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Saturday, September 15, 2012

Six Factors that Affect Pain

Pain is a sensory and emotional experience that the unpleasant result of tissue damage, actual and potential. Similarly, understanding the pain of Brunner & Suddarth, 2002.

This pain can only be felt by a person without being perceived by others, and will include patterns of thought, activity someone directly, as well as changes in a person's life. Pain is an important signs and symptoms which may indicate the occurrence of a physiological disorder.

For a nurse or other health professionals should consider the factors that influence pain in the face of patients who experience pain. It is very important in the accurate assessment of pain and for nursing action.

Here are Six Factors that Affect Pain, including:

1. Age Factor. Age is an important variable that affects the pain, especially in children and adults. Developmental differences were found between the two age groups may affect how children and adults react to pain. Children difficulty to understand the pain and think that what nurses can cause pain. Children who do not have a lot of vocabulary, have difficulty verbally describing and expressing pain to parents or caregivers. Children can not express the pain, so the nurse should assess pain responses in children. In adults often report pain if it is pathological and malfunction.

2. Anxiety Factor. Although it is generally believed that the anxiety will increase the pain, may not be entirely true in all circumstances. Research does not show a consistent relationship between anxiety and pain also showed that preoperative stress reduction training at lower postoperative pain. However, the relevant anxiety, or dealing with the pain can increase the patient's perception of pain. In general, an effective way to relieve pain is to direct the treatment of pain rather than anxiety (Smeltzer & Bare, 2002).

3. Gender Factor. Gender factor this in conjunction with the factors that affect pain is that men and women did not have significant differences regarding their response to pain. It is doubtful that gender is an independent factor in the expression of pain. For example, boys must be brave and not cry in which a woman can cry at the same time.

4. Family and Social Support Factors. Other factors that also affect the response to pain is the presence of people nearby. People who are in a state of pain often rely on family for support, help or protect. The absence of family or close friends might make the pain increased. The presence of parents is particularly important for children in the face of pain (Potter & Perry, 1993).

5. Cultural Factors. Beliefs and cultural values ​​influence the way individuals cope with pain. Individuals learn what is expected and what is acceptable to their culture. This includes how to react to pain (Calvillo & Flaskerud, 1991). Recognizing the cultural values that have one and understand why these values ​​differ from the values ​​of other cultures helps to avoid evaluating a patient's behavior based on a person's expectations and cultural values. Nurses are aware of cultural differences will have a greater understanding of the patient's pain and be more accurate in assessing pain and behavioral responses to pain are also effective in relieving pain patients (Smeltzer & Bare, 2003).

6. Coping Pattern Factor. When a person is experiencing pain and undergoing treatment at the hospital is very unbearable. Continually client lost control and was not able to control the environment, including pain. Clients often find a way to overcome the effects of physical and psychological pain. It is important to understand the sources of individual coping during painful. Sources of coping is like communicating with family, exercise and singing can be used as a plan to support the client and the client reduce pain.

Thursday, September 6, 2012

Signs and Symptoms of Yaws

Clinical symptoms of yaws, consists of 3 Stadium, namely:

Stage I:

This stage is also known as infectious stage. The average incubation period of 3 weeks or in the range of 3-90 days. Initial form of papilloma lesions on port d 'entre shaped like strawberries, wet surfaces, damp, festering, recovered spontaneously without leaving a trace, sometimes accompanied by an increase in body temperature, headache, sore bones and joints later, papules spread which resolved after 1-3 months. Lesions intinial last a few weeks and a few months later recovered. These lesions are often found around the mouth, the anus and vagina, and similar kandilomatalata on syphilis. These symptoms were healed without leaving scars, although sometimes with pigmentation. In addition there is a kind of papilloma on palms or feet, and usually humid. Symptoms of the skin, can be macula, macula Papulosa, papules, micropapula, nodules, without showing damage to the structure of the epidermis and no exudation. The form of the primary lesion is an infectious form.

Stage II

Or a period of transition: at this stage, where the lesion was found Treponema pallidum pertenue. This positive Treponema be several weeks to several months after stage I. At this stage, no infectious yaws with various clinical forms, such as hyperkeratosis. Abnormalities in the bones and joints, often the fingers and limb bones, which can lead to atrophy occurs nails, and gangosa deformation, which is a form of necrotizing disorder and can cause damage to the nasal bone and septum nasi with images of loss of nose shape, gondou (a form of hypertrophic osteitis), although rarely encountered. Joint disorders, hydrarthrosis and juxta articular nodules (subcutaneous nodules, easy to move, chewy, multiple), usually found in the ankle, near the caput fibulae, Acral areas or plantar and palmar.

Stage III:

At this stage, there Guma or indolent ulcer with steep edges or resonate, when cured, these lesions leave scars, keloids and contractures can form. If there is infection in the bone can lead to defects and damage to the bone. Damage often occurs on the palate, nasal bone, the tibia.

