Global Nursing Challenges in The Free Trade Era 182
STUDY COMPARATION TO FIND CORRELATION BETWEEN
Global Nursing Challenges in The Free Trade Era 183 expensive and have more side effects that will
be caused. Another problem, the drug resistance spread in various countries often unknown and inadequate management of patients with MDR (Iskandar, 2010).
Based on antecedent studies conducted in Dr. SoetomoHospital in 2012-2014, found data on the number of patients with typhoid fever as many as 493 patients and found 30 patients have been infected with MDR strains of Salmonella thyphi. Cases of typhoid fever is to have as many as 493 patients with possible cases and probable cases as many as 60 patients. It motivates researchers to conduct this research.
RESEARCH METHODS
This research is an analytic study using a retrospective cohort design. The sampling technique in this research is simple random sampling. Researcher using secondary data is DMK (Document Medical Health) data of the hospital in 2012-2014.
The population in this study is the all DMK patients hospitalized with typhoid fever Non MDR and MDR to antibiotics in Dr.
Soetomo Hospital. The sample used is DMK's disease patients and children data with a clinical diagnosis of typhoid fever at the Dr.Soetomohospital who are Non TB and MDR against the antibiotics and microbiological data that has been proven by culture results. The samples were obtained of 60 samples with details of 30 cases and 30 controls.
Inclusion criteria of this study were:
DMK typhoid fever who were hospitalized in the Dr.Soetomohospital during the period 2012 - 2014. DMK typhoid fever whowere given antibiotics. And DMK typhoid fever whowere declared not healed and recovered from typhoid fever by doctors. While the exclusion criteria of this study are : DMK typhoid fever with comorbidities. DMK typhoid fever who given antibiotics because of comorbidities. And data status of the patientsareincomplete, lost, not clearly legible.
Variables that will be examined in this study is the independent variable that is antibiotic resistance incidence in both Non MDR and the MDR. While the dependent variable is the clinical patients with typhoid fever caused by a strain of salmonella typhi.
Data collection procedures in this study begins with data collection phase in the installation of Clinical Microbiology, after obtaining the data and then proceed with the data collection in the Medical Record Centre, after the DMK data is collected and the data is processed and analyzed. The study was conducted at Dr.Soetomo Hospital. Research conducted in August-October 2014.
RESULTS AND DISCUSSION
The results indicated that based on the proportion of patients with typhoid fever who were treated at the Dr. Soetomohospital complained of symptoms that include fever (96.7%), anorexia (86.7%), nausea (83.3%), vomiting (75%) ,epigastric pain (56.7%), and constipation (33.3%).
Based on the research can be seen that the proportion of patients with non-MDR typhoid fever greater with the typical triad of typhoid fever symptoms are fever (93.3%), epigastric pain (36.3%) and dirty tongue (6.7%). The proportion of patients with MDR typhoid fever greater with the typical triad of symptoms of typhoid fever include fever (100%), dirty tongue (53.3%) and epigastric pain (50%). These data were taken at the beginning of the history of typhoid fever patientsadmission to the hospital.
Based on the statistical analysis of the results obtained by the chi-square test p value less than α <0.05, which means that there is a significant difference of clinical symptoms of anorexia, nausea, vomiting, abdominal distension, constipation, dirty tongue, lethargy and diarrhea among patients with typhoid fever both MDR and Non MDR.
It is also in line with research conducted by Saraswati, et al., (2010) who obtained results clinical signs and symptoms research most commonly encountered include fever (100%), and digestive system disorders such as: nausea (58.46% ), vomiting (50.31%), abdominal pain (35.38%), anorexia (32.31%), diarrhea (18.46%), constipation (12.31%), as well as dirty tongue (27.69 %). This is slightly different to the research conducted by Herdiman in 2004 at Persahabatan Hospital Jakarta from 119 typhoid fever patients have a fever (100%), nausea/vomiting (84.7%) and diarrhea (84%).
CONCLUSSIONS AND RECOMENDATION
Global Nursing Challenges in The Free Trade Era 184 Conclusion
Based on the research results can be concluded:
1) Clinical patients with typhoid fever caused by Salmonella who Non MDR with the typical triad of symptoms of typhoid fever are fever (93.3%), epigastric pain (36.3%) and dirty tongue (6.7%).
2) Clinical patients with typhoid fever caused by Salmonella who MDR with the typical triad of symptoms of typhoid fever include fever (100%), dirty tongue (53.3%) and epigastric pain (50%).
3) The difference in the patient's clinical typhoid fever caused by Salmonella Typhi strains of MDR and non-MDR where different symptoms include anorexia, nausea, vomiting, abdominal distension, constipation, diarrhea and dirty tongue.
4) The difference in the effectiveness of treatment duration and circumstances while returning, the Non MDR patients with a treatment duration of less than 7 days was able to return to be recovered condition while the MDR patients require a longer time to heal is a treatment duration of 7-14 days.
Recomendation
Expected to give antibiotics rationally by performing a culture specimen of patient before giving antibiotics to patients with typhoid fever that antibiotics used in accordance with the type of bacteria.
Clinical fever and dirty tongue is possible MDR typhoid fever. Types of Antibiotic that can be selected to treat include ciprofloxacin and cefotaxime for undiscovered resistance than that due to the nature of this antibiotic is bacteriostatic. Selection of antibiotic therapy for the treatment of typhoid fever that will result in the duration of treatment will be shorter.
REFERENCES
Iskandar. 2010. Hubungan Karakteristik Penderita, Lingkungan Fisik Rumahdan Wilayah dengan Kejadian Demam Tifoid di Kabupaten Aceh Tenggara.
Tesis. Fakultas Kesehatan Masyarakat Universitas Sumatera Utara.
Nasronudin., Usman, H., Vitanata., Erwin. A.
T., Bramantono., Suharto., Eddy Suwandojo., A. Retno. P. R., Indah. S.
T, 2011. Penyakit infeksi di Indonesia dan solusi kini mendatang edisi kedua.
Surabaya : Unair press. Hal 187-218.
Soewandoyo, E. S, 2002. Seri Penyakit Tropik Infeksi Perkembangan Terkini dalam Pengelolaan beberapa Penyakit Tropik Infeksi. Edisi 1. Surabaya. Airlangga University Pers.
Soewondo, E.S., 2002. Demam tifoid deteksi dini dan tatalaksana. Makalah lengkap:
Seminar Kewaspadaan terhadap demam pada penyakit typhus Abdominalis, DBD dan Malaria Serta Penggunaan Tes Diagnostik Laboratorium untuk Deteksi Dini. Tropical Diseases Centre UNAIR, Surabaya, hlm 15.
Global Nursing Challenges in The Free Trade Era 185