Nama : ADELIA FERDIYANTO PUTRI Blood tests include: GDS> 200 mg / dl,

fasting blood sugar> 120 mg / dl and two

Nim : 201501019 post-prandial hours> 200 mg / dl.
b. Urine
INTRODUCTION REPORT GANGREN Examination found the presence of
glucose in the urine. The examination is done
1. Definition
by Benedict (reduction). The results can be
Gangrene is tissue death, usually associated seen through the color changes in urine: green
with cessation of blood flow to the affected area. (+), yellow (++), red (+++), and red brick
(++++).
2. Etiology
c. Puschult culture
Gas gangrene occurs due to infection by Know the type of germs in the wound and
clostridium bacteria, which is an aerobic bacteria provide antibiotics that suit the type of germs.
(grown when there is no oxygen). During its
growth, clostridium produces gas, so the 7. Complications
infection is called gangrene gas. 1. Dry gangrene
2. Wet gangrene
3. Classification
3. Gang gangrene
Gangrene is a result of cell death in large
4. Gangren internal
quantities, gangrene can be classified as dry or
5. Fournier's gangrene
wet.
1. Dry ganggren extends slowly with only a few
8. Medical Management
symptoms.
1. Improve the general state of the patient with
2. Wet gangrene is an area where dead tissue is
adequate nutrition
rapidly expanding.
2. Provision of platelet anti aggregation if
necessary, hypolipidemic and anti-
5. Manifestasi Clinis
hertensi
1. Usually manifested with severe sudden pain
3. If suspected of a gangrene, immediately
that occurs 1 to 4 days after injury, pain
given broad-spectrum antibiotics,
caused by gas and edema in injury tissue.
although for destroying clostridia only
2. Around the normal looking wound is brightly
needed penicillin.
colored and taut but then becomes dark.
4. Conducted removal of damaged tissue.
3. The stench of the liquid comes out of the
Sometimes if the circulation is very
wound. Gases and fluids retained increased
bad, part or all of the limbs must be
local pressure and disrupted the blood supply
amputated to prevent the spread of
and drainage of visible and necrotic muscle.
infection.
5. High pressure oxygen therapy (hyperbaric
6.Diagnostic Examination
oxygen) can also be used to treat
DIAGNOSIS
gangrene skin wide. Patients are placed in a
Diagnosis of diabetic gangrene is established by :
room containing oxygen high
1. Anamnesis / clinical symptoms
pressure, which will help kill clostridia.
2. Physical examination of "Physis diagnostic"
6. Clean the wound on the skin thoroughly.
3. Laboratory examination.
7. Be alert to signs of infection (redness, pain,
discharge, swelling).
Laboratory tests are :
a. Blood examination
 1. Malaria Serebral
MALARIA DISEASE
2. Acute Kidney Failure (ARF)
2.1 Definition of Malaria 3. Lung Edema is often called Lung

Malaria is a disease caused by parasites of the genus 4. Hypoglycemia

Plasmodium , which belongs to the protozoa group 5. Haemoglobinuria (Black Water Fever)

through the intercession of prick (bite) mosquito 6. Malaria Algid

Anopheles spp. Indonesia is one country that has

high endemicity. 2.6 Treatment of Malaria
Malaria treatment should be performed
2.2 Types of Malaria
after malaria diagnosis confirmed through clinical
There are four types of Plasmodium that can cause and laboratory examinations. Treatment should pay
malaria, namely as follows : attention to three main factors, namely species
plasmodium,clinical status penderita and drug
1. Malaria tertiana
toxicity to the parasite infect. Anti-malarial drugs
2. Malaria quartana
that can be used to eradicate malaria including
3. Malaria Tropica
malaria falcifarum is artemisinin and
4. Malaria Pernisiosa
deriviatnya,chinchona alkaloids,meflokuin,
2.3 Transmission of Malaria
balofantrin,sulfadoxinpirimetamines, and
a. Congenital Malaria
proguanil. Meanwhile, to treat malaria vivax and
b. Mechanically
malaria ovale ,using anti-malarial drugs
c. Orally (by mouth)
chloroquine.However when used as radical
2.4 Prevention of Malaria treatment of administration chloroquine followed
1. Using bed net at bedtime, preferably with by giving primaquine,not to mention infections that
insecticide-treated bed nets. caused plasmodium malariae, the type of drug
2. Smearing the body with mosquito repellent. chloroquine still used .
3. Using mosquito repellent, whether fuel,
spray or other.
4. Installing wire netting on windows and
ventilation.
5. The location of the residence is cultivated
away from the livestock enclosure.
6. Prevent malaria sufferers and mosquito
bites for infection not spread

