PBL HOLISTIK.doc

8/18/2019 PBL HOLISTIK.doc

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HOLISTIC MODULE

PROBLEM BASED LEARNING

SCENARIO 2

TUTOR

dr. Danti Nur Indiastuti, M.ked

SCENARIO COMPOSER

Dr. Sri Umijati,dr.,MS

Dr. Sulistiawati,dr,Mkes

EDITOR

Prof. Dr. N. Margarita Rehatta, dr., Sp.AnI!., NA

P"# $roup %" &a'ult( of Medi'ine Airlangga Uni)ersit(

*olisti' Module Page 1


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COMPOSED BY

4B GROUP

LEADER

Muhammad Bagas Pratista !""#"""$$!%%&

SECRETARY

E'(i) Nu*u'isti)a !""#"""$$!%+&

NOTULEN

Ha)i,a Ima)sari !""#"""$$!%4&

MEMBERS

Ch-'i,ati) Nur Ardhi.ah !""#"""$$!#%&

Nur Imr-atu' Murs.idah !""#"""$$!#+&

Ismi Mas.ithah !""#"""$$!%!&

Ari)da Agu)g /atritama !""#"""$$!%2&

Er'.ta 0u',ai*ah !""#"""$$!1!&

Ris)a)da Putri Ras.da !""#"""$$!12&




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!+N-NS

!o)er../

$roup mem0er...1

!ontents.2

!hapter I3 "rain Storming.4

/./ S'enario.....4/.1 Main Pro0lem....4

/.2 e(words..4

/.% &irst *(pothesis....4

/.4 #earning Issues I...5

!hapter II3 Pro0lem Anal(sis6

1./ Answer..6

1././ *ow is holisti' approa'h7..........61./.1 !auses and S(mptoms of u0er'ulosis, Asthma, Pneumonia,

-mph(sema and #ung !an'er...8

1./.2 9hat is 'ement and 'otton 'ontaining7............//1./.% *ow is a holisti' approa'h 0ased on the s'enario7............…………/%

1./.4 *ow 'an happen the pro0lem of medi'al 0ased on holisti'

approa'h7....................../41.1 Method and Steps to &ind Information.../8

1.2 &irst Mind Mapping..../:

!hapter III 3 utorial !on'lusion....1;

2./ Data Anal(sis .....1;

2.1 &inal *(pothesis.11

2.2 !on'ept Mapping....12

2.% Pathoph(siologi' D(spnea


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!riti'al Appraisal.2%




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CHAPTER I

BRAIN STORMING

"" S3)ari-

Nia is 12rd (ears old girl 'ome from =akarta. She feel that, she alwa(s 'ough and

sometimes d(spnea in 2 month after she mo)e to > 'it(. She 0oarding in house that

ha)e religious people . hat 0oarding house rather dust( 0e'ause it near to semen

fa'tor(.

"2 Mai) Pr-5'm

Nia has 'ough and d(spnea after she mo)e to > 'it(.

"$ /.6-rds

&rom the s'enario and main pro0lem, we use 2 ke(words for it. he( are 3

/. 12rd (ears old girl1. Mo)e to > 'it(

2. Religious en)ironmet.

%. he 0oarding house near to Semen fa'tor(

"4 7irst H.8-thsis&rom the s'enario and a main pro0lem that we 'hoose. 9e h(pothesi?e 3

/. Dust allergi'

1. u0er'ulosis2. Asthma

%. Pneumonia

4. -mfisema5. #ung !an'er

"# Lar)i)g Issus "

&rom all a0o)e, there are man( learning issues that we state. &or the learning

issues there are3/. 9hat is 'ough and d(spnea 7

1. 9hat are the 'auses and s(mptoms of tu0er'ulosis, asthma, pneumonia,

emph(sema and lung 'an'er7

2. 9hat is 'ement and 'otton 'ontaining 7%. *ow is holisti' approa'h7

4. *ow is holisti' approa'h 0ased on the s'enario7




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5. *ow 'an happen the pro0lem of medi'al 0ased on holisti' approa'h7

CHAPTER II

PROBLEM ANALYSIS

2" A)s6rs

2"" C-ugh a)d D.s8)a

C-ugh

he 'ough is a natural response 0od( to 'lean mu'us or irritation fa'tor 'auses, likedust, smoke. Usuall( So it 'an go out from the respirator( s(stem. An irritant stimulates

ner)es there to send a 'ough impulse to the 0rain. hen, the 0rain gi)es the signal to a0domen

and 'hest wall. A0domen and 'hest wall will gi)e a push the air to the lungs and e@pel the

irritant.

!ough is the s(mptom of some diseases either a'ute or 'hroni'. he 'hroni' diseases

like allergies, asthma, 0ron'hitis, $-RD, and postnasal drip. he a'ute diseases like

influen?a, 'ommon 'old, pneumonia, and !+PD. !ough 'an 0e a'ute if it lasts than three

weeks while 'ough 'an 0e 'hroni' if it lasts longer than eight weeks Ma(o !lini', 1;/2B.

D.s8)a

D(spnea is a feeling diffi'ult to 0reathe. Usuall( it happen when ph(si'al a'ti)it(.

D(spnea has man( 'auses affe'ting either the 0reathing passages and lungs or the heart. he

d(spnea 'an o''urs graduall( or all of a sudden. he 'auses of d(spnea 'an 0e asthma,




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0ron'hitis, pneumonia, pneumothora@, anemia, lung 'an'er, inhalation injur(, pulmonar(

em0olism, 'ongesti)e heart failure, allergi' rea'tion, anaph(la@is, interstitial lung disease,

o0esit(, tu0er'ulosis, emph(sema, pulmonar( arter( h(pertension, and aero0i' e@er'ise.

D(spnea 'an 0e asso'iated with s(mptoms of 'hest pain, di??iness, fainting, 'ough,whee?ing, ne'k pain, and 'hest injur( #ongo, 1;// 'ited in 9illiam, 1;/4B

2"2 Causs a)d S.m8t-ms -, Tu5r3u'-sis9 Asthma9 P)um-)ia9

Em8h.sma a)d Lu)g Ca)3r

A. u0er'ulosis

u0er'ulosis is a disease that 'aused 0( infe'tion of m('o0a'terium

tu0er'ulosis. his disease 'an transmitted to the other human through sali)a.

