 1 2"> <v:f eqn="prod @7 21600 pixelWidth"> <v:f eqn="sum @8 21600 0"> <v:f eqn="prod @7 21600 pixelHeight"> <v:f eqn="sum @10 21600 0"> </v:formulas> <v:path extrusionok="f" gradientshapeok="t" connecttype="rect"> <o:lock ext="edit" aspectratio="t"> </v:shapetype><v:shape id="_x0000_i1025" type="#_x0000_t75" alt="" style="'width:117pt;" button="t"> <v:imagedata src="file:///C:\Users\ADMIN\AppData\Local\Temp\msohtml1\01\clip_image001.jpg" href="http://sg.inmagine.com/400nwm/photoalto/paa300/paa300000014.jpg"> </v:shape><![endif]--><!--[if !vml]--><!--[endif]--></span></a><span style=""> </span><a href="javascript:;"><span style="color: rgb(120, 120, 120); text-decoration: none;"><!--[if gte vml 1]><v:shape id="_x0000_i1026" type="#_x0000_t75" alt="" style="'width:114pt;height:129pt'" button="t"> <v:imagedata src="file:///C:\Users\ADMIN\AppData\Local\Temp\msohtml1\01\clip_image003.jpg" href="http://sg.inmagine.com/400nwm/photoalto/paa300/paa300000015.jpg"> </v:shape><![endif]--><!--[if !vml]--><!--[endif]--></span></a><span style=""> </span><o:p>
<br /></o:p></span></p> <p class="MsoNormal"><span style="color:black;"><o:p> </o:p></span></p> <p class="MsoNormal"><b style=""><u><span style="color:black;">Perkembangan fizikal<o:p></o:p></span></u></b></p> <p class="MsoNormal" style="text-align: center;" align="center"><span style="color:black;"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align: center;" align="center"><b style=""><span style="color:black;">
<br /></span></b></p><p class="MsoNormal" style="text-align: center;" align="center"><b style=""><span style="color:black;">1 BULAN</span></b></p><p class="MsoNormal" style="text-align: center;" align="center">
<br /><b style=""><span style="color:black;"><o:p></o:p></span></b></p> <p class="MsoNormal"><span style="color:black;"><span style=""> </span><o:p></o:p></span></p> <table class="MsoTableGrid" style="width: 580px; margin-left: 5.4pt; border-collapse: collapse; border: medium none; height: 242px;" border="1" cellpadding="0" cellspacing="0"> <tbody><tr style=""> <td style="width: 2.25in; border: 1pt solid windowtext; padding: 0in 5.4pt;" valign="top" width="216"> <p class="MsoNormal"><b style=""><span style="color:black;">Perkembangan Tubuh Badan<o:p></o:p></span></b></p> <p class="MsoNormal"><span style="color:black;"><o:p> </o:p></span></p> <p class="MsoNormal"><span style="color:black;">Sejak lahi, bayi akan sentiasa berada di dalam kedudukan mengerekot. Rangka kepalanya sangat lembut ( otot leher masih tidak kuat untuk menyokong kepalanya). Kakinya lebih cenderung dalam posisi membengkok dan hanya berupaya mengangkat sedikit kepalanya untuk menoleh kea rah kiri dan kanan.<o:p></o:p></span></p> </td> <td style="width: 2in; border-width: 1pt 1pt 1pt medium; border-style: solid solid solid none;" valign="top" width="192"> <p class="MsoNormal"><b style=""><span style="color:black;">Mengawal Pergerakan Tangan (kemahiran)<o:p></o:p></span></b></p> <p class="MsoNormal"><span style="color:black;"><o:p> </o:p></span></p> <p class="MsoNormal"><span style="color:black;">Masih tidak pandai mengawal pergerakkan tangannya kerana tangannya masih cenderung berada dalam posisi menggenggam.<o:p></o:p></span></p> </td> <td style="width: 2.2in; border-width: 1pt 1pt 1pt medium; border-style: solid solid solid none;" valign="top" width="211"> <p class="MsoNormal"><b style=""><span style="color:black;">Mengawal Daya Penglihatan (kemahiran)<o:p></o:p></span></b></p> <p class="MsoNormal"><span style="color:black;"><o:p> </o:p></span></p> <p class="MsoNormal"><span style="color:black;">Daya penglihatannya masih belum berfungsi dengan sempurna. Belajar untuk memfokus pada jarak 10 inci ( 25 sm ).<o:p></o:p></span></p> </td> </tr> </tbody></table> <p class="MsoNormal"><span style="color:black;"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align: center;" align="center"><b style=""><span style="color:black;">
<br /></span></b></p><p class="MsoNormal" style="text-align: center;" align="center"><b style=""><span style="color:black;">
<br /></span></b></p><p class="MsoNormal" style="text-align: center;" align="center"><b style=""><span style="color:black;">2 BULAN</span></b></p><p class="MsoNormal" style="text-align: center;" align="center">
<br /></p><p class="MsoNormal" style="text-align: center;" align="center">
<br /><b style=""><span style="color:black;"><o:p></o:p></span></b></p> <p class="MsoNormal" style="text-align: center;" align="center"><b style=""><span style="color:black;"><o:p> </o:p></span></b></p> <table class="MsoTableGrid" style="width: 587px; border-collapse: collapse; border: medium none; height: 202px;" border="1" cellpadding="0" cellspacing="0"> <tbody><tr style="height: 17.25pt;"> <td style="width: 167.4pt; border: 1pt solid windowtext; padding: 0in 5.4pt; height: 17.25pt;" valign="top" width="223"> <p class="MsoNormal"><b style=""><span style="color:black;">Perkembangan Tubuh Badan<o:p></o:p></span></b></p> <p class="MsoNormal" style="text-align: justify;"><span style="color:black;"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="color:black;"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="color:black;">Pandai menggeliat.<o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="color:black;"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="color:black;">Boleh mengagkat kepalanya pada 45◦ selama beberapa minit.<o:p></o:p></span></p> </td> <td style="width: 142.8pt; border-width: 1pt 1pt 1pt medium; border-style: solid solid solid none; height: 17.25pt;" valign="top" width="190"> <p class="MsoNormal"><b style=""><span style="color:black;">Mengawal Pergerakan Tangan (kemahiran)<o:p></o:p></span></b></p> <p class="MsoNormal"><span style="color:black;"><o:p> </o:p></span></p> <p class="MsoNormal"><span style="color:black;"><o:p> </o:p></span></p> <p class="MsoNormal"><span style="color:black;">Bayi akan membuka dan menggenggam tangannya sesuka hati.<o:p></o:p></span></p> <p class="MsoNormal"><span style="color:black;"><o:p> </o:p></span></p> <p class="MsoNormal"><span style="color:black;">Menghabiskan masa meneliti bagaimana rupa parasnya, menyelami perasaannya sendiri dan menerokai pergerakannya.<o:p></o:p></span></p> </td> <td style="width: 155.1pt; border-width: 1pt 1pt 1pt medium; border-style: solid solid solid none; height: 17.25pt;" valign="top" width="207"> <p class="MsoNormal"><b style=""><span style="color:black;">Mengawal Daya Penglihatan (kemahiran)</span></b><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal"><span style="color:black;"><o:p> </o:p></span></p> <p class="MsoNormal"><span style="color:black;">Sangat suka melihat tangan dan jari – jemarinya apabila diletakkan berdekatan kea rah mukanya.<o:p></o:p></span></p> </td> </tr> </tbody></table> <p class="MsoNormal" style=""><span style="color:black;"><span style=""> </span><o:p></o:p></span></p> <p class="MsoNormal" style="text-align: center;" align="center"><b style=""><span style="color:black;">
<br /></span></b></p><p class="MsoNormal" style="text-align: center;" align="center"><b style=""><span style="color:black;">
<br /></span></b></p><p class="MsoNormal" style="text-align: center;" align="center"><b style=""><span style="color:black;">3 BULAN</span></b></p><p class="MsoNormal" style="text-align: center;" align="center">
<br /><b style=""><span style="color:black;"><o:p></o:p></span></b></p> <p class="MsoNormal" style="text-align: center;" align="center"><span style="color:black;"><o:p> </o:p></span></p> <table class="MsoTableGrid" style="width: 586px; border-collapse: collapse; border: medium none; height: 242px;" border="1" cellpadding="0" cellspacing="0"> <tbody><tr style="height: 18.75pt;"> <td style="width: 167.4pt; border: 1pt solid windowtext; padding: 0in 5.4pt; height: 18.75pt;" valign="top" width="223"> <p class="MsoNormal"><b style=""><span style="color:black;">Perkembangan Tubuh Badan<o:p></o:p></span></b></p> <p class="MsoNormal" style=""><span style="color:black;"><o:p> </o:p></span></p> <p class="MsoNormal" style=""><span style="color:black;"><o:p> </o:p></span></p> <p class="MsoNormal" style=""><span style="color:black;">Badannya tidak lagi mengerekot. Dia boleh mendepangkan lengan dan kakinya. Dapat menendang dengan kuat. Apabila didukung dalam keadaan menegak, dapat mengawal pergerakkan kepalanya.<o:p></o:p></span></p> </td> <td style="width: 142.8pt; border-width: 1pt 1pt 1pt medium; border-style: solid solid solid none; height: 18.75pt;" valign="top" width="190"> <p class="MsoNormal"><b style=""><span style="color:black;">Mengawal Pergerakan Tangan (kemahiran)<o:p></o:p></span></b></p> <p class="MsoNormal" style=""><span style="color:black;"><o:p> </o:p></span></p> <p class="MsoNormal" style=""><span style="color:black;"><o:p> </o:p></span></p> <p class="MsoNormal" style=""><span style="color:black;">Mungkin tidak berapa pandai menggunakan tangannya untuk mencapai objek yang berdekatan dengannya.<o:p></o:p></span></p> <p class="MsoNormal" style=""><span style="color:black;"><o:p> </o:p></span></p> <p class="MsoNormal" style=""><span style="color:black;">Tidak berupaya untuk menggenggam sesuatu untuk masa yang lama.<o:p></o:p></span></p> </td> <td style="width: 155.1pt; border-width: 1pt 1pt 1pt medium; border-style: solid solid solid none; height: 18.75pt;" valign="top" width="207"> <p class="MsoNormal" style=""><b style=""><span style="color:black;">Mengawal Daya Penglihatan (kemahiran)</span></b><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style=""><span style="color:black;"><o:p> </o:p></span></p> <p class="MsoNormal" style=""><span style="color:black;">Mula mengetahui hubungan antara melihat dan membuat sesuatu.<o:p></o:p></span></p> <p class="MsoNormal" style=""><span style="color:black;">Melihat tangannya dengan penuh perhatian dan amat khusyuk.<o:p></o:p></span></p> <p class="MsoNormal" style=""><span style="color:black;">Mengajuk pergerakkan badan orang lain.<o:p></o:p></span></p> <p class="MsoNormal" style=""><span style="color:black;">Mula pandai merenung mata orang dewasa dan akan tersenyum buat pertama kalinya.<o:p></o:p></span></p> </td> </tr> </tbody></table> <p class="MsoNormal" style="text-align: center;" align="center"><span style="color:black;"><o:p> </o:p></span></p> <p class="MsoNormal" style=""><span style="color:black;"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align: center;" align="center"><b style=""><span style="color:black;">
<br /></span></b></p><p class="MsoNormal" style="text-align: center;" align="center"><b style=""><span style="color:black;">4 BULAN</span></b></p><p class="MsoNormal" style="text-align: center;" align="center">
<br /><b style=""><span style="color:black;"><o:p></o:p></span></b></p> <p class="MsoNormal" style="text-align: center;" align="center"><b style=""><span style="color:black;"><o:p> </o:p></span></b></p> <table class="MsoTableGrid" style="width: 586px; border-collapse: collapse; border: medium none; height: 202px;" border="1" cellpadding="0" cellspacing="0"> <tbody><tr style="height: 27.75pt;"> <td style="width: 167.4pt; border: 1pt solid windowtext; padding: 0in 5.4pt; height: 27.75pt;" valign="top" width="223"> <p class="MsoNormal"><b style=""><span style="color:black;">Perkembangan Tubuh Badan<o:p></o:p></span></b></p> <p class="MsoNormal" style=""><span style="color:black;"><o:p> </o:p></span></p> <p class="MsoNormal" style=""><span style="color:black;"><o:p> </o:p></span></p> <p class="MsoNormal" style=""><span style="color:black;"><o:p> </o:p></span></p> <p class="MsoNormal" style=""><span style="color:black;"><o:p> </o:p></span></p> <p class="MsoNormal" style=""><span style="color:black;">Dapat berpusing dari posisi melenting kemudian meniarap, menyokong berat badan dengan lengannya.<o:p></o:p></span></p> </td> <td style="width: 142.8pt; border-width: 1pt 1pt 1pt medium; border-style: solid solid solid none; height: 27.75pt;" valign="top" width="190"> <p class="MsoNormal"><b style=""><span style="color:black;">Mengawal Pergerakan Tangan (kemahiran)<o:p></o:p></span></b></p> <p class="MsoNormal" style=""><span style="color:black;"><o:p> </o:p></span></p> <p class="MsoNormal" style=""><span style="color:black;"><o:p> </o:p></span></p> <p class="MsoNormal" style=""><span style="color:black;">Akan mula menghisap jari dan bermain – main dengan tanganya seolah – olah dia baru menemui tangannya.<o:p></o:p></span></p> <p class="MsoNormal" style=""><span style="color:black;"><o:p> </o:p></span></p> <p class="MsoNormal" style=""><span style="color:black;">Akan menyentuh apa sahaja yang dia Nampak. Tibalah masanya bagi anda memberikan mainan untuknya.<o:p></o:p></span></p> </td> <td style="width: 155.1pt; border-width: 1pt 1pt 1pt medium; border-style: solid solid solid none; height: 27.75pt;" valign="top" width="207"> <p class="MsoNormal" style=""><b style=""><span style="color:black;">Mengawal Daya Penglihatan (kemahiran)</span></b><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal" style=""><span style="color:black;"><o:p> </o:p></span></p> <p class="MsoNormal" style=""><span style="color:black;"><o:p> </o:p></span></p> <p class="MsoNormal" style=""><span style="color:black;">Boleh melihat sesuatu objek dan dapat meneka jarak objek tersebut dan <st1:country-region st="on"><st1:place st="on">cuba</st1:place></st1:country-region> mencapainya. <o:p></o:p></span></p> <p class="MsoNormal" style=""><span style="color:black;">Amat menyukai warna – warna terang.<o:p></o:p></span></p> </td> </tr> </tbody></table> <p class="MsoNormal" style="text-align: center;" align="center"><span style="color:black;"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align: center;" align="center"><span style="color:black;"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align: center;" align="center"><span style="color:black;"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align: center;" align="center"><b style=""><span style="color:black;">
<br /></span></b></p><p class="MsoNormal" style="text-align: center;" align="center"><b style=""><span style="color:black;">5 BULAN</span></b></p><p class="MsoNormal" style="text-align: center;" align="center">
<br /><b style=""><span style="color:black;"><o:p></o:p></span></b></p> <p class="MsoNormal" style="text-align: center;" align="center"><span style="color:black;"><o:p> </o:p></span></p> <table class="MsoTableGrid" style="width: 588px; border-collapse: collapse; border: medium none; height: 162px;" border="1" cellpadding="0" cellspacing="0"> <tbody><tr style=""> <td style="width: 167.4pt; border: 1pt solid windowtext; padding: 0in 5.4pt;" valign="top" width="223"> <p class="MsoNormal"><b style=""><span style="color:black;">Perkembangan Tubuh Badan<o:p></o:p></span></b></p> <p class="MsoNormal" style=""><span style="color:black;"><o:p> </o:p></span></p> <p class="MsoNormal" style=""><span style="color:black;"><o:p> </o:p></span></p> <p class="MsoNormal" style=""><span style="color:black;">Apabila diletakkan dalam keadaan meniarap, dapat mengangkat kepalanya.<o:p></o:p></span></p> <p class="MsoNormal" style=""><span style="color:black;"><o:p> </o:p></span></p> <p class="MsoNormal" style=""><span style="color:black;">Dapat berpusing dari posisi meniarap dan kemudian melentang.<o:p></o:p></span></p> </td> <td style="width: 2in; border-width: 1pt 1pt 1pt medium; border-style: solid solid solid none;" valign="top" width="192"> <p class="MsoNormal"><b style=""><span style="color:black;">Mengawal Pergerakan Tangan (kemahiran)<o:p></o:p></span></b></p> <p class="MsoNormal" style=""><span style="color:black;"><o:p> </o:p></span></p> <p class="MsoNormal" style=""><span style="color:black;"><o:p> </o:p></span></p> <p class="MsoNormal" style=""><span style="color:black;"><o:p> </o:p></span></p> <p class="MsoNormal" style=""><span style="color:black;">Belajar untuk memegang objek, dengan membuka dan kemudian menggenggam jari – jemarinya.<o:p></o:p></span></p> </td> <td style="width: 153pt; border-width: 1pt 1pt 1pt medium; border-style: solid solid solid none;" valign="top" width="204"> <p class="MsoNormal" style=""><b style=""><span style="color:black;">Mengawal Daya Penglihatan (kemahiran)</span></b><span style="color:black;"><o:p></o:p></span></p> <p class="MsoNormal"><b style=""><span style="color:black;"><o:p> </o:p></span></b></p> <p class="MsoNormal" style=""><span style="color:black;"><o:p> </o:p></span></p> <p class="MsoNormal" style=""><span style="color:black;">Daya penglihatannya akan menjadi lebih baik dan boleh memfokus pada sesuatu objek pada apa jua jarak dan mengikuti pergerakan objek tersebut..<o:p></o:p></span></p> </td> </tr> </tbody></table> <p class="MsoNormal" style="text-align: center;" align="center"><span style="color:black;"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align: center;" align="center"><b style=""><span style="color:black;">
<br /></span></b></p><p class="MsoNormal" style="text-align: center;" align="center"><b style=""><span style="color:black;">6 BULAN</span></b></p><p class="MsoNormal" style="text-align: center;" align="center">
<br /><b style=""><span style="color:black;"><o:p></o:p></span></b></p> <p class="MsoNormal" style="text-align: center;" align="center"><b style=""><span style="color:black;"><o:p> </o:p></span></b></p> <p class="MsoNormal" style="text-align: center;" align="center"><b style=""><span style="color:black;"><o:p> </o:p></span></b></p> <table class="MsoTableGrid" style="width: 589px; border-collapse: collapse; border: medium none; height: 162px;" border="1" cellpadding="0" cellspacing="0"> <tbody><tr style="height: 14.25pt;"> <td style="width: 167.4pt; border: 1pt solid windowtext; padding: 0in 5.4pt; height: 14.25pt;" valign="top" width="223"> <p class="MsoNormal" style=""><span style="color:black;">Mungkin dapat duduk tanpa sokongan untuk beberapa saat. <o:p></o:p></span></p> <p class="MsoNormal" style=""><span style="color:black;">Dapat mengangkat kepalanya ketika berbaring.<o:p></o:p></span></p> <p class="MsoNormal" style=""><span style="color:black;"><o:p> </o:p></span></p> <p class="MsoNormal" style=""><i style=""><span style="color:black;">Perhatian : Giginya yang pertama mungkin akan tumbuh pada usia 6 bulan, namun setiap bayi adalah berbeza.<o:p></o:p></span></i></p> </td> <td style="width: 142.8pt; border-width: 1pt 1pt 1pt medium; border-style: solid solid solid none; height: 14.25pt;" valign="top" width="190"> <p class="MsoNormal" style=""><span style="color:black;">Boleh memegang sesuatu objek dengan jari tangannya dan mungkin boleh menggerakkan pergelangan tangannya.<o:p></o:p></span></p> <p class="MsoNormal" style=""><span style="color:black;"><o:p> </o:p></span></p> <p class="MsoNormal" style=""><span style="color:black;">Memasukkan semua benda dalam mulut.<o:p></o:p></span></p> </td> <td style="width: 155.1pt; border-width: 1pt 1pt 1pt medium; border-style: solid solid solid none; height: 14.25pt;" valign="top" width="207"> <p class="MsoNormal" style=""><span style="color:black;">Dapat memfokus dan menilai jarak sesuatu objek.<o:p></o:p></span></p> <p class="MsoNormal" style=""><span style="color:black;"><o:p> </o:p></span></p> <p class="MsoNormal" style=""><span style="color:black;">Dapat membezakan antara objek yang kecil/besar.<o:p></o:p></span></p> </td> </tr> </tbody></table> <p class="MsoNormal" style="text-align: center;" align="center"><span style="color:black;"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align: center;" align="center"><b style=""><span style="color:black;">
