PBL Holistik

7/21/2019 PBL Holistik

1/29

1 | P a g e

PBL Medical Faculty of Airlangga University

Holistic Module

General Instructional Objective

After completing this module based on Problem Based Learning, the 1st semesterstudents of Faculty of Medicine Airlangga University will be able to:

1.Understand the approach of holistic human environment concept.2.Able to assess the condition of health care and families according to physical

aspect.

3.Able to assess the condition of health care and families according to mental aspect.4.Able to assess the condition of health care and families according to social aspect.5.Able to assess the condition of health care and families according to cultural aspect.6. Able to identify the efforts of health maintenance and disease prevention.

Specific Instructional Objective

1. Able to explain the nutritional condition of children.

2. Able to explain various risk factors of nutritional problems.

3. Able to explain the risk factors of health care and nutrition in children.

4. Able to explain the physical, mental, social, and cultural aspect of health care and

family of children.

5. Able to explain the occurrence of nutritional problems in children through a holistic

approach of the human and environment concept.


2/29

2 | P a g e


Holistic Module

CHAPTER ONE

FIRST TUTORIAL

Brain Storming and Cogni tive Strategy

1.1 SCENARIO 2

Ida, an 8 years old was taken to a nearest health center by her mother because

of always sleeping during class at school. On the check up were found that Ida weight

22 kg, is 125 cm tall, and has10,2 g/dL hemoglobin rate.

1.2 KEYWORDS

1.2.1 Ida, an 8 years old

1.2.2 Always sleeping during class

1.2.3 Weight 22 Kg

1.2.4 Height 125 cm

1.2.5 Hemoglobin rate: 10,2 g/dL


3/29

3 | P a g e


Holistic Module

1.3 EARLY HYPOTHESIS

1.3.1. Ida, an 8 years old child has health problems based on a general check up on

the levelof hemoglobin, which is 10,2 g/dL or usually called anemia.

And always sleeping during class at school that also shows on of the

characteristics of suffering from anemia.

1.3.2. Ida, an 8 years old child has health problems based on mallnutrition.


the rate of hemoglobin, which is 10,2 g/dL that also shows on on of the

characteristics of suffering from Leukimia (blood cancer)

1.3.4. Ida, an 8 years old child suspected having of wormy.

1.3.5. Ida, an 8 years old child having problem in a healthy lifestyle, include :

1.3.5.1. Rest

1.3.5.2. Environment

1.3.5.3. Higenitation and Sanitation

1.4 COGNITIVE STRATEGY

1.4.1. Group discussion without tutor, brainstorming: suggests ideas among

students.

1.4.2. Group discussion on tutorial, tutor acts as a facilitator.

1.4.3. Study independently with facilitation such as text books, journals, other

information such as internet from any audiovisual facilitation.

1.4.4. Arrange the conclusion of the group discussion.

1.4.5. Attend the plenary discussion between guest speaker and the group that

is chosen to present their group conclusion.


4/29

4 | P a g e


Holistic Module

1.5 LEARNING ISSUES 1

1.5.1. How height and weight that are ideal for children 8 years old?

1.5.2. How the rate of hemoglobin that is ideal for children 8 years old?

1.5.3. What is the definition and kinds of anemia?

1.5.4. What symptoms and causesof anemia?

1.5.5. What is the definition of mallnutrition?

1.5.6. What symptoms and causesof mallnutrition?

1.5.7. What is the definition of Leukimia?

1.5.8. What symptoms and causesof Leukimia?

1.5.9. What is the definition of wormy(Anclyostomiasis)?

1.5.10. What symptoms and causesof wormy(Anclyostomiasis)?

1.5.11. How the sleep patterns of children 8 years old is ideal?

1.5.12. What are the indication of a healthy and good nutrition child ?


5/29

5 | P a g e


Holistic Module

1.6 ADDITIONAL QUESTIONS OR INFORMATION

No. Question Reason Answer

1. Does Ida eat on a

regular basis?