And the s(mptom is a 'ough with sputum a0out 2 weeks, 0lood( 'ough, high

0od(Cs temperature, sweat in a night da(, de'rease satiet(.

". Asthma

Asthma is a disease in whi'h the airwa(s narrow e@'essi)el( in response to

)arious stimuli in the presen'e of airwa( h(perresponsi)eness A*RB and

eosinophili' airwa( inflammation. In 'lassi' asthmaE !AB )aria0le airflow

o0stru'tion t(pi'all( leads to s(mptoms su'h as whee?e, d(spnea and 'ough.

Niimi.1;//B

Asthma 'aused 0( 2 fa'tors, first is geneti' fa'tor. $eneti' fa'tor is 0ig role

how asthma o''urred, if there is our famil( that suffer asthma, so we ha)e pro0a0ilit(

suffer asthma. Se'ond is allergi', like allergi' of dust, temperature, and humidit(.




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Allergi' 'an trigger rea'tion in respirational tra't, and it will produ'e e@'essi)e

sputum and respirational tra't 0e'ome narrow, and asthma o''urred. hird is a

ps('hologi', emotion and stressed 'an 'ause asthma.

AsthmaCs s(mptoms are d(spnea with a whee?ing sound. &or the pre)ention,

asthma sufferer ha)e to 'lean their en)ironment like 'lean their 0ed from dust, a)oid

high humidit( room, pets and food that trigger allergi'.

!. Pneumonia

Pneumonia is a infe'tious disease that o''urred in lung tissue and 'aused 0(

0a'teria, )irus and fungi. Strepto'o''us 0a'teria, m('oplasma pneumonia are a

'ommon 0a'teria that 'an o''urred pneumonia. he s(mptoms are a 'ough with

sputum, 'hest pain, and d(spnea with high temperature.

D. -mph(sema

!hroni' o0stru'ti)e pulmonar( disease !+PDB is a disease 'hara'teri?ed 0(

airflow limitation that is not full( re)ersi0le. he pathogenesis of !+PD is thought to

0e 'hroni' inflammation throughout the airwa(s, paren'h(ma, and pulmonar(

)as'ulature. Pathologi' 'hanges 'hara'teristi' of !+PD o''ur in all these respirator(

stru'tures. Among these 'hanges, destru'tion of the lung paren'h(ma is 'ommonl(

referred to as pulmonar( emph(sema, defined as an a0normal permanent

enlargement of the air spa'e distal to the terminal 0ron'hioles, a''ompanied 0(

destru'tion of the al)eolar walls, and without o0)ious fi0rosisE




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-mph(sema 'ause 0( smoke from 'igarettes, and la'k of aphaF/Fatitripsin

en?(me, 0e'ause of that al)eolus lost its elasti'it(. he s(mptoms are d(spnea in a

long period and 'annot 'ure 0( sal)e medi'ine. he de'rease of satiet(, and lost

0od(Cs weight is an e@ample of emph(semaCs s(mptoms.

-. #ung !an'er

#ung 'an'er is the most freGuentl( diagnosed 'an'er and the leading 'ause of

'an'erFrelated deaths worldwide. -)iden'e suggests that there is a relationship

0etween pre)ious respirator( disease PRDB, in'luding 'hroni' 0ron'hitis,

emph(sema, tu0er'ulosis, and pneumonia, and lung 'an'er diagnoses. o0a''o is a

shared risk fa'tor of PRD and lung 'an'er.

Main 'auses of lung 'an'er in the world is smoke from 'igarettes, it 'ontain

man( to@i' su0stan'es and if we inhales it, it will a''umulate in our lung for man(

(ears and trigger a 'ell mutation that 'an 'ause lung 'an'er. he other 'ause of lung

'an'er is radiation, other to@i' 'hemi'al su0stan'es and geneti' fa'tor.

he s(mptoms of lung 'an'er are 'ough, 'hest pain, d(spnea, 0lood( 'ough,

tired and de'rease of 0od(Cs weight. "ut, like the other 'an'er, the 'ommon s(mptom

of 'an'er will showed when the 'an'er has growth for along time and has spread all

o)er the 0od(.

2"2 Cm)t a)d C-tt-) C-)tai)

Cm)t




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!ement is an essential ingredient and man( 'onne'ti)e used in ph(si'al

de)elopment in the 'i)il 'onstru'tion se'tor. If plus water, 'ement would 0e the

'ement paste. If the plus fine aggregate, 'ement paste will 0e the mortar that if

'oupled with the 'oarse aggregate will 0e a mi@ture of 'on'rete &resh after the

'on'rete hardens will 0e hard 'on'reteB.

Portland 'ement made from fine powder minerals 'r(stalline 'omposition is

primaril( 'al'ium and aluminum sili'ate. he addition of this mineral water produ'es

a pasta that if it dries will is as strong as a ro'k. Densit( produ'ed ranges 0etween

23/1 and 23/5 and the hea)( )olume a0out /4;; kg 'm2 Naw(, /:843 :B. he main

ingredient forming portland 'ement is lime !a+B, sili'a Si+2B, alumina Al1+2B, a

little magnesia Mg+B, and sometimes slightl( alkaline. o 'ontrol the 'omposition,

sometimes add iron o@ide, while g(psum !aS+%.*1+B was added to set the timing

0elt 'ement.

Semen that one 'an 0e distinguished with 'ement other 0ased on their 'hemi'al

'omposition and fineness 0utim(a. !omparison of main 'onstituent materials

portland 'ement is lime !a+B of a0out 5;H F54H, sili'a Si+1B of a0out 1;H F14H,

and iron o@ide as well as alumina &e1+2 and Al1+2B appro@imatel( 6H F/1H.

here are four %B 'ompound he main 'hemi'als that make portland 'ement,

namel(3

/. ri'al'ium Sili'ate 2!a+. Si+1B whi'h is a00re)iated 0e !2S.

1. Di'al'ium Sili'ate 1!a+. Si+1B whi'h is a00re)iated 0e !1S.2. ri'al'ium aluminate 2!a+. Al1+2B are in0riefl( 0e'ame !2A.

