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General Instructional Objective


After completing this module based on Problem Based Learning, the 1st semester students 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.

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CHAPTER ONE FIRST TUTORIAL


Brain Storming and Cognitive 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

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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. 1.3.3. Ida, an 8 years old child has health problems based on a general check up on 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. 1.4.5. is Arrange the conclusion of the group discussion. Attend the plenary discussion between guest speaker and the group that chosen to present their group conclusion.

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1.5 LEARNING ISSUES 1


1.5.1. 1.5.2. 1.5.3. 1.5.4. 1.5.5. 1.5.6. 1.5.7. 1.5.8. 1.5.9. 1.5.10. 1.5.11. 1.5.12. How height and weight that are ideal for children 8 years old? How the rate of hemoglobin that is ideal for children 8 years old? What is the definition and kinds of anemia? What symptoms and causesof anemia? What is the definition of mallnutrition? What symptoms and causesof mallnutrition? What is the definition of Leukimia? What symptoms and causesof Leukimia? What is the definition of wormy(Anclyostomiasis)? What symptoms and causesof wormy(Anclyostomiasis)? How the sleep patterns of children 8 years old is ideal? What are the indication of a healthy and good nutrition child ?

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1.6 ADDITIONAL QUESTIONS OR INFORMATION


No. Question 1. Does Ida eat on a regular basis? Reason Because we need to know if Ida have a enough nutrition or no. Answer - Ida and her family eats three times a day even completed with milk - Ida always use a spoon when she eats. - Ida always breakfast. - Ida like eat sausage and crackers.

2.

How is the condition of Idas family?

We need to know the environment of Idas Family

- Bathroom stands beside Dining Room. - Her Father is Vegetable seller and her Mother housewife. - Idas parents graduate only from Junior High School - Ida helps her grandfather sells things from his shop. - Idas Family never affect of cancer

3.

What is Idas daily activities?

To determine higenitation and sanitation from herself.

- Ida always play after school and she always use sandal. - Ida doesnt like playing at sand.

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- Ida always sleep in 2 pm oclock. - Ida always go to sleep 8 pm oclock and wake up in the morning.

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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.

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2.2 ANSWER OF LEARNING ISSUES


2.2.1 Answer : Normal Height 8 years old (age x 6) + 77 = (8 x 6) + 77 = 125 cm (Needlman RD, 2004) Normal weight 8 years old How height and weight that are ideal for children 8 years old?

2.2.2 Answer :

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

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)

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2.2.3 Answer :

What is the definition and kinds of anemia?

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 deficiency The 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, or colon, 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.

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b. Anemia of chronic disease Anemia 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 as Crohn's disease, systemic lupus erythematosus, rheumatoid arthritis, and ulcerative colitis, Cancer, including lymphoma and Hodgkin's disease, Chronic kidney disease, Liver cirrhosis, and Long-term infections, such as bacterial endocarditis, osteomyelitis (bone infection), HIV/AIDS, hepatitis B or hepatitis C c. Hemolytic anemia Normally, 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 as sickle cell anemia, thalassemia, and hemolytic 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 anemia Aplastic anemia 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

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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 anemia Sickle 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 have sickle cell trait. People with sickle cell trait do not have the symptoms of sickle cell anemia. g. Thalassemia Thalassemia is a blood disorder passed down through families (inherited) in which the body makes an abnormal form of hemoglobin, the protein in red blood

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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. Thalassemia occurs 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 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. What symptoms and causes of anemia?

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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 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 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 ).

What is the definition of mallnutrition?

What symptoms and causes of mallnutrition?

2.2.7 Answer :

What is the definition and kinds of Leukimia?

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 stem cells 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 leukemia is a malignant primary bone marrow which means there terdesaknya normal blood components by abnormal blood components , along with the spread to other organs PBL Medical Faculty of Airlangga University Holistic Module

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. 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 is more 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 that lasts or occurs because of hematological malignancies . 1 . Chronic Lymphocyte Leukimia Is a clonal malignant B lymphocytes , travels slowly . Tend to snack known attack 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 Answer :

What symptoms and causes of Leukimia?

Clinical symptoms of leukemia in general : Anemia , thrombocytopenia , neutropenia , infaksi , abnormalities of the affected organ infiltration , hypermetabolism , dyspnea , abdominal pain . PBL Medical Faculty of Airlangga University Holistic Module

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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 Answer :

What is the definition of wormy ?

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).

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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 Answer :

What symptoms and causes of wormy(Anclyostomiasis)?

