Marriage With Lecturer
Episode 3

Adrian

I just got home from the hospital, my job was pretty busy. In addition to being a lecturer while killing Ms. Dwi, I also have to serve in the hospital as a doctor. I entered the house that looked lonely, maybe Mama and Papa had rested.

Both of my sisters already have their own lives, so now only me and my two parents live in this mansion. I walked into my room and kept my car keys with my phone on the nightstand. I rushed into the bathroom to wash my sticky body.

After feeling refreshed, I walked up to the bed and played my phone. There were some incoming messages from Milner, who asked me to meet him. Milner was my girlfriend this month. In addition to messages from Milner, group chat makes my notipku break down to 999+. Group chat Men's Association and the Little Brotherhood Association Group is always crowded every day especially with the chatter of Kak Datan who never finished. Oh don't forget the Group of Gossipers, which is full of ramblings of Leonna's sister.

I kept my phone on the nightstand and rushed to sleep, because it felt like my body needed rest.

***

I just got out of my room walking towards the dining room where Mama and Papa were.

"Dear Ones" said my dear Mama, the woman I loved and loved so much in this world.

"For Ma," I said, taking a seat on the right side of Papa, and Mama sat in front of me on the left side of Papa. She seemed to be serving breakfast to both of us.

"How did you become a Lecturer?" asked Papa while sipping his tea.

"Everything's going normally, Pa."

"Thank God" said Mama.

"Adrian," cried Papa making me turn my gaze from the fried rice in front of me to Papa. "Tomorrow night, we have a dinner invitation with one of Papa's friends. Can you take your time?" ask Papa Dhika.

"Tomorrow at night, I'll try Pa."

"All right,"

***

Today I don't have a schedule, but I'm going to college because there's something I need to take. After I get down my sports car. I set foot into my room, until my steps came to a halt in the hallway which was quite quiet, not far from me two students seemed to walk towards me. I was lazy to answer all their questions, so I chose to hide behind a wall.

"Loe knows, it's a great day for me" one girl exclaimed.

"Why?" ask friend.

"Because I didn't meet Mister Adrian, the lecturer of TMII!" TMII'S?

"Dear Attractive Cute Cute" exclaimed his friend, making me smile proudly.

"Didnuts tralala, which is true Tuh Tengil, Sucks, Idiot, Idih sok kecakepan again." What the hell is Hell?

"Makep times, loe cataract well," exclaimed his friend whom I agreed to. This blonde girl must be a cataract or minus 28. That's why I can't see my looks.

"My eyes are looking, you see using your eyes that are easily fooled. I looked at my inner eyes, and I knew how rotten the DMII Lecturer was, "the fiery cry made me unable to hold back a smile.

"Loe also has acute Alay's disease, Stella."

"Damn loe Lenna!" the two of them ran off chasing each other.

"Stella?" I tried to remember it and I immediately smiled with satisfaction when I found out who the girl was. The girl who received my first sentence.

Well? Let's see Stella, how much you hate me and reject my charm. Because I made sure you'd immediately bend your knees in front of me.

***

"Adrian," the call made me look over. At this moment, Papa is approaching me. "We're talking in Papa's room."

"Alright," I said, handing over the patient examination file to the nurse standing next to me. I followed Papa to his room.

Papa asked me to sit on the sofa casually. He also seemed so relaxed by leaning his back against the back of the sofa and lifting his legs.

"How was the patient. Elsa?" tanyakanya.

"There's still no progress, after yesterday's surgery, he's still unconscious." Papa seemed to understand. I've only been a Thoracic and Cardiovascular Physician for a few months at AMI Hospital. My father who is the doctor also although now no longer down to the operating table and choose busy at the desk of the director taught me everything. Yesterday was a big operation that I just had after a few months just helped my mom do the surgery.

"According to your mother, there was a blockage in her left heart." I nodded my head back. "You have to keep monitoring his condition, Adrian. Because seeing the disease complications in the patient suffered quite severe."

"For now, Miss. Elsa is my main focus, Papa."

"Try an analysis of this case," said Papa handed the file to me making me open it immediately.

I. Client Identity

Name: Mr. Muhrom

MRS Dates: 09 - 04 - 20--

Source: Patient and his wife

Medical Diagnosis: IMA Inferior CHD

Age: 68 Years

Gender: Male

Address : Jl. Krangan No.146 B Jakarta Education: S1

Marriage Status: Married

Occupation: Private

Reason Treated: Chest pain such as stabbing felt since 4 hours before MRS.