Because we need

to know if Ida

have a enough

nutrition or no.

- Ida and her familyeats three times a day

even completed with

milk

- Ida always use aspoon when she eats.

- Ida always breakfast.- Ida like eat sausage

and crackers.

2. How is the condition

of Idasfamily?

We need to know

the environment

of IdasFamily

- Bathroom standsbeside Dining Room.

- Her Father isVegetable seller and

her Mother housewife.

- Idas parents graduateonly from Junior High

School

- Ida helps hergrandfather sells

things from his shop.

- Idas Family neveraffect of cancer

3. What is Idas daily

activities?

To determine

higenitation and

sanitation from

herself.

- Ida always play afterschool and she always

use sandal.

- Ida doesnt likeplaying at sand.


6/29

6 | P a g e


Holistic Module

- Ida always sleep in 2pm oclock.

- Ida always go to sleep8 pm oclock and

wake up in the

morning.


7/29

7 | P a g e


Holistic Module

CHAPTER TWO

SECOND TUTORIAL

Problem Analysis

2.1 LEARNING METHODS AND STEPS

2.1.1 Search all the information related to the learning issues from the internet,

text books, and journals.

2.1.2 Critically appraise the information sources to determine which sources

are valid, important, and applicable to answer the learning issues.

2.1.3 Answer the learning issues based on all sorted information.


8/29

8 | P a g e


Holistic Module

2.2 ANSWER OF LEARNING ISSUES

2.2.1 How height and weight that are ideal for children 8 years old?

Answer :

Normal Height 8 years old

(age x 6) + 77 = (8 x 6) + 77

= 125 cm (Needlman RD, 2004)

Normal weight 8 years old

2.2.2 How the rate of hemoglobin that is ideal for children 8 years old?

Answer :

The rate of Hemoglobin for children 8 years old is less than 12 g/dL (normal if it is

between 11 g/dL - 13 g/dL) (WHO)


9/29

9 | P a g e


Holistic Module

2.2.3 What is the definition and kinds of anemia?

Answer :

Anemia is condition when the body has lack of red blood cell, expecially

haemoglobin to bond oxygen. Many cause also can cause of anemia, example :

bleeding, menstruasi, pregnancy and etc. All about that is make much red blood

cell disapeared. Anemia is no longer a case in medical education. The people of

medical person has thought this disease and did much observation until now. But

many form of thi disease still cant cureable. This disease can cause big trouble for

human. For example, anemia cause by blood cancer. The cancer can spread in all of

cardiovascular system and eat the red blood cell. The lack of red blood cell cause of

death.

There is many types of anemia. Anemia due to B12, folate, and iron deficiency,

Anemia of chronic disease, Hemolytic anemia, Idiopathic aplastic anemia,

Megaloblastic anemia, Pernicious anemia, Sickle cell anemia, and Thalassemia.

a. Anemia due to B12, folate, and iron deficiencyThe body needs certain vitamins, minerals, and nutrients to make enough red

blood cells, Iron, vitamin B12, and folic acid are three of the most important ones.

The lack of one of them can cause anemia, because body cant produce much red

blood cell. Lack of vitamin b12 cannot produce much blood cell. Lack of folate can

cause abnormally red blood cell. And lack of iron can cause un effectively carry the

oxygen.

This disease can be cause by Eating a vegetarian diet, Poor diet in infants, Poor

nutrition during pregnancy, infection by worm (the worm eat blood nutrition, and

cause lack of nutrition for produce blood), Heavy, long, or frequent menstrual

periods, Cancer in the esophagus, stomach, orcolon, Esophageal varices usually

from cirrhosis, The use of aspirin, ibuprofen, or arthritis medicines for a long time,

which can cause gastrointestinal bleeding,Peptic ulcer disease and etc.
http://www.nlm.nih.gov/medlineplus/ency/article/000262.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000268.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000206.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000206.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000268.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000262.htm


10/29

10 | P a g e


Holistic Module

b. Anemia of chronic diseaseAnemia is a lower-than-normal number of red blood cells in the blood. Anemia of

chronic disease is anemia that is found in people with certain long-term (chronic)

medical conditions.