<br /></span></b></p><p class="MsoNormal" style="text-align: center;" align="center"><b style=""><span style="color:black;">7 BULAN</span></b></p><p class="MsoNormal" style="text-align: center;" align="center">
<br /><b style=""><span style="color:black;"><o:p></o:p></span></b></p> <p class="MsoNormal" style="text-align: center;" align="center"><b style=""><span style="color:black;"><o:p> </o:p></span></b></p> <table class="MsoTableGrid" style="width: 590px; border-collapse: collapse; border: medium none; height: 122px;" border="1" cellpadding="0" cellspacing="0"> <tbody><tr style="height: 17.25pt;"> <td style="width: 167.4pt; border: 1pt solid windowtext; padding: 0in 5.4pt; height: 17.25pt;" valign="top" width="223"> <p class="MsoNormal" style=""><span style="color:black;">Keupayaannya untuk duduk menjadi lebih baik, mungkin akan <st1:place st="on"><st1:country-region st="on">cuba</st1:country-region></st1:place> mengimbangi badannya.<o:p></o:p></span></p> </td> <td style="width: 142.8pt; border-width: 1pt 1pt 1pt medium; border-style: solid solid solid none; height: 17.25pt;" valign="top" width="190"> <p class="MsoNormal" style=""><span style="color:black;">Dapat memegang sesuatu objek dengan kedua-dua belah tangannya.<o:p></o:p></span></p> <p class="MsoNormal" style=""><span style="color:black;"><o:p> </o:p></span></p> <p class="MsoNormal" style=""><span style="color:black;">Mula mencuba untuk menggunakan tangannya untuk makan.<o:p></o:p></span></p> </td> <td style="width: 155.1pt; border-width: 1pt 1pt 1pt medium; border-style: solid solid solid none; height: 17.25pt;" valign="top" width="207"> <p class="MsoNormal" style=""><span style="color:black;">Dapat memfokus dan menilai jarak sesuatu objek.<o:p></o:p></span></p> <p class="MsoNormal" style=""><span style="color:black;"><o:p> </o:p></span></p> <p class="MsoNormal" style=""><span style="color:black;">Dapat membezakan antara objek yang kecil/besar.<o:p></o:p></span></p> </td> </tr> </tbody></table> <p class="MsoNormal" style="text-align: center;" align="center"><span style="color:black;"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align: center;" align="center"><b style=""><span style="color:black;">
<br /></span></b></p><p class="MsoNormal" style="text-align: center;" align="center"><b style=""><span style="color:black;">8 BULAN</span></b></p><p class="MsoNormal" style="text-align: center;" align="center">
<br /><b style=""><span style="color:black;"><o:p></o:p></span></b></p> <p class="MsoNormal" style="text-align: center;" align="center"><b style=""><span style="color:black;"><o:p> </o:p></span></b></p> <table class="MsoTableGrid" style="width: 591px; border-collapse: collapse; border: medium none; height: 122px;" border="1" cellpadding="0" cellspacing="0"> <tbody><tr style="height: 21.75pt;"> <td style="width: 167.4pt; border: 1pt solid windowtext; padding: 0in 5.4pt; height: 21.75pt;" valign="top" width="223"> <p class="MsoNormal" style=""><span style="color:black;">Dapat duduk dengan baik tanpa perlu disokong jika dia tidak bergerak. <o:p></o:p></span></p> <p class="MsoNormal" style=""><span style="color:black;">Mungkin badannya akan bergoyang ke hadapan atau kebelakang.<o:p></o:p></span></p> </td> <td style="width: 142.8pt; border-width: 1pt 1pt 1pt medium; border-style: solid solid solid none; height: 21.75pt;" valign="top" width="190"> <p class="MsoNormal" style=""><span style="color:black;">Tindakbalas refleks penggenggamannya menjadi lebih baik.<o:p></o:p></span></p> <p class="MsoNormal" style=""><span style="color:black;">Dapat mengutip objek kecil dengan ibu jari dan telunjuk.<o:p></o:p></span></p> <p class="MsoNormal" style=""><span style="color:black;">Boleh melambaikan tangannya.<o:p></o:p></span></p> </td> <td style="width: 155.1pt; border-width: 1pt 1pt 1pt medium; border-style: solid solid solid none; height: 21.75pt;" valign="top" width="207"> <p class="MsoNormal" style=""><span style="color:black;">Mengenali wajah- wajah yang biasa dilihatnya.<o:p></o:p></span></p> </td> </tr> </tbody></table> <p class="MsoNormal" style="text-align: center;" align="center"><span style="color:black;"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align: center;" align="center"><b style=""><span style="color:black;">
<br /></span></b></p><p class="MsoNormal" style="text-align: center;" align="center"><b style=""><span style="color:black;">9 BULAN</span></b></p><p class="MsoNormal" style="text-align: center;" align="center">
<br /><b style=""><span style="color:black;"><o:p></o:p></span></b></p> <p class="MsoNormal" style="text-align: center;" align="center"><b style=""><span style="color:black;"><o:p> </o:p></span></b></p> <table class="MsoTableGrid" style="width: 594px; border-collapse: collapse; border: medium none; height: 102px;" border="1" cellpadding="0" cellspacing="0"> <tbody><tr style="height: 19.5pt;"> <td style="width: 167.4pt; border: 1pt solid windowtext; padding: 0in 5.4pt; height: 19.5pt;" valign="top" width="223"> <p class="MsoNormal" style=""><span style="color:black;">Berusaha untuk merangkak dan mneyokong berat badannya dengan menggunakan tangan dan lutut. Boleh menukar kedudukannya daripada berbaring kepada duduk.<o:p></o:p></span></p> </td> <td style="width: 142.8pt; border-width: 1pt 1pt 1pt medium; border-style: solid solid solid none; height: 19.5pt;" valign="top" width="190"> <p class="MsoNormal" style=""><span style="color:black;">Dapat mengawal pergerakan setiap jari-jemarinya.<o:p></o:p></span></p> <p class="MsoNormal" style=""><span style="color:black;"><o:p> </o:p></span></p> <p class="MsoNormal" style=""><span style="color:black;">Mula menggunakan jari telunjuk untuk mencucuk atau menunjukkan sesuatu.<o:p></o:p></span></p> </td> <td style="width: 155.1pt; border-width: 1pt 1pt 1pt medium; border-style: solid solid solid none; height: 19.5pt;" valign="top" width="207"> <p class="MsoNormal" style=""><span style="color:black;">Lebih bijak memfokus – pandai mencari objek yang telah terjatuh dan tersembunyi atau disembunyikan.<o:p></o:p></span></p> </td> </tr> </tbody></table> <p class="MsoNormal" style="text-align: center;" align="center"><span style="color:black;"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align: center;" align="center"><b style=""><span style="color:black;">
<br /></span></b></p><p class="MsoNormal" style="text-align: center;" align="center"><b style=""><span style="color:black;">10 BULAN</span></b></p><p class="MsoNormal" style="text-align: center;" align="center">
<br /><b style=""><span style="color:black;"><o:p></o:p></span></b></p> <p class="MsoNormal" style="text-align: center;" align="center"><b style=""><span style="color:black;"><o:p> </o:p></span></b></p> <table class="MsoTableGrid" style="width: 595px; border-collapse: collapse; border: medium none; height: 162px;" border="1" cellpadding="0" cellspacing="0"> <tbody><tr style="height: 25.5pt;"> <td style="width: 167.4pt; border: 1pt solid windowtext; padding: 0in 5.4pt; height: 25.5pt;" valign="top" width="223"> <p class="MsoNormal" style=""><span style="color:black;">Merangkak dengan tangan dan kaki yang lebih tegak. Mungkin akan mengundur buat seketika. <o:p></o:p></span></p> <p class="MsoNormal" style=""><span style="color:black;">Menarik sesuatu benda sebagai sokongan untuk berdiri. Sesetengah bayi akan terus berdiri tegak dan berjalan tanpa peringkat merangkak.<o:p></o:p></span></p> </td> <td style="width: 142.8pt; border-width: 1pt 1pt 1pt medium; border-style: solid solid solid none; height: 25.5pt;" valign="top" width="190"> <p class="MsoNormal" style=""><span style="color:black;">Akan menerokai setiap objek baru dengan tangannya.<o:p></o:p></span></p> <p class="MsoNormal" style=""><span style="color:black;"><o:p> </o:p></span></p> <p class="MsoNormal" style=""><span style="color:black;">Berupaya untuk memegang dua objek dengan sebelah tangan tetapi mungkin sedikit cuai apabila hendak melepaskannya.<o:p></o:p></span></p> </td> <td style="width: 155.1pt; border-width: 1pt 1pt 1pt medium; border-style: solid solid solid none; height: 25.5pt;" valign="top" width="207"> <p class="MsoNormal" style=""><span style="color:black;">Lebih bijak memfokus – pandai mencari objek yang telah terjatuh dan tersembnyi atau disembunyikan.<o:p></o:p></span></p> </td> </tr> </tbody></table> <p class="MsoNormal" style="text-align: center;" align="center"><span style="color:black;"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align: center;" align="center"><b style=""><span style="color:black;">
<br /></span></b></p><p class="MsoNormal" style="text-align: center;" align="center"><b style=""><span style="color:black;">11 BULAN HINGGA 12 BULAN</span></b></p><p class="MsoNormal" style="text-align: center;" align="center">
<br /><b style=""><span style="color:black;"><o:p></o:p></span></b></p> <p class="MsoNormal" style="text-align: center;" align="center"><b style=""><span style="color:black;"><o:p> </o:p></span></b></p> <table class="MsoTableGrid" style="width: 595px; border-collapse: collapse; border: medium none; height: 222px;" border="1" cellpadding="0" cellspacing="0"> <tbody><tr style="height: 19.5pt;"> <td style="width: 167.4pt; border: 1pt solid windowtext; padding: 0in 5.4pt; height: 19.5pt;" valign="top" width="223"> <p class="MsoNormal" style=""><span style="color:black;">Berjalan mengiring atau ke hadapan dengan memegang seseorang atau perabot.<o:p></o:p></span></p> <p class="MsoNormal" style=""><span style="color:black;"><o:p> </o:p></span></p> <p class="MsoNormal" style=""><span style="color:black;">Mungkin pandai bertatih dan berjalan jatuh.<o:p></o:p></span></p> </td> <td style="width: 142.8pt; border-width: 1pt 1pt 1pt medium; border-style: solid solid solid none; height: 19.5pt;" valign="top" width="190"> <p class="MsoNormal" style=""><span style="color:black;">Dapat mengawal pergerakan tangannya dengan lebih baik.<o:p></o:p></span></p> <p class="MsoNormal" style=""><span style="color:black;"><o:p> </o:p></span></p> <p class="MsoNormal" style=""><span style="color:black;">Dapat mengutip benda-benda kecil seperti butang baju.<o:p></o:p></span></p> <p class="MsoNormal" style=""><span style="color:black;"><o:p> </o:p></span></p> <p class="MsoNormal" style=""><span style="color:black;">Berlajar untuk mencampakkan barang dengan sengaja.<o:p></o:p></span></p> <p class="MsoNormal" style=""><span style="color:black;"><o:p> </o:p></span></p> <p class="MsoNormal" style=""><span style="color:black;">Mengalihkan sesuatu objek dari tangan kiri ke kanan atau sebaliknya.<o:p></o:p></span></p> <p class="MsoNormal" style=""><span style="color:black;"><o:p> </o:p></span></p> <p class="MsoNormal" style=""><span style="color:black;">Belajar menyuapkan makanan dengan sendiri.<o:p></o:p></span></p> </td> <td style="width: 155.1pt; border-width: 1pt 1pt 1pt medium; border-style: solid solid solid none; height: 19.5pt;" valign="top" width="207"> <p class="MsoNormal" style=""><span style="color:black;">Mula melihat dan mengikut objek yang bergerak dengan pantas.<o:p></o:p></span></p> </td> </tr> </tbody></table> <p class="MsoNormal" style="text-align: center;" align="center"><span style="color:black;"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align: center;" align="center"><span style="color:black;"><o:p> </o:p></span></p> <span class="fullpost"></span>misibbhttp://www.blogger.com/profile/14827173537467932982noreply@blogger.com0tag:blogger.com,1999:blog-1717129759233064518.post-47419285086531212442010-03-28T11:59:00.008+08:002010-03-28T12:48:47.258+08:00Apakah Masalah Biasa Bayi Yang Baru Lahir?<meta equiv="Content-Type" content="text/html; charset=utf-8"><meta name="ProgId" content="Word.Document"><meta name="Generator" content="Microsoft Word 11"><meta name="Originator" content="Microsoft Word 11"><link rel="File-List" href="file:///C:%5CUsers%5CADMIN%5CAppData%5CLocal%5CTemp%5Cmsohtml1%5C01%5Cclip_filelist.xml"><!--[if gte mso 9]><xml> <w:worddocument> <w:view>Normal</w:View> <w:zoom>0</w:Zoom> <w:punctuationkerning/> <w:validateagainstschemas/> <w:saveifxmlinvalid>false</w:SaveIfXMLInvalid> <w:ignoremixedcontent>false</w:IgnoreMixedContent> <w:alwaysshowplaceholdertext>false</w:AlwaysShowPlaceholderText> <w:compatibility> <w:breakwrappedtables/> <w:snaptogridincell/> <w:wraptextwithpunct/> <w:useasianbreakrules/> <w:dontgrowautofit/> </w:Compatibility> <w:browserlevel>MicrosoftInternetExplorer4</w:BrowserLevel> </w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:latentstyles deflockedstate="false" latentstylecount="156"> </w:LatentStyles> </xml><![endif]--><style> <!-- /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-parent:""; margin:0in; margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-fareast-font-family:"Times New Roman";} @page Section1 {size:8.5in 11.0in; margin:1.0in 1.25in 1.0in 1.25in; mso-header-margin:.5in; mso-footer-margin:.5in; mso-paper-source:0;} div.Section1 {page:Section1;} --> </style><!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} </style> <![endif]--> <p class="MsoNormal"><b style="">Bab 2<o:p></o:p></b></p> <p class="MsoNormal"><b style=""><o:p> </o:p></b></p> <p class="MsoNormal"><b style="">Masalah – masalah biasa Yang dihadapi Oleh Bayi Yang Baru Lahir<o:p></o:p></b></p>
<br />
<br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://2.bp.blogspot.com/_StW9Y6v_f4I/S67fAtiLUEI/AAAAAAAAAC4/MXYsmCA0GY8/s1600/Baby3.jpg"><img style="display: block; margin: 0px auto 10px; text-align: center; cursor: pointer; width: 240px; height: 320px;" src="http://2.bp.blogspot.com/_StW9Y6v_f4I/S67fAtiLUEI/AAAAAAAAAC4/MXYsmCA0GY8/s400/Baby3.jpg" alt="" id="BLOGGER_PHOTO_ID_5453541402108186690" border="0" /></a>
<br /><meta equiv="Content-Type" content="text/html; charset=utf-8"><meta name="ProgId" content="Word.Document"><meta name="Generator" content="Microsoft Word 11"><meta name="Originator" content="Microsoft Word 11"><link rel="File-List" href="file:///C:%5CUsers%5CADMIN%5CAppData%5CLocal%5CTemp%5Cmsohtml1%5C01%5Cclip_filelist.xml"><!--[if gte mso 9]><xml> <w:worddocument> <w:view>Normal</w:View> <w:zoom>0</w:Zoom> <w:punctuationkerning/> <w:validateagainstschemas/> <w:saveifxmlinvalid>false</w:SaveIfXMLInvalid> <w:ignoremixedcontent>false</w:IgnoreMixedContent> <w:alwaysshowplaceholdertext>false</w:AlwaysShowPlaceholderText> <w:compatibility> <w:breakwrappedtables/> <w:snaptogridincell/> <w:wraptextwithpunct/> <w:useasianbreakrules/> <w:dontgrowautofit/> </w:Compatibility> <w:browserlevel>MicrosoftInternetExplorer4</w:BrowserLevel> </w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:latentstyles deflockedstate="false" latentstylecount="156"> </w:LatentStyles> </xml><![endif]--><style> <!-- /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-parent:""; margin:0in; margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-fareast-font-family:"Times New Roman";} @page Section1 {size:8.5in 11.0in; margin:1.0in 1.25in 1.0in 1.25in; mso-header-margin:.5in; mso-footer-margin:.5in; mso-paper-source:0;} div.Section1 {page:Section1;} --> </style><!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} </style> <![endif]--> <p class="MsoNormal">Ketika tempoh beberapa minggu pertama kehidupan bayi, bayi yang sihat boleh turut menghadapi beberapa masalah biasa yang dihadapi oleh bayi-bayi yang lain. Namun, anda boleh menguruskan masalah ini dengan sendirinya. Berikut adalah senarai beberapa masalah biasa yang kerap dialami oleh bayi yang baru lahir dan apa yang patut anda lakukan :</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal"><b style="">
<br /></b></p><p class="MsoNormal"><b style="">Masalah-masalah biasa dan apa yang patut anda lakukan:-<o:p></o:p></b></p>
<br />
<br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://2.bp.blogspot.com/_StW9Y6v_f4I/S67erK_JK1I/AAAAAAAAACw/jjMFUl7Jldg/s1600/baby.jpg"><img style="display: block; margin: 0px auto 10px; text-align: center; cursor: pointer; width: 400px; height: 300px;" src="http://2.bp.blogspot.com/_StW9Y6v_f4I/S67erK_JK1I/AAAAAAAAACw/jjMFUl7Jldg/s400/baby.jpg" alt="" id="BLOGGER_PHOTO_ID_5453541032057187154" border="0" /></a>
<br /><meta equiv="Content-Type" content="text/html; charset=utf-8"><meta name="ProgId" content="Word.Document"><meta name="Generator" content="Microsoft Word 11"><meta name="Originator" content="Microsoft Word 11"><link rel="File-List" href="file:///C:%5CUsers%5CADMIN%5CAppData%5CLocal%5CTemp%5Cmsohtml1%5C01%5Cclip_filelist.xml"><o:smarttagtype namespaceuri="urn:schemas-microsoft-com:office:smarttags" name="country-region"></o:smarttagtype><o:smarttagtype namespaceuri="urn:schemas-microsoft-com:office:smarttags" name="place"></o:smarttagtype><!--[if gte mso 9]><xml> <w:worddocument> <w:view>Normal</w:View> <w:zoom>0</w:Zoom> <w:punctuationkerning/> <w:validateagainstschemas/> <w:saveifxmlinvalid>false</w:SaveIfXMLInvalid> <w:ignoremixedcontent>false</w:IgnoreMixedContent> <w:alwaysshowplaceholdertext>false</w:AlwaysShowPlaceholderText> <w:compatibility> <w:breakwrappedtables/> <w:snaptogridincell/> <w:wraptextwithpunct/> <w:useasianbreakrules/> <w:dontgrowautofit/> </w:Compatibility> <w:browserlevel>MicrosoftInternetExplorer4</w:BrowserLevel> </w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:latentstyles deflockedstate="false" latentstylecount="156"> </w:LatentStyles> </xml><![endif]--><!--[if !mso]><object classid="clsid:38481807-CA0E-42D2-BF39-B33AF135CC4D" id="ieooui"></object> <style> st1\:*{behavior:url(#ieooui) } </style> <![endif]--><style> <!-- /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-parent:""; margin:0in; margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-fareast-font-family:"Times New Roman";} @page Section1 {size:8.5in 11.0in; margin:1.0in 1.25in 1.0in 1.25in; mso-header-margin:.5in; mso-footer-margin:.5in; mso-paper-source:0;} div.Section1 {page:Section1;} --> </style><!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} </style> <![endif]--> <p class="MsoNormal"><b style=""><u>Sedu<o:p></o:p></u></b></p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal"><o:p></o:p>Sedu adalah perkara biasa yang berlaku selepas penyusuan yang mungkin akan berlarutan sehingga 10 minit. Maka, adalah digalakkan agar anda kerap menyendawakan bayi anda. Bayi mungkin akan menyedut sedikit udara ketika sedang menyusu, dan sedikit udara inilah, akan menyebabkan dia berasa sudah kenyang walaupun dia belum cukup kenyang, sebenarnya. <st1:country-region st="on"><st1:place st="on">Cuba</st1:place></st1:country-region> sendawakan bayi anda selepas setiap penyusuan.</p> <p class="MsoNormal"><o:p> </o:p></p>