%. ertrakalsium aluminoferrit %!a+. A#1+2.&e1+2B is shortened to !%A&.

C-tt-)

!otton 'omes from randu trees. Man( people think that sleep on the kapuk is

more 'omforta0le and not hot 'oolerB. "ut a 0ed of 'otton 'an flat after 0eing used

for a long time. "ed from 'otton is not 0eing suggested for people who ha)e allergi'.




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"e'ause 'atton keep the dust inside 0ed. apuk has smooth pie'ess that 'an inhale

on repirator( s(stem.

2"$ D,i)iti-) -, H-'isti3 A88r-a3h

*olism is deri)ed from the $reek, holos, whi'h means whole, was first used 0( South

Afri'an philosopher =an !hristian Smuts /:15B in *olism and -)olution Daniel and

-Gulinet, 1;;5B. *olisti' approa'h to medi'ine is we 'an see the whole person. he whole

person means their 0od(, mind, and spirit. he 'on'ept of holisti' approa'h is a link 0etween

ph(si'al health and the 'lose interrelation with that ph(si'al health like 0iologi'al,

ps('hologi'al, so'ial, and 'ultural. An holisti' approa'h is not onl( treating the s(ptoms 0ut

also thinking a0out the 'auses of those s(mptoms. It is usuall( 'alled the stor( 0ehind the

stor(E. Daniel Mengistu and -Gulinet Misganaw. 1;;5. !ommunit( *ealth Nursing. Page /1

*olisi' Approa'h di)ide into 2 part 3

AGENT

Agent is fa'tor outside the 0od( that ha)e a0ilit( to 'auses, triggers, or worsen

disease. Agent 'an 0e from ph(si'al ha?ard, "iologi'al *a?ard, !hemi'al *a?ard or

Ps('hoso'ial *a?ard. -a'h *a?ard des'ri0ed 0elow !om'are.go).au, 1;/%B.

" Ph.si3a' Ha*ardA ph(si'al ha?ard is defined as a fa'tor within the en)ironment that 'an harm

the 0od( without ne'essaril( tou'hing it. i0ration and noise are e@amples of

ph(si'al ha?ardsJ. Ph(si'al ha?ards in'lude 0ut arenKt limited to ele'tri'it(, radiation,

pressure, noise, heights and )i0ration amongst man( others.

2 Bi-'-g.3a' Ha*ard

"iologi'al ha?ards are organi' su0stan'es that pose a threat to the health

of humans and other li)ing organisms. "iologi'al ha?ards in'lude pathogeni'

mi'roForganisms, )iruses, to@ins from 0iologi'al sour'esB, spores, fungi and 0ioF

a'ti)e su0stan'es. "iologi'al ha?ards 'an also 0e 'onsidered to in'lude 0iologi'al

)e'tors or transmitters of disease.

"iologi'al ha?ards pose risks for man( people in a wide )ariet( of wa(s.

&or e@ample, workers in health 'are professions are e@posed to 0iologi'al ha?ards

)ia 'onta't with human 0odil( matter, su'h as 0lood, tissues, sali)a, mu'ous,




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urine and fae'es, 0e'ause these su0stan'es ha)e a high risk of 'ontaining )iral or

0a'terial diseases. #ikewise, people who work with li)e animals or animal

produ'ts 0lood, tissue, milk, eggsB are e@posed to animal diseases and infe'tions,

some of whi'h ?oonosesB ha)e the potential to infe't humans for e@ample, LF

fe)er, a)ian flu or *endra )irusB or 'ause serious allerg( )ia sensitisation.

$ Chmi3a' Ha*ard

*a?ardous 'hemi'als in the workpla'e are su0stan'es, mi@tures and

materials that 'an 0e 'lassified a''ording to their health and ph(si'o'hemi'al

risks and dangers.

*ealth ha?ards in'lude skin irritants, 'ar'inogens or respirator( sensitisers that

ha)e an ad)erse effe't on a workerKs health as a result of dire't 'onta't with or

e@posure to the 'hemi'al, usuall( through inhalation, skin 'onta't or ingestion.

Ph(si'o'hemi'al ha?ards generall( result from a su0stan'eKs ph(si'al and

'hemi'al properties, as is the 'ase with flamma0le, 'orrosi)e, o@idising or

e@plosi)e su0stan'es.

4 S-3ia' Ha*ard

Ps('hoso'ial ha?ards in'lude 0ut arenCt limited to stress, )iolen'e and

other workpla'e stressors.

here are 'ir'umstan'es, howe)er, in whi'h work 'an ha)e ad)erse

'onseGuen'es for health and well0eing. Risks to ps('hologi'al health at work

ma( arise from organi?ational or personal fa'tors, with the major fa'tors 0eing

poor design of work and jo0s, poor 'ommuni'ation and interpersonal

relationships, 0ull(ing, o''upational )iolen'e and fatigue. Risks to ps('hologi'al

health due to work should 0e )iewed in the same wa( as other health and safet(

risks and a 'ommitment to pre)ention of workFrelated stress should 0e in'luded in

an organi?ationCs health and safet( poli'ies.

EN:IRONMENT

-n)ironment is fa'tor that 'an affe't on health. -n)ironment in'luding

Umijati, 1;/4B 3




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/. &amil(

In'luding parents, dietar( ha0it, lifest(le, famil( 'ulture, famil(Cs e'onomi',

health and nutritional status, and Spiritual.

1. *ome -n)ironmentIn'luding home sanitation.

2. *ealth Ser)i'esIn'luding poli'ies and programs of nutrition and 'ompan( health ser)i'es.

%. 9ork -n)ironment

In'luding work pla'e sanitation, la0or 'ompensation, 0ioFps('hoFso'ioF

'ulture ha?ard, and so'ial and 'ultural 'onditions of so'iet(.