Main complaint Previous: Clients suffer from rheumatic diseases, clients complain of lumbago, pain in the left thigh area, left leg joints.

Efforts that have been done: The client has been treated at RSUD Dr. Santoso in West Jakarta. Geriatric Room, Interna Room II and see a doctor.

The operation that was performed: never in operation.

II. NURSING HISTORY Current Health Status :

The reason for the visit/major complaint: Chest pain such as stabbing in the chest area and the body feels weak. When in client review: still complaining of chest pain, shortness of breath and body feels weak. Cold sweat, Feels like a fever, If moving pain.

Trigger factor: Night sleep and when too tired.

Complaint length: 1 month before MRS.

Complaints are being raised: gradually

Factors that aggravate: Shortness of breath increases when sleeping/lying and when doing activities.

Efforts are made to overcome it: Wake up and sit for a while, because it feels more pain then: Go to IRD RSUD Dr. Jakarta Santoso.

Medical Diagnosis: Old Myocard Infarct

III. Past medical history

Diseases that have been experienced: heat, cough, cold. He was treated at RSUD Dr Santoso Jakarta in 2012.

Allergies: -

Immunization:--

Habit: Smoking kretek and has stopped since 2012

Medications :--

Nutritional pattern :

· of eating frequency: 3 times a day

· Weight: 53 kg

· Height: 170 cm

· Food type: rice, vegetable, side dish, fruit

· Favored food: all food likes

· Unliked food: none

· Abstinence Food: None

· Appetite: Normal

· 6 Months of weight change: Never weigh weight

Elimination pattern :

· defecate

· Frequency: 1-3 x per day Laxative use: none

· Time: morning and noon

· Color: yellow

· Consistency: mushy

· Urinate

· Frequency: 4-5 x per day

· Color: yellow

· odor Addiction: ammonia

Sleep and rest patterns

· Sleep time (hour): 21.00 to 05.00 Wib

· Length of sleep/day: 8 hours

· lullaby habit: none

· sleeping habits: wearing more than three pillows

· difficulty in terms of sleep: Frequent awakening during sleep due to shortness of breath and chest pain.

Activity and exercise patterns

· Activities in work: Up and down stairs

· sports ·

· Type: Walking

· Freakuensi: not sure

· Activities in free time: Reading

· Difficulty in terms of:(X) easy to feel tired

Patterns work

· Work type: 23 years old weight

· Number of working hours: 07.00 - 17.00.00 lama: 10hours

· Working schedule: regular

· miscellaneous (mention) : none.

V. Environmental history

Cleanliness: less

Danger: none

Pollution: large roads and garbage bins

VI. Psychosocial Aspects

Mindset and perception

· Auxiliary tools used: glasses

· Difficulty experienced: frequent dizziness

Self-perception

· Things that are very thoughtful at this time: is the disease can be cured/not ?

· Hope after treatment: want to change all the habits that can interfere with his health.

· Changes in pain after pain: all habits are restricted

Mood: anxious, resigned to his illness.

Attention span: very range.

Relationship/communication

· Where to Stay: With wife and 4 children

VII. PHYSICAL ASSESSMENT

Head, eyes, ears, nose, and throat

Head: Round shape oval

Related complaints: dizziness

Eyes :

Pupil size: - isochore: - Reaction to light: good, accommodation: good, shape: symmetrical, Conjunctiva: not anemic, Vision function: disturbed, Signs of inflammation: none, Conjunctiva : not anemis, Last eye examination: Forgot, operation: no, Client wears glasses.lens box: no.

Nose :

Allergic reactions: no , Ever had the flu: ever, How the frequency in a year :3 X a year, Sinuses : - , bleeding :-

Mouth and throat:

Teeth tingling: - ,Difficulty/talking disorders: no, Difficulty swallowing: no, Last dental examination: never.

Breathing :

Pulmonary sounds: washing (-), Ronchi wet (-), breathing patterns: regular, Cough (-), sputum :(-), pain : (-), ability to perform activities: limited, limited, Coughing up blood: (-), Last Ro: MRS, Result: in the doctor.