<br />
<br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://1.bp.blogspot.com/_StW9Y6v_f4I/S67d1GJQ9JI/AAAAAAAAACo/wy3rdVe9tg4/s1600/baby1.jpg"><img style="display: block; margin: 0px auto 10px; text-align: center; cursor: pointer; width: 400px; height: 300px;" src="http://1.bp.blogspot.com/_StW9Y6v_f4I/S67d1GJQ9JI/AAAAAAAAACo/wy3rdVe9tg4/s400/baby1.jpg" alt="" id="BLOGGER_PHOTO_ID_5453540103044527250" border="0" /></a>
<br /><meta equiv="Content-Type" content="text/html; charset=utf-8"><meta name="ProgId" content="Word.Document"><meta name="Generator" content="Microsoft Word 11"><meta name="Originator" content="Microsoft Word 11"><link rel="File-List" href="file:///C:%5CUsers%5CADMIN%5CAppData%5CLocal%5CTemp%5Cmsohtml1%5C01%5Cclip_filelist.xml"><!--[if gte mso 9]><xml> <w:worddocument> <w:view>Normal</w:View> <w:zoom>0</w:Zoom> <w:punctuationkerning/> <w:validateagainstschemas/> <w:saveifxmlinvalid>false</w:SaveIfXMLInvalid> <w:ignoremixedcontent>false</w:IgnoreMixedContent> <w:alwaysshowplaceholdertext>false</w:AlwaysShowPlaceholderText> <w:compatibility> <w:breakwrappedtables/> <w:snaptogridincell/> <w:wraptextwithpunct/> <w:useasianbreakrules/> <w:dontgrowautofit/> </w:Compatibility> <w:browserlevel>MicrosoftInternetExplorer4</w:BrowserLevel> </w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:latentstyles deflockedstate="false" latentstylecount="156"> </w:LatentStyles> </xml><![endif]--><style> <!-- /* Font Definitions */ @font-face {font-family:Wingdings; panose-1:5 0 0 0 0 0 0 0 0 0; mso-font-charset:2; mso-generic-font-family:auto; mso-font-pitch:variable; mso-font-signature:0 268435456 0 0 -2147483648 0;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-parent:""; margin:0in; margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-fareast-font-family:"Times New Roman";} @page Section1 {size:8.5in 11.0in; margin:1.0in 1.25in 1.0in 1.25in; mso-header-margin:.5in; mso-footer-margin:.5in; mso-paper-source:0;} div.Section1 {page:Section1;} /* List Definitions */ @list l0 {mso-list-id:772818641; mso-list-type:hybrid; mso-list-template-ids:1058540282 67698699 67698691 67698693 67698689 67698691 67698693 67698689 67698691 67698693;} @list l0:level1 {mso-level-number-format:bullet; mso-level-text:; mso-level-tab-stop:.5in; mso-level-number-position:left; text-indent:-.25in; font-family:Wingdings;} ol {margin-bottom:0in;} ul {margin-bottom:0in;} --> </style><!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} </style> <![endif]--><meta equiv="Content-Type" content="text/html; charset=utf-8"><meta name="ProgId" content="Word.Document"><meta name="Generator" content="Microsoft Word 11"><meta name="Originator" content="Microsoft Word 11"><link rel="File-List" href="file:///C:%5CUsers%5CADMIN%5CAppData%5CLocal%5CTemp%5Cmsohtml1%5C01%5Cclip_filelist.xml"><!--[if gte mso 9]><xml> <w:worddocument> <w:view>Normal</w:View> <w:zoom>0</w:Zoom> <w:punctuationkerning/> <w:validateagainstschemas/> <w:saveifxmlinvalid>false</w:SaveIfXMLInvalid> <w:ignoremixedcontent>false</w:IgnoreMixedContent> <w:alwaysshowplaceholdertext>false</w:AlwaysShowPlaceholderText> <w:compatibility> <w:breakwrappedtables/> <w:snaptogridincell/> <w:wraptextwithpunct/> <w:useasianbreakrules/> <w:dontgrowautofit/> </w:Compatibility> <w:browserlevel>MicrosoftInternetExplorer4</w:BrowserLevel> </w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:latentstyles deflockedstate="false" latentstylecount="156"> </w:LatentStyles> </xml><![endif]--><style> <!-- /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-parent:""; margin:0in; margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-fareast-font-family:"Times New Roman";} @page Section1 {size:8.5in 11.0in; margin:1.0in 1.25in 1.0in 1.25in; mso-header-margin:.5in; mso-footer-margin:.5in; mso-paper-source:0;} div.Section1 {page:Section1;} --> </style><!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} </style> <![endif]--> <p class="MsoNormal"><b style=""><u>Kembung Perut<o:p></o:p></u></b></p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal"><o:p></o:p>Bayi akan menagis dengan jeritan yang kuat dan dalam keadaan teresak-esak. Selalunya ini terjadi pada bayi yang berusia 1-3 bulan. Punca masalah kembung perut ini masih belum diketahui. Bayi yang mengalami masalah kembung perut ini sukar untuk dipujuk dan anda boleh perhatikan caranya menagis dengan kakinya terangkat-angkat kea rah dadanya.</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal">Mintalah nasihat daripada doctor. Bagi mengurangkan masalah kembung perut ini, anda mesti mengamalkan teknik penyusuan yang betul, kerap sendawakan bayi dan mengenalpasti makanan-makanan yang boleh menyebabkan alahan pada bayi.</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal">Buat teknik massage / sentuhan di bahagian perut dengan menggunakan minyak bayi yang boleh digunakan. Kemungkinan bayi berasa terlalu dingin atau cara pemberian susu dengan botol, penolakakn udara bersama susu yang boleh mengundang rasa tidak selesa bayi.</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal"><b style=""><u>
<br /></u></b></p><p class="MsoNormal"><b style=""><u>Muntah / Tumpah susu ( Jeluak )<o:p></o:p></u></b></p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal">
<br /></p><p class="MsoNormal">Muntah susu adalah masalah biasa yang dialami oleh kebanyakkan bayi dan adalah disebabkan oleh pelbagai factor. Bayi yang diberi minum susu yang terlalu banyak akan memuntahkan susunya semula. Faktor-faktor lain termasuklah cara penyediaan susu yang kurang tepat, saiz lubang pada putting susu tidak sesuai dan cara anda memegang botol semasa memberi susu adalah salah, di mana bayi akan cenderung untuk menyedut lebih banyak udara ketika menyusu. Maka, pastikan teknik penyusuan yang digunakan adalah betul. Kerap sendawakan bayi anda. Lambat laun bayi akan kurang memuntahkan susunya semula. Jika bayi anda menyusu dengan sempurna dan berkembang secara normal, anda tidak perlu risau mengenainya.</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal">Namun, jika bayi anda bertukar menjadi biru semasa memuntahkan susunya dengan banyak, sukar untuk bernafas, atau nafas bunyi berdehit atau tercekik dan berat badannya tidak bertambah, maka segeralah berjumpa dengan doctor.</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal"><b style=""><u>
<br /></u></b></p><p class="MsoNormal"><b style=""><u>Kulit Kepala Berkerak<o:p></o:p></u></b></p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal">
<br /></p><p class="MsoNormal">Keadaan ini berlaku apabila terdapat selaput yang tebal, berwarna kekuningan dan berkerak di atas kulit kepala bayi. Usah risau, kerana keadaan ini tidak menyakitkan bayi. Anda boleh membuangnya dengan mencuci kulit kepala bayi dengan minyak bayi atau minyak zaitun dan biarkannya selama 10-15 minit, seterusnya, basuh rambutnya dan lap kulit kepala bayi dengan lembut.</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-left: 0.5in; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family:Wingdings;"><span style="">
<br /></span></span></p><p class="MsoNormal" style="margin-left: 0.5in; text-indent: -0.25in;"><span style="font-family:Wingdings;"><span style="">Ø<span style="font: 7pt "Times New Roman";"> </span></span></span><!--[endif]--><b style="">Ruam Panas<o:p></o:p></b></p> <p class="MsoNormal" style="margin-left: 0.25in;">
<br /></p><p class="MsoNormal" style="margin-left: 0.25in;">Pada bayi yang baru lahir, akan kelihatan beberapa tompok merah pada muka , leher dan badan. Namun, anda tidak harus berasa risau kerana keadaan ini akan hilang begitu sahaja tanpa memerlukan apa-apa rawatan. Jangan sapukan bedak pada kulit bayi, kerana bedak tersebut tidak akan mengeringkannya bahkan debu bedak itu akan merangsang perpeluhan dan ruam akan menjadi bertambah teruk.</p> <p class="MsoNormal" style="margin-left: 0.25in;"><o:p> </o:p></p> <p class="MsoNormal" style="margin-left: 0.25in;"><o:p> </o:p></p> <p class="MsoNormal" style="margin-left: 0.5in; text-indent: -0.25in;"><o:p></o:p><span style="font-family:Wingdings;"><span style="">
<br /></span></span></p><p class="MsoNormal" style="margin-left: 0.5in; text-indent: -0.25in;"><span style="font-family:Wingdings;"><span style="">Ø<span style="font: 7pt "Times New Roman";"> </span></span></span><!--[endif]--><b style="">Ruam Lampin<o:p></o:p></b></p> <p class="MsoNormal" style="margin-left: 0.25in;">
<br /></p><p class="MsoNormal" style="margin-left: 0.25in;">Kulit di sekitar bahagian ari-ari, punggung, sekitar kemaluan akan menjadi merah dan gatal-gatal disebabkan oleh kencing atau najis. Pastikan kulit bayi sentiasa bersih dan kering dengan kerap menukar lampinnya yang telah lembap dan basah. Bersihkan bahagian di sekitarnya dengan air dan gumpalan kapas terutamanya selepas dia membuang air besar. Adalah dinasihatkan agar anda menggunakan lampin yang berkualiti tinggi untuk bayi anda.</p> <p class="MsoNormal" style="margin-left: 0.25in;"><o:p> </o:p></p> <p class="MsoNormal" style="margin-left: 0.5in; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family:Wingdings;"><span style="">
<br /></span></span></p><p class="MsoNormal" style="margin-left: 0.5in; text-indent: -0.25in;"><span style="font-family:Wingdings;"><span style="">Ø<span style="font: 7pt "Times New Roman";"> </span></span></span><!--[endif]--><b style="">Ruam susu<o:p></o:p></b></p> <span style=";font-family:";font-size:100%;" >Kadangkala susu yang keluar dari mulut bayi boleh menyebabkan ruam pada bahagian tepi mulutnya, pipi dan dagu. Selepas setiap penyusuan, anda haruslah mengelap mulut dan muka bayi anda dengan kain atau gumpalan kapas yang basah</span>
<br />
<br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://1.bp.blogspot.com/_StW9Y6v_f4I/S67c-2_xJ-I/AAAAAAAAACg/GqMx-Hyj0B8/s1600/jaundisbaby.jpg"><img style="display: block; margin: 0px auto 10px; text-align: center; cursor: pointer; width: 400px; height: 300px;" src="http://1.bp.blogspot.com/_StW9Y6v_f4I/S67c-2_xJ-I/AAAAAAAAACg/GqMx-Hyj0B8/s400/jaundisbaby.jpg" alt="" id="BLOGGER_PHOTO_ID_5453539171265226722" border="0" /></a>
<br /><meta equiv="Content-Type" content="text/html; charset=utf-8"><meta name="ProgId" content="Word.Document"><meta name="Generator" content="Microsoft Word 11"><meta name="Originator" content="Microsoft Word 11"><link rel="File-List" href="file:///C:%5CUsers%5CADMIN%5CAppData%5CLocal%5CTemp%5Cmsohtml1%5C01%5Cclip_filelist.xml"><!--[if gte mso 9]><xml> <w:worddocument> <w:view>Normal</w:View> <w:zoom>0</w:Zoom> <w:punctuationkerning/> <w:validateagainstschemas/> <w:saveifxmlinvalid>false</w:SaveIfXMLInvalid> <w:ignoremixedcontent>false</w:IgnoreMixedContent> <w:alwaysshowplaceholdertext>false</w:AlwaysShowPlaceholderText> <w:compatibility> <w:breakwrappedtables/> <w:snaptogridincell/> <w:wraptextwithpunct/> <w:useasianbreakrules/> <w:dontgrowautofit/> </w:Compatibility> <w:browserlevel>MicrosoftInternetExplorer4</w:BrowserLevel> </w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:latentstyles deflockedstate="false" latentstylecount="156"> </w:LatentStyles> </xml><![endif]--><style> <!-- /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-parent:""; margin:0in; margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-fareast-font-family:"Times New Roman";} @page Section1 {size:8.5in 11.0in; margin:1.0in 1.25in 1.0in 1.25in; mso-header-margin:.5in; mso-footer-margin:.5in; mso-paper-source:0;} div.Section1 {page:Section1;} --> </style><!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} </style> <![endif]--> <p class="MsoNormal" style="margin-left: 0.25in;"><b style=""><u>Jaundis ( sakit kuning )<o:p></o:p></u></b></p> <p class="MsoNormal" style="margin-left: 0.25in;"><o:p> </o:p></p> <p class="MsoNormal" style="margin-left: 0.25in;">Masalah ini tidak terdapat pada bayi ketika dia lahir, tetapi mula terjadi pada hari kedua atau ketiga dan menjadi semakin teruk pada akhir minggu pertama. Jaundis adalah satu keadaan di mana kulit dan mata putih bayi bertukar menjadi kuning. Warna tersebut sebenarnya terjadi apabila darah terkumpul dalam hati bayi yang belum cukup matang dan hati tersebut tidak berupaya memproses bahan kimia yang berwarna kuning yang dipanggil<span style=""> </span>bilirubin dengan cukup pantas.</p> <p class="MsoNormal" style="margin-left: 0.25in;"><o:p> </o:p></p> <p class="MsoNormal" style="margin-left: 0.25in;">Anda harus berjumpa dengan doctor untuk mengetahui tahap keseriusan keadaan jaundis ini. Bayi yang mengidap jaundis yang amat teruk akan dirawat di hospit l, biasanya melalui fototerapi atau proses menukar darah. Jaundis yang tidak begitu teruk adalah tidak merbahaya, biasanya dapat <span style=""> </span>dirawat di rumah dengan meletakkan bayi di tepi tingkap agar kulit bayi dapat disinari dengan cahaya matahari pagi untuk beberapa jam setiap hari.</p> <p class="MsoNormal" style="margin-left: 0.25in;"><o:p> </o:p></p> <p class="MsoNormal" style="margin-left: 0.25in;">Sebenarnya, bayi yang menyusu badan akan mneyebabkan masalah jaundis ini bertambah teruk. Bayi akan lambat sembuh dan akan mengidap jaundis untuk beberapa minggu. Namun, jika keadaan jaundis ini tidak begitu teruk, adalah selamat untuk meneruskan penyusuan susu ibu.</p> <span class="fullpost"></span>misibbhttp://www.blogger.com/profile/14827173537467932982noreply@blogger.com0tag:blogger.com,1999:blog-1717129759233064518.post-29794872940418185852010-03-23T13:43:00.005+08:002010-03-28T11:58:53.542+08:00Menguasai Asas-asas Kemahiran Penjagaan Bayi<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://1.bp.blogspot.com/_StW9Y6v_f4I/S6o04cI77II/AAAAAAAAACI/8tLStr-6XIQ/s1600/same.jpg"><img style="display: block; margin: 0px auto 10px; text-align: center; cursor: pointer; width: 400px; height: 96px;" src="http://1.bp.blogspot.com/_StW9Y6v_f4I/S6o04cI77II/AAAAAAAAACI/8tLStr-6XIQ/s400/same.jpg" alt="" id="BLOGGER_PHOTO_ID_5452228443116399746" border="0" /></a>
<br /><meta equiv="Content-Type" content="text/html; charset=utf-8"><meta name="ProgId" content="Word.Document"><meta name="Generator" content="Microsoft Word 11"><meta name="Originator" content="Microsoft Word 11"><link rel="File-List" href="file:///C:%5CUsers%5CADMIN%5CAppData%5CLocal%5CTemp%5Cmsohtml1%5C01%5Cclip_filelist.xml"><o:smarttagtype namespaceuri="urn:schemas-microsoft-com:office:smarttags" name="country-region"></o:smarttagtype><o:smarttagtype namespaceuri="urn:schemas-microsoft-com:office:smarttags" name="City"></o:smarttagtype><o:smarttagtype namespaceuri="urn:schemas-microsoft-com:office:smarttags" name="place"></o:smarttagtype><!--[if gte mso 9]><xml> <w:worddocument> <w:view>Normal</w:View> <w:zoom>0</w:Zoom> <w:punctuationkerning/> <w:validateagainstschemas/> <w:saveifxmlinvalid>false</w:SaveIfXMLInvalid> <w:ignoremixedcontent>false</w:IgnoreMixedContent> <w:alwaysshowplaceholdertext>false</w:AlwaysShowPlaceholderText> <w:compatibility> <w:breakwrappedtables/> <w:snaptogridincell/> <w:wraptextwithpunct/> <w:useasianbreakrules/> <w:dontgrowautofit/> </w:Compatibility> <w:browserlevel>MicrosoftInternetExplorer4</w:BrowserLevel> </w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:latentstyles deflockedstate="false" latentstylecount="156"> </w:LatentStyles> </xml><![endif]--><!--[if !mso]><object classid="clsid:38481807-CA0E-42D2-BF39-B33AF135CC4D" id="ieooui"></object> <style> st1\:*{behavior:url(#ieooui) } </style> <![endif]--><style> <!-- /* Font Definitions */ @font-face {font-family:Wingdings; panose-1:5 0 0 0 0 0 0 0 0 0; mso-font-charset:2; mso-generic-font-family:auto; mso-font-pitch:variable; mso-font-signature:0 268435456 0 0 -2147483648 0;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-parent:""; margin:0in; margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-fareast-font-family:"Times New Roman";} @page Section1 {size:8.5in 11.0in; margin:1.0in 1.25in 1.0in 1.25in; mso-header-margin:.5in; mso-footer-margin:.5in; mso-paper-source:0;} div.Section1 {page:Section1;} /* List Definitions */ @list l0 {mso-list-id:1407611096; mso-list-type:hybrid; mso-list-template-ids:-816797024 67698699 67698691 67698693 67698689 67698691 67698693 67698689 67698691 67698693;} @list l0:level1 {mso-level-number-format:bullet; mso-level-text:; mso-level-tab-stop:.5in; mso-level-number-position:left; text-indent:-.25in; font-family:Wingdings;} @list l1 {mso-list-id:2065984113; mso-list-type:hybrid; mso-list-template-ids:2042637500 67698689 67698691 67698693 67698689 67698691 67698693 67698689 67698691 67698693;} @list l1:level1 {mso-level-number-format:bullet; mso-level-text:; mso-level-tab-stop:.25in; mso-level-number-position:left; margin-left:.25in; text-indent:-.25in; font-family:Symbol;} ol {margin-bottom:0in;} ul {margin-bottom:0in;} --> </style><!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} table.MsoTableGrid {mso-style-name:"Table Grid"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; border:solid windowtext 1.0pt; mso-border-alt:solid windowtext .5pt; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-border-insideh:.5pt solid windowtext; mso-border-insidev:.5pt solid windowtext; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} </style> <![endif]--> <p class="MsoNormal" style="">Bab 1</p><p class="MsoNormal" style="">
<br /></p> <p class="MsoNormal" style=""><span style=""> </span></p> <p class="MsoNormal" style="text-align: left;">Menguasai Asas-asas Kemahiran Penjagaan Bayi</p><p class="MsoNormal" style="text-align: left;">
<br /></p> <p class="MsoNormal" style=""><o:p> </o:p></p> <p class="MsoNormal" style="">Jika bayi anda merupakan cahayamata pertama, tingkah laku bayi anda pada sekitar minggu pertama mungkin menjadi satu misteri kepada anda. Namun, lambat-laun anda akan mula memahami sikap dan tingkah lakunya. Kebanyakan ibu bapa, terutamanya bapa, berasa gentar untuk memegang bayi yang baru lahir kerana takut bayi akan terlepas dari pegangannya. Jadi , anda haruslah bersikap tenang kerana naluri dan sifat kasih sayang anda terhadap bayi akan menjadi panduan dalam membantu anda mengharungi pengalaman yang baru dan indah ini. Sebenarnya tidak sukar untuk menguasai asas-asas kemahiran penjagaan bayi. Justeru itulah, kami akan membantu anda dalam memberi pelbagai panduan berguna agar anda lebih mahir dan yakin dalam menjaga dan mengasuh anak anda.</p><p class="MsoNormal" style="">