2"4 H-'isti3 A88r-a3h Basd -) S3)ari-

9e know that holisti' approa'h di)ide into 2, 0ased on s'enario that is 3

/. *+S

a. Age 3 9oman, 12 (ears old. 0. -du'ation 3 S/ "a'helor of -'onom(

'. 9ork 3 A''ountant

d. *(giene 3 *a)e a ha0it of 'oming home late at night after work e. *ealth Status 3

F Disease Profile3 /. Past3 -@perien'ed a dust allerg( at /1 (ears old

1. Now3 *a)e 'ough and shortness ronkiB and fe)er

emperature 26,4BF &amil( Profile3 *er father and aunt suffered 0ron'hial asthma and

allergi' rhinitis

f. #ife St(le 3 *a)e a ha0it 0u(ing food from outsiderestaurant

g. &amil( and so'ial roles 3&emale workers who go a0road

1. A$-N

a. "iologi'al *a?ard3 fungi and 0a'teria 0. !hemi'al *a?ard3

'. Ph(si'al *a?ard3 !ement dust, humidit(

d. So'ial *a?ard3 "oarding near0( friends also ha)e 'ough and shortness

2. -NIR+NM-N

a. ost

• he si?e is 1; m @ 4 m 9ide *ouse

• +nl( has 2 openedFwindows with si?e 1 m @ / m less

)entilation




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• #i)ed 0( 5 person too man( person in a house

• "ed were 0uilt 0( kapok

• *umidit( 84 H too high

• #i)e with religious famil(

• *er friend has 'ough and asthma too

• #o'ated near 'ement fa'tor(

0. 9ork

• Ma'hine !ompan(

• As a'ountant

2"# Mdi3a' Pr-5'm 5as) -) h-'isti3 a88r-a3h

In this 'ase a''ording to the holisti' approa'h, we 'an not dire'tl( diagnose

the disease suffered 0( the woman, whi'h we 'an do is how the woman ma(

e@perien'e medi'al pro0lems seen from a holisti' approa'h. As e@plained pre)iousl(,

a holisti' approa'h 'an 0e di)ided into 2 parts in ad)an'e, namel( *ost, Agent and

-n)ironment. hrough 2 of them, we 'an anal(?e how a medi'al pro0lem o''urs in a

woman .

If we look from the *ost, we 'an di)ided again into se)eral small parts su'h

as age, se@, o''upation, lifest(le, h(giene, life status and medi'al histor(. 9e 'an take

some parts and we 'an make the anal(sis of wh( women ma( e@perien'e medi'al

pro0lems. hese things are lifest(le, o''upation and medi'al histor(. As our

dis'ussion, this woman has a jo0 as an a''ountant in a ma'hine 'ompan(. &or us, an

a''ountant must ha)e worked just fo'us on the task and regardless of the work

en)ironment so that her health is less well preser)ed. he se'ond is her lifest(le, if we

look more deepl( a0out her lifest(le, he often ate outside and often go home at night,

often eat outside that ena0ling redu'ed h(giene and food eaten 'an 'ontain dangerous

mi'roorganisms that 'an ad)ersel( affe't the 0od( and 'ause a medi'al pro0lem su'h

as in this 'ase. +ften go home the e)ening 'an also 'ause a medi'al pro0lem su'h as

in this 'ase. he fourth is the histor( of the disease, it is )er( important 0e'ause 0(

knowing how the medi'al histor( we 'an 'ertainl( know what she was e@posed to

medi'al pro0lems. As we know at the age of /1 (ears, he is allergi' to dust, and it is




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in line with how the disease o''urs 0e'ause of the home en)ironment that is 'lose to a

'ement plant and a large housing 'onditions without air 'ir'ulation .

If we look at the se'ond aspe't , namel( agents, it is in'reasingl( o0)ious

influen'e. Agent 'an 0e seen in four parts, namel( the threat of 0iologi'al , 'hemi'al ,

ph(si'al and so'ial . +f the 0iologi'al threat , we 'an menngetahui humidit( le)el of

the house of the woman is )er( high . !ausing his house to 0e a pla'e that is )er(

good for the growth of fungi and other mi'roorganisms that 'an 'ause medi'al

pro0lems . "esides the mattress he used made of 'otton that 'an 'ause 'oughing and

0reathing diffi'ulties if inhaled.

"oth are part of a 'hemi'al threat , as the information we know , theen)ironment around the house is a 'ement fa'tor( whi'h will ine)ita0l( happen

deplo(ment of su0stan'es deri)ed from 'ement and )er( dangerous if it gets inhaled

0( the woman. !hemi'als su'h as sili'ates in 'ement 0( inhalation would 0e )er(

harmful to the human 0od( . he sili'ate 'an also 'ause a disease that is one of the

s(mptoms of 'ough and shortness of 0reath . he third is the ph(si'al threat in the

form of dust in the house of the woman , as the information we re'ei)e , the home of

the woman is Guite large 0ut has a )er( slight amount of )entilation . So that the

'ir'ulation 0e'omes )er( less and the dust would 0e harmful if inhaled , 'an 'ause

tightness and 'oughing . he fourth is a so'ial threat , 0oarding a friend Ks woman has

the same disease with the woman , whi'h means there is a possi0ilit( that a friend of

his 0oarding 'an transmit the disease in women.



Cough and

shortness of

breath

Host

Job

Often hanging out at

evening

Eat outside

edi!a" histor#

!auses


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17/31

1.1./ +pen we0 0rowser and t(pe the ke(words, su'h as 3 holisti' approa'h, holisti',

holisti' approa'h to medi'ine,ph(si'al ha?ard et'.

1.1.1 Sear'h engine and we0 address that we used are 3

www.google.'om

www.s'holar.google.'om

www.gopu0med.orgwe0gopu0med



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shortness

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Host

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http://www.google.com/http://www.scholar.google.com/http://www.gopubmed.org/web/gopubmed/http://www.google.com/http://www.scholar.google.com/http://www.gopubmed.org/web/gopubmed/


18/31


19/31

CHAPTER $

TUTORIAL CONCLUSION

$" Data A)a'.sis

!ough and d(spnea are 'ommon s(mptoms of some diseases related to

lung or 'ardia'. 9e donCt dis'uss a0out what the disease host suffered 0ut we just

'an anal(?e a0out wh( 'ough and d(spnea happened. In this modul, we use the

holisti' approa'h. It is like knowing the stor( 0ehind the stor(E.