The disease that certain long-term medical condition example : Autoimmune

disorders, such asCrohn's disease,systemic lupus erythematosus,rheumatoid

arthritis,andulcerative colitis,Cancer,including lymphoma andHodgkin's disease,

Chronic kidney disease,Liver cirrhosis,and Long-term infections, such as bacterial

endocarditis,osteomyelitis (bone infection),HIV/AIDS,hepatitis B orhepatitis C

c. Hemolytic anemiaNormally, red blood cells last for about 120 days before the body gets rid of

them. In hemolytic anemia, red blood cells in the blood are destroyed earlier than

normal. Hemoltic anemia is when the bone marrow can replace the red blood cell

that has destroyed.

The body may also destroy red blood cells because of Certain genetic defects that

cause the blood cells to take on abnormal shapes (such assickle cell

anemia,thalassemia,andhemolytic anemia due to G6PD deficiency,Exposure to

certain chemicals, drugs, and toxins, Infections, Blood clots in small blood vessels,

and Transfusion of blood from a donor with a blood type that does not match

yours.

d. Aplastic anemiaAplasticanemia is a condition in which the bone marrow does not make enough

new blood cells. Bone marrow is the soft, fatty tissue in the center of bones. The

immature cell in bone marrow can cause decrease product of all type of blood cell,

like red bloodcell, white blood cell, and platelets. Aplastic anemia also can cause by

pregnancy, or lupus, and also chemotherapy. It can cause aplastic anemia.

e. Pernicious Anemia
http://www.nlm.nih.gov/medlineplus/ency/article/000816.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000816.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000249.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000435.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000431.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000431.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000250.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/001289.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000580.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000255.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000437.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000594.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000279.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000284.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000527.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000527.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000587.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000528.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000560.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000560.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000528.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000587.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000527.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000527.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000284.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000279.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000594.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000437.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000255.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000580.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/001289.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000250.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000431.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000431.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000435.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000249.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000816.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000816.htm


11/29

11 | P a g e


Holistic Module

Pernicious anemia is a decrease in red blood cells that occurs when your

intestines cannot properly absorb vitamin B12.

A special protein, called intrinsic factor, helps the intestines absorb vitamin B12.This protein is released by cells in the stomach. When the stomach does not make

enough intrinsic factor, the intestine cannot properly absorb vitamin B12.

This type of anemia never seen in under 30 years old, the average is 60 years old.

The disease common has cause by Weakened stomach lining (atrophic gastritis),

and An autoimmune condition in which the body's immune system attacks intrinsic

factor protein or the cells that make it.

f. Sickle cell anemiaSickle cell anemia is a disease passed down through families. The red blood cells

which are normally shaped like a disc take on a sickle or crescent shape. Red blood

cells carry oxygen to the body.

Sickle cell anemia is caused by an abnormal type of hemoglobin called

hemoglobin S. Hemoglobin is a protein inside red blood cells that carries oxygen.

Hemoglobin S changes the red blood cells. The red blood cells become fragile and

shaped like crescents or sickles. The abnormal cells deliver less oxygen to the

body's tissues. They can also easily get stuck in small blood vessels and break into

pieces. This can interrupt healthy blood flow and cut down even more on the

amount of oxygen flowing to body tissues.

Sickle cell anemia is inherited from both parents. If you get the sickle cell gene

from only one parent, you will havesickle cell trait.People with sickle cell trait do

not have the symptoms of sickle cell anemia.

g. ThalassemiaThalassemia is a blood disorder passed down through families (inherited) in

which the body makes an abnormal form ofhemoglobin,the protein in red blood
http://www.nlm.nih.gov/medlineplus/ency/article/003666.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003645.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003645.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003666.htm


12/29

12 | P a g e


Holistic Module

cells that carries oxygen. The disorder results in excessive destruction of red blood

cells, which leads to anemia.