<br /></p> <p class="MsoNormal" style=""><o:p> </o:p></p> <p class="MsoNormal" style=""><b style="">Cara Memegang Bayi</b></p><p class="MsoNormal" style="">
<br /><b style=""><o:p></o:p></b></p> <p class="MsoNormal" style=""><o:p> </o:p></p> <p class="MsoNormal" style="">Ia merupakan naluri semulajadi seorang ibu untuk mendukung bayinya rapat kea rah tubuh badannya, bercakap dengan lembut sambil merenung wajah dan matanya dengan penuh kasih sayang. Bayi yang baru lahir ini akan berasa lebih selesa apabila dia sentiasa didakap, belay dan dipeluk mesra. Pastikan anda mendakap erat dirinya, terutamanya pada minggu-minggu awal kehidupannya kerana ini akan membuatnya berasa selamat dan selesa ( sama ada dalam pelukan anda, pakaian atau kain selimut).</p> <p class="MsoNormal" style=""><o:p> </o:p></p> <p class="MsoNormal" style="">Jangan berasa takut untuk memegang bayi anda. Dia sebenarnya lebih kuat dari yang anda sangkakan. Yang perlu anda beri perhatian adalah kepalanya yang masih lagi lembut. Sehinggalah dia berusia lebih kurang 4 minggu, bayi tidak berupaya mengawal pergerakkan kepalanya. Jadi, pastikan anda sentiasa menyokong kepalanya. Apabila anda hendak meletakkannya pula, pastikan keseluruhan lengan anda menyokong tulang belakang, tengkuk dan kepalanya sehingga dia telah diletakkan dalam keadaan selamat di atas katilnya.</p> <p class="MsoNormal" style=""><o:p> </o:p></p> <p class="MsoNormal" style=""><o:p> </o:p></p> <p class="MsoNormal" style=""><o:p></o:p><u>
<br /></u></p><p class="MsoNormal" style=""><u>Tingkah laku dan tindakbalas refleks bayi “ kemahiran Semulajadi Bayi”<o:p></o:p></u></p> <p class="MsoNormal" style=""><o:p> </o:p></p> <p class="MsoNormal" style="">
<br /></p><p class="MsoNormal" style="">Semua bayi yang baru lahir mempunyai tindakbalas refleks atau tingkah laku semulajadi yang bertujuan untuk melindungi mereka. Tindakbalas refleks ini akan berlaku sehingga bayi dapat belajar dengan sendirinya, iaitu setelah bayi berusia 3 bulan. <st1:place st="on"><st1:city st="on">Ada</st1:city></st1:place> beberapa jenis tindakbalas refleks yang dapat dilihat dengan jelas sekali.</p> <p class="MsoNormal" style=""><o:p> </o:p></p> <p class="MsoNormal" style=""><u>
<br /></u></p><p class="MsoNormal" style=""><u>Kemahiran Semulajadi<o:p></o:p></u></p> <p class="MsoNormal" style=""><o:p> </o:p></p> <p class="MsoNormal" style="">
<br /></p><p class="MsoNormal" style=""><span style=""></span>
<br /></p> <p class="MsoNormal" style=""><o:p> </o:p></p> <table class="MsoTableGrid" style="width: 447.4pt; border-collapse: collapse; border: medium none;" border="1" cellpadding="0" cellspacing="0" width="597"> <tbody><tr style="height: 126.5pt;"> <td style="width: 111.85pt; border: 1pt solid windowtext; padding: 0in 5.4pt; height: 126.5pt;" valign="top" width="149"> <p class="MsoNormal" style=""><span style="font-weight: bold; color: rgb(102, 0, 0);">Refleks Perlecakkan</span>
<br /></p><p class="MsoNormal" style="">
<br /></p><p class="MsoNormal" style="">Jika anda menyentuh pipi bayi dengan hujung jari anda, dia akan memalingkan kepalanya kea rah rangsangan ini dan mulutnya juga akan turut terbuka. Refleks ini<span style=""> </span>memberi panduan kepada bayi untuk<span style=""> </span>memudahkannya mencari puting payudara anda untuk memulakan penyusuan.</p> </td> <td style="width: 111.85pt; border-width: 1pt 1pt 1pt medium; border-style: solid solid solid none; height: 126.5pt;color:windowtext windowtext windowtext -moz-use-text-color;" valign="top" width="149"> <p class="MsoNormal" style=""><span style="font-weight: bold; color: rgb(102, 0, 0);">Refleks Penyedutan</span>
<br /></p><p class="MsoNormal" style="">
<br /></p><p class="MsoNormal" style="">Setiap bayi yang baru dilahirkan mempunyai keupayaan untuk menghisap. Bayi akan <st1:country-region st="on">cuba</st1:country-region> menghisap apabila sesuatu <st1:country-region st="on">cuba</st1:country-region> dimasukkan ke dalam mulutnya atau jika anda <st1:country-region st="on"><st1:place st="on">cuba</st1:place></st1:country-region> menyentuh lelangitnya dengan hujung jari anda.</p> </td> <td style="width: 111.85pt; border-width: 1pt 1pt 1pt medium; border-style: solid solid solid none; height: 126.5pt;color:windowtext windowtext windowtext -moz-use-text-color;" valign="top" width="149"> <p class="MsoNormal" style=""><span style="font-weight: bold; color: rgb(102, 0, 0);">Refleks Pengenggaman</span>
<br /></p><p class="MsoNormal" style="">
<br /></p><p class="MsoNormal" style="">Bayi yang baru lahir akan mengenggam dengan kuat apabila sesuatu diletakkan di tapak tangannya secara automatic. Jika anda <st1:country-region st="on"><st1:place st="on">cuba</st1:place></st1:country-region> menyentuh kakinya pula, dia turut membalas seperti mahu menggenggam sesuatu.</p> </td> <td style="width: 111.85pt; border-width: 1pt 1pt 1pt medium; border-style: solid solid solid none; height: 126.5pt;color:windowtext windowtext windowtext -moz-use-text-color;" valign="top" width="149"> <p class="MsoNormal" style=""><span style="font-weight: bold; color: rgb(102, 0, 0);">Refleks Kejut/Moro</span>
<br /></p><p class="MsoNormal" style="">
<br /></p><p class="MsoNormal" style="">Sebagai tindakbalas terhadap bunyi yang kuat atau hentakan yang mengejut, kedua-dua belah kaki bayi akan terangkat dan kedua-dua belah tangannya akan turut terlempar kea rah sisi badannya. Jika ini terjadi, dakaplah bayi dengan erat agar dia berasa selamat dan selesa.</p> </td> </tr> </tbody></table> <p class="MsoNormal" style=""><o:p> </o:p></p> <p class="MsoNormal" style=""><o:p> </o:p></p> <p class="MsoNormal" style=""><o:p> </o:p></p> <p class="MsoNormal" style=""><o:p></o:p><b style="">
<br /></b></p><p class="MsoNormal" style=""><b style="">Penjagaan Pangkal Tali Pusat<o:p></o:p></b></p> <p class="MsoNormal" style=""><o:p> </o:p></p> <p class="MsoNormal" style="">
<br /></p><p class="MsoNormal" style="">Pangkal tali pusat akan kering dan tertanggal 1-3 minggu selepas bayi lahir. Anda harus memastikan bahagian tersebut sentiasa bersih dan kering. Anda mungkin dinasihatkan untuk hanya mengelap pangkal tali pusat tersebut dengan lembut iaitu dengan menggunakan ubat antiseptic dan kapas yang bersih. Anda tidak perlu menunggu hingga pangkal tali pusat itu tertanggal untuk memandikannya, asalkan anda sentiasa memastikan kawasan tersebut benar-benar telah dikeringkan sebaik sahaja anda selesai memandikannya.</p> <p class="MsoNormal" style=""><o:p> </o:p></p> <p class="MsoNormal" style="">Jika pangkal tali pusat itu merah dan membengkak, mintalah nasihat daripada doctor. Adalah perkara biasa jika terdapat sedikit pendarahan atau cecair keluar, tetapi ia sepatutnya hanya untuk beberapa hari sahaja.</p> <p class="MsoNormal" style=""><o:p> </o:p></p> <p class="MsoNormal" style=""><b style=""><o:p> </o:p></b></p> <p class="MsoNormal" style=""><b style=""><o:p> </o:p></b></p> <p class="MsoNormal" style=""><b style=""><o:p></o:p>
<br /></b></p><p class="MsoNormal" style=""><b style="">Mandi dan membersihkan bayi<o:p></o:p></b></p> <p class="MsoNormal" style=""><o:p> </o:p></p> <p class="MsoNormal" style="">
<br /></p><p class="MsoNormal" style="">Sebahagian daripada rutin harian anda ialah memastikan bayi anda sentiasa bersih. Dengan badannya yang masih kecil dan kelihatan halus dan lemah, pastinya pengalaman memandikan bayi buat pertama kalinya merupakan sesuatu yang mencabar. Namun, jika anda <st1:country-region st="on">cuba</st1:country-region> memperuntukkan masa selama stengah jam, menyediakan segala kelengkapan yang diperlukan dengan lebih awal dan <st1:place st="on"><st1:country-region st="on">cuba</st1:country-region></st1:place> bertenang, anda mungkin berasa seronok melakukannya. Lambat laun, ia akan menjadi rutin yang begitu mudah dan anda berasa amat yakin dan tidak kekok untuk melakukannya lagi.</p> <p class="MsoNormal" style=""><o:p> </o:p></p> <p class="MsoNormal" style=""><o:p> </o:p></p> <p class="MsoNormal" style=""><o:p> </o:p></p> <p class="MsoNormal" style=""><o:p></o:p>
<br /></p><p class="MsoNormal" style="">Panduan memandikan bayi:</p> <p class="MsoNormal" style=""><o:p>
<br /></o:p></p> <p class="MsoNormal" style=""><o:p> </o:p></p> <table class="MsoTableGrid" style="border-collapse: collapse; border: medium none;" border="1" cellpadding="0" cellspacing="0"> <tbody><tr style=""> <td style="width: 88.55pt; border: 1pt solid windowtext; padding: 0in 5.4pt;" valign="top" width="118"> <p class="MsoNormal" style="">1. Seelok-eloknya gunakan sebuah besen kecil. Sebelum meletakkan bayi di dalam air, periksa suhu air dengan siku anda. Ia tidak seharusnya terlalu panas atau terlalu sejuk.</p> </td> <td style="width: 88.55pt; border-width: 1pt 1pt 1pt medium; border-style: solid solid solid none; border-color: windowtext windowtext windowtext -moz-use-text-color; padding: 0in 5.4pt;" valign="top" width="118"> <p class="MsoNormal" style="">2. Kesemua kelengkapan untuk mandi hendaklah diletakkan di tempat yang mudah dicapai seperti:</p> <p class="MsoNormal" style="margin-left: 0.25in; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family:Symbol;"><span style="">·<span style="font: 7pt "Times New Roman";"> </span></span></span><!--[endif]-->Sabun<span style=""> </span>dan syampu bayi</p> <p class="MsoNormal" style="margin-left: 0.25in; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family:Symbol;"><span style="">·<span style="font: 7pt "Times New Roman";"> </span></span></span><!--[endif]-->Sehelai kain untuk mengelap bayi </p> <p class="MsoNormal" style="margin-left: 0.25in; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family:Symbol;"><span style="">·<span style="font: 7pt "Times New Roman";"> </span></span></span><!--[endif]-->Gumpalan kapas yang bersih untuk membersihkan mata bayi</p> <p class="MsoNormal" style="margin-left: 0.25in; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family:Symbol;"><span style="">·<span style="font: 7pt "Times New Roman";"> </span></span></span><!--[endif]-->Sehelai tuala</p> <p class="MsoNormal" style="margin-left: 0.25in; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family:Symbol;"><span style="">·<span style="font: 7pt "Times New Roman";"> </span></span></span><!--[endif]-->Pakaian dan lampin yang bersih</p> </td> <td style="width: 88.55pt; border-width: 1pt 1pt 1pt medium; border-style: solid solid solid none; border-color: windowtext windowtext windowtext -moz-use-text-color; padding: 0in 5.4pt;" valign="top" width="118"> <p class="MsoNormal" style="">3.Pastikan bilik mandi atau bilik anda sentiasa hangat. Tutup semua tingkap untuk mengelakkan tiupan angina yang kuat.</p> <p class="MsoNormal" style="">Tanggalkan semua pakaiannya dan balutkannya dengan tuala.</p> </td> <td style="width: 88.55pt; border-width: 1pt 1pt 1pt medium; border-style: solid solid solid none; border-color: windowtext windowtext windowtext -moz-use-text-color; padding: 0in 5.4pt;" valign="top" width="118"> <p class="MsoNormal" style="">4. Cuci mata dan basuh mukanya terlebih dahulu.</p> <p class="MsoNormal" style="">Celupkan gumpalan kapas di dalam air suam yang telah dimasak dan bersihkan kedua-dua belah matanya. Dengan lembut, usaplah mata bayi anda bermula dari bahagian sebelah hidung kearah bahagian pinggir luar mata.</p> <p class="MsoNormal" style="">Kemudian, gunakan gumpalan kapas bersih yang lain untuk mencuci mukanya.</p> </td> <td style="width: 88.6pt; border-width: 1pt 1pt 1pt medium; border-style: solid solid solid none; border-color: windowtext windowtext windowtext -moz-use-text-color; padding: 0in 5.4pt;" valign="top" width="118"> <p class="MsoNormal" style="">5.Seterusnya basuh rambut bayi. Gunakan tapak tangan anda untuk menyokong kepala dan bahagian bahu bayi. Rapatkan kepalanya dengan air mandi. Dengan lembut, cedokkan air mandi ke atas kulit kepala bayi dengan tangan anda.</p> <p class="MsoNormal" style="">Tuangkan sedikit syampu tanpa pewangi atau sabun bayi dan bilas dengan bersih. Pastikan rambutnya dikeringkan dengan baik.</p> </td> </tr> </tbody></table> <p class="MsoNormal" style=""><o:p>
<br /></o:p></p> <table class="MsoTableGrid" style="border-collapse: collapse; border: medium none;" border="1" cellpadding="0" cellspacing="0"> <tbody><tr style=""> <td style="width: 110.7pt; border: 1pt solid windowtext; padding: 0in 5.4pt;" valign="top" width="148"> <p class="MsoNormal" style="">6. Seterusnya tanggalkan tuala. Pangku bayi anda dengan menggunakan lengan. Pegang bahagian atas lengannya dengan ibu jari dan jari telunjuk anda. Sebenarnya, cara pegangan ini adalah untuk memastikan anda masih dapat memegang lengan bayi sekiranya bayi terlepas dari lengan anda.</p> </td> <td style="width: 110.7pt; border-width: 1pt 1pt 1pt medium; border-style: solid solid solid none; border-color: windowtext windowtext windowtext -moz-use-text-color; padding: 0in 5.4pt;" valign="top" width="148"> <p class="MsoNormal" style="">7. Letakkan bayi dalam posisi separuh tegak agar bahagian bawah tubuhnya terendam di dalam air dan pastikan kepala serta bahuya tidak berada di dalam air. </p> <p class="MsoNormal" style="">Gunakan tangan anda untuk membersihkan bayi. Mulakan dengan bahagian tubuh yang paling bersih kepada yang paling kotor. Berbual-bual dan senyum dengannya ketika memandikannya.</p> </td> <td style="width: 110.7pt; border-width: 1pt 1pt 1pt medium; border-style: solid solid solid none; border-color: windowtext windowtext windowtext -moz-use-text-color; padding: 0in 5.4pt;" valign="top" width="148"> <p class="MsoNormal" style="">8. Setelah bayi anda benar-benar bersih, pastikan anda sentiasa menyokong bahagian lehernya dan letakkan tangan anda di bawah punggungnya dan dengan perlahan-lahan angkat bayi anda dan balutkannya dengan tuala . Keringkannya dengan lembut.</p> </td> <td style="width: 110.7pt; border-width: 1pt 1pt 1pt medium; border-style: solid solid solid none; border-color: windowtext windowtext windowtext -moz-use-text-color; padding: 0in 5.4pt;" valign="top" width="148"> <p class="MsoNormal" style="">9. Anda harus mengeringkan kawasan sekitar pangkal tali pusatnya dengan baik. Kemudian cuci pangkal tali pusat dengan ubat antiseptic atau alcohol /spirit. Biarkan kawasan sekitar pangkal tali pusat terdedah dan elakkannya dari tergesel dengan kain lampin dengan memakaikan lampin di bawah pangkal tali pusat tersebut.</p> </td> </tr> </tbody></table> <p class="MsoNormal" style=""><o:p> </o:p></p> <p class="MsoNormal" style=""><o:p> </o:p></p> <p class="MsoNormal" style=""><o:p></o:p><b style="">
<br /></b></p><p class="MsoNormal" style=""><b style="">Amalan Pemakanan Bayi<o:p></o:p></b></p> <p class="MsoNormal" style=""><o:p> </o:p></p> <p class="MsoNormal" style="">
<br /></p><p class="MsoNormal" style="">Ingatlah bahawa asas atau tujuan pertama yang perlu anda ingat mengenai pemberian makanan kepada bayi adalah untuk memastikan yang bayi anda mendapat segala khasiat makanan yang diperlukan dan sentiasa sihat. Susu ibu merupakan makanan unggul untuk bayi. Namun, jika anda tidak dapat melakukannya atas sebarang alas an sekalipun, anda boleh memberinya susu melalui susu botol. Jangan berasa bersalah sekiranya anda telah membuat keputusan untuk memberinya susu botol, kerana apa jua pilihan anda samada menyusu badan atau menyusu botol adalah hak peribadi anda sendiri. Asalkan anda selesa dan yakin tentang pilihan anda, pengalaman memberi bayi anda makan adalah satu perkara yang amat inda dan membahagiakan.</p> <p class="MsoNormal" style=""><o:p> </o:p></p> <p class="MsoNormal" style=""><i style="">Pilihan peribadi anda…..<o:p></o:p></i></p> <p class="MsoNormal" style=""><o:p> </o:p></p> <p class="MsoNormal" style=""><b style=""><o:p> </o:p></b></p> <p class="MsoNormal" style=""><b style=""><o:p></o:p>
<br /></b></p><p class="MsoNormal" style=""><b style="">Penyusuan susu ibu<o:p></o:p></b></p> <p class="MsoNormal" style=""><o:p> </o:p></p> <p class="MsoNormal" style="">
<br /></p><p class="MsoNormal" style="">Penyusuan susu ibu adalah suatu anugerah alam semulajadi dan memang tidak dapat dinafikan bahawa susu ibu adalah sumber makanan yang terbaik bagi bayi. Malah, ia bukan sahaja mengandungi khasiat pemakanan yang sempurna untuk bayi, bahkan ia juga dapat melindungi bayi daripada jangkitan penyakit dan mengukuhkan jalinan kasih sayang antra ibu dan anak. Ini semua adalah amat penting untuk perkembangan psikologi bayi yang sihat. Kandungan susu ibu pula berubah setiap hari mengikut keperluan bayi, sejajar dengan perkembangan dan tumbesarannya.</p> <p class="MsoNormal" style=""><o:p> </o:p></p> <p class="MsoNormal" style=""><o:p> </o:p></p> <table class="MsoTableGrid" style="border-collapse: collapse; border: medium none; width: 466px; height: 217px;" border="1" cellpadding="0" cellspacing="0"> <tbody><tr style="height: 24pt;"> <td style="width: 167.7pt; border: 1pt solid windowtext; padding: 0in 5.4pt; height: 24pt;" valign="top" width="224"><div style="text-align: center;"> </div><p class="MsoNormal" style="color: rgb(51, 0, 51); font-weight: bold; text-align: center;"><i style="">Susu Ibu<o:p></o:p></i></p><div style="text-align: center;"> </div><p style="text-align: center;" class="MsoNormal"><i style=""><span style="color: rgb(51, 0, 51); font-weight: bold;">Apabila anda memangku bayi anda dan sebaik sahaja mulutnya melekap di sekeliling kawasan puting payudara (areola), bayi pun akan mula menyusu. Merujuk kepada gambarajah disebelah, anda dapat melihat yang mulut bayi anda seakan-akan memicit di kawasan pengumpulan susu tersebut ketika menghisap susu badan anda. Ini akan membolehkan putting payudara anda menjadi panjang sedikit dan susu akan mengalir keluar.</span><o:p></o:p></i></p> <p class="MsoNormal" style=""><o:p> </o:p></p> </td> </tr> </tbody></table> <p class="MsoNormal" style=""><o:p> </o:p></p> <p class="MsoNormal" style=""><o:p> </o:p></p> <p class="MsoNormal" style=""><i style=""><o:p> </o:p></i></p> <p class="MsoNormal" style=""><i style=""><o:p> </o:p></i></p> <p class="MsoNormal" style=""><i style=""><o:p> </o:p></i></p> <p class="MsoNormal" style=""><i style=""><o:p> </o:p></i></p> <p class="MsoNormal" style=""><i style=""><o:p> </o:p></i></p> <p class="MsoNormal" style=""><i style="">
