Diagnosing Helt Problem

1. Diagnose disease

The definition of a disease diagnosis is a term or terminology that directs

an attempt to establish or know, identify about a type of disease or health problem
suffered or experienced by a patient / patient or community. While the results of
the diagnosis of disease is a diagnosis / diagnosis of disease. To diagnose a
disease or health problem requires some action or business measures such as the
following:

a. Anamnesis

anamnesis is a question and answer either directly or indirectly

between health personnel [in this case is that will diagnose the disease-for
example: nurse, doctor] with patient or individual or family of patient. There
are two types of anamnesis to diagnose diseases are as follows:

1. Auto anamnesis
Auto anamnesa: interview with the client directly. Patients
alone answer all the doctor's questions and tell the problem. This is the
best history way because the patient is the best person to tell what he
really feels.

Examples of autoannesa conversations to patients

Nurse : good afternoon mam?

Patient : good afternoon nurse

Nurse : introduce I nurse nisa who served on this afternoon, may I

know your name sist?

Patient : I am tini

Nurse : Where do you life?

Patient : I life in Teak Village Banyu Manik, Semarang

Nurse : Mam Tini its age how many?

Patient : I am 38 years old

 Nurse : Mam who with came to the hospital ?

Patient : I with my husbant

Nurse : What is bringing you here to come to the hospital?

Patient: This is my sus from yesterday sick on stomach nurse

Nurse : Do you know what causes it?

Patient : I yesterday ate spicy and sour foods.

Nurse : The pain in the stomach next to mam? Does the pain spread
or in one area?

Patient : No, only at the bottom of the pit of the stomach

Nurse : If I give a 1- 10 pain scale, with 1-3 ordinary pain 4-6

moderate pain 7-10 severe pain.

Patient : Scale 6

Nurse : What does it feel like?

Patient : As in the squeeze of milk

Nurse : When is the pain complaint felt?

Patient : Yesterday nurse.

Nurse : How often does the pain complaint feel?

Patients: During your time, sometimes suddenly sus

Nurse : Usually to relieve pain, what do you do? Eg let it go, or take
medicine or sleep for a while?

Patient : Suspend sus, usually when I sleep the bangunya no longer

feel pain sus.

Nurse : ok thankyou for his cooperation.

2. Allo anamnesis, which is an anamnesis question and answer

addressed to the patient's family such as the patient's parents, friends,
relatives, friends. Generally this type of history is performed when: the
patient or the patient is still a child, the patient is unconscious, the patient
is not communicative, and the patient with the memory disorder.

Allo anamnesa: interview with family / nearest person.

However, in practice not always autoannesis can be done. In an

unconscious patient, very weak or very sick to answer a question, or in a
pediatric patient, someone else needs to tell the problem.

Example of alloanamnesa conversation with the patient's family

Nurse : Good morning mam?

Family : morning nurse

nurse : Is this true with mams Mrs. Tini?

Family : Right , I am the mother of the patient Tini.

Nurse : If you can know what is your name mam?

Family : My name is Susi's mother.

Nurse : Well Mam, for the smoothness of the examination I need

information about Ms. Tini. Kindly cooperate for the
smoothness of the examination.

Family : All right nurse.

Nurse : According to explanation from Mrs. Tini, Mrs. Tini

experience pain in the stomach?

Family : Right nurse, my son complained of pain in his stomach since

yesterday after coming home from school.

Nurse : So since yesterday yes mam, upset stomach after school about
the child's mother is upset because of what?

Family : Yesterday I asked, he said he ate meatballs and ice in the

school cafeteria.
Nurse : What did the mam to overcome her stomachache? Did mother
give her medicine?

Family : yes.

Nurse : Did the previous tbuh have a history of diseases related to

abdominal pain?

Family : yes sus, he actually has an ulcer.

Nurse : So mam, since when do not get stomach ulcer?

Family : From childhood, about 4th grade.

Nurse : In the past, I have never been treated in a hospital because of

an ulcer?

Family : Not nurse, just check with your doctor and give medication.

Nurse : Okay mam, I think is enough, if there is data that I still need I
will contact mother again. Thank you for your cooperation bu.

Family : good sus.

The main and most important note when making anamnesis for
the success of disease diagnosis is to try to ask about the main
complaints that cause or cause the patient's treatment or admission to
the hospital or health care.

Interviews with family or friends may be helpful.

a. Family

"Is everything okay at home?"

"Do you have any family problems?"

It may be enough to ask "What about your marriage? Is there no

problem in sex?"