Hemoglobin is made of two proteins: Alpha globin and beta globin. Thalassemiaoccurs when there is a defect in a gene that helps control production of one of

these proteins.

There are two main types of thalassemia: Alpha thalassemia occurs when a gene

or genes related to the alpha globin protein are missing or changed (mutated). Beta

thalassemia occurs when similar gene defects affect production of the beta globin

protein.

2.2.4 What symptoms and causes of anemia?

Answer :

Anemia has three main causes: blood loss, lack of red blood cell production, or

high rates of red blood cell destruction. These causes might be the result of

diseases, conditions, or other factors.

You may have no symptoms if the anemia is mild. If the problem develops slowly,

symptoms that may occur first include: Feeling grumpy, Feeling weak or tired more

often than usual, or with exercise, Headaches, Problems concentrating or thinking.

If the anemia gets worse, symptoms may include: Blue color to the whites of the

eyes, Brittle nails, Light-headedness when you stand up, Pale skin color,Shortness

of breath,and Sore tongue.

Some types of anemia may have other symptoms.

Many chase of anemia can be be mild, short term, and easily treated. People

can cure this disease with some healthy diet. It need more nutrition that contain

b12, folate, and iron. It can be use for increase red blood production. So there is no

need some highly medical treatment.
http://www.nlm.nih.gov/medlineplus/ency/article/003075.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003075.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003075.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003075.htm


13/29

13 | P a g e


Holistic Module

But in the other hand, some disease that cause anemia must have highly

medical treament like chemotherapy, eat some anthelmitic, medical check up, and

other medical treatment. To cure this disease, we must now the main disease that

cause anemia. So we can choose the perfect treatment that can cure it.

2.2.5 What is the definition of mallnutrition?

Answer :

Malnutrition is a condition where the body has unbalance nutrition. It occurs

because the person cant maintain a healthy lifestyle. In developed country like Indonesia,

malnutrition often misunderstood by deficiency of nutrition. Infact malnutrition includes

deficiency and surplus of nutrition.In general malnutrition will result minor healt problem.

But when its severe, will result major health problem.

2.2.6 What symptoms and causes of mallnutrition?

Answer :

Clinical symptoms of malnutrition varies depending on the degree and duration of

protein and energy depletion, the age of patients, lack of vitamins and minerals.

Factors causing malnutrition in the form of lack of quantity and quality of healthy and

balanced diet ( UNSOED, 2010 ).

2.2.7 What is the definition and kinds of Leukimia?

Answer :

Leukemia is a malignancy derived from a genetic change in one or more cells in the

bone marrow . Growth of normal cells would be depressed at the time of leukemia cells

multiply so will cause clinical symptoms . Hematologic malignancy is the result of a process

of differentiation of neoplastic disorders accompanied at various levels of hematopoietic stemcells resulting in progressive expansion of the group of malignant cells in the bone marrow

,and then cells of leukimia circulate by sistemic

Simply leukemia can be classified based on cell maturation and cell type of origin, are

:

a. Acute leukemiais a malignant primary bone marrow which means there terdesaknya normal blood

components by abnormal blood components , along with the spread to other organs


14/29

14 | P a g e


Holistic Module

. Acute leukemia has a rapid clinical course , without treatment the patient will die

within an average of 4-6 months .

1 . Acute Lymphocyte Leukemia

Leukemia with characteristic presence of proliferation and accumulation of

pathological cells limfopoetik system resulting in organomegaly( enlargement of

the tools ) and organ failure . LLA is more common in children ( 82 % ) than in

adults ( 18 % ) . LLA will peak at age 3-7 years . Without treatment the children

will live 2-3 months after diagnosis .

2 . Acute chronic myelogenous leukemia

Leukemia is a hematopoietic stem cell know that will differentiate into all cell

meiloid . LMA is a non - lymphocyte leukemia is most often the case . LMA ismore commonly found in adults ( 85 % ) than children ( 15 % ) . Sudden and

progressive beginning 1-3 months with brief symptoms . If untreated would be

fatal 3-6 months .

b. Chronic leukemia is a disease characterized neoplastic proliferation of one cell thatlasts or occurs because of hematological malignancies .