"ased on holisti' approa'h, we 'an use a model 'alled epidemiolog( triangle.

It is a model usuall( used to stud( a0out the health pro0lems 'ough and d(spneaB.

hese health pro0lems 'an 0e asso'iated with three major fa'tors. hese fa'tors are 3

/. *ost the person with the health pro0lemsBhe host is a woman 12 (ears old. She is an a''ountant in a 'ompan(

0ased ma'hine. She has past medi'al histor(, had e@perien'ed dust allerg(

sin'e /1 (ears old. *er families her father and auntB ha)e rhinitis allergi' and

0ron'hiale asthma. She mo)es from her domi'ile to 'it( >. She li)es in a

kosE whi'h is owned 0( religious people. After three months she li)es in her

new domi'ile, she has the health pro0lems 'ough and d(spneaB

1. Agent ha?ards in the en)ironmentB

"iologi'al ha?ard 3 Mi'roorganims

!hemi'al ha?ard 3 he 'omposition of 'ement dust, Si+1 Sili'on

dio@ideB

Ph(si'al ha?ard 3 84H humidit( in the houseSo'ial ha?ard 3 people around the host

2. -n)ironment pla'e in whi'h the host and the agent intera'tB

he en)ironment 'an 0e di)ided into3/. Mi'ro en)ironment 3 *er new domi'ile




20/31

1. Meso en)ironment 3 *er new domi'ile is near the 'ement

fa'tor(, her work en)ironmen

he new domi'ile of the host 'hanges the en)ironment of the host. &rom the

data we got, there are mi'ro and meso en)ironment 'hanges. he mi'ro en)ironment

is the pla'e where the host li)es. It has si?e1; m > 4 m 0ut with minimum

)entilation. here are onl( 2 windows in that house. he meso en)ironment is the

en)ironment around the host li)ing. It is near the 'ement fa'tor(. he meso

en)ironment 'an 0e the pla'e where the host works. It is a ma'hine 'ompan(. he

'hanges of the en)ironment mean the 'hanges of the agent. &rom mi'ro en)ironment,

so man( agents (ang didapatkan. he ph(si'al agent is the 84H humidit( in that

house. It 'an 0e 'aused 0( that house whi'h has minimum )entilation and windows.

he dust in the house is also the ph(si'al agent. he hostC 0ed is made from 'otton.

A'tuall(, 'otton is soft and 'omforta0le for sleeping. "ut, 'otton is not re'ommended

for people who ha)e dust allerg( 0e'ause 'otton 'an a''umulate dust around it so it

'an 0e inhaled while sleeping. &rom the meso en)ironment, there is 'ement dust

e@posure. he 0iologi'al agent is there will 0e )er( 0ig pro0a0ilit( of mi'roorganisms

li)e in that house 0e'ause of the a0normal houseCs humidit(. he 'hemi'al agent is

from the 'omposition of 'ement dust like Si+1 Sili'on dio@ideB. It is tin( parti'les'an enter into small air sa's in the lungs. If it is often inhaled, it 'an 'ause 'ough,

d(spnea, and whee?ing.

he so'ial agent 'an 0e anal(?ed from the people around the host. he host

li)es in the house whi'h is owned 0( religious people. he host 'an get the pressure

from them 0e'ause of Nia ha0it who often go home at night. In addition, when

)iewed from the side of the hostKs role in the famil(, she is a woman who works and

migrated out of the 'it(, this ma( trigger ps('hologi'al host. Stress 'an o''ur 0e'ause

she is a woman who must work and also to adapt to the new ligkungan and should far

from her famil(. And the last, it is a0out the hostCs medi'al histor( and her famil(Cs

medi'al histor(. It 'an make the pro0a0ilit( of the host to has 'ough and d(spnea. he




21/31

host has past medi'al histor(, had e@perien'ed dust allerg( sin'e /1 (ears old. *er

families her father and auntB ha)e rhinitis allergi' and 0ron'hiale asthma.

If all three se'tions are 'onne'ted to the host, agent and en)ironment as the

'ause medi'al pro0lems, it 'an 0e found links 0etween ea'h other. !hanges in the

en)ironment on the host would 'ause 'hanges to the agent, so there will 0e man(

fa'tors that affe't the health of the host. It is not onl( host, agent, or en)ironment

itself. "ut, all of those are linked ea'h other.

$2 7i)a' H.8-thsis

he en)ironment 'hange will 0e follow 0( the agent 'hanges that will affe't

the host so that arose s(mptoms su'h as 'ough and d(spnea. A''ording holisti'

approa'h, asthma is a disease that has most likel( suffered 0( the host.

$$ C-)38t Ma88i)g



&E/

"iologi'al *a?ard 3

Mold

!hemi'al *a?ard 3

!ement dust

Ps('hologi'al *a?ard 3

dust

So'ial *a?ard 3 stress

a0out work

HO%

/

E+OE

/

#ife St(le ost

9orkpla'e

!ough and D(spnea

Pstolog(

Solution

&irst *ost

Medi'al dan Medi'al &amil( *istor(

Domi'ile

Mo)ement

Causing a !hange

to


22/31

$4 Path-8h.si-'-gi3 ma88i)g

Path-8h.si-'-g. -, D.s8)a

A. De'reased tissue o@(genation

Disease or a'utel( 'ertain 'ir'umstan'es 'an 'ause the speed of deli)er( of

o@(gen to all tissues de'reases . A de'rease in tissue o@(genation will impro)e

shortness of 0reath . +@(gen depends on transport 0e'ause of the 'ir'ulation of 0lood

and hemoglo0in le)els , then some 'ir'umstan'es su'h as 0leeding , anemia

hemol(sis B , 'hange in hemoglo0in sulfhemoglo0in , methemoglo0in ,

'ar0o@(hemoglo0in B ma( 'ause shortness of 0reath .

Paren'h(ma lung disease that 'auses intrapulmonar( shunt , )entilation

disorders also 'ause asph(@iation . So , shortness of 0reath 'an 0e 'aused 0( diseases

of 0ron'hial asthma, 0ron'hitis and pulmonar( 0lood )essels disease group su'h as

em0oli , )as'ulitis and primar( pulmonar( h(pertension .