This problem may be due to physical or emotional reasons, and the

patient may be able to appreciate the opportunity to talk about his
or her concerns.
b. Residence

" Where do you live ? "

"Is there all right?" "Is your housing solid?" "How is the
ventilation of your house?" "Use of a private bathroom or use a
public bathroom?" "Are your houses affected by floods?" "near the
factory with?"

c. Work

"What is your job ?"

"Can you explain to me exactly what you are doing?" , "Does it

satisfy you?", "Does your illness affect your work?"

d. Hobby

"What are you doing in your spare time?"

"Do you do social activities?"

e. Alcohol

"How much alcohol do you drink?"

Alcoholics usually underestimate the amount of alcohol they drink

every day. It might help to keep track of it all day long. If there is
any suspicion of drinking problems, we may ask "Did you drink in
the morning?" "Are you worried about limiting your drinking
juices?" What are the consequences to affect your work, your
household or your social life? "

f. Smoke

" Do you smoke ? "

"Did you ever smoke?"

"Why did you quit smoking?"

"How many cigarettes do you smoke each day?"

 These are particularly relevant for heart and lung disease.
However, it should always be asked.

If relevant, ask about pets, traveling abroad when working in

contact with eg charcoal dust, asbetosis, etc., both past and present.

g. Drugs

"What drugs do you drink now?"

"Did you take any other medication in the last few months?"

"Do you drink Jamu?"

This is a very important question. A list of all the medications and

complete doses as far as is known.

Start with light and general questions about each system. This focuses
on the attention of the patient and allows us to think of more specific
questions about the system that we want to pay more attention to. Examples
for starting a question are:

"How does your vision and hearing go?"

"How is your lungs and breathing?"

"Is there a problem with your heart?"

"How's your digestion?"

"How's your piss?"

We can also add and vary questions depending on the patient's age,
patient complaints, the patient's general state, and our temporary clinical
diagnosis. We can also review this system at the same time as physical
diagnostics, ask about the eyes, ears, and others when we check. If the patient
has few symptoms it can be effective. When there are many symptoms, the
diagnostic and diagnostic history and history will be disturbed and the
important things become undetected and recorded.
 If at the time of reviewing these systems a positive answer is obtained,
details should also be given. The (*) indicates questions that are almost
always asked.

3. Common Questions

Ask about the following symptoms:

*Weight

"What was your weight before it hurt?"

"Did you lose weight or rise recently?"

"Is your shirt narrower or looser than before?

*Appetite

"How is your appetite?

About appetite is important. Ask about when decreased

appetite or hunger continues to show up. Decreased appetite and
weight gain due to diet and intensive exercise should also be asked

2. Physical examination

In determining the diagnosis of disease, the second step is to conduct a

polite physical examination, to be in a confined space [to maintain the
confidentiality of the circumstances related to the patient's body-privacy], not
in a hurry and thorough.

Things to keep in mind during physical examination

- Always ask the patient for any examination.

- Keep the patient's privacy.
- The examination should be thorough and systematic.
- Explain what will be done before the examination (purpose, usefulness,
means and sections to be examined)
- Give clear specific instructions.
- Speak the communicative.
- Encourage the patient to cooperate in the examination.
- Note the non-verbal expressions / language of the patient.

Physical examination can be done in several ways, such as:

a. Inspection
1. Definition

Inspection is an examiner's act by using the sense of sight to detect

normal characteristics or certain marks of the body parts or body functions
of the patient. Inspection is used to detect the shape, color, position, size,
tumor and other of the patient's body.

2. How to check
- The patient's position can sleep, sit or stand
- The part of the examined body should be open (the patient
should open his / her own clothes.) It should not be opened at
the same time, but opened as necessary for inspection while the
other part is covered by a blanket).
- Compare the opposite body parts (symmetry) and abnormality.
- Record the result
b. Palpate
1. Definition

Palpation is an act of examination that is done by touching and

pressing the body with the fingers or hands. Palpation can be used to
detect body temperature, vibration, movement, shape, consistency and
size. Tenderness and abnormalities of the tissues / organs. In other words,
palpation is an act of affirmation of the results of the inspection, in
addition to finding the invisible.