Physical Examination and Investigations of Stroke

Physical Examination of Stroke
  1. The general state
    Awareness: Generally, decreased consciousness
    The voice spoke: Some disorders are difficult to understand, sometimes can not talk
    Vital signs: increased blood pressure, pulse rate varied.

  2. Examination of Integument
    Skin: If the client is less oxygen skin will look pale. If less fluid, it's ugly skin turgor. In addition, it should also be assessed signs of pressure sores, especially on areas that stand out as the client CVA Bleeding should bed rest 2-3 weeks
    Nails: Need to see a finger clubbing, cyanosis
    Hair: Generally no abnormalities

  3. Examination of the head and neck
    Head: Shape normocephalic
    Advance: Generally not symmetrical is lopsided to one side
    Neck: Stiff neck rare (Satyanegara, 1998)

  4. Examination of the chest
    In breathing audible breath sounds sometimes obtained ronchi, wheezing breath sounds or additional, irregular breathing due to decreased cough reflex and swallowing.

  5. Examination of the abdomen
    Obtained decrease intestinal peristalsis caused by bed rest periods, and sometimes there are bloated.

  6. Examination of inguinal, genital, anal
    Sometimes there incontinensia or urinary retention.

  7. Examination of the extremities
    Often obtained paralysis on one side of the body.

  8. Examination of neurology
    • Cranial Nerve
      Generally there is interference with cranial nerve VII and XII central.
    • Motor
      Almost always happens paralysis / weakness on one side of the body.
    • Sensory
      Hemihypesthesia can occur.
    • Reflex
      In the acute phase of physiological reflexes are paralyzed side will disappear. After several days of physiological reflexes will reappear didahuli with pathological reflexes.

Investigations of Stroke
  1. Radiological Examination
    • CT scan: hyperdense focal obtained, sometimes get in the ventricles, or spread to the brain surface. (Linardi Widjaja, 1993)
    • Magnetic resonance imaging (MRI) to show the area that experienced hemorrhagic. (Marilynn E. Doenges, 2000)
    • Cerebral angiography: to find the source of bleeding such as aneurysms or vascular malformations. (Satyanegara, 1998)
    • X-ray of the thorax: to show the state of the heart, whether there is an enlargement of the left ventricle, which is one sign of chronic hypertension in patients with stroke. (Jusuf Misbach, 1999)

  2. Laboratory Tests
    • Lumbar puncture: a red liquor inspection is usually found in massive bleeding, minor bleeding while liquor is usually normal color (xanthochromia) during the first days. (Satyanegara, 1998)
    • Routine blood tests
    • Chemical examination of blood: in acute stroke hyperglycemia may occur. Blood sugar can reach 250 mg in the serum and then gradually fell back. (Jusuf Misbach, 1999)
    • Complete blood count: fatherly look for abnormalities in the blood itself. (Linardi Widjaja, 1993)

Wednesday, September 5, 2012

Basic Concept of Nursing Care Plan for Stroke

Assessment is an early stage and the foundation of the nursing process to identify client problems, in order to give direction to nursing actions. Assessment phase consists of three activities: data collection, data classification and formulation of nursing diagnoses. (Lismidar, 1990)

Data Collection

Data collection is to collect information about the overall health status of the client's physical, psychological, social, cultural, spiritual, cognitive, developmental level, economic status, ability to function and lifestyle of patients. (Marilynn E. Doenges et al, 1998)

a) The identity of the client
Includes name, age (most often in old age), sex, education, address, occupation, religion, ethnicity, date and time of hospital admission, registration number, medical diagnosis.
b) The main complaint
Limb weakness typically found next to the body, speech pelo, and can not communicate. (Jusuf Misbach, 1999)
c) History of present illness
Hemorrhagic stroke often take place very suddenly, when the client is doing the activity. Usually occurs headache, nausea, vomiting and even seizures to unconsciousness, paralysis symptoms besides half body or other brain dysfunction. (Siti Rochani, 2000)
d) History of previous illness
A history of hypertension, diabetes mellitus, heart disease, anemia, history of head trauma, a long oral contraceptives, use of anti-coagulant drugs, aspirin, vasodilators, addictive drugs, obesity. (Donna D. Ignativicius, 1995)
e) A family history of disease
There is usually a family history of hypertension or diabetes mellitus. (Hendro Susilo, 2000)
f) Psychosocial History
Stroke is a disease that is very expensive. The cost for testing, treatment and care of the family finances that can disrupt these cost factors can affect the stability of the emotions and thoughts of clients and families.