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 infection Direct 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

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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 skin Transmission 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 Answer :

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

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

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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 New baby born Babies ( 0-1 years old ) Toddler ( 2-3 years old ) Pre-school children ( 3-6 years old ) School children ( 6-years old )

Normal sleep pattern 14 until 18 hours/day 12 until 14 hours/day 11 until 12 hours/day 11 hours/day 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 Answer : Childrenwithgood nutrition, it can be seenfromsomeof the common signsareeasily visible. Here are10common signs of healthy children: What are the indication of a healthy and good nutrition child ?

1. Increasingage, gain weight, grow taller 2. Uprightpostureandmuscledense 3. shinyandstrong hair 4. Skinandnailsare cleanand are notpale 5. Cheerfulface, clear eyesandfreshlips 6. Cleanteethandpinkgums

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7. Good appetite and 8. Move actively and speak fluently 9. Attentive and active towards reaction 10. 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) 0 1.7 GiziBuruk GiziKurang GiziLebih GiziLebih (kg) (kg) 1.8 - 2.1 (kg) 2.2 - 3.9 4.0 (kg)

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1 2 3 4 5 6 7 8 9 10 11 12 13 14

2.1 2.6 3.1 3.6 4.0 4.5 4.9 5.3 5.6 5.8 6.1 6.3 6.5 6.6

2.2 - 2.7 2.7 - 3.2 3.2 - 3.8 3.7 - 4.4 4.1 - 4.9 4.6 - 5.4 5.0 - 5.8 5.4 - 6.2 5.7 - 6.5 5.9 - 6.8 6.2 - 7.1 6.4 - 7.3 6.6 - 7.5 6.7 - 7.7

2.8 - 5.0 3.3 - 6.0 3.9 - 6.9 4.5 - 7.6 5.0 - 8.3 5.5 - 8.9 5.9 - 9.5 6.3 - 10.0 6.6 - 10.4 6.9 - 10.8 7.2 - 11.2 7.4 - 11.5 7.6 - 11.8 7.8 - 12.1

5.1 6.1 7.0 7.7 8.4 9.0 9.6 10.1 10.5 10.9 11.3 11.6 11.9 12.2

Son Age 0 1 2 3 4 5 GiziBuruk (kg) 1.9 2.1 2.5 3.0 3.6 4.2 GiziKurang (kg) 2.0 - 2.3 2.2 - 2.8 2.6 - 3.4 3.1 - 4.0 3.7 - 4.6 4.3 - 5.2 GiziBaik (kg) 2.4 - 4.2 2.9 - 5.5 3.5 - 6.7 4.1 - 7.6 4.7 - 8.4 5.3 - 9.1 4.3 5.6 6.8 7.7 8.5 9.2 GiziLebih (kg)

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6 7 8 9 10 11 12 13 14

4.8 5.3 5.8 6.2 6.5 6.8 7.0 7.2 7.4

4.9 - 5.8 5.4 - 6.3 5.9 - 6.8 6.3 - 7.1 6.6 - 7.5 6.9 - 7.8 7.1 - 8.0 7.3 - 8.2 7.5 - 8.4

5.9 - 9.7 6.4 - 10.2 6.9 - 10.7 7.2 - 11.2 7.6 - 11.6 7.9 - 11.9 8.1 - 12.3 8.3 - 12.6 8.5 - 12.9

9.8 10.3 10.8 11.3 11.7 12.0 12.4 12.7 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. PBL Medical Faculty of Airlangga University Holistic Module

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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 1113gr/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, we couldnt identify more what kind of Anemia that Ida suffer.

2.5 LEARNING ISSUES 2


2.5.1 What is the meaning of good sanitation ?

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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


3.2.1. 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. 3.2.2. Ida, an 8 years old child suspected having of wormy

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3.3 ANALYSIS 2

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CHAPTER FOUR Critical Appraisal 4.1 REFERENCES

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4.2 APPRAISAL SCIENTIFIC PAPER APPRAISAL SHEET

Name/Group Papers Title

: 8B : Dietary Recommendation for Children and Adolescents: A Guide for Practitioners

1. JOURNAL CONTENTS Items


Present/Absent (pages) Present (p. 1) Present (p. 1) Present (p. 11) Present (p. 11-12) Present (p. 13-17)

Title Abstract and or Summary Introduction, background Method Result Discussion acknowledgement Reference

Conclusion :This journal does not have complete contents.

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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 Design Rank on hierarchy of evidence Sample Review -7 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 Findings (pages)

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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 Compatibility between asessment and measurement and instrument

: compatible : compatible

Conclusion: This research is valid based on two criterias above. TELAAH IMPORTANCE PENELITIAN

OR/PR/RR Confidence Interval P value

:::-

4. APPLICABILITY

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Items burden of illness

Value Not the same as in our scenario

barriers to treatment

Not the same as in our scenario

behaviours needed balance

Not much Balanced

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