2.5 Complications of Malaria

 LEPROSY
A. Identification and Illustration Epidemiology
Leprosy Disease
Hansen Disease or Morbus Disease Hansen
formerly known as Leprosy or Leprosy is a
chronic disease caused by bacteria, especially
attacking the peripheral nerve, then attack the
skin, mouth mucosa, upper airways, eyes,
muscles, bones and testes except the central
nervous system.
B. The Cause of Leprosy Mycobacterium leprae
is the cause of leprosy.
An acid-resistant M. leprae bacterium is also
aerobic, gram-positive, rod-shaped bacterium,
and is surrounded by a wax cell membrane
characteristic of the Mycobacterium species.
The time of division of M. leprae is very long,
ie 2-3 weeks. Outside the human body (in
tropical conditions) leprosy germs can last up
to 9 days. The optimal growth of leprosy germs
is at 27 ° -30 ° C and the average shoot period
is 2-5 years.
C. How to Transmit Leprosy
Leprosy can be transmitted from leprosy type
Multi basiler (MB) to other people by means of
direct transmission. The exact mode of
transmission is unknown, but most experts
argue that leprosy can be transmitted through
the inhalation and skin (long and close
contacts). Germs reach the surface of the skin
through hair follicles, sweat glands, and
allegedly also through breast milk. The
implantation site is not always the site of the
first lesion. The incidence of leprosy for
someone is not easy, and not to be feared
depends on several factors including: Factors
Source of Transmission. Factor of Leprosy
Germ. Body Resistance Factor
D. Leprosy Disease Incubation Period
It ranges from 9 months to 20 years with an
average of 4 years for tuberculoid leprosy and
twice as long for lepromatous leprosy. This
disease is rarely found in children under 3 years
of age, although more than 50 cases have been
found in children children under the age of 1
year, the youngest is 2.5 months.
E. Transmission
The clinical and laboratory facts prove that the
infectivity of the disease is gone within 3
months through continuous and regular
treatment using Dapsone (DDS) or clofasimine
or within 3 days using rifampin.
F. Signs of suspected leprosy (suspect):
Ø Signs on the skin
1. Spots / Disorders of red or white skin on
the body
2. 2. Glossy skin
3. 3. Non-itchy spots
4. The presence of body parts that are not
sweating or not haired.
Ø Signs on the nerves
1. Tingling, piercing and pain in limbs or
face.
2. Impaired movement of limbs or the face
3. The existence of defects (deformity)
G. Spesific Treatment
Specific treatment: Given the very high level of
resistance from dapsone and the emergence of
resistance to rifampin, the treatment of combination
therapy (multidrug theraphy) is very important. The
minimum regimen recommended by WHO for
multibacillary type leprosy is rifampin, 600 mg
once a month; dapsone (DDS), 100 mg daily; and
clofasimine, 300 mg once a month and 50 mg daily
Rifampin and clofasimin given every month should
be closely monitored
 HIV / AIDS c. High risk groups are advised not to be blood
2.1 Definition of HIV / AIDS donors.
AIDS is "acronym for Acquired Immune d. The use of syringes and other punctures
Defense Syndreome, a disease caused by a virus should be guaranteed sterility.
that destroys the human immune system. So people e. People who are already HIV (+) and still
can die not solely by their HIV virus by other have sexually active use condoms properly.
diseases that can actually be rejected if the body f. Avoid it sexual intercourse when being
power is not damaged, whereas HIV is the name of injured on the genitals or the mouth and also
the virus causing AIDS or called Human avoid the use of certain tools during
Immunodeficiency Virus. "(1999, 9) intercourse that allows wounds.

2.5 Mode of Transmission Increase keimana and ketaqwaan to God Almighty.

How to Avoid from HIV Virus by way of ABCD:

A: Abstinence, stay away from sex alternating

couples without a condom.

B: Be faithful, be faithful to each other.

C: Condom Use / Consistent; Prevent by using

condoms, consistent use of protective equipment.

D: Drugs / Dont, avoidtheuseofdrugs.

a. Through the blood fluid
E: Education, providinginformationabout HIV /
b. Through the fluid sperm and vaginal fluid
AIDS.
c. Through breast milk
2.7 PeopleatRisk
2.6 Prevention
Accordingto H. JH. Wartono, Abu Chanif, etal,
According to H. JH. Wartono, Abu Chanif, et al. (1999) 12) there are five types AIDS, namely:
(1999. 12) ways to prevent HIV / AIDS
a.Thosewithmultiplesexualpartners
transmission are:
b. Receiverofbloodtransfusion.
a. Avoid sexual intercourse outside of
marriage. Try only sex with one sex partner, c. Babiesborntomotherswith HIV.
not having sex with other people.
d. Injectableinjectionnckotics.
b. Mothers with HIV, should not get pregnant,
because it will transfer HIV to the fetus. e. Couplesfrompeoplewith HIV.
 RABIES g. hallucinations, nightmares, and insomnia