1 . Chronic Lymphocyte Leukimia

Is a clonal malignant B lymphocytes , travels slowly . Tend to snack knownattack aged 50-70 with a 2:1 ratio for male.

2 . Chronic chronicmyelogenous leukemia

Is a disorder characterized by excessive production

meiloproliferatifbyangmeilod relatively mature cells . 20 % is common in

middle age ( 40-50 years ) . Most of the patients died after entering the final

phase ( phase BLASTIK critical that excessive production of leukocytes of

young cells , usually in the form of meiloblas , accompanied by the production

of neutrophils , platelets , and red blood cells are much less ) .

2.2.8 What symptoms and causes of Leukimia?

Answer :

Clinical symptoms of leukemia in general :

Anemia , thrombocytopenia , neutropenia , infaksi , abnormalities of the affected organ

infiltration , hypermetabolism , dyspnea , abdominal pain .


15/29

15 | P a g e


Holistic Module

Causes of Leukimia

the causes of leukemia is not known with certainty , there are several factors thought to affect

the occurrence of leukemia are Radiation ,Leukemogenik, Hereditary, Virus (retrovirus ,

feline leukemia virus , HTLV - 1 ).

2.2.9 What is the definition of wormy ?

Answer :

Wormy or commonly referred to as worms infection is an infections caused by

parasitic worms ( nematodes class ). Parasites are tiny creatures that invade the human body

by attaching themselves (inside and outside the human body) and take the nutrients of the

human body. Worms usually accours due to a lack of awareness of hygiene, both to

themselves and to their environment. Worms can infect any part of the body that lived in, like

the skin, muscle, lungs, and digestive tract. Worms infection are not lethal but disrupt the

human bodys health and lowering the nutritional condition and humans health. In Indonesia

this infection has a high relative prevalence, especially in elementary school children.

Wormy disease caused by several gastrointestinal nematode that is transmitted

through the ground. transmission can occur in two ways: direct infection / swallow eggs

and larvae penetrate the skin. Loss caused by worm infection is very large on physical

development, intelligence, and productivity of children who are the future generation

(Aru Sudoyo, 2006).

There is called Soil Transmitted Helminths. It is a group of wormy parasitic (

Nematode class) which can cause infection in humans, through contact with eggs or larvae of

the parasite itself, which growing in moist soil that found in tropical countries and subtropical

(Bethony, et al., 2006).

According to Hotez (2006) Soil Transmitted Helminths are the most frequently

infected is roundworm (Ascaris lumbricoides), whipworm (Trichuris trichiura) and

hookworm / anthropophilic hookworm (Ancylostoma duodenale and Necator americanus)

while Strongyloides stercoralis rarely found mainly in cold climates (Gandahusada 2006).


16/29

16 | P a g e


Holistic Module

In the other side, wormy generally caused by an infection of (Ascaris lumbricoides),

pinworms (Oxyuris vermecularis), tapeworms (Taenea solium) and hookworms (Ancylostoma

duodenale) (Zulkoni Akhsin, 2007).

2.2.10 What symptoms and causes of wormy(Anclyostomiasis)?

Answer :

Symptoms of wormy:

Symptoms of intestinal worms are often confused with other diseases. In the

beginning, there may be coughing and eosinofilin. Children who suffer from

intestinal worms usually listless, listlessness, and lack of concentration.

In children suffering from ascaris lumbricoides, her stomach looks bloated,

frequent abdominal pain, diarrhea, and lack of appetite. Usually, a child can still

run their activity despite decreased learning ability and productivity ( Menteri

Kesehatan, 2006 )

Cause of wormy :

1. roundworms (Ascaris lumbricoides)2. pinworms (Oxyuris vermecularis)3. tapeworms (Taenea solium)4. hookworms (Ancylostoma duodenale).(Zulkoni Akhsin, 2007).