". he need of o@(gen in'reasesDisease or 'ondition suddenl( in'reased o@(gen reGuirement would gi)e the

sensation of shortness of 0reath . &or e@ample , a'ute infe'tion will reGuire more



D(spnea intensit( and

Gualit(

entilator(Mus'les

S)s-r. C-rt;

&eed0a'k

&eedFforward

-rror Signal

-rror Signal

Motor

!orte@

!hemore'eptors

Respirator( 'enters

Respirator( dri)eB

Me'hanore'eptors

Meta0ore'eptors

!orollar(

dis'harge


23/31

o@(gen due to in'reased meta0olism . In'rease in 0od( temperature due to material

p(rogens or stimuli in the 'entral ner)ous 'ausing in'reased o@(gen demand and

e)entuall( lead to shortness of 0reath . #ikewise with th(roto@i'osis disease , 0asal

meta0oli' rate is in'reased so that the o@(gen demand is also in'reasing . Ph(si'al

a'ti)it( also reGuires more o@(gen , 'ausing suffo'ation .

!. he work of 0reathing in'reases

Paren'h(m lung disease su'h as pneumonia , swollen lungs whi'h 'auses redu'ed

lung elasti'it( and disease that 'auses narrowing of the airwa(s su'h as 0ron'hial

asthma, 0ron'hitis and 0ron'hiolitis 'an lead to de'reased lung )entilation . o

'ompensate for this situation and that the o@(gen demand also remains 'an 0e met ,

the respirator( mus'les are for'ed to work harder , or in other words the in'reased

work of 0reathing . his situation raises the meta0olism in'reases and e)entuall(

meta0olites that are in the 0lood stream in'reases. Meta0olites 'onsisting of la'ti'

a'id and p(ru)i' a'id will stimulate the 'entral ner)ous s(stem . +@(gen demand

in'reases in o0esit( also leads to in'reased work of 0reathing .

D. Stimulate In !entral Ner)ous S(stemA disease that atta'ks the 'entral ner)ous s(stem 'an lead to an atta'k of shortness of

0reath suddenl( . *ow to atta'k this , until now un'lear , su'h as meningitis ,

'ere0ro)as'ular a''ident and others . Idiopathi' h(per)entilation also found ,

although the me'hanism is un'lear .

-. Neuromus'ular diseases

Luite a lot of diseases that 'an 'ause disorders of the respirator( s(stem , espe'iall( if

the disease was a0out diaphragms , su'h as m(asthenia gra)is and am(otrophi' 0een

literall( s'lerosis . he me'hanism that 'auses shortness of 0reath due to

neuromus'ular disease is as (et un'lear .

$# Pr-5'm S-'(i)g

Solutions "ased +n *olisti'




24/31

S(mptoms of health pro0lem that was taken 0( host is 'aused 0( some fa'tors

depends on holisti'. In e)er( part of host, agent, and en)ironment 'an support hostCs

health pro0lem. herefore, to sol)e this health pro0lem, we should fi@ e)er( part of

host, agent, and en)ironment depends on holisti'.In holisti', the solution of fa'tors that support health pro0lem are 3

a. *ost

In host, part that support health pro0lem are edu'ation, life st(le, medi'al histor(,

and so'ial roles. he edu'ation means host with s/ 0a'helor of e'onomi's ma(0e has

less health edu'ation. So, 0( in'reasing health edu'ation also 'an in'rease hostCs

health le)el.

he se'ond is life st(le, someoneCs 0ad ha0it will influen'e hostCs health

'ondition. In this s'enario, host often going home late until night, this 'ondition gi)es

0ad impa't to host 0e'ause night wind has low temperature. "( this low temperature,

ma(0e hostCs immunit( 'an not 'ontrol it or ma(0e host has nightFwind allergi'.

Moreo)er, this 'ondition 'an trigger pneumonia. herefore, host should de'rease her

0ad ha0it not to going home late at night often.

he third is medi'al histor(, medi'al histor( are medi'al histor( in the past and

famil(. &or disease histor(, host was e)er taken allergi' to dust at /1 (ears old.

Allerg( 'an appear for the se'ond time if there are some triggers.

he last is so'ial roles. In this s'enario, so'ial roles means host roles as female

who works outside town far from her famil(, this 'ondition 'an 0uild stress to host.

So, the solution are de'reasing work portion and fi@ing her 'ommuni'ation with her

famil(.

0. Agent

In agent, there are some fa'tors that support this health pro0lem. here are

0iologi'al ha?ard, ph(si'al and so'ial ha?ard. "iologi'al ha?ard is a0out

mi'roorganism and fungi that 'ause this health pro0lem 0ased on the 'ondition in




25/31

s'enario. So, wa(s to sol)e and pre)ent this health pro0lem are adding more

)entilation in the kost and 'leaning kost regularl(.

Se'ond is ph(si'al ha?ard. Ph(si'al ha?ard 0ased on s'enario means the dust that

was inhaled 0( host then flew in host respirator( s(stem and humidit(. #e)elhumidit( in s'enario is too high, so it 'an triggers 'ough and d(spnea. o 0alan'ing

humidit(, host should keep the kost dr( and setting air 'ir'ulation. hen, to de'rease

the dust, host should keep the )entilation onl( open when wind outside kost is 'alm.

'. -n)ironment

In en)ironment, some fa'tors that 'ause s(mptom of 'ough and sesak are house

en)ironment and workpla'e. In house en)ironment 0ased on s'enario, hostCs kost

lo'ated near 'ement 'ompan( with less )entilation and kost area is too wide. *ostCs

workpla'e 0ased on s'enario is ma'hine 'ompan(. o pre)ent new health pro0lem,host must 'lean kost and workpla'e where she often spend her most time there

regularl( and ma(0e host needs use masker in kost or at work.

Solution +f !ough And D(spnea In !ommon

A medi'al pro0lem suffered 0( host is 'ough and d(spnea. Ds(pnea 'an 'ause

la'k of o@(gen in the 0od(, it happened 0e'ause of trou0le in 0reathing. hus, the

solutions are plant more trees, dail( e@er'ise and li)e in a 'lean and wide

en)ironment.