Definisi h. priapism, or permanent erection, in males

Rabies is a virus that is usually spread by the bite or
scratch of an animal. By the time the symptoms
appear, it is generally too late to save the patient.
Fast facts on rabies
a. Rabies is a viral disease that is nearly always
transmitted by an infected animal bite.
b. Anyone who receives a bite in a geographical
area where rabies occurs should seek treatment
at once.
c. For treatment to be successful, it must be given
before symptoms appear.
d. Symptoms include neurological problems and a
fear of light and water.
e. Following the vaccination requirements for pets
helps prevent and control rabies.
i. photophobia, or a fear of light
Toward the end of this phase, breathing
becomes rapid and inconsistent.
Coma and death
If the person enters a coma, death will occur within
a matter of hours, unless they are attached to a
ventilator.
Rarely, a person may recover at this late stage.
Why does rabies cause a fear of water?
Rabies used to be known as hydrophobia because it
appears to cause a fear of water.
Intense spasms in the throat are triggered when
trying to swallow. Even the thought of swallowing
water can cause spasms. This is where the fear
comes from.

Symptoms The excess saliva that occurs is probably due to the

impact of the virus on the nervous system.
Rabies progresses in five distinct stages:
If the individual could swallow saliva easily, this
a. Incubation would reduce the risk of spreading the virus to a
new host.
b. Prodrome
c. acute neurologic period
d. coma
e. death

Acute neurologic period

Neurologic symptoms develop, including:
a. confusion and aggression
b. partial paralysis, involuntary muscle twitching,
and rigid neck muscles
c. convulsions
d. hyperventilation and difficulty breathing
e. hypersalivation or producing a lot of saliva, and
possibly frothing at the mouth
f. fear of water, or hydrophobia, due to difficulty
swallowing
 TUBERCULOSIS DISEASE
1. DEFINITION
Tuberculosis is a contagious disease caused
by TB (Myobacterium tuberculosis). Most TB
germs attack the lungs, but can also affect other
organs. (Depkes RI, 2007).
2. Clasification of TB
In according with Gerdunas P2TB program
pulmonary TB classification IS divided as follows :
1. Lung smear positif tuberculosis with criteria :
 with or without clinical syntom
 BTA positif : positif mikroscopic 2
times, positif microscopic 1 time
supported positif culture 1 time or
supported by positif radiology 1 time
 radiology picture according to
pulmonary tuberculosis
2. BTA negative pulmonary tuberculosis with
criteria :
 Clinical symptoms with radiologic
features in according with active
pulmonary tuberculosis
 BTA negative but positive radiologic
3. Former lung TB with criteria :
 Bacteriologic (microscopic and culture)
negative
 No clinical symptoms or any residual
symptom due to lung abnormalitas
 radiologic shows and an inactive
tuberculosis lession, showing unchanged
serial image
 There is a distory of OAT treatment is
adequate
3. ETIOLOGY
Tuberculosis is caused by Mycobacterium
tuberculosis. These germs are rod-shaped, have
special properties that are resistant to acid in
staining. Therefore it is also called as Acid
Resistant Basil (BTA). (Depkes RI, 2008). Basil is
not berspora so easy to discharge by heating,
sunlight and ultraviolet rays (Nurarif dan Kusuma,
2013), but can survive for several hours in a dark
and humid place. In body tissues these germs can be
dormant, falling asleep for several years. (Depkes
RI, 2008). There are two kinds of mycobacteria
tuberculosis that is human type and bovin type.
Bovin-type bacilli are present in cow's milk with
intestinal tuberculosis mastitis. Basil type human
can be in spit (droplet) in the air coming from open
tuberculosis patient. (Nurarif dan Kusuma, 2013).
3. MANIFESTATION CLINICAL
According to Wong (2008) signs and symptoms
of tuberculosis are :
a. Fever
b. Malaise
c. Anorexia
d. Weight loss
e. Cough is present or not (develops slowly for
weeks to months)
f. Increased respiratory rate
g. Bad expansion on the sick place
h. The sound of breath disappeared and ronkhi
rough, deaf at the time of percussion
i. Persistent fever
j. Common symptoms manifestation: pallor,
anemia, weakness and weight loss
5. PREVENTION FOR THOSE ALREADY
INFECTED WITH TUBERCULOSIS
a. Use a clean mouth mask, do not mention every
day a mask is used
b. Do not spit indiscriminately
c. Eat good and healthy foods
d. Keep room or home ventilation good, and
open the window for air circulation to run
smoothly.
6. SUPPORTING INVESTIGATION
According to Somantri (2008), investigations on
tuberculosis patients are:
a. Sputum Culture
b. Ziehlneelsen: Positive for smear
c. Skin test (PPD, mantoux, tine, and vollmer,
patch)
d. Chest X-ray
e. Histology or tissue culture: positive
forMycobacterium tuberculosis