The Process of Worms Tranmission which can get someone to have this disease

Worms disease which transmitted trough the soil is included in gastrointestinal

nematode family. Transmission can occur through 2 ways (Aru Sudoyo, 2006):

1. Direct infectionDirect transmission can occur when the worm eggs from anal edge come into the

mouth without ever developing first on the ground. This way occurred in pinworms

(Oxyuris vermicularis) and trichuriasis (Trichuris trichura). Transmission can also


17/29

17 | P a g e


Holistic Module

happen after the development period of eggs on the ground and then the eggs

ingested through contaminated hands or food (Ascaris Lumbricoides).

2. The larvae penetrate the skinTransmission happen through the skin in hookworm / ankilostomiasis and

strongyloidiasis where the eggs hatch in the ground first and then filariform larvae

infect through the skin.

Transmission worm eggs, other than through the hands, can also through food and

drink. Especially the street food that is not packaged and sealed. Worm eggs in the soil or

dust will come to the food, blown by the wind, or fly through the DAPT also previously

landed on the ground or waste water so that the legs carry the worm eggs (Helmy,

2006).

Transmission through the vegetables are eaten raw (not cooked) and imperfect

cleaning process can also occur, especially if the vegetables fertilized with fresh feces. In

some countries the use of excreta as fertilizer should be treated first with certain

chemicals in the form of desinfentasi (Brown, 1979).

2.2.11 How the sleep patterns of children 8 years old is ideal?

Answer :

Sleep is a state of unconsciousness experienced by a person, which can be awakened

again by the senses or enough stimulation (Priharjo, 2005). Sleep is characterized by minimal

physical activity, levels awareness varies, changes the biological processes of the body, and

decrease in response to external stimuli. Sleep is a basic necessity that everyone needs.

Similarly, people who are sick, they also need adequate rest and sleep.

Sleep is one of the important things for a person. The function is to protect the body,

energy conservation, restoration brain, homeostasis, improve immunity function, and

regulation of body temperature (Lumbantobing, 2004).

But some experts argue, sleep is detoxification (neutralization) or a toxic poison that

accumulates in the body. The accumulation of these toxins that cause sleepy, triggering a


18/29

18 | P a g e


Holistic Module

person to sleep. It is a form of protection that a person does to his body during sleep

(hipotoksins theory).

Long sleep a person needs depends on age and stage of development. The older a

person, the less sleep longer necessary (Priharjo, 2005).

Sleep patterns based on age level

Level of development Normal sleep pattern

New baby born 14 until 18 hours/day

Babies ( 0-1 years old ) 12 until 14 hours/day

Toddler ( 2-3 years old ) 11 until 12 hours/day

Pre-school children ( 3-6 years old ) 11 hours/day

School children ( 6-years old ) 8 until 11 hours/day

Based on the research of experts, that increasing age, the time spent in sleep decreases.

This is due to increased physical activity, such as playing (Suherman, 2000).

2.2.12 What are the indication of a healthy and good nutrition child ?

Answer :

Childrenwithgood nutrition, it can be seenfromsomeof the common signsareeasily

visible. Here are10common signs of healthy children:

1. Increasingage, gain weight, grow taller2. Uprightpostureandmuscledense3. shinyandstrong hair4. Skinandnailsare cleanand are notpale5. Cheerfulface, clear eyesandfreshlips6. Cleanteethandpinkgums


19/29

19 | P a g e


Holistic Module

7. Good appetite and8. Move actively and speak fluently9. Attentive and active towards reaction10.sleep comfortable

These 10common signs

ofhealthy children, as

outlined above, can

makeindicatorsto a healthy

children. If some children

do not have these these

common signs,we can

makeindicatorstoactproperlyandaccurately as possible. These common signs helps

the families to care more of the health of their children.