2. How to check
- The patient's position may sleep, sit or stand depending on
which part is examined and the body part being examined
should be open
- Make sure the patient is in a relaxed state with a comfortable
position to avoid muscle tension that can interfere with the
results of the examination
 - The nails of the examiner's fingers should be short, warm and
dry hands
- Ask the patient to take a deep breath to increase muscle
relaxation.
- Palpate with a touch of slowly with light pressure and
intermittently.
- Palpasil of suspected areas, the presence of tenderness
indicates abnormalities
- Palpate cautiously in case of bone fracture.
- Avoid excessive pressure on blood vessels.
- Perform Palpate lightly when examining the organ / tissue is
less than 1 cm deep.
- Perform deep Palpation when examining the organ / tissue with
a depth of 1 - 2.5 cm.
- Perform bimanual Palpation when performing an examination
with a depth of more than 2.5 cm. That is by using both hands
where one hand is relaxed and placed at the bottom of the
organ / tissue, while the other hand presses towards the hand
below to detect the characteristics of the organ / tissue.
- Thoroughly feel the abnormalities of the organ / tissue, the
presence of nodules, tumor moves / not with consistency solid /
chewy, is rough / soft, its size and the presence / absence of
vibration / trill, and the pain touch / tap.
- Record the results of the examination obtained.

c. Percussion
1. Definition

Percussion is an act of examination by listening to the sound of

vibrations / sound waves delivered from the body surface of the examined
body. The examination is done by tapping a finger or hand on the surface
of the body. The journey of vibration / sound waves depends on the
density of the media being traversed. The degree of sound is called
resonance. The resulting sound character can determine the location, size,
shape, and density of the structure under the skin. The nature of sound
waves is that the more networks, the weaker the conductor and the most
resonant air / gas.

2. How to check
- The position of the patient may sleep, sit or stand depending on
which part will be examined and the body part being examined
should be open
- Make sure the patient is in a relaxed state and comfortable
position to avoid muscle tension that can interfere with
percussion results.
- Ask the patient to take a deep breath to increase muscle
relaxation.
- The nails of the examiner's fingers should be short, warm and
dry hands.
- Perform a thorough and systematic percussion by:
a. The direct method is to do the percussion or direct the
fingers directly by using 1 or 2 fingertips.
- The indirect method is as follows:
a. The middle finger of the left hand (which is not dominant)
as the flexymeter is placed gently on the surface of the
body, strive the palms of the hands and other fingers do not
stick to the surface of the body.
b. The tip of the middle finger of the right hand (dominant) as
the flexor, to hit / tap the distal joints of the middle finger
of the left hand.
c. The blow must be fast, sharp with fixed / fixed arm and
wrist rilek.
d. Give the same blow power to every area of the body.
e. Compare the frequency sound accurately.
f. Compare or notice the sound produced by percussion.
g. The sound caused saa
3. Investigations.

The third way and step to determine the diagnosis of disease of patient
is by doing investigation. This investigation is generally performed if the
diagnostic checking steps above have not been able to definitively diagnose a
disease suffered by the patient so that investigation is needed for a definitive
diagnosis of the disease.

An example of investigations performed to determine the diagnosis

include laboratory tests, x-ray examination, ultrasound examination, CT scan,
MRI examination and many other investigations that can be done to assist in
determining the diagnosis of the disease.

a. Vocabulary for Conversations with Doctors

In an English conversation with a doctor, we can use several ways to

explain our condition. All you have to do is make the sentences easy by using
common words to describe a particular medical condition or illness. For example:

I have(saya punya) + nama penyakit atau gejala.

Example : - I have heart/lung/kidney condition (saya punya kondisi

jantung/paru-paru/ginjal)
- I have diabetes (saya punya diabetes)
- I have ulcer (saya punya maag)
- I have pimpled skin (saya punya kulit berjerawat)
- I have fever (saya demam)
- I have headache (saya sakit kepala)
- I have stomachache (saya sakit perut), I have toothache (saya sakit
gigi).

I am + gejala.

Exemple :- I am nauseous (saya mual)

- I am cold (saya kedinginan)
- I am dizzy (saya pusing)
- I am in pain (saya kesakitan)
- I am shivering (saya gemetaran/menggigil).
b. Example of English Conversation with Doctor 1

Here is an example of a conversation between a general practitioner and a

patient complaining of ulcer-like symptoms:

Doctor: Hello, have a seat. (Halo, silakan duduk).

Patient: Thank you (terima kasih).

Doctor: So what seems to be the problem? (Jadi apa keluhan Anda?).

Patient: Lately, I feel nauseous, especially at night and around the afternoon.
Sometimes, I also vomit. My stomach also feels bloated (Akhir-akhir ini, saya
merasa mual, terutama saat malam dan sekitar siang hari. Kadang-kadang,
saya juga mintah. Perut saya juga terasa kembung).

Doctor: Do you feel pain in the stomach? (Apakah Anda merasa sakit di
perut?).

Patient: Sometimes (kadang-kadang).

Doctor: How long have you had these symptoms? (Sudah berapa lama Anda
memiliki gejala-gejala ini?).