<br /></i></p><p class="MsoNormal" style=""><i style=""><span style="color: rgb(102, 0, 0); font-weight: bold;">Bagaimana untuk menyusukan bayi?</span><o:p></o:p></i></p> <p class="MsoNormal" style=""><o:p> </o:p></p> <p class="MsoNormal" style="">Bayi yang menyusu badan harus disusukan apabila sahaja dia menginginkannya. Bayi menyusu lebih kurang 8-10 kali sehari. Lambat laun, bayi dapat menetapkan jadual penyusuannya sendiri di mana bilangan penyusuan setiap hari akan semakin berkurangan kepada 6-8 kali sehari. Walaubagaimanapun, setiap bayi mempunyai keperluan dan selera masing-masing. Maka, anda haruslah memerhatikan sebarang tanda yang menunjukkan bayi anda telah pun kenyang atau masih lapar. Misalnya, bayi yang telah kenyang akan kelihatan selesa, ceria dan tidak meragam selepas setiap penyusuan pada kedua-dua belah payudara selama 5-20 minit, membasahkan lampinnya sebanyak 6-8 kali sehari dan mempunyai pertambahan berat badan yang baik.</p> <p class="MsoNormal" style=""><o:p> </o:p></p> <p class="MsoNormal" style="">Jika bayi anda tidak mahu menghisap susu sebagaimana biasanya pada waktu pagi, maka anda haruslah memerah susu tersebut. Ini akan memastikan susu badan anda terus dapat dihasilkan dengan sempurna sepanjang hari itu. Jika anda tidak sihat atau tidak berada dirumah untuk menyusukan bayi, anda juga harus memerah susu agar susu dapat terus dihasilkan dengan sempurna.<o:p>
<br /></o:p></p> <p class="MsoNormal" style=""><b style=""><o:p> </o:p></b></p> <p class="MsoNormal" style=""><b style="">
<br /></b></p><p class="MsoNormal" style=""><b style="">Pemberian susu melalui botol: susu formula<o:p></o:p></b></p> <p class="MsoNormal" style=""><o:p> </o:p></p> <p class="MsoNormal" style="">
<br /></p><p class="MsoNormal" style="">Apabila anda telah membuat keputusan untuk memberi bayi anda susu botol, teruskannya dan jangan berasa bersalah. Walaubagaimanapun, adalah disarankan agar anda meminta nasihat doctor terlebih dahulu sebelum memilih susu formula untuk bayi anda.</p> <p class="MsoNormal" style=""><o:p> </o:p></p> <table class="MsoTableGrid" style="border-collapse: collapse; border: medium none; width: 502px; height: 89px; font-style: italic; color: rgb(51, 0, 51); font-weight: bold;" border="1" cellpadding="0" cellspacing="0"> <tbody><tr style="height: 35.2pt;"> <td style="width: 194.75pt; border: 1pt solid windowtext; padding: 0in 5.4pt; height: 35.2pt;" valign="top" width="260"><div style="text-align: center;"> </div><p style="text-align: center;" class="MsoNormal">Pemberian susu melalui botol</p><div style="text-align: center;"> </div><p style="text-align: center;" class="MsoNormal">Sentiasa pastikan susu dengan cara memegang dengan betul. Jika tidak, bayi akan menyedut udara bersama-sama dengan susu.</p> </td> </tr> </tbody></table> <p class="MsoNormal" style=""><o:p> </o:p></p> <p class="MsoNormal" style=""><b style="">
<br /></b></p><p class="MsoNormal" style=""><b style="">Penyediaan susu formula<o:p></o:p></b></p> <p class="MsoNormal" style=""><o:p> </o:p></p> <p class="MsoNormal" style="">
<br /></p><p class="MsoNormal" style="">Setelah anda memilih untuk menggunakan susu formula untuk bayi anda, ada beberapa perkara yang perlu anda patuhi, misalnya kebersihan dan cara penyediaan susu formula tersebut. Kesemua perkakas termasuklah botol, putting susu perlu dibersihkan dan disteril dengan sempurna. Anda harus mematuhi arahan yang ditunjukkan dalam jadual yang terdapat pada tin susu tersebut dalam menyediakan susu formula untuk<span style=""> </span>bayi anda. Sebaik sahaja anda telah membancuhnya, berikan susu tersebut kepada bayi anda dengan segera. Susu yang tidak habis diminum, haruslah dibuang. Susu yang telah dibancuh dan diletakkan dam suhu bilik lebih daripada 1 jam adalah tidak digalakkan kerana ia boleh merangsang pertumbuhan bacteria.</p> <p class="MsoNormal" style=""><o:p> </o:p></p> <p class="MsoNormal" style=""><o:p>
<br /></o:p></p> <p class="MsoNormal" style=""><b style="">Bercerai susu<o:p></o:p></b></p> <p class="MsoNormal" style=""><o:p> </o:p></p> <p class="MsoNormal" style="">
<br /></p><p class="MsoNormal" style="">Selain dari susu, bayi juga memerlukan makanan pejal, di mana ini adalah peringkat pemberian makanan seterusnya yang dipanggil “ bercerai susu “. Bercerai susu bermaksud mencampurkan susu dengan sebarang makanan pejal. Namun, susu masih merupakan sebahagian penting dalam diet harian bayi anda. Makanan pejal haruslah diperkenalkan secara perlahan-lahan. Kebanyakan bayi selamat untuk diberi makanan pejal seawall usianya 4 bulan. Namun, tidak ada kebaikan jika anda mula memberi bayi anda makanan pejal pada usia kurang 4 bulan. Bukan sahaja makanan tersebut tidak dapat dihadam dengan baik, malah akan memberi tekanan kepada ginjal bayi yang masih belum cukup matang. Kajian terbaru mengatakan bayi mungkin kurang mendapat alahan terhadap makanan jika pemberian makanan pejal ditangguhkan sehingga bayi mencecah usia 6 bulan.</p> <p class="MsoNormal" style=""><o:p> </o:p></p> <p class="MsoNormal" style="">Setiap bayi merupakan individu yang berbeza dan istimewa. Usah risau jika bayi anda makan lambat atau lebih cepat daripada yang dijadualkan ATAU dia makan sedikit atau lebih banyak dari bayi lain. Berilah bayi anda makan mengikut ketetapan dan keupayaannya yang tersendiri. Jangan sekali-sekali memaksa bayi anda mengikut kemahuan anda dan memaksanya makan. Makanan baru perlu diperkenalkan secara perlahan-lahan dan tidak harus diberikan sekaligus.</p> <p class="MsoNormal" style="">Ini adalah untuk memberi peluang bayi menyesuaikan dirinya dengan makanan baru dan juga memudahkan anda untuk mengesan kembali makanan yang menyebabkan alahan kepadanya. Mulakan dengan memberi 1-2 sudu the makanan disamping terus memberikannya susu seperti mana biasa. Lambat laun, jumlah susu yang diminumnya akan berkurangan apabila anda meningkatkan pemberian makanan pejal kepadanya. Adalah sesuatu yang sukar untuk menentukan banyak mana bayi anda perlu makan kerana setiap bayi mempunyai selera dan keperluan yang brbeza. Anda adalah orang yang terbaik untuk menilai sebanyak mana yang bayi anda mahukan.</p> <p class="MsoNormal" style=""><u>
<br /></u></p><p class="MsoNormal" style=""><u>
<br /></u></p><p class="MsoNormal" style=""><u>Panduan untuk memperkenalkan makanan pejal<o:p></o:p></u></p> <p class="MsoNormal" style=""><u><o:p><span style="text-decoration: none;"> </span></o:p></u></p> <p class="MsoNormal" style="">
<br /></p><p class="MsoNormal" style="">Umur<span style=""> </span>Makanan pejal yang ideal<span style=""> </span>Tekstur / Rupa bentuk makanan</p><p class="MsoNormal" style="">
<br /></p> <table class="MsoTableGrid" style="border-collapse: collapse; border: medium none;" border="1" cellpadding="0" cellspacing="0"> <tbody><tr style=""> <td style="width: 2.05in; border: 1pt solid windowtext; padding: 0in 5.4pt; font-weight: bold; color: rgb(51, 0, 51);" valign="top" width="197"> <p class="MsoNormal" style="">Pada peringkat awal-</p> <p class="MsoNormal" style="">4 bulan</p> </td> <td style="width: 2.05in; border-width: 1pt 1pt 1pt medium; border-style: solid solid solid none; border-color: windowtext windowtext windowtext -moz-use-text-color; padding: 0in 5.4pt;" valign="top" width="197"> <p class="MsoNormal" style="">Buah-buahan dansayur-sayuran dimasak; bijirin nasi tanpa gluten (diperkaya dengan zat besi)</p> </td> <td style="width: 2.05in; border-width: 1pt 1pt 1pt medium; border-style: solid solid solid none; border-color: windowtext windowtext windowtext -moz-use-text-color; padding: 0in 5.4pt;" valign="top" width="197"> <p class="MsoNormal" style="">Dikisar dan dipotong halus, ditapis, mkanan lembik dan lembut ( separa cecair)</p> </td> </tr> <tr style=""> <td style="width: 2.05in; border-width: medium 1pt 1pt; border-style: none solid solid; border-color: -moz-use-text-color windowtext windowtext; padding: 0in 5.4pt; font-weight: bold; color: rgb(51, 0, 51);" valign="top" width="197"> <p class="MsoNormal" style="">5-6 bulan</p> </td> <td style="width: 2.05in; border-width: medium 1pt 1pt medium; border-style: none solid solid none; border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; padding: 0in 5.4pt;" valign="top" width="197"> <p class="MsoNormal" style="">Perkenalkan kanji atau bubur nasi yang lembik dicampur dengan daging atau kacang panjang, tauhu dan kacang pis. Jus buah-buahan yang telah dicairkan. Biskut rusk dan roti lembut ( untuk merangsang dia supaya mengunyah)</p> </td> <td style="width: 2.05in; border-width: medium 1pt 1pt medium; border-style: none solid solid none; border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; padding: 0in 5.4pt;" valign="top" width="197"> <p class="MsoNormal" style="">Dilenyek, dipotong nipis dan halus.</p> <p class="MsoNormal" style="">Apabila gigi telah tumbuh, perkenalkan makanan yang boleh dikunyah.</p> </td> </tr> <tr style=""> <td style="width: 2.05in; border-width: medium 1pt 1pt; border-style: none solid solid; border-color: -moz-use-text-color windowtext windowtext; padding: 0in 5.4pt; font-weight: bold; color: rgb(51, 0, 51);" valign="top" width="197"> <p class="MsoNormal" style="">7-8 bulan</p> </td> <td style="width: 2.05in; border-width: medium 1pt 1pt medium; border-style: none solid solid none; border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; padding: 0in 5.4pt;" valign="top" width="197"> <p class="MsoNormal" style="">Perkenalkan bubur nasi yang lebih kasar, mee , macaroni atau meehoon yang telah dilenyek, ikan bilis yang ditumbuk lumat. Hati , daging ayam tanpa kulit, ikan bilis yang dimasak, kuning telur ( apabila usianya 8 bulan)</p> </td> <td style="width: 2.05in; border-width: medium 1pt 1pt medium; border-style: none solid solid none; border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; padding: 0in 5.4pt;" valign="top" width="197"> <p class="MsoNormal" style="">Tekstur makanan yang lebih kasar. Dilenyek dan ditumbuk lumat.</p> </td> </tr> <tr style=""> <td style="width: 2.05in; border-width: medium 1pt 1pt; border-style: none solid solid; border-color: -moz-use-text-color windowtext windowtext; padding: 0in 5.4pt; font-weight: bold; color: rgb(51, 0, 51);" valign="top" width="197"> <p class="MsoNormal" style="">9-12 bulan</p> </td> <td style="width: 2.05in; border-width: medium 1pt 1pt medium; border-style: none solid solid none; border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; padding: 0in 5.4pt;" valign="top" width="197"> <p class="MsoNormal" style="">Mula memperkenalkan makanan yang boleh dipegang, misalnya potongan kecil buah-buahan atau sayur-sayuran yang telah dimasak.</p> <p class="MsoNormal" style="">Apabila usianya mencecah 10 bulan, bayi boleh memakan makanan yang sama seperti ahli keluarga lain.</p> </td> <td style="width: 2.05in; border-width: medium 1pt 1pt medium; border-style: none solid solid none; border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; padding: 0in 5.4pt;" valign="top" width="197"> <p class="MsoNormal" style="">Makanan yang mudah dipegang dengan jarinya, kepingan-kepingan kecil, emping. Makanan tidak perlu lagi dilenyek.</p> </td> </tr> </tbody></table> <p class="MsoNormal" style=""><o:p> </o:p></p> <p class="MsoNormal" style=""><o:p> </o:p></p> <p class="MsoNormal" style=""><b style="">
<br /></b></p><p class="MsoNormal" style=""><b style="">Membuang Air Besar<o:p></o:p></b></p> <p class="MsoNormal" style=""><o:p> </o:p></p> <p class="MsoNormal" style="">
<br /></p><p class="MsoNormal" style="">Najis pertama bayi dipanggil mekonium. Ia berwarna hijau pekat kehitam-hitaman. Apabila bayi anda telah mula menyusu atau makan, najisnya akan bertukar kepada kuning, coklat atau hijau.</p> <p class="MsoNormal" style=""><o:p> </o:p></p> <p class="MsoNormal" style="">Jika bayi anda sihat, ceria dan berat badannya bertambah dengan baik, jangan terlalu resah memikirkan tentang masalah pembuangan air besarnya. Kekerapan bayi membuang air besar adalah amat berbeza antara bayi-bayi yang lain, tetapi kekerapannya akan berkurangan apabila dia semakin membesar.</p> <p class="MsoNormal" style=""><o:p> </o:p></p> <p class="MsoNormal" style="">Najis bayi biasanya cair. Bayi yang menyusu badan akan membuang air besar dengan lebih kerap dan najisnya lebih cair dan berwarna kuning. Kadang-kadang bayi tidak membuang air besar selama 1-3 hari kerana dia telah menyerap kesemua susu ibunya, maka dia tidak perlu membuang air besar dengan kerap. Namun, perkara ini tidak harus disalahertikan dan mengatakan bayi anda mengalami sembelit. Walaubagaimanapun, jika najis bayi anda terlalu cair, berwarna hijau dan berbau busuk, ini mungkin tanda-tanda dia menghidap cirit-birit. Segeralah berjumpa doctor.</p> <p class="MsoNormal" style=""><o:p> </o:p></p> <p class="MsoNormal" style="">Najis bayi yang menghisap susu botol pula adalah lebih keras, berwarna lebih coklat, berbau lebih busuk berbanding bayi yang diberi susu ibu. Untuk melembutkan najis, adalah amat penting bayi diberi minum lebih banyak air di antara masa penyusuan. Jus buah-buahan yang telah dicairkan boleh diberi kepada Bayi yang telah berusia beberapa bulan.</p> <p class="MsoNormal" style=""><o:p> </o:p></p> <p class="MsoNormal" style="">Sembelit atau dengan perkataan lain “ najis yang keras dan bayi jarang membuang air besar” adalah perkara biasa dalam kehidupan awal bayi. Bayi yang jarang membuang air besar bermaksud dia tidak membuang air besar lebih daripada 3-4 hari dan najisnya sangat keras dan menyebabkan dia berasa tidak selesa dan sakit. Biasanya jika bayi kelihatan sangat sukar untuk meneran ketika membuang air besar dan berasa sakit, berjumpalah dengan doctor dan ketahui sama ada ubat julap diperlukan atau tidak. Walaubagaimanapun,dalam kebanyakan kes, masalah ini dapat diatasi dengan memberi lebih banyak air atau cecair kepada bayi anda.</p> <p class="MsoNormal" style=""><o:p> </o:p></p> <p class="MsoNormal" style=""><o:p>
<br /></o:p></p> <p class="MsoNormal" style=""><b style="">Corak Tidur Bayi<o:p></o:p></b></p> <p class="MsoNormal" style=""><o:p> </o:p></p> <p class="MsoNormal" style="">
<br /></p><p class="MsoNormal" style="">Bayi yang baru lahir menghabiskan kebanyakan masanya dengan tidur. Namun, apabila dia semakin membesar, dia dapat menentukan corak tidurnya secara tetap. Melainkan bayi anda berasa lapar, sejuk atau tidak selesa, dia akan menghabiskan masa di antara waktu penyusuannya dengan tidur. Ini mungkin mengambil masa selama 22 jam dalam satu hari. Namun, setiap bayi mempunyai corak tidu yang berbeza dan sesetengah bayi yang baru lahir akan terjaga pada tempoh yang lebih lama dan tidak akan meragam.</p> <p class="MsoNormal" style=""><o:p> </o:p></p> <p class="MsoNormal" style="">Walaupun bayi anda akan mempunyai corak tidurnya yang tersendiri, adalah penting untuk anda membantu bayi agar dapat membezakan antara siang dan malam; dengan menggunakan lampu malap di dalam bilik ketika bayi sedang tidur.</p> <p class="MsoNormal" style=""><o:p> </o:p></p> <p class="MsoNormal" style=""><st1:place st="on"><st1:country-region st="on">Cuba</st1:country-region></st1:place> tidurkan bayi anda pada masa yang sama pada setiap hari. Ini dapat membantu bayi menyesuaikan dirinya dengan rutin yang tetap dan lambat laun bayi anda akan terjaga dari tidur pada waktu yang sama setiap hari. Adalah disyorkan agar bayi anda tidur mengiring atau melenting untuk mengurangkan risiko bayi lemas. Bayi yang baru lahir tidak seharusnya diberikan bantal.</p> <p class="MsoNormal" style=""><o:p> </o:p></p> <p class="MsoNormal" style="">Asalkan bayi anda hendak menyusu dan membesar dengan normal, ini bermakna dia telah mendapat tidur yang secukupnya.</p> <p class="MsoNormal" style=""><i style="">Menangis… apakah ertinya?<o:p></o:p></i></p> <p class="MsoNormal" style=""><o:p> </o:p></p> <p class="MsoNormal" style="">Bentuk komunikasi pada bayi yang baru lahir adalah sangat terhad. Maka, satu-satunya bentuk komunikasi yang paling awal adalah menangis.</p> <p class="MsoNormal" style=""><o:p> </o:p></p> <p class="MsoNormal" style="">Bagaimana bayi menangis adalah berbeza antara satu sama lain, tetapi mengapa mereka menangis adalah sentiasa disebabkan oleh alas an yang serupa, iaitu “ mereka memerlukan sesuatu “. Berikut adalah beberapa sebab mengapa bayi anda menangis :</p> <p class="MsoNormal" style=""><o:p> </o:p></p> <p class="MsoNormal" style="margin-left: 0.5in; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family:Wingdings;"><span style="">Ø<span style="font: 7pt "Times New Roman";"> </span></span></span><!--[endif]-->Lapar </p> <p class="MsoNormal" style="margin-left: 0.5in; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family:Wingdings;"><span style="">Ø<span style="font: 7pt "Times New Roman";"> </span></span></span><!--[endif]-->Tidak sihat</p> <p class="MsoNormal" style="margin-left: 0.5in; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family:Wingdings;"><span style="">Ø<span style="font: 7pt "Times New Roman";"> </span></span></span><!--[endif]-->Kembung perut</p> <p class="MsoNormal" style="margin-left: 0.5in; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family:Wingdings;"><span style="">Ø<span style="font: 7pt "Times New Roman";"> </span></span></span><!--[endif]-->Lampin basah atau kotor</p> <p class="MsoNormal" style="margin-left: 0.5in; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family:Wingdings;"><span style="">Ø<span style="font: 7pt "Times New Roman";"> </span></span></span><!--[endif]-->Tidak berasa selesa</p> <p class="MsoNormal" style="margin-left: 0.5in; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family:Wingdings;"><span style="">Ø<span style="font: 7pt "Times New Roman";"> </span></span></span><!--[endif]-->Terlalu panas atau sejuk</p> <p class="MsoNormal" style="margin-left: 0.5in; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family:Wingdings;"><span style="">Ø<span style="font: 7pt "Times New Roman";"> </span></span></span><!--[endif]-->Rasa sunyi, atau bosan, ingin dibelai dan didakap</p> <p class="MsoNormal" style="margin-left: 0.5in; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family:Wingdings;"><span style="">Ø<span style="font: 7pt "Times New Roman";"> </span></span></span><!--[endif]-->Penat , ingin tidur</p> <p class="MsoNormal" style="margin-left: 0.5in; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family:Wingdings;"><span style="">Ø<span style="font: 7pt "Times New Roman";"> </span></span></span><!--[endif]-->Terkejut atau takut</p> <p class="MsoNormal" style=""><o:p> </o:p></p> <p class="MsoNormal" style="font-style: italic; font-weight: bold; color: rgb(51, 0, 51);">Ibu bapa adalah dinasihatkan untuk belajar memahami corak tangisan bayi, kerana ia merupakan langkah yang amat penting untuk memahami keperluan bayi.</p> <p class="MsoNormal" style=""><o:p> </o:p></p> <p class="MsoNormal" style=""><o:p> </o:p></p> <p class="MsoNormal" style=""><o:p> </o:p></p> <p class="MsoNormal" style=""><o:p> </o:p></p> <span class="fullpost"></span>misibbhttp://www.blogger.com/profile/14827173537467932982noreply@blogger.com0tag:blogger.com,1999:blog-1717129759233064518.post-37662486432054046252010-03-09T18:00:00.003+08:002010-03-09T18:10:09.934+08:00KERIANGAN MEMBELAI CAHAYAMATA ANDA...<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://4.bp.blogspot.com/_StW9Y6v_f4I/S5YeMceqfSI/AAAAAAAAACA/Ai30YtEdnI0/s1600-h/picbb.jpg"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 300px;" src="http://4.bp.blogspot.com/_StW9Y6v_f4I/S5YeMceqfSI/AAAAAAAAACA/Ai30YtEdnI0/s400/picbb.jpg" alt="" id="BLOGGER_PHOTO_ID_5446573998503263522" border="0" /></a>