!hroni' d(spnea sufferer ha)e to a)oid a food and drink that 'ontain a high

sugar like milk, white sugar, 'and(, wheat, and ri'e. "eside unhealth( food and

drinks, sufferer must 'onsume fruit and )egeta0le, and also enough mineral water.

D(spnea 'an 0e pre)ented and 'ured 0( a dail( e@er'ise, the fun'ion of the

e@er'ise are to in'rease mo)ement of 0a'k and 'hest that 'an train mus'le around

lung, diaphragm and 0lood 'ir'ulation. "est e@er'ise is swimming 0e'ause all of the

0od( mo)e in swimming.




26/31

Medi'ines that 'an 'ure d(spnea is a kind of drug that 'an enlarge respirator(

tra't. he main reaseon wh( d(spnea 'an o''ur in human 0od( is a ps('hologi'

pressure that trigger d(spnea. hud, we ha)e to enjo( our life and dont think to mu'h.

Sigit Nugroho 1;;:B 'ited in 9ara ushartanti 1;;1B said that 0reathing

e@er'ise must 0e done e)er(da( in few minutes. hese are the dire'tion 3

a. -@hale air through nose until mu'us is pulled up. 0. ake short inhale pass through nose and take long e@hale through mouth so it

'an produ'es )oi'e.

'. #oose 'lothes or pants then setting air 0reath. ell someone if there is ngikE

)oi'es during first few minutes from diaphragm 0reathing.

d. Drink a glass of water 0efore and after take an e@er'ise.

R,r)3s

!. Shiel =r., 9illiam. 1;/4. Shorness of "reath D(spneaB. Medi'ineNet, In'.

http3www.medi'inenet.'oms'riptmainmo0ileart.asp7arti'leke(O2%%2% onlineBA''essed 11 No). 1;/4Q.

!om'are.go).au, 1;/%B. Managing hazards. onlineQ A)aila0le at3

http3www.'om'are.goF).aupre)entingha?ards A''essed 11 No). 1;/4Q.

Denholm, Ra'hel, et al. JIs pre)ious respirator( disease a risk fa'tor for lung

'an'er7.J Ameri'an journal of respirator( and 'riti'al 'are medi'ine /:;.4 1;/%B3

4%:F44:.

$oogle.'o.id, 1;/4B. Semen. onlineQ A)aila0le at3 https3www.google.'o.idurl7

saOtr'tOjGOesr'Ossour'eOwe0'dO1'adOrjaua'tO8)edO;ahU-wiR4

#:@j=AhR0%*@4"I;L&gggMA-urlOhttpH2AH1&

H1&kk.mer'u0uana.a'.idH1&elearningH1&filesTmodulH1&//;;%F6F



http://www.medicinenet.com/script/main/mobileart.asp?articlekey=34434http://www.comcare.go-v.au/preventing/hazards/https://www.google.co.id/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&cad=rja&uact=8&ved=0ahUKEwiR5YL9xKjJAhVRbY4KHZx5BI0QFgggMAE&url=http%3A%2F%2Fkk.mercubuana.ac.id%2Felearning%2Ffiles_modul%2F11004-7-901570378753.pdf&usg=AFQjCNG6w6TC46xn7ewYhXuiOlBQuzuSsw&sig2=eU8sGo8q97RQXrlmKOGmZAhttps://www.google.co.id/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&cad=rja&uact=8&ved=0ahUKEwiR5YL9xKjJAhVRbY4KHZx5BI0QFgggMAE&url=http%3A%2F%2Fkk.mercubuana.ac.id%2Felearning%2Ffiles_modul%2F11004-7-901570378753.pdf&usg=AFQjCNG6w6TC46xn7ewYhXuiOlBQuzuSsw&sig2=eU8sGo8q97RQXrlmKOGmZAhttps://www.google.co.id/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&cad=rja&uact=8&ved=0ahUKEwiR5YL9xKjJAhVRbY4KHZx5BI0QFgggMAE&url=http%3A%2F%2Fkk.mercubuana.ac.id%2Felearning%2Ffiles_modul%2F11004-7-901570378753.pdf&usg=AFQjCNG6w6TC46xn7ewYhXuiOlBQuzuSsw&sig2=eU8sGo8q97RQXrlmKOGmZAhttps://www.google.co.id/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&cad=rja&uact=8&ved=0ahUKEwiR5YL9xKjJAhVRbY4KHZx5BI0QFgggMAE&url=http%3A%2F%2Fkk.mercubuana.ac.id%2Felearning%2Ffiles_modul%2F11004-7-901570378753.pdf&usg=AFQjCNG6w6TC46xn7ewYhXuiOlBQuzuSsw&sig2=eU8sGo8q97RQXrlmKOGmZAhttp://www.medicinenet.com/script/main/mobileart.asp?articlekey=34434http://www.comcare.go-v.au/preventing/hazards/https://www.google.co.id/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&cad=rja&uact=8&ved=0ahUKEwiR5YL9xKjJAhVRbY4KHZx5BI0QFgggMAE&url=http%3A%2F%2Fkk.mercubuana.ac.id%2Felearning%2Ffiles_modul%2F11004-7-901570378753.pdf&usg=AFQjCNG6w6TC46xn7ewYhXuiOlBQuzuSsw&sig2=eU8sGo8q97RQXrlmKOGmZAhttps://www.google.co.id/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&cad=rja&uact=8&ved=0ahUKEwiR5YL9xKjJAhVRbY4KHZx5BI0QFgggMAE&url=http%3A%2F%2Fkk.mercubuana.ac.id%2Felearning%2Ffiles_modul%2F11004-7-901570378753.pdf&usg=AFQjCNG6w6TC46xn7ewYhXuiOlBQuzuSsw&sig2=eU8sGo8q97RQXrlmKOGmZA


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:;/46;268642.pdfusgOA&Lj!N$5w5!%5@n6ewh>ui+l"Lu?uSswsig1OeU8

s$o8G:6RL>rlm+$mA A''essed 1% No). 1;/4Q.