Circulation:

Peripheral pulse: Sufficient, Capilary refilling: Less than 3 seconds, Jugular vein Distention: none, Heart sound: arrhythmia (-), Auxiliary heart sound: (-), Heart rhythm (monitor) : (-), Pain :(-), Edema : (-), Palpitations : (-), Baal : (+), Skin discoloration : invisible, Clubbing : (-) : (-), Extremity state : peripheral edem no , , Dizziness : (+), Hemodynamic Monitoring : CVP: not installed

Nutrition:

Type of diet: High calorie, high protein, Less appetite, nausea feeling: sometimes, vomiting, fluid intake: Peroral 1000-1500 cc/24 hours

Elimination:

Routine pattern : b.a.b. laxantia use : (-), Colostomy : (-), Ileostomy :(-), Constipation: (+)

Routine pattern: b.a.k. Incontinence: (-), Infections: kidney, Hematuria:(-), Catheter :(-), Urine out put :750 - 1000 cc/24 hours

Reproduction

Self-examination: (-), Prostate: normal, Catheter use: (-)

Neurologically

Level of consciousness: mental compass, Orientation: good, Coordination: less, Behavior pattern: still within normal limits, History of epilepsy/spasms/parkinson: (-), Reflex: good, grasping strength: decreased, decreased, Movement of extremities: limited

Musculoskeletal

Pain : joints (+), Movement exercise pattern : reduced, Stiffness : none

Skin

Color: Ripe Sawo, Turgor: Normal, integrity: within normal limits.

Laboratory Data: GD random erm creatinine (0.4Meq/dl), BUN (10), SGOT (32), SGPT (12), Total protein, Positive BTA, Hb, 10.6 mg/dl

Treatment: NaCl 500 cc/24 hours, Lisinopril 1 X 5 mg, Asa 1 X 100 mg, ISDN 3 X 5 mg, Furosemide 1-0-0

Client's perception of his illness : Illnesses can be cured.

Nurse's impression of the client: The cooperative client is caused by curiosity about his illness and the desire to recover is very large. The client seems agitated due to his illness

TROUBLES

Subjective data: Clients complain of weakness, fatigue, shortness of breath, difficulty doing activities because of fatigue, palpitations. Frequent waking at night due to tightness and chest pain.

Objective Data: Tension 100/60, Pulse 100 X/min, irregular, cold skin, Captain refill less than 3 seconds, CTR 60 %

Decreased Cardiac Contractions: no reports yet.

Decreased Cardiac out put: -

Subjective Data: Clients complain of tightness when getting up from a sleeping position.

Objective Data: Cold sweats when changing position from sleeping directly sitting.

Vital signs after getting out of bed: -

Tensile :110/80 mmHg, Pulse :124 x/min, Resp.:28 x/min.

An imbalance between the supply and the need for oxygen

No tolerance for activity

Subjective Data: The patient says that he is anxious about his disease because the person said his disease (jantrung) is dangerous, the patient asks about - the development of his disease.

Objective data: Clients often contemplate and have trouble sleeping, many ask questions, Anxious facial expressions, Pulse 100 X/min

NURSING DIAGNOSIS :

Decreased Cardiac OutPut with respect to decreased Myocardial Contractions.

2.Untolerance of activities with respect to imbalances between oxygen demand and supply.

Anxious with respect to the lack of knowledge about the disease and its development.

EVALUATIONS

Decreased Cardiac out put due to decreased heart contration. Criterion :

Blood Pressure Within normal limits (120/80 mmHg

Pulse 80 X /min

There is no arrhythmia

Heart rate and regular heart rhythm

Cappillary refill less than 3 seconds

Assess and report signs of CO decline.

Monitor and record ECG continuously to assess rate, rhythm and any changes per 2 or 4 hours or if necessary. Create 12 lead ECG.

Assess and monitor vital signs and hemodynamic parameters per 1 - 2 hours or indications due to clinical fitness.

Maintain bed rest with bed head elevation 300

Giving drugs - drugs arythemia, nitrates. Beta blockers.

Continuing assessment and moitor signs of CO decline. Auscultation of lung and heart sounds every 4 - 8 hours

Increase activity level according to clinic status.

Rationale: The occurrence of mortality and morbidity with respect to MI that is more than the first 24 hours.

Rationale: Ventrical vibrillation is the main cause of death due to acute MI occurs in 4 to 12 hours I of the attack. ECG 12 leads identify MI locations.

Rationale: Detect the occurrence of myocardial dysfunction due to complications.