<br /><meta equiv="Content-Type" content="text/html; charset=utf-8"><meta name="ProgId" content="Word.Document"><meta name="Generator" content="Microsoft Word 11"><meta name="Originator" content="Microsoft Word 11"><link rel="File-List" href="file:///C:%5CUsers%5CADMIN%5CAppData%5CLocal%5CTemp%5Cmsohtml1%5C01%5Cclip_filelist.xml"><!--[if gte mso 9]><xml> <w:worddocument> <w:view>Normal</w:View> <w:zoom>0</w:Zoom> <w:punctuationkerning/> <w:validateagainstschemas/> <w:saveifxmlinvalid>false</w:SaveIfXMLInvalid> <w:ignoremixedcontent>false</w:IgnoreMixedContent> <w:alwaysshowplaceholdertext>false</w:AlwaysShowPlaceholderText> <w:compatibility> <w:breakwrappedtables/> <w:snaptogridincell/> <w:wraptextwithpunct/> <w:useasianbreakrules/> <w:dontgrowautofit/> </w:Compatibility> <w:browserlevel>MicrosoftInternetExplorer4</w:BrowserLevel> </w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:latentstyles deflockedstate="false" latentstylecount="156"> </w:LatentStyles> </xml><![endif]--><style> <!-- /* Font Definitions */ @font-face {font-family:Wingdings; panose-1:5 0 0 0 0 0 0 0 0 0; mso-font-charset:2; mso-generic-font-family:auto; mso-font-pitch:variable; mso-font-signature:0 268435456 0 0 -2147483648 0;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-parent:""; margin:0in; margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-fareast-font-family:"Times New Roman";} @page Section1 {size:8.5in 11.0in; margin:1.0in 1.25in 1.0in 1.25in; mso-header-margin:.5in; mso-footer-margin:.5in; mso-paper-source:0;} div.Section1 {page:Section1;} /* List Definitions */ @list l0 {mso-list-id:1088772112; mso-list-type:hybrid; mso-list-template-ids:689577820 67698689 67698691 67698693 67698689 67698691 67698693 67698689 67698691 67698693;} @list l0:level1 {mso-level-number-format:bullet; mso-level-text:; mso-level-tab-stop:.5in; mso-level-number-position:left; text-indent:-.25in; font-family:Symbol;} @list l1 {mso-list-id:1162887842; mso-list-type:hybrid; mso-list-template-ids:-80192346 67698689 67698691 67698693 67698689 67698691 67698693 67698689 67698691 67698693;} @list l1:level1 {mso-level-number-format:bullet; mso-level-text:; mso-level-tab-stop:.5in; mso-level-number-position:left; text-indent:-.25in; font-family:Symbol;} @list l2 {mso-list-id:1777865572; mso-list-type:hybrid; mso-list-template-ids:293120624 67698689 67698691 67698693 67698689 67698691 67698693 67698689 67698691 67698693;} @list l2:level1 {mso-level-number-format:bullet; mso-level-text:; mso-level-tab-stop:.5in; mso-level-number-position:left; text-indent:-.25in; font-family:Symbol;} ol {margin-bottom:0in;} ul {margin-bottom:0in;} --> </style><!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} </style> <![endif]--> <p class="MsoNormal" style="text-align: center;" align="center"><b style=""><i style="">“Caring Nurses For You and Your Baby”<o:p></o:p></i></b></p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal" style="text-align: center;" align="center"><i style="">Keriangan Membelai Cahayamata anda….<o:p></o:p></i></p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal">Dalam Episod kali ini saya akan menerangkan tentang penjagaan bayi seharian.</p> <p class="MsoNormal">Ada 3 Bab utama asas penjagaan Bayi</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal">Kandungan:-</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal">Bab 1: Menguasai asas-asas kemahiran penjagaan bayi</p> <p class="MsoNormal"><o:p> </o:p></p> <ul style="margin-top: 0in;" type="disc"><li class="MsoNormal" style="">Cara memegang bayi</li><li class="MsoNormal" style="">Tingkah laku dan tindakbalas refleks bayi “ Kemajuan Semulajadi Bayi”</li><li class="MsoNormal" style="">Penjagaan pangkal tali pusat</li><li class="MsoNormal" style="">Mandi dan membersihkan bayi</li><li class="MsoNormal" style="">Amalan pemakanan bayi</li><li class="MsoNormal" style="">Membuang air besar</li><li class="MsoNormal" style="">Corak tidur bayi</li><li class="MsoNormal" style="">Menangis…apakah ertinya?</li></ul> <p class="MsoNormal" style="margin-left: 0.25in;"><o:p> </o:p></p> <p class="MsoNormal">Bab 2: Masalah-masalah biasa yang dihadapi oleh bayi yang baru lahir</p> <ul style="margin-top: 0in;" type="disc"><li class="MsoNormal" style="">Sedu</li><li class="MsoNormal" style="">Kembung perut</li><li class="MsoNormal" style="">Muntah / tumpah susu</li><li class="MsoNormal" style="">Kulit kepala berkerak</li><li class="MsoNormal" style="">Ruam</li><li class="MsoNormal" style="">Jaundis ( sakit kuning )</li></ul> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal">Bab 3: Perkembangan Awal Bayi</p> <ul style="margin-top: 0in;" type="disc"><li class="MsoNormal" style="">Perkembangan fizikal</li><li class="MsoNormal" style="">Perkembangan mental dan social</li></ul> <p class="MsoNormal"><o:p> </o:p></p> <span class="fullpost"></span>misibbhttp://www.blogger.com/profile/14827173537467932982noreply@blogger.com1tag:blogger.com,1999:blog-1717129759233064518.post-24983990597876011042010-03-09T17:52:00.002+08:002010-03-09T17:54:15.052+08:00NURSING PROTOCOLS (PART ONE )<div class="MsoNormal"><p><b>PHYSICAL FACILITIES IN ICU</b></p></div><ol start="1" style="margin-top: 0in;" type="1"><li class="MsoNormal">Bed requirements</li><ul style="margin-top: 0in;" type="disc"><li class="MsoNormal">Number of ICU beds per hospital should depend on type of services available in the hospital as well as the needs of the community.</li><li class="MsoNormal">Ranges from 2-6% of total number of hospital beds</li></ul></ol><div class="MsoNormal"><p><br /></p></div><ol start="2" style="margin-top: 0in;" type="1"><li class="MsoNormal">working area about 200sq. ft/bed.</li><li class="MsoNormal">Open concept is highly preferred.</li><li class="MsoNormal">placing of bed in semi-circular position.</li><ul style="margin-top: 0in;" type="disc"><li class="MsoNormal">All patients can be viewed from the nursing station.</li></ul></ol><div class="MsoNormal"><p><br /></p></div><ol start="5" style="margin-top: 0in;" type="1"><li class="MsoNormal">Windows located near the bed.</li><li class="MsoNormal">Day light in ICU.</li><li class="MsoNormal">Nursing station with central monitor ( optional ).</li><li class="MsoNormal">Sister’s office.</li><li class="MsoNormal">Male and female changing room with toilet and shower facilities.</li><li class="MsoNormal">Common rest rooms.</li><li class="MsoNormal">Treatment / preparation room.</li><li class="MsoNormal">Mini laboratory for essential test e.g. ABG, BUSE.</li><li class="MsoNormal">Sluice room.</li><li class="MsoNormal">Pantry.</li><li class="MsoNormal">Reception / conference room and library.</li><li class="MsoNormal">Waiting room for immediate family members.</li><li class="MsoNormal">Store room</li><li class="MsoNormal">Isolation room.</li><li class="MsoNormal">Doctor’s room.</li><li class="MsoNormal">Family waiting room.</li></ol><div class="MsoNormal"><p><br /></p></div>misibbhttp://www.blogger.com/profile/14827173537467932982noreply@blogger.com0tag:blogger.com,1999:blog-1717129759233064518.post-73659615376792234492010-03-09T00:11:00.004+08:002010-03-09T12:18:59.044+08:00Panduan Penting Untuk Anda dan Bayi<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://3.bp.blogspot.com/_StW9Y6v_f4I/S5XMA3GUbHI/AAAAAAAAAB4/AB4ipVPePLI/s1600-h/life.jpg"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 300px;" src="http://3.bp.blogspot.com/_StW9Y6v_f4I/S5XMA3GUbHI/AAAAAAAAAB4/AB4ipVPePLI/s400/life.jpg" alt="" id="BLOGGER_PHOTO_ID_5446483639537003634" border="0" /></a>
<br /><meta equiv="Content-Type" content="text/html; charset=utf-8"><meta name="ProgId" content="Word.Document"><meta name="Generator" content="Microsoft Word 11"><meta name="Originator" content="Microsoft Word 11"><link rel="File-List" href="file:///C:%5CUsers%5CADMIN%5CAppData%5CLocal%5CTemp%5Cmsohtml1%5C01%5Cclip_filelist.xml"><o:smarttagtype namespaceuri="urn:schemas-microsoft-com:office:smarttags" name="place"></o:smarttagtype><o:smarttagtype namespaceuri="urn:schemas-microsoft-com:office:smarttags" name="country-region"></o:smarttagtype><!--[if gte mso 9]><xml> <w:worddocument> <w:view>Normal</w:View> <w:zoom>0</w:Zoom> <w:punctuationkerning/> <w:validateagainstschemas/> <w:saveifxmlinvalid>false</w:SaveIfXMLInvalid> <w:ignoremixedcontent>false</w:IgnoreMixedContent> <w:alwaysshowplaceholdertext>false</w:AlwaysShowPlaceholderText> <w:compatibility> <w:breakwrappedtables/> <w:snaptogridincell/> <w:wraptextwithpunct/> <w:useasianbreakrules/> <w:dontgrowautofit/> </w:Compatibility> <w:browserlevel>MicrosoftInternetExplorer4</w:BrowserLevel> </w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:latentstyles deflockedstate="false" latentstylecount="156"> </w:LatentStyles> </xml><![endif]--><!--[if !mso]><object classid="clsid:38481807-CA0E-42D2-BF39-B33AF135CC4D" id="ieooui"></object> <style> st1\:*{behavior:url(#ieooui) } </style> <![endif]--><style> <!-- /* Font Definitions */ @font-face {font-family:Wingdings; panose-1:5 0 0 0 0 0 0 0 0 0; mso-font-charset:2; mso-generic-font-family:auto; mso-font-pitch:variable; mso-font-signature:0 268435456 0 0 -2147483648 0;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-parent:""; margin:0in; margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-fareast-font-family:"Times New Roman";} @page Section1 {size:8.5in 11.0in; margin:1.0in 1.25in 1.0in 1.25in; mso-header-margin:.5in; mso-footer-margin:.5in; mso-paper-source:0;} div.Section1 {page:Section1;} /* List Definitions */ @list l0 {mso-list-id:717244099; mso-list-type:hybrid; mso-list-template-ids:-437362794 67698699 67698691 67698693 67698689 67698691 67698693 67698689 67698691 67698693;} @list l0:level1 {mso-level-number-format:bullet; mso-level-text:; mso-level-tab-stop:.5in; mso-level-number-position:left; text-indent:-.25in; font-family:Wingdings;} @list l1 {mso-list-id:1100560901; mso-list-type:hybrid; mso-list-template-ids:406983728 67698699 67698691 67698693 67698689 67698691 67698693 67698689 67698691 67698693;} @list l1:level1 {mso-level-number-format:bullet; mso-level-text:; mso-level-tab-stop:.5in; mso-level-number-position:left; text-indent:-.25in; font-family:Wingdings;} @list l2 {mso-list-id:1691641046; mso-list-type:hybrid; mso-list-template-ids:1564227176 67698699 67698691 67698693 67698689 67698691 67698693 67698689 67698691 67698693;} @list l2:level1 {mso-level-number-format:bullet; mso-level-text:; mso-level-tab-stop:.5in; mso-level-number-position:left; text-indent:-.25in; font-family:Wingdings;} ol {margin-bottom:0in;} ul {margin-bottom:0in;} --> </style><!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} </style> <![endif]--> <p class="MsoNormal"><b style="">Untuk Ibu –ibu Mengandung<o:p></o:p></b></p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal"><span class="fullpost"></span>Apabila anda dianugerahkan tanggungjawab sebagai seorang ibu, anda pasti risau tentang kesihatan dan perkembangan minda si manja dalam kandungan anda. Alangkah baiknya jika anda yakin bahawa terdapat nutrient penting yang boleh menggalakkan perkembangan minda si manja.</p> <p class="MsoNormal">Nutrien- nutrient ini – Asid Folik atau Folat, Zat Besi, Asid Lemak Perlu (EFA) dan Asid Sialik (SA). </p> <p class="MsoNormal">Amalkan pemakanan yang sihat untuk menjamin kandungan kesayangan anda menerima nutrient-nutrien ini secara berterusan.</p> <p class="MsoNormal">Kepada bapa/suami galakkan isteri anda yang mengandung meminum susu tepung 2 gelas sehari. Contoh ANMUM MATERNAL atau Ig-G Plus atau pastikan kandungan susu<span style=""> </span>seperti yang saya sebut diatas.</p> <p class="MsoNormal">Pada peringkat ini, deria bayi anda sudahpun mula berkembang; si manja boleh merasakan apa yang anda mkan, dapat mendengar bunyi seperti degupan jantung dan suara anda, dan bergerak dengan aktif dalam kandungan!</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal">Terdapat banyak cara untuk meransang deria bayi anda. Berikut adalah beberapa petua:</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-left: 0.5in; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family:Wingdings;"><span style="">Ø<span style=";font-family:";font-size:7pt;" > </span></span></span><!--[endif]-->Berbual, menyanyi dan membaca kepada bayi dalam kandungan anda. Suara anda menenangkanya, dan akan dikenalinya pada saat kelahiran. Malah, si ayah juga boleh turut serta berbuat demikian.</p> <p class="MsoNormal" style="margin-left: 0.25in;"><o:p> </o:p></p> <p class="MsoNormal" style="margin-left: 0.5in; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family:Wingdings;"><span style="">Ø<span style=";font-family:";font-size:7pt;" > </span></span></span><!--[endif]-->Mainkan muzik yang menenangkan bayi anda. Muzik klasikal adalah yang terbaik, dan mendengar bacaan surah Al-Quran. Ini dapat mengasah minat dalam diri bayi anda.</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-left: 0.25in;"><o:p> </o:p></p> <p class="MsoNormal" style="margin-left: 0.5in; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family:Wingdings;"><span style="">Ø<span style=";font-family:";font-size:7pt;" > </span></span></span><!--[endif]-->Belai dan sentuh anak anda dengan sentuhan pada perut anda pada waktu-waktu yang sesuai seperti selepas makan dan ketika tidur atau apabila bayi dalam kandungan anda telah punbergerak dengan aktif. Aksi ini akan mencetuskan hubungan yang bermakna antara anda dengan bayi anda, dan akan terus berkembang selepas kelahirannya serta apabila membesar nanti.</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal"><b style="">Untuk Yang Baru Bergelar Ibu<o:p></o:p></b></p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal">Sambil meraikan saat-saat gembira ini, teruslah bekalkan khasiat untuk perkembangan minda si manja dengan nutrien penting. Susu ibu adalah sumber khasiat yang paling baik untuk si manja – kolostrum atau ‘susu awal’ merupakan makanan awal yang sempurna kerana ia padat dengan nutrient termasuk antibody yang dapat mencegah penyakit dan melindungi kesihatan bayi anda. Kolostrum mengandungi kesan ‘ lawas’ dan membantu menyingkirkan bilirubin* berlebihan untuk mengelakkan penyakit kuning.</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal">Kolostum juga merupakan ‘vaksin’ semulajadi dan selamat yang melindungi bayi anda daripada serangan kuman di bahagian sensitive, iaitu lapisan membrane dalam kerongkong, paru-paru dan usus. Selagi bayi anda diberi susu ibu, dia akan mendapat imunisasi perlindungan semulajadi daripada pelbagai virus dan bacteria.</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal">Oleh itu, berusahalah untuk menyusukan bayi anda. Pada mulanya, usaha ini mungkin terasa rumit dan berat, tetapi anda akan mendapati bahawa menyusukan anak mendatangkan kebaikan dari segi zat pemakanan dan juga perkembangan fisiologi. Ikatan antara ibu dan anak yang bermula dalam kandungan akan diperkukuhkan.</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal">Menggalakkan ibu-ibu meminum susu sekurang-kurangnye 2 gelas sehari, ia bukan sahaja minuman yang lazat dan menyihatkan anda tetapi juga memberi manfaat kepada si manja.</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal">Berikut adalah panduan menyusukan bayi:</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-left: 0.5in; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family:Wingdings;"><span style="">Ø<span style=";font-family:";font-size:7pt;" > </span></span></span><!--[endif]-->Pastikan anda berada dalam kedudukan yang selesa. Gunakan bantal untuk meninggikan dan menyokong kedudukan lengan anda, dan gunakan bantal lain untuk mendekatkan bayi ke payudara anda.</p> <p class="MsoNormal" style="margin-left: 0.5in; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family:Wingdings;"><span style="">Ø<span style=";font-family:";font-size:7pt;" > </span></span></span><!--[endif]-->Dakapkan bayi anda supaya dia rapat dengan tubuh anda supaya hidung dan mulutnya menghadap puting payudara anda.</p> <p class="MsoNormal" style="margin-left: 0.5in; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family:Wingdings;"><span style="">Ø<span style=";font-family:";font-size:7pt;" > </span></span></span><!--[endif]-->Galakkan bayi anda supaya membuka mulutnya dengan luas da sokonglah bahagian belakangnya ( bukan bahagian belakang kepalanya) agar dagunya menekan payudara anda. Dalam kedudukkan itu, hidungnya akan menyentuh payudara anda dan tangan anda bertindak sebagi ‘ leher kedua’ bagi bayi anda.</p> <p class="MsoNormal" style="margin-left: 0.5in; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family:Wingdings;"><span style="">Ø<span style=";font-family:";font-size:7pt;" > </span></span></span><!--[endif]-->Belay bayi anda dan bercakap-cakap dengannya secara lembut semasa dia menyusu.</p> <p class="MsoNormal" style="margin-left: 0.5in; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family:Wingdings;"><span style="">Ø<span style=";font-family:";font-size:7pt;" > </span></span></span><!--[endif]-->Nikmatilah saat-saat istimewa ini! Anda mungkin memerlukan beberapa cubaan sebelum mencapai kedudukan yang terbaik bagi anda dan bayi anda. Jika anda berasa kurang selesa, pisahkan bayi anda daripada payudara anda dan <st1:place st="on"><st1:country-region st="on">cuba</st1:country-region></st1:place> sekali lagi.</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal">*<i style="">Bilirubin ialah pigmen utama hempedu yang terbentuk daripada penguraian haemoglobin, sejenis pigmen dalam sel darah merah. <st1:place st="on">Aras</st1:place> bilirubin yang terlalu tinggi boleh menyebabkan pigmentasi kekuningan yang berkaitan dengan jaundis.