Patient: About a week, and they are very annoying (Sekitar seminggu, dan
mereka sangat mengganggu).

Doctor: Do you have ulcer before? (Apakah Anda punya maag sebelumnya?).

Patient: No (Tidak).

Doctor: Do you drink coffee? Eat spicy foods? (Apakah Anda minum kopi?
Makan makanan pedas?).

Patient: I drink coffee every morning, and I like spicy foods (Saya minum
kopi setiap pagi, dan saya suka makanan pedas).
 Doctor: I think you have ulcer symptoms. I will prescribe you some
medications, and you must stop coffee and spicy foods for a while (Saya pikir
Anda punya gejala maag. Saya akan resepkan beberapa obat, dan Anda harus
menghentikan kopi dan makanan pedas untuk sementara).

Patient: Can I still drink tea? (Bisakah saya minum teh?).

Doctor: Yes, you can drink green tea, milk, and fresh juice. Cut down coffee,
soda, and alcohol. Water is the best drink, of course (Ya, Anda bisa minum
teh hijau, susu, dan jus segar. Kurangi kopi, soda dan alkohol. Air putih
adalah minuman terbaik, tentu saja).

Patient: Okay, thank you (Baiklah, terima kasih).

PASSIVE VOICE

Rumus Passive Voice Contoh Kalimat

Simple Present Tense

Active:
S + verb-1 + direct object
People make books from trees.
Passive: (Orang membuat buku dari pohon.)
Books are made from trees.
S (direct object) + is/am/are + past participle+/- (Buku dibuat dari pohon.)
by (agent) Soal Passive Simple Present Tense

Present Continuous Tense

Active:
S + am/is/are + present participle + direct object

The surveyor is using the digital theodolite.

Passive: (Surveyor sedang menggunakan teodolit
digital.)
S (direct object) + is/am/are + being + past
The digital teodolit is being used.
participle +/- by (agent)
(Teodolit digital sedang digunakan.)
Soal Passive Present Continuous
Present Perfect Tense

Active:
S + have/has + present participle + direct object

We have verified your application.

Passive: (Kami kami akan memverifikasi
aplikasimu.)
S (direct object) + have/has + been + past participle
Your application has been verified.
+/- by (agent)
(Aplikasimu telah diverfikasi.)
Soal Passive Present Perfect Tense
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Simple Past Tense

Active:
S + verb-2 + direct object

Sunmark Press printed the first book in 2005.

Passive: (Sunmark Press mencetak buku pertama tersebut pada tahun
2005.)
S (direct object) + was/were
The first book was printed in 2005 by Sunmark Press.
+ past participle +/- by
(Buku pertama tersebut dicetak pada tahun 2005 oleh Sunmark
(agent)
Press.)
Soal Passive Simple Past Tense

Past Continuous Tense

Active:
S + was/were + present
participle + direct object

Passive:
My friend was baking bread when I came.
S (direct object) +was/were
(Teman saya sedang memanggang roti ketika saya datang.)
+ being + past participle +/-
Bread were being baked when I came.
by (agent)
(Roti sedang dipanggang ketika saya datang.)
Soal Passive Past Continuous Tense

Past Perfect Tense

Active:
S + had + past participle +
direct object

Passive: They had used poison gas in World War I.

(Mereka telah menggunakan gas beracun dalam perang dunia
S (direct object) + had +
pertama.)
been + past participle +/- by
Poison gas had been used in World War I.
(agent)
(Gas beracun telah digunakan dalam perang dunia pertama.)
Soal Passive Past Perfect

Simple Future Tense

Active:
S + will + verb-1 + direct
object
S + am/is/are going to +
bare infinitive + direct
object

Passive: Dino will show you something interesting.

(Dino akan menunjukkan padamu sesuatu yang menarik.)
S (direct object) + will + You will be shown something interesting.
be + past participle +/- (Kamu akan ditunjukkan sesuatu yang menarik.)
by (agent) He is going to meet a new client tomorrow.
S (direct object) + (Dia akan bertemu seorang klien baru besok.)
am/is/are going to + be + A new client is going to be met tomorrow.
past participle +/- by (Seorang klien baru akan ditemui besok.)
(agent) Soal Passive Simple Future Tense

Future Perfect Tense

Active:
S + will have + past
participle + direct object

Passive:
I will have saved much money at this time next year.
S (direct object) +
(Saya akan telah menyimpan banyak uang tahun depan.)
will have + been + past
Much money will have been saved at this time next year.
participle +/- by (agent)
(Banyak uang akan telah disimpan tahun depan.)
Soal Passive Future Perfect Tense