10 signs of healthy children in Indonesian :

Daughter

Age (In

months)

GiziBuruk

(kg)

GiziKurang

(kg)

GiziLebih

(kg)

GiziLebih

(kg)

0 1.7 1.8 - 2.1 2.2 - 3.9 4.0


20/29

20 | P a g e


Holistic Module

1 2.1 2.2 - 2.7 2.8 - 5.0 5.1

2 2.6 2.7 - 3.2 3.3 - 6.0 6.1

3 3.1 3.2 - 3.8 3.9 - 6.9 7.0

4 3.6 3.7 - 4.4 4.5 - 7.6 7.7

5 4.0 4.1 - 4.9 5.0 - 8.3 8.4

6 4.5 4.6 - 5.4 5.5 - 8.9 9.0

7 4.9 5.0 - 5.8 5.9 - 9.5 9.6

8 5.3 5.4 - 6.2 6.3 - 10.0 10.1

9 5.6 5.7 - 6.5 6.6 - 10.4 10.5

10 5.8 5.9 - 6.8 6.9 - 10.8 10.9

11 6.1 6.2 - 7.1 7.2 - 11.2 11.3

12 6.3 6.4 - 7.3 7.4 - 11.5 11.6

13 6.5 6.6 - 7.5 7.6 - 11.8 11.9

14 6.6 6.7 - 7.7 7.8 - 12.1 12.2

Son

AgeGiziBuruk

(kg)

GiziKurang

(kg)

GiziBaik

(kg)

GiziLebih

(kg)

0 1.9 2.0 - 2.3 2.4 - 4.2 4.3

1 2.1 2.2 - 2.8 2.9 - 5.5 5.6

2 2.5 2.6 - 3.4 3.5 - 6.7 6.8

3 3.0 3.1 - 4.0 4.1 - 7.6 7.7

4 3.6 3.7 - 4.6 4.7 - 8.4 8.5

5 4.2 4.3 - 5.2 5.3 - 9.1 9.2


21/29

21 | P a g e


Holistic Module

6 4.8 4.9 - 5.8 5.9 - 9.7 9.8

7 5.3 5.4 - 6.3 6.4 - 10.2 10.3

8 5.8 5.9 - 6.8 6.9 - 10.7 10.8

9 6.2 6.3 - 7.1 7.2 - 11.2 11.3

10 6.5 6.6 - 7.5 7.6 - 11.6 11.7

11 6.8 6.9 - 7.8 7.9 - 11.9 12.0

12 7.0 7.1 - 8.0 8.1 - 12.3 12.4

13 7.2 7.3 - 8.2 8.3 - 12.6 12.7

14 7.4 7.5 - 8.4 8.5 - 12.9 13.0

2.3 METHODS AND STEPS TO FIND THE INFORMATION

2.3.1 Sources

-2.3.2 Obstacles

- Having difficulties in knowing the aim of the issue- Having difficulties in finding the valid websites- Having difficulties in finding the reliable and relevant websites- Having difficulties in finding the right answers for learning issues

stage 1

2.4 ANALYSIS 1

According to the scenario that had been given, Ida weight 22 kg and 125 cm

tall . As we can see from the learning issues above, Ida weight normally just like a

normal children. Idas weight place normally in the range of a normal female

children that is 20-25 kg. As for her height, she height normally just like any

other children with range 120 125 cm. So we can conclude that Idas weight

normally and height normally just like any other fulfilled nutrition children.


22/29

22 | P a g e


Holistic Module

Because of the above reason, we couldnt say that Ida got malnutrition. She must

have another reason why she gets sleepy at class. Then we came into the second

thought about, she having symptoms from a person who have an anemia. It shows

from the scenario that Ida has 10,2 gr/dl hemoglobin rate. This kind of

hemoglobin rate stands below average children generally which is between 11-

13gr/dl of hemoglobin. This low rates of hemoglobin indicates one of the

diagnosis for anemia. Moreover, the main problem for this scenario is Ida always

sleeps during classes which shows another symptoms Easy fatigue and loss of

energy and Difficulty concentrating contrarily to a normal 8 years old children

who supposed to be active and be energetic. So from the above reasons that

shown, we came into a conclusion that Ida suspected to have Anemia. But, wecouldnt identify more what kind of Anemia that Ida suffer.