<o:p></o:p></i></p> <p class="MsoNormal"><i style=""><o:p> </o:p></i></p> <p class="MsoNormal"><b style="">Untuk Si Manja<o:p></o:p></b></p> <p class="MsoNormal">Jika anda tertanya-tanya mengapakah si manja seolah-olah mengalami masalah penglihatan, ini adalah kerana deria penglihatannya adalah deria terakhir yang berkembang ketika baru lahir. Oleh sebab itu, teruskanlah menyusukan bayi anda dengan susu ibu, dan buat si ibu minumlah susu selalu…</p> <p class="MsoNormal">*EFA merupakan asas pembinaan DHA dan AA. Ia adalah kompenen utama otak dan mata. Breastfeeding mengandungi nutrien penting ini.</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal">Apabila bayi anda bertambah aktif, dia memerlukan makanan yang lain selain daripada susu; bayi anda juga akan bersedia untuk mencuba rasa tekstur makanan yang baru. Perkenalkanlah makanan pejal kepada si manja secara beransur-ansur, bermula dengan makanan mudah seperti kacang dhal yang telah direbus dan dijadikan pati, lobak merah atau bayam atau kentang yang dilecek bersama sedikit susu. Garam atau perasa tidak diperlukan.</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal">Ini merupakan waktu yang paling sesuai untuk anda dan si manja saling berkenalan. Rangsangkanlah deria dan mindanya!</p> <p class="MsoNormal">Cubalah idea-idea menarik berikut:</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-left: 0.5in; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family:Wingdings;"><span style="">Ø<span style=";font-family:";font-size:7pt;" > </span></span></span><!--[endif]-->Luangkan masa untuk bertentang mata dengan si manja. Bayi yang baru lahir amat suka melihat wajah anda, terutama mata anda. Pelbagaikan mimik muka anda seperti membesarkan <span style=""> </span>mata, menggerakkan mulut, dan mengangguk atau menggelengkan kepala anda.</p> <p class="MsoNormal" style="margin-left: 0.5in; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family:Wingdings;"><span style="">Ø<span style=";font-family:";font-size:7pt;" > </span></span></span><!--[endif]-->Tarik perhatiannya dengan warna-warna yang berkontras tinggi seperti merah dan putih serta warna cerah untuk merangsangkan perhubungan sel-sel otak si manja. Alihkan warna-warna ini supaya dia mengikuti pergerakan itu dengan matanya.</p> <p class="MsoNormal" style="margin-left: 0.5in; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family:Wingdings;"><span style="">Ø<span style=";font-family:";font-size:7pt;" > </span></span></span><!--[endif]-->Pelbagaikan makanannya supaya bayi anda menikmati dan mengenal rasa yang baru, serta menentukan kegemarannya. Elakkan makanan yang boleh menyebabkan alahan seperti telur dan makanan laut sehingga bayi anda mencapai umur 12 bulan.</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal"><b style="">Untuk Kanak-Kanak Kecil<o:p></o:p></b></p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal">Ini merupakan peringkat tumbesaran yang mencabar. Kanak-kanak kecil begitu comel tetapi meletihkan. Peringkat ini juga mencabar untuk anak anda. Banyak yang perlu dipelajari dan dilakukan, dan pembelajaran berlaku dengan begitu pesat. Setiap hari, dia belajar perkara baru: berjalan tanpa dipimpin, minum dari cawan sendiri tanpa menumpahkan air, membina menara mainan dengan kiub mainan dan menyelesaikan teka-teki susun suai gambar.</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal">Perkayakanlah perkembangan fizikal dan mentalnya. Si manja terus memerlukan DHA, Zat Besi, Fosfolipid, Asid Lemak Perlu( EFA) dan Asid Sialik (SA). Nutrien-nutrien diperkayakan untuk minda si manja agar berkembang secara sempurna.</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal">“Apa itu ?”, “Mengapa?”, “Mengapa begitu?”, “Lepas itu…?” merupakan soalan-soalan yang kerap ditanya si manja dan inilah caranya menimba ilmu. Bersedialah menyahut cabaran ini. Rangsangkan mindanya secara langsung dan berterusan. Gunakanlah pelbagai permainan dan alat mengajar, di samping percakapan, drama dan hiburan.</p> <p class="MsoNormal">Berikut adalah beberapa petunjuk yang boleh membantu kemajuan anak anda sambil dia berinteraksi dengan dunia di sekelilingnya:</p> <p class="MsoNormal">A) Pengukuhan Tatabahasa.</p> <p class="MsoNormal" style="margin-left: 0.25in;"><span style=""> </span>Gunakan perkataan-perkataan deskriptif apabila anda berbual dengan anak anda tentang segala yang anda melakukan, merasa, melihat, mendengar atau menyentuh.</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal">B) Memperkuat Daya Ingatan.</p> <p class="MsoNormal"><span style=""> </span>Ulangi percakapan atau aksi dalam permainan dan interaksi supaya perjalanan maklumat dalam otak diperkukuhkan.</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal">C) Menanam minat si manja terhadap Matematik.</p> <p class="MsoNormal"><span style=""> </span>Galakkan si manja membilang objek yang terdapat dalam rumah semasa anda menjalankan kerja rumah.</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal"><i style="">* saya sarankan supaya mengasah peranan anda ketika anda mengandung lagi. Buat aktiviti yang menguji minda anda seperti membaca pelbagai bahasa , memahami dan membuat latihan matematik dari peringkat 1 hingga<span style=""> </span>SPM. Memang geliga otak anak anda macam tahap professor….InsyaAllah!<o:p></o:p></i></p> misibbhttp://www.blogger.com/profile/14827173537467932982noreply@blogger.com0tag:blogger.com,1999:blog-1717129759233064518.post-9023506041032663452010-03-08T16:24:00.005+08:002010-03-08T16:43:24.800+08:00" Caring Nurses For You and Your Baby "<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://3.bp.blogspot.com/_StW9Y6v_f4I/S5S31fkzw3I/AAAAAAAAABw/Z_E-2I7DRF0/s1600-h/picbb.jpg"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 300px;" src="http://3.bp.blogspot.com/_StW9Y6v_f4I/S5S31fkzw3I/AAAAAAAAABw/Z_E-2I7DRF0/s400/picbb.jpg" alt="" id="BLOGGER_PHOTO_ID_5446179979034608498" border="0" /></a>
<br /><meta equiv="Content-Type" content="text/html; charset=utf-8"><meta name="ProgId" content="Word.Document"><meta name="Generator" content="Microsoft Word 11"><meta name="Originator" content="Microsoft Word 11"><link rel="File-List" href="file:///C:%5CUsers%5CADMIN%5CAppData%5CLocal%5CTemp%5Cmsohtml1%5C01%5Cclip_filelist.xml"><!--[if gte mso 9]><xml> <w:worddocument> <w:view>Normal</w:View> <w:zoom>0</w:Zoom> <w:punctuationkerning/> <w:validateagainstschemas/> <w:saveifxmlinvalid>false</w:SaveIfXMLInvalid> <w:ignoremixedcontent>false</w:IgnoreMixedContent> <w:alwaysshowplaceholdertext>false</w:AlwaysShowPlaceholderText> <w:compatibility> <w:breakwrappedtables/> <w:snaptogridincell/> <w:wraptextwithpunct/> <w:useasianbreakrules/> <w:dontgrowautofit/> </w:Compatibility> <w:browserlevel>MicrosoftInternetExplorer4</w:BrowserLevel> </w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:latentstyles deflockedstate="false" latentstylecount="156"> </w:LatentStyles> </xml><![endif]--><style> <!-- /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-parent:""; margin:0in; margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-fareast-font-family:"Times New Roman";} @page Section1 {size:8.5in 11.0in; margin:1.0in 1.25in 1.0in 1.25in; mso-header-margin:.5in; mso-footer-margin:.5in; mso-paper-source:0;} div.Section1 {page:Section1;} --> </style><!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} </style> <![endif]--> <p class="MsoNormal"><b style="">Kepada Bakal – bakal Bergelar Ibu dan Bapa,<o:p></o:p></b></p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal">Tahniah! Setelah menunggu sekian lama, akhirnya anda telah pun menimang cahayamata yang pastinya akan menyinari hidup anda sekeluarga. Sudah tentu ini merupakan detik yang paling membahagiakan di dalam kehidupan anda. Sesungguhnya, menjadi seorang ibu atau ayah buat pertama kalinya, anda pasti dahagakan pelbagai maklumat dan petua berguna yang dapat membantu anda mengharungi cabaran dan dugaan yang mendatang. Anda juga mungkin bersa sedikit resah dan gentar memikirkan tentang tanggungjawab anda dalam mendidik dan mengasuh permata hati anda.</p> <p class="MsoNormal">Namun begitu, anda harus sentiasa bersedia untuk memikul setiap tanggungjawab dan tugs yang berat tetapi menyeronokkan ini. Pastikan anda mendapat rehat secukupnya agar anda sentiasa berada di dalam keadaan ceria, bayinya juga turut berasa gembira. Luangkan masa bersamanya sebanyak yang mungkin kerana masa akan berlalu begitu pantas dan anda akan tidak menyedari bahawa anak anda telah pun membesar dalam sekelip mata.</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal">Bagi membantu menjawab beberapa persoalan tentang petua penjagaan anak-anak, Saya dengan sukacitanya ingin menhadiahkan maklumat –maklumat tentang “ Caring Nurses For You and Your Baby”. Semoga dengan petua-petua tentang penjagaan bayi dan nasihat berguna sebagai panduan untuk anda agar anda berasa yakin dalam hal-hal berkenaan penjagaan bayi. Ia ditulis di dalam bentuk yang mudah di baca dan senang dilakukan kerana ia mengandungi gambar-gambar dan petua-petua yang<span style=""> </span>praktikal sebagai panduan mudah untuk anda terutamanya jika anda berasa ragu-ragu ataupun ketika anda berseorangan.</p> <p class="MsoNormal">Namun begitu, jika anda masih berasa sangsi dan risau tentang kesihatan bayi anda secara keseluruhannya, adalah dinasihatkan supaya anda berjumpa dengan doctor perubatan atau pakar kanak-kanak anda.</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal">Sekian, Terima kasih.</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal">Salam Bahagia daripada</p> misibbhttp://www.blogger.com/profile/14827173537467932982noreply@blogger.com0tag:blogger.com,1999:blog-1717129759233064518.post-13934890907490692052010-03-08T13:54:00.005+08:002010-05-13T01:32:03.420+08:00Caring Nurses - Critical Thinking In Client Care<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://2.bp.blogspot.com/_StW9Y6v_f4I/S5SUkeVWKmI/AAAAAAAAABo/cOueCL7DNeY/s1600-h/life.jpg"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 300px;" src="http://2.bp.blogspot.com/_StW9Y6v_f4I/S5SUkeVWKmI/AAAAAAAAABo/cOueCL7DNeY/s400/life.jpg" alt="" id="BLOGGER_PHOTO_ID_5446141203736570466" border="0" /></a>
<br /><meta name="ProgId" content="Word.Document"><meta name="Generator" content="Microsoft Word 11"><meta name="Originator" content="Microsoft Word 11"><link rel="File-List" href="file:///C:%5CUsers%5CADMIN%5CAppData%5CLocal%5CTemp%5Cmsohtml1%5C01%5Cclip_filelist.xml"><o:smarttagtype namespaceuri="urn:schemas-microsoft-com:office:smarttags" name="place"></o:smarttagtype><o:smarttagtype namespaceuri="urn:schemas-microsoft-com:office:smarttags" name="country-region"></o:smarttagtype><!--[if gte mso 9]><xml> <w:worddocument> <w:view>Normal</w:View> <w:zoom>0</w:Zoom> <w:punctuationkerning/> <w:validateagainstschemas/> <w:saveifxmlinvalid>false</w:SaveIfXMLInvalid> <w:ignoremixedcontent>false</w:IgnoreMixedContent> <w:alwaysshowplaceholdertext>false</w:AlwaysShowPlaceholderText> <w:compatibility> <w:breakwrappedtables/> <w:snaptogridincell/> <w:wraptextwithpunct/> <w:useasianbreakrules/> <w:dontgrowautofit/> </w:Compatibility> <w:browserlevel>MicrosoftInternetExplorer4</w:BrowserLevel> </w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:latentstyles deflockedstate="false" latentstylecount="156"> </w:LatentStyles> </xml><![endif]--><!--[if !mso]><object classid="clsid:38481807-CA0E-42D2-BF39-B33AF135CC4D" id="ieooui"></object> <style> st1\:*{behavior:url(#ieooui) } </style> <![endif]--><style> <!-- /* Font Definitions */ @font-face {font-family:Wingdings; panose-1:5 0 0 0 0 0 0 0 0 0; mso-font-charset:2; mso-generic-font-family:auto; mso-font-pitch:variable; mso-font-signature:0 268435456 0 0 -2147483648 0;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-parent:""; margin:0in; margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-fareast-font-family:"Times New Roman";} @page Section1 {size:8.5in 11.0in; margin:1.0in 1.25in 1.0in 1.25in; mso-header-margin:.5in; mso-footer-margin:.5in; mso-paper-source:0;} div.Section1 {page:Section1;} /* List Definitions */ @list l0 {mso-list-id:845167096; mso-list-type:hybrid; mso-list-template-ids:443440684 67698699 67698691 67698693 67698689 67698691 67698693 67698689 67698691 67698693;} @list l0:level1 {mso-level-number-format:bullet; mso-level-text:; mso-level-tab-stop:.5in; mso-level-number-position:left; text-indent:-.25in; font-family:Wingdings;} @list l1 {mso-list-id:1160385095; mso-list-type:hybrid; mso-list-template-ids:-5492084 67698703 67698713 67698715 67698703 67698713 67698715 67698703 67698713 67698715;} @list l1:level1 {mso-level-tab-stop:.5in; mso-level-number-position:left; text-indent:-.25in;} @list l2 {mso-list-id:1478184963; mso-list-type:hybrid; mso-list-template-ids:1320462264 67698699 67698691 67698693 67698689 67698691 67698693 67698689 67698691 67698693;} @list l2:level1 {mso-level-number-format:bullet; mso-level-text:; mso-level-tab-stop:.5in; mso-level-number-position:left; text-indent:-.25in; font-family:Wingdings;} @list l3 {mso-list-id:1620333898; mso-list-type:hybrid; mso-list-template-ids:-906061146 67698703 67698713 67698715 67698703 67698713 67698715 67698703 67698713 67698715;} @list l3:level1 {mso-level-tab-stop:.5in; mso-level-number-position:left; text-indent:-.25in;} @list l4 {mso-list-id:1983807236; mso-list-type:hybrid; mso-list-template-ids:614655742 67698699 67698691 67698693 67698689 67698691 67698693 67698689 67698691 67698693;} @list l4:level1 {mso-level-number-format:bullet; mso-level-text:; mso-level-tab-stop:.5in; mso-level-number-position:left; text-indent:-.25in; font-family:Wingdings;} ol {margin-bottom:0in;} ul {margin-bottom:0in;} --> </style><!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} </style> <![endif]--> <p class="MsoNormal"><b style=""><o:p></o:p>Make Sense and Feeling<o:p></o:p></b></p> <p class="MsoNormal"><b style=""><o:p> </o:p></b></p> <p class="MsoNormal">Sense<span style=""> </span>of Commitment - Devoted , dedicated and responsive in what ever action </p> <p class="MsoNormal">Sense of Belonging -<span style=""> </span>Ownership – security usage and maintenance </p> <p class="MsoNormal">Sense of Guilt - Aware and realize the effect of failure for not fulfilling expectations or observing correct form guideline or procedures </p> <p class="MsoNormal">Sense of Sin - Realized , acknowledge and regret of whatever wrong doings.</p> <p class="MsoNormal">Sense of Shame - Having strong believe in protecting and preserving self – esteem and self – pride from moral decadence as a result of wrong doings ( written and unwritten rules and practices ) </p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal" style="text-align: center;" align="center"><o:p> </o:p></p> <p class="MsoNormal" style="text-align: left;"><b style="">
<br /></b></p><p class="MsoNormal" style="text-align: left;"><b style="">PROFESSIONAL DEVELOPMENT OF NURSES<o:p></o:p></b></p> <p class="MsoNormal" style="text-align: center;" align="center"><o:p> </o:p></p> <p class="MsoNormal">
<br /></p><p class="MsoNormal">Nursing involves the giving of care to the patients together with other members of the health care team including doctors. The person in the centre of these activities is a biopsychososial being called the PATIENT. Nurses exist because of these important individuals – THE PATIENTS.</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal">A PROFESSIONAL NURSE is one who works with her patients at the highest level of knowledge, skills and a caring attitude while adhering to a set of code of ethics.</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal">
<br /></p><p class="MsoNormal">Of importance in the definition are:</p> <ol style="margin-top: 0in;" start="1" type="1"><li class="MsoNormal" style="">Highest level – best of the highest possible standards.</li><li class="MsoNormal" style="">Knowledge – Need to be aware of advances in knowledge and technologies in medical sciences.</li><li class="MsoNormal" style="">Skill – Competency in the various skills required in nursing.</li><li class="MsoNormal" style="">Caring attitude – Recognizing the need of the patient to be managed with compassion, courtesy, respect and dignity.</li><li class="MsoNormal" style="">Code of ethics – A set of rules to guide professional behaviour.</li></ol> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal">
<br /></p><p class="MsoNormal">All the above are ingredients of the professional development of a nurse.</p> <p class="MsoNormal">The early professional development of a nurse is initiated by training schools but it does not end here. Professional development is a continuous process in the nurses career. This is<span style=""> </span>important if we nurses are to gain respect and recognition.</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal">There is<span style=""> </span>a need for the nurse to be assertive and to function as an equal member of the health care team. This would become possible if she develops appropriately in the following three arrears:</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-left: 0.5in; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family:Wingdings;"><span style="">Ø<span style=";font-family:";font-size:7pt;" > </span></span></span><!--[endif]-->KNOWLEDGE</p> <p class="MsoNormal" style="margin-left: 0.5in; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family:Wingdings;"><span style="">Ø<span style=";font-family:";font-size:7pt;" > </span></span></span><!--[endif]-->SKILLS</p> <p class="MsoNormal" style="margin-left: 0.5in; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family:Wingdings;"><span style="">Ø<span style=";font-family:";font-size:7pt;" > </span></span></span><!--[endif]-->ATTITUDES</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal"><b style="">
<br /></b></p><p class="MsoNormal"><b style="">Background <o:p></o:p></b></p> <p class="MsoNormal"><u><o:p><span style="text-decoration: none;"> </span></o:p></u></p> <ol style="margin-top: 0in;" start="1" type="1"><li class="MsoNormal" style="">The level of care provided in a general intensive care unit (ICU) is more complex than delivered in a general ward.</li><li class="MsoNormal" style="">It is about 3.8 times more expensive to maintain ICU than a general ward.</li><li class="MsoNormal" style="">currently, in <st1:country-region st="on"><st1:place st="on">United States</st1:place></st1:country-region> the provision of ICU costs about 15% of the total hospital care.</li><li class="MsoNormal" style="">Level of ICU care defers from hospital to hospital in <st1:country-region st="on"><st1:place st="on">Malaysia</st1:place></st1:country-region>, according to facilities available.</li></ol> <p class="MsoNormal" style="margin-left: 0.25in;"><o:p> </o:p></p> <p class="MsoNormal" style="margin-left: 0.25in;"><o:p> </o:p></p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal"><b style="">