Rationale: To reduce the requirement demands 02 myocard.

Rationale: Reduce the extent of infractions by re-perfusion of the muscles - the heart muscle is ischemia.

Rationale: Monitor signs of early complications, Examples: widespread MI, widespread cardioganic, cardioganic shock. Heart failure's. Myocardial rupture, which may occur within 10 days of the attack

Rationale: A liver-liver monitor is needed to detect hypotension and dysthythmia and step up to the next appropriate level of activity :

- Perform a review of the signs of Cardiac out put decline,

- Performing an ECG recording,

- Monitor tension and pulse every 3 hours

giving the patient a sleeping position with a bed head elevation of 300

- Monitor droplets and fluid infues

- Provide Treatment according to the order of the doctor

- Conducting pulmonary asuscultation

- Provide an explanation to the client and how to mobilize gradually.

- Anxious with respect to the lack of knowledge about the disease and its development.

Rationale: The level of anxiety develops into panic that stimulates a sympathetic response by releasing catecholamines. Which contributes to the increased need for O2 myocardial.

Rationale: Reduce unnecessary external stimuli.

Rationale: The notion that empathy is a treatment and may improve the patient's copyng ability.

Rationale: Giving information before the procedure and treatment increases komtrol self and uncertainty.

Rationale: The use of patient support systems can increase comfort and reduce relief.

Rationale: Accepting the expression of feelings helps the patient's ability to cope with the patient's indecision and dependence.

Rationale: To divert the patient from events that have just happened.

Disruption of comfort: Pain in connection with an imbalance between the supply and need for oxygen.

Do. The client does not want to change his sleeping position

Vital signs after a change in position:

tension: 110/70 mmHg.

pulse: 130 x/min

resp. 28 x/min.

Ds. The client complained of pain so reluctant to change sleeping position

Treating the pain :

Criterion :

After the change in the position of vital signs within normal limits :

tension 110/70 mmHg

Pulse 60-80x/min

resp. 16-24x/min

Evaluation: The client said After finishing the meal this morning took 3 puffs so afraid to eat more. Still feel weak, if you worship to kmar bath feels like falling.

: Client looks weak, Pulse 60 X/min, Tensi 90/60

: Clients still have nutritional disorders

: Maintain and implement the plan that has been prepared

: Give understanding and understanding of the Client who is still wrong about nutrition and his sick state. Motivation for the family to always accompany the patient.

: The Client's understanding of Nursing and his illness is lacking

Nursing Diagnosis: Risk of Infection Spread due to the presence of an active infectious agent in the body.

: Patients and families say they understand the information provided about ways to prevent transmission of infection. The client said he would always keep himself clean.

: Client Can demostrate the way of cough and the way of good sputum removal.

: The patient and Family have understood the Information provided

: The HE action on transmission and spread of infection is terminated

: Maintain Techniques and Universal Pre Caution Principles in Patient Care.

: Patients and Families Know how to prevent and manage the risk of transmission and infection.

Diangose: Nutritional Disorders: Less of the Body's Need in Relation to Inadequate Intake

Evaluation

: The client said keep trying to eat a lot even though it continues to retreat, Feel a bit strong, Not too dizzy when going to the bathroom.

: Clients walk to the bathroom without being guided, Pulse 72 X/min, Tensi 90/60, facial expression when meeting the nurse is rather cheerful.

: Clients still have nutritional disorders

: Maintain and implement the plan that has been prepared

: Encourage the family to keep motivating clients to eat more

Final Assessment :

Conjunctiva is still anemic, Pulse 76 cal/min, eni 90/60 mmHg, No complaining weak.

"How's it?" papa asked me to turn my eyes towards Papa.

"Seeing from the final evaluation, we haven't been able to perform the surgery." Papa looked mangut mangut with his sharp gaze pointed towards me.

"Do you think this patient can recover without surgery?" papa asked as if testing my skills. Yeah, I realize because I'm still the new doctor here.

"The possibilities are very slim" I replied.

"And the surgery will still be at risk to the condition of the patient's body, Adrian." I nodded back. "Communicate always with Dr. Rehan in the Heart to perform the action. Patient's been in care for almost a month here." I nodded in understanding.

Papa always wanted to jump right in to test my abilities. He was already planning to take his retirement with Mama after I was determined to lead this hospital as well as my skills as a doctor.

***