2.5 LEARNING ISSUES 2

2.5.1 What is the meaning of good sanitation ?


23/29

23 | P a g e


Holistic Module

CHAPTER THREE

THIRD TUTORIAL

Problem Solving

3.1.1 What is the meaning of good sanitation?

Good sanitation

Good sanitation refers to the appropriate behaviour and practices of the people living

in a specific environment

The people know to avoid contact with human excreta and to hygienically dispose of

human waste.

The peoples behaviour displays a responsible attitude towards the hygiene of their

families, the community,and the environment. Especially to children since they do not

understand between hygiene and dirty. By being a responsible and hygienic individual

it makes sure that families do not spread diseases.

3.2 FINAL HYPOTHESIS


the levelof hemoglobin, which is 10,2 g/dL or usually called anemia.

And always sleeping during class at school that also shows on of the

characteristics of suffering from anemia.

3.2.2. Ida, an 8 years old child suspected having of wormy


24/29

24 | P a g e


Holistic Module

3.3 ANALYSIS 2


25/29

25 | P a g e


Holistic Module

CHAPTER FOUR

Crit ical Appraisal

4.1 REFERENCES


26/29

26 | P a g e


Holistic Module

4.2 APPRAISAL

SCIENTIFIC PAPER APPRAISAL SHEET

Name/Group : 8B

Papers Title : Dietary Recommendation for Children and Adolescents: A Guide for

Practitioners

1. JOURNAL CONTENTSItems Present/Absent (pages)

Title Present (p. 1) Abstract and or Summary Present (p. 1) Introduction, background - Method - Result Present (p. 11) Discussion - acknowledgement Present (p. 11-12) Reference Present (p. 13-17)

Conclusion :This journal does not have complete contents.


27/29

27 | P a g e


Holistic Module

2. VALIDITY

Objective of the research: To provide dietary and physical activity recommendations for

healthy children, discusses the current content of children's diets, reviews the adverse health

consequences of increased intakes of calories (relative to energy expenditure), saturated and

trans fat, and cholesterol; and provides age-specific guidelines for implementation of the

recommended diet.

Methods:

Item Findings (pages)

Design Review

Rank on hierarchy of evidence -7

Sample 1982 documents on the same topic about nutritions for

infants, children, and adolescents and recent consensus

statement on optimal nutrition for the prevention of

many chronic diseases of adulthood. (page 3)

Sample size 1982 documents on the same topic about nutritions for

infants, children, and adolescents and recent consensus

statement on optimal nutrition for the prevention of

many chronic diseases of adulthood. (page 3)

Eligibility criteria Only matters which are critical component and scientific

evidence based of 1982 documents and recent consensus

used. (page 3)

Exclusion criteria -

Sampling frame -

Measurement and or assesment The documents and recent consensus are reviewed in


28/29

28 | P a g e


Holistic Module

such ways from documents and recent consensus about

nutrition for infants, children, and adolescents.

Instrument -

Randomization -

Intervention -

Analysis method Analysis of the appropriate nutritions for infants,

children, and adolescents is based on recommendations

from the writer which is based on scientific evidence

based with regard to diet composition, total calorie

intake, and physical activity. (page 13)

Compatibility between design and objective of the research : compatible

Compatibility between asessment and measurement and instrument : compatible

Conclusion: This research is validbased on two criterias above.

TELAAH IMPORTANCE PENELITIAN

OR/PR/RR : -

Confidence Interval : -

P value : -

4. APPLICABILITY

Applicability criteria : 4 B


29/29

29 | P a g e


Items Value

burden of illness Not the same as in our

scenario

barriers to treatment Not the same as in our

scenario

behaviours needed Not much

balance Balanced

Date post:	12-Apr-2018
Category:	Documents
Upload:	tasialalala
View:	245 times
Download:	1 times

PBL Holistik

Documents