<br /></b></p><p class="MsoNormal"><b style="">Philosophy<o:p></o:p></b></p> <p class="MsoNormal"><i style="">The philosophy of the unit is that each patient is a person with a unique human dignity for whom medical personnel assume the responsibility of giving comprehensive, safe, effective medical & nursing care and protection.</i></p><p class="MsoNormal">
<br /><i style=""><o:p></o:p></i></p> <p class="MsoNormal"><i style=""><o:p> </o:p></i></p> <p class="MsoNormal"><b style="">Objectives<o:p></o:p></b></p> <p class="MsoNormal"><b style=""><o:p> </o:p></b></p> <p class="MsoNormal" style="margin-left: 0.5in; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family:Wingdings;"><span style="">Ø<span style=";font-family:";font-size:7pt;" > </span></span></span><!--[endif]-->To provide directions in the nursing management of ICU.</p> <p class="MsoNormal" style="margin-left: 0.5in; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family:Wingdings;"><span style="">Ø<span style=";font-family:";font-size:7pt;" > </span></span></span><!--[endif]-->To develop protocols and guidelines in the running of ICU since it demands an extensive commitment of time, manpower, equipment and money.</p> <p class="MsoNormal" style="margin-left: 0.5in; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family:Wingdings;"><span style="">Ø<span style=";font-family:";font-size:7pt;" > </span></span></span><!--[endif]-->To manage critically ill patients with potential reversible pathology who require intensive monitoring and life support system.</p> <p class="MsoNormal" style="margin-left: 0.5in; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family:Wingdings;"><span style="">Ø<span style=";font-family:";font-size:7pt;" > </span></span></span><!--[endif]-->To provide training and skills for medical and paramedical staffs in the field of critical care.</p> <p class="MsoNormal"><b style=""><o:p> </o:p></b></p> <p class="MsoNormal"><b style="">
<br /></b></p><p class="MsoNormal"><b style="">Our vision<o:p></o:p></b></p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal">To provide nursing knowledge that can be applied in the clinical setting when caring for real people.</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-left: 0.5in; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family:Wingdings;"><span style="">Ø<span style=";font-family:";font-size:7pt;" > </span></span></span><!--[endif]-->Reflect current knowledge of the science and art of nursing<span style=""> </span>in today’s world.</p> <p class="MsoNormal" style="margin-left: 0.5in; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family:Wingdings;"><span style="">Ø<span style=";font-family:";font-size:7pt;" > </span></span></span><!--[endif]-->Provide clear explanations of the pathophysiologic processes of various disorders.</p> <p class="MsoNormal" style="margin-left: 0.5in; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family:Wingdings;"><span style="">Ø<span style=";font-family:";font-size:7pt;" > </span></span></span><!--[endif]-->Emphasize the nurse’s role in collaborative care.</p> <p class="MsoNormal" style="margin-left: 0.5in; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family:Wingdings;"><span style="">Ø<span style=";font-family:";font-size:7pt;" > </span></span></span><!--[endif]-->Prioritize nursing interventions specific to altered human responses to illness.</p> <p class="MsoNormal" style="margin-left: 0.5in; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family:Wingdings;"><span style="">Ø<span style=";font-family:";font-size:7pt;" > </span></span></span><!--[endif]-->Foster critical-thinking skills</p> <p class="MsoNormal" style="margin-left: 0.5in; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family:Wingdings;"><span style="">Ø<span style=";font-family:";font-size:7pt;" > </span></span></span><!--[endif]-->Offer visual tools for learners</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal"><o:p> </o:p></p> misibbhttp://www.blogger.com/profile/14827173537467932982noreply@blogger.com0tag:blogger.com,1999:blog-1717129759233064518.post-14552011315008465102010-03-08T12:13:00.007+08:002010-03-08T15:26:12.358+08:00Nurse<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://4.bp.blogspot.com/_StW9Y6v_f4I/S5R_HXmkH2I/AAAAAAAAABg/2Kqt1c57Jco/s1600-h/misibb.jpg"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 300px;" src="http://4.bp.blogspot.com/_StW9Y6v_f4I/S5R_HXmkH2I/AAAAAAAAABg/2Kqt1c57Jco/s400/misibb.jpg" alt="" id="BLOGGER_PHOTO_ID_5446117613969350498" border="0" /></a>
<br /><meta name="ProgId" content="Word.Document"><meta name="Generator" content="Microsoft Word 11"><meta name="Originator" content="Microsoft Word 11"><link rel="File-List" href="file:///C:%5CUsers%5CADMIN%5CAppData%5CLocal%5CTemp%5Cmsohtml1%5C01%5Cclip_filelist.xml"><!--[if gte mso 9]><xml> <w:worddocument> <w:view>Normal</w:View> <w:zoom>0</w:Zoom> <w:punctuationkerning/> <w:validateagainstschemas/> <w:saveifxmlinvalid>false</w:SaveIfXMLInvalid> <w:ignoremixedcontent>false</w:IgnoreMixedContent> <w:alwaysshowplaceholdertext>false</w:AlwaysShowPlaceholderText> <w:compatibility> <w:breakwrappedtables/> <w:snaptogridincell/> <w:wraptextwithpunct/> <w:useasianbreakrules/> <w:dontgrowautofit/> </w:Compatibility> <w:browserlevel>MicrosoftInternetExplorer4</w:BrowserLevel> </w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:latentstyles deflockedstate="false" latentstylecount="156"> </w:LatentStyles> </xml><![endif]--><style> <!-- /* Font Definitions */ @font-face {font-family:"Footlight MT Light"; panose-1:2 4 6 2 6 3 10 2 3 4; mso-font-charset:0; mso-generic-font-family:roman; mso-font-pitch:variable; mso-font-signature:3 0 0 0 1 0;} @font-face {font-family:CordiaUPC; panose-1:2 11 3 4 2 2 2 2 2 4; mso-font-charset:0; mso-generic-font-family:swiss; mso-font-pitch:variable; mso-font-signature:-2130706429 0 0 0 65537 0;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-parent:""; margin:0in; margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-fareast-font-family:"Times New Roman";} a:link, span.MsoHyperlink {color:blue; text-decoration:underline; text-underline:single;} a:visited, span.MsoHyperlinkFollowed {color:purple; text-decoration:underline; text-underline:single;} p {mso-margin-top-alt:auto; margin-right:0in; mso-margin-bottom-alt:auto; margin-left:0in; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-fareast-font-family:"Times New Roman";} @page Section1 {size:8.5in 11.0in; margin:1.0in 1.25in 1.0in 1.25in; mso-header-margin:.5in; mso-footer-margin:.5in; mso-paper-source:0;} div.Section1 {page:Section1;} --> </style><!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} </style> <![endif]--> <p style="background: rgb(248, 252, 255) none repeat scroll 0% 0%; -moz-background-clip: border; -moz-background-origin: padding; -moz-background-inline-policy: continuous;font-family:times new roman;"><span lang="MS" style="font-size:100%;">JURURAWAT<o:p></o:p></span></p> <p style="background: rgb(248, 252, 255) none repeat scroll 0% 0%; -moz-background-clip: border; -moz-background-origin: padding; -moz-background-inline-policy: continuous;font-family:times new roman;"><span lang="MS" style="font-size:100%;">Dalam <a href="http://ms.wikipedia.org/w/index.php?title=Bidang_kesihatan&action=edit&redlink=1" title="Bidang kesihatan (belum ditulis)"><span style="color: rgb(204, 34, 0);">bidang penjagaan kesihatan</span></a>, <b>jururawat</b> adalah seseorang yang bertugas sebagai <a href="http://ms.wikipedia.org/w/index.php?title=Penjagaan&action=edit&redlink=1" title="Penjagaan (belum ditulis)"><span style="color: rgb(204, 34, 0);">penjagaan</span></a> profesional. Jururawat bertanggungjawab bagi keselamatan dan menyembuhkan mereka yang sakit teruk, penjagaan kesihatan bagi mereka yang sihat, dan menangani kecemasan dalam semua keadaan membahayakan nyawa dalam semua bidang penjagaan kesihatan.<o:p></o:p></span></p> <p style="background: rgb(248, 252, 255) none repeat scroll 0% 0%; -moz-background-clip: border; -moz-background-origin: padding; -moz-background-inline-policy: continuous;font-family:times new roman;"><span lang="MS" style="font-size:100%;">Jabatan kejururawatan adalah [plan penjagaan jururawat, plan penjagaan], kadang-kadang memerlukannya bekerjasama dengan ahli fizik, ahli terapi,pesakit, keluarga pesakit dan rakan sejawat.Di united state dan united kingdom,[latihan kejururawatan], seperti [pakar klinik kerujurwatan] dan [jururawat terlatih],diagnosis masalah kesihatan dan menentukan [pengubatan]dan lain-lain terapi.jururawat akan membantu koordinat membantu menjaga pesakit yang dijalankan oleh ahli kesihatan yang lain seperti ahli terapi, pembantu perubatan terlatih, pakar pemakanan dan lain-lain. jururawat akan menyediakan segala tugasan antara satu-satu jabatan contohnya seperti dengan ahli terapi dan pakar jururawat.</span></p><meta equiv="Content-Type" content="text/html; charset=utf-8"><meta name="ProgId" content="Word.Document"><meta name="Generator" content="Microsoft Word 11"><meta name="Originator" content="Microsoft Word 11"><link style="font-family: times new roman;" rel="File-List" href="file:///C:%5CUsers%5CADMIN%5CAppData%5CLocal%5CTemp%5Cmsohtml1%5C01%5Cclip_filelist.xml"><!--[if gte mso 9]><xml> <w:worddocument> <w:view>Normal</w:View> <w:zoom>0</w:Zoom> <w:punctuationkerning/> <w:validateagainstschemas/> <w:saveifxmlinvalid>false</w:SaveIfXMLInvalid> <w:ignoremixedcontent>false</w:IgnoreMixedContent> <w:alwaysshowplaceholdertext>false</w:AlwaysShowPlaceholderText> <w:compatibility> <w:breakwrappedtables/> <w:snaptogridincell/> <w:wraptextwithpunct/> <w:useasianbreakrules/> <w:dontgrowautofit/> </w:Compatibility> <w:browserlevel>MicrosoftInternetExplorer4</w:BrowserLevel> </w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:latentstyles deflockedstate="false" latentstylecount="156"> </w:LatentStyles> </xml><![endif]--><style> <!-- /* Font Definitions */ @font-face {font-family:CordiaUPC; panose-1:2 11 3 4 2 2 2 2 2 4; mso-font-charset:0; mso-generic-font-family:swiss; mso-font-pitch:variable; mso-font-signature:-2130706429 0 0 0 65537 0;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-parent:""; margin:0in; margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-fareast-font-family:"Times New Roman";} @page Section1 {size:8.5in 11.0in; margin:1.0in 1.25in 1.0in 1.25in; mso-header-margin:.5in; mso-footer-margin:.5in; mso-paper-source:0;} div.Section1 {page:Section1;} --> </style><!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} </style> <![endif]--> <p class="MsoNormal" style="font-family:times new roman;"><span style=";font-size:100%;color:black;" >Menurut <i>International Council of Nursing (ICN</i>)...</span><span style=";font-size:100%;color:black;" ><o:p></o:p></span></p> <p class="MsoNormal" style="font-family:times new roman;"><span style=";font-size:100%;color:black;" >"<i>Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all settings Nursing includes the promotion of health, prevention of illness, and the care of ill, disabled and dying . people environment, research, participation in shaping health policy and in patient and health systems management, and . Advocacy, promotion of a safe education are also key nursing roles</i><b>— ICN - International Council of Nursing.</b><i>"</i></span></p><meta equiv="Content-Type" content="text/html; charset=utf-8"><meta name="ProgId" content="Word.Document"><meta name="Generator" content="Microsoft Word 11"><meta name="Originator" content="Microsoft Word 11"><link style="font-family: times new roman;" rel="File-List" href="file:///C:%5CUsers%5CADMIN%5CAppData%5CLocal%5CTemp%5Cmsohtml1%5C01%5Cclip_filelist.xml"><!--[if gte mso 9]><xml> <w:worddocument> <w:view>Normal</w:View> <w:zoom>0</w:Zoom> <w:punctuationkerning/> <w:validateagainstschemas/> <w:saveifxmlinvalid>false</w:SaveIfXMLInvalid> <w:ignoremixedcontent>false</w:IgnoreMixedContent> <w:alwaysshowplaceholdertext>false</w:AlwaysShowPlaceholderText> <w:compatibility> <w:breakwrappedtables/> <w:snaptogridincell/> <w:wraptextwithpunct/> <w:useasianbreakrules/> <w:dontgrowautofit/> </w:Compatibility> <w:browserlevel>MicrosoftInternetExplorer4</w:BrowserLevel> </w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:latentstyles deflockedstate="false" latentstylecount="156"> </w:LatentStyles> </xml><![endif]--><style> <!-- /* Font Definitions */ @font-face {font-family:CordiaUPC; panose-1:2 11 3 4 2 2 2 2 2 4; mso-font-charset:0; mso-generic-font-family:swiss; mso-font-pitch:variable; mso-font-signature:-2130706429 0 0 0 65537 0;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-parent:""; margin:0in; margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-fareast-font-family:"Times New Roman";} @page Section1 {size:8.5in 11.0in; margin:1.0in 1.25in 1.0in 1.25in; mso-header-margin:.5in; mso-footer-margin:.5in; mso-paper-source:0;} div.Section1 {page:Section1;} --> </style><!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} </style> <![endif]--> <p class="MsoNormal" style="font-family:times new roman;"><span style="font-size:100%;"><b><span style="color:black;">
<br /></span></b></span></p><p class="MsoNormal" style="font-family:times new roman;"><span style="font-size:100%;"><b><span style="color:black;">Apakah tugas-tugas yang dilakukan oleh jururawat?</span></b></span><span style=";font-size:100%;color:black;" ><o:p></o:p></span></p> <p class="MsoNormal" style="font-family:times new roman;"><span style=";font-size:100%;color:black;" >Untuk mengetahui apa yang dilakukan oleh jururawat, elok jika anda fahami kata-kata Virginia Henderson ini</span><span style=";font-size:100%;color:black;" ><o:p></o:p></span></p> <p class="MsoNormal" style="font-family:times new roman;"><span style="font-size:100%;"><i><span style="color:black;">"Fungsi unik kejururawatan ialah untuk membantu klien, sama ada yang sakit atau sihat, dalam melakukan aktiviti-aktiviti yang membawa kepada kesihatan, penyembuhan, atau yang memudahkan kematian (aktiviti-aktiviti yang klien akan lakukan TANPA BANTUAN sekiranya mereka mempunyai kekuatan, semangat, dan pengetahuan yang diperlukan.). Juga, untuk melakukan perkara-perkara tersebut dalam cara-cara tertentu, supaya dapat membantu klien 'berdikari' secepat yang boleh."<b> — Virginia Henderson, 'Definition of nursing' 1955,`66,`69,`78.</b></span></i></span><span style=";font-size:100%;color:black;" ><o:p></o:p></span></p> <p class="MsoNormal" style="font-family:times new roman;"><span style="font-size:100%;"><i><span style="color:black;">"The unique function of the nurse is to assist clients, sick or well, in performing those activities contributing to health, its recovery, or peaceful death -- activities that clients would perform unaided if they had the necessasary strengh, will, or knowledge. Also, to do so in such a way as to help clients gain independence as rapidly as possible."<b> — Virginia Henderson, 'Definition of nursing' 1955,`66,`69,`78.</b></span></i><i><span style="color:black;"> </span></i></span><span style=";font-size:100%;color:black;" ><o:p></o:p></span></p> <p class="MsoNormal" style="font-family:times new roman;"><span style=";font-size:100%;color:black;" >
<br /></span></p><p class="MsoNormal" style="font-family:times new roman;"><span style=";font-size:100%;color:black;" >Jururawat membantu pesakit untuk berdikari dengan cepat. jadi sudah tentu tugas mereka banyak. Mereka bertanggung jawab daripada perkara asas manusia (makan, minum, kebersihan, etc.), memastikan klien mengambil ubat pada masa yang ditetapkan, memerhati keadaan pesakit (tanda-tanda vital, dan sebagainya), serta MENGURANGKAN risiko pesakit daripada mendapat masalah kesihatan lain di wad. Itu cuma di wad, bagaimana di tempat lain seperti dewan bedah.<o:p></o:p></span></p> <p class="MsoNormal" style="font-family:times new roman;"><span style=";font-size:100%;color:black;" >Jururawat menjalankan kerja kejururawatan,biasanya menggunakan pendekatan menyelesaikan masalah yang melibatkan pentaksiran, pengenalan masalah, perancangan, perlaksanaan dan penilaian sebagai satu kitaran berterusan. Ini menghasilkan jagaan yang khas bagi seorang pesakit dan bukan jagaan rutin untuk suatu penyakit.</span><span style=";font-size:100%;color:black;" ><o:p></o:p></span></p> <p class="MsoNormal" style="font-family:times new roman;"><span style=";font-size:100%;color:black;" >Oleh kerana bidang kejururawatan amat banyak, maka terdapat jururawat yang dilatih khas untuk disiplin-disiplin (bidang) tertentu. Seperti perawatan paliatif, diabetik, dewan bedah, dan ENT (Mata, hidung, dan telinga), dan banyak lagi. </span><span style=";font-size:100%;color:black;" ><o:p></o:p></span></p> <p class="MsoNormal" style="">
<br /><span style=";font-family:CordiaUPC;font-size:16pt;color:black;" ></span><span style=";font-family:CordiaUPC;font-size:16pt;color:black;" ><o:p></o:p></span></p> <a href="http://mynursingbox.blogspot.com"></a>misibbhttp://www.blogger.com/profile/14827173537467932982noreply@blogger.com2tag:blogger.com,1999:blog-1717129759233064518.post-21205523004279016152010-03-06T23:26:00.006+08:002010-03-07T00:34:08.117+08:00When I'm thinking of you...<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://2.bp.blogspot.com/_StW9Y6v_f4I/S5KCmSSsaAI/AAAAAAAAAAk/-qaB4VCpcmw/s1600-h/misibb.jpg"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 300px;" src="http://2.bp.blogspot.com/_StW9Y6v_f4I/S5KCmSSsaAI/AAAAAAAAAAk/-qaB4VCpcmw/s400/misibb.jpg" alt="" id="BLOGGER_PHOTO_ID_5445558493701236738" border="0" /></a><br /><span style="font-family:arial;">We met online, had</span><span style="font-family:lucida grande;"> a good time, chatted again and become good friends. Time went on and we're still here and I truly believe you're someone dear ! Here's something I'd like to share with you, for all of your love, careers and kindness too. It's a symbol of the friendship we share together, a friendship I hope will last forever. And although we live so far apart...</span> <span style="font-family:lucida grande;">Always remember you hold a piece of my heart!</span><br /><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://1.bp.blogspot.com/_StW9Y6v_f4I/S5KCM2c9fKI/AAAAAAAAAAc/dNB8j_7Yo9Y/s1600-h/hearts.jpg"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 206px; height: 163px;" src="http://1.bp.blogspot.com/_StW9Y6v_f4I/S5KCM2c9fKI/AAAAAAAAAAc/dNB8j_7Yo9Y/s200/hearts.jpg" alt="" id="BLOGGER_PHOTO_ID_5445558056731376802" border="0" /></a>misibbhttp://www.blogger.com/profile/14827173537467932982noreply@blogger.com0