#ongo, D.#., et al. 1;//. *arrisonCs Prin'iples of Internal Medi'ine., /8th ed. United

States3 M'$rawF*ill Professional

Mengistu Daniel and -Gulinet Misganaw. 1;;5. !ommunit( *ealth Nursing. Page /1

PD&B A''essed 1% No). 1;/4Q

+0er, !arole, and sung!hieh ao. Jhe geneti's of asthma and allergi' disease3 a

1/st 'entur( perspe'ti)e.J Immunologi'al re)iews 1%1./ 1;//B3 /;F2;.

Nugroho, Sigit, Dosen Pendidikan +lahraga esehatan &akultas Ilmu, and

eolahragan Uni)ersitas Negeri. Jerapi Pernapasan Pada Penderita Asma.J 1;;8B.

Pres'ott, *allie !., Mi'hael 9. Sjoding, and heodore =. Iwash(na. JDiagnoses of

-arl( and #ate Readmissions after *ospitali?ation for Pneumonia. A S(stemati'

Re)iew.J Annals of the Ameri'an hora'i' So'iet( //.6 1;/%B3 /;:/F//;;.

Umijati, Sri. KModul Pendekatan *olistik Manusia Dan #ingkunganK. 1;/4. #e'ture.

#IN 3

http3mitaunairFfk/1.we0.unair.a'.id

http3www.alodokter.'om0atukF0atuk

http3www.ma(o'lini'.orgdiseasesF'onditions0arrettsFesophagusmultimedia)idF1;;68415

http3artikel.'o61sesakFnafasFdanFsolusin(a.html

http3www.medi'inenet.'oms'riptmainmo0ileart.asp7arti'leke(O2%%2%



https://www.google.co.id/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&cad=rja&uact=8&ved=0ahUKEwiR5YL9xKjJAhVRbY4KHZx5BI0QFgggMAE&url=http%3A%2F%2Fkk.mercubuana.ac.id%2Felearning%2Ffiles_modul%2F11004-7-901570378753.pdf&usg=AFQjCNG6w6TC46xn7ewYhXuiOlBQuzuSsw&sig2=eU8sGo8q97RQXrlmKOGmZAhttps://www.google.co.id/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&cad=rja&uact=8&ved=0ahUKEwiR5YL9xKjJAhVRbY4KHZx5BI0QFgggMAE&url=http%3A%2F%2Fkk.mercubuana.ac.id%2Felearning%2Ffiles_modul%2F11004-7-901570378753.pdf&usg=AFQjCNG6w6TC46xn7ewYhXuiOlBQuzuSsw&sig2=eU8sGo8q97RQXrlmKOGmZAhttp://mitaunair-fk12.web.unair.ac.id/http://www.alodokter.com/batuk-batuk/http://www.mayoclinic.org/diseases-conditions/barretts-esophagus/multimedia/vid-20078526http://artikel.co/72/sesak-nafas-dan-solusinya.htmlhttps://www.google.co.id/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&cad=rja&uact=8&ved=0ahUKEwiR5YL9xKjJAhVRbY4KHZx5BI0QFgggMAE&url=http%3A%2F%2Fkk.mercubuana.ac.id%2Felearning%2Ffiles_modul%2F11004-7-901570378753.pdf&usg=AFQjCNG6w6TC46xn7ewYhXuiOlBQuzuSsw&sig2=eU8sGo8q97RQXrlmKOGmZAhttps://www.google.co.id/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&cad=rja&uact=8&ved=0ahUKEwiR5YL9xKjJAhVRbY4KHZx5BI0QFgggMAE&url=http%3A%2F%2Fkk.mercubuana.ac.id%2Felearning%2Ffiles_modul%2F11004-7-901570378753.pdf&usg=AFQjCNG6w6TC46xn7ewYhXuiOlBQuzuSsw&sig2=eU8sGo8q97RQXrlmKOGmZAhttp://mitaunair-fk12.web.unair.ac.id/http://www.alodokter.com/batuk-batuk/http://www.mayoclinic.org/diseases-conditions/barretts-esophagus/multimedia/vid-20078526http://artikel.co/72/sesak-nafas-dan-solusinya.html


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29/31

a. Purpose of resear'h 3 o de)elop and e)aluate an e@pert panel s'oring methodof the ha?ard potential of -UR+*A!+N landfill sites, and to in)estigate

whether sites 'lassified as posing a greater potential ha?ard.

a. Resear'h method

Itm Rsu't

Design !aseF!ontrol Stud(

hierar'h( of e)iden'e %

Sample he sample is landfill sites whi'h

'ontained

ha?ardousE waste of nonFdomesti'

origin as defined in the

-! dire'ti)e :/58: on *a?ardous

9aste/2B in the regions 'o)ered

0( the parti'ipating 'entres

Sample Si?e 1; landfill sites in /% stud(

areas

-@'lusion !riteria geographi' site 'oordinates used in initial

anal(ses pro)ed

in'orre't

Sampling &rame Random Sampling

Measurement and or assessment And &inal ha?ard s'ores after 'hanges

were madeB of the four

e@perts were a)eraged to form the final

o)erall, water, and air

ha?ard s'oring. *igh, medium, and low

ha?ard 'ategories were 'reated using

tertiles of the ha?ard s'ores as 'ut off

points.

Instrument Guestionnaires




30/31

Randomi?ation F

Inter)ention F

Anal(sis Method In order to assess the agreement 0etween

e@perts in 0oth initial

and final s'ores, intra'lass 'orrelation

'oeffi'ients I!!B

were 'al'ulated 0( anal(sis of )arian'e.

In addition, the

relia0ilit( of the a)erage e@pert s'ores

I!!kB was 'al'ulated.

aB !ompati0ilit( of he Design and he +0je'ti)e of he Stud( 3

'ompati0le 0B !ompati0ilit( of he Measurement he instruments 3

'ompati0le

!ons'lusion 3 :a'id Not alid

2. IMP+RAN!- +& R-S-AR!*

A. P O ;.;5, if the resear'h was reheld /;; times, 5 among of them didnCtgi)e results as this resear'h.

+R O ;,6: ;.4//.1/B in the low ha?ard 'ategor(, /.%2 /./;/.85B in the

medium, to /.5; /./51.1/B in the high water ha?ard 'ategor(.

". !on'lusion 3 Im8-rta)3Not Importan'e.




31/31

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