The Patterns of Health Functions

1) Pattern perception of healthy living and governance
There is usually a history of smoking, alcohol use, use of oral contraceptives.
2) The pattern of nutrition and metabolism
Complaints difficulty swallowing, loss of appetite, nausea and vomiting in the acute phase.
3) The pattern of elimination
It usually occurs in the urinary incontinence and bowel habit constipation usually occurs due to decreased intestinal peristalsis.
4) The pattern of activity and exercise
There is the difficulty of the move as weakness, sensory loss or paralise / hemiplegia, tiredness.
5) The pattern of sleep and rest
Usually clients are having difficulties to rest because of muscle spasms / muscle pain.
6) The pattern of relationships and roles
A change in the relationship and role as client has difficulty communicating due to impaired speech.
7) The pattern of perception and self-concept
Clients feel helpless, hopeless, irritable, uncooperative.
8) The pattern of sensory and cognitive
At the client's pattern of sensory impaired vision / blurring sight, touch / touch down on the face and extremity pain. On the pattern of cognitive decline typically memory and thought processes.
9) Patterns of sexual reproduction
It usually occurs due to decreased sexual desire of some of the treatment of stroke, such as anti-seizure drugs, anti-hypertensive, histamine antagonists.
10) The pattern of response to stress
Clients often find it difficult to solve due to the disruption of thinking and difficulty communicating.
11) The pattern of values ​​and beliefs
Clients rarely practicing because of unstable behavior, weakness / paralysis on one side of the body.

Tuesday, September 4, 2012

Hyperparathyroidism Definition, Etiology, Pathophysiology and Clinical Manifestations

Definition of Hyperparathyroidism

Hyperparathyroidism is excessive production of parathyroid hormone by the parathyroid glands, characterized by decalcification of bone and the formation of kidney stones, which contain calcium. Hyperparathyroidism is divided into two, namely primary and secondary hyperparathyroidism. Primary hyperparathyroidism occurs two or three times more often in women than men and in patients aged 60-70 years. While secondary hyperparathyroidism with manifestations similar to patients with chronic renal failure. Renal rickets, caused by retention of phosphorus will increase the stimulation of the parathyroid glands and increased secretion of parathyroid hormone. (Brunner & Suddath, 2001)

Hyperparathyroidism is a character of a disease caused by excess secretion of parathyroid hormone, amino acid polypeptide hormone. Secretion of parathyroid hormone is directly regulated by the concentration of calcium ion fluid. The major effect of parathyroid hormone is increased by increasing the concentration of liquid calcium and phosphate calcium release from bone matrix, increases the absorption of calcium by the kidneys, and the kidneys to increase production. Parathyroid hormone also causes phosphaturia, if dehydrated phosphate. Hyperparathyroidism is usually divided into primary, secondary and tertiary. (Lawrence Kim, MD, 2005, section 2).

Etiology of Hyperparathyroidism

According to Lawrence Kim, MD. 2005, the etiology of hyperparathyroidism are:
  1. Approximately 85% of cases of primary hyperparathyroidism caused by single adenoma.
  2. While the other 15% involves various glands (eg various adenoma or hyperplasia). Usually hereditary and frequency associated with other endocrine disorders.
  3. Few cases of primary hyperparathyroidism caused by parathyroid carcinoma. Etiology of adenoma and hyperplasia in most cases unknown. Family cases can occur either as part of various endocrine neoplasia syndrome, hyperparathyroidism tumor syndrome, or hyperparathyroidism derivatives. Familial hypercalcemia and hypocalcuric and neonatal severe hyperparathyroidism are also included into this category.
  4. Some surgeons and pathologist reported that enlargement of the gland adenoma types are generally multiple doubles. In about 15% of patients with hyper-function of all glands; chief cell parathyroid hyperplasia.
Pathophysiology of Hyperparathyroidism

Hyperparathyroidism can be primary (ie caused by hyperplasia or parathyroid neoplasm) or secondary, where cases are usually associated with chronic renal failure.

In 80% of cases of primary hyperparathyroidism caused by parathyroid adenomas are benign; 18% of cases caused by hyperplasia of the parathyroid glands: and 2% of cases are caused by parathyroid carcinoma (damjanov, 1996). Normally there are four parathyroid glands. Parathyroid adenoma or carcinoma is characterized by enlargement of the gland, with the other glands remained normal. In parathyroid hyperplasia, four enlarged glands. Because the diagnosis of adenoma or hyperplasia can not be enforced preoperative, so it is important for the surgeon to examine the four gland.

If one identified an enlarged adenomatous gland, the gland is usually removed and others left intact. If it is an enlarged lymph fourth surgeon will lift the third and leave one lymph gland that should be sufficient to maintain the homeostasis of calcium-phosphate.

Secondary parathyroid hyperplasia can be distinguished from primary hyperplasia, because the four symmetrically enlarged glands. Enlarged parathyroid glands and hiperfungsi are compensatory mechanisms that are triggered by the retention of the format and hypercalcemia associated with chronic kidney disease. Osteomalacia caused by hipovitaminosis D, as in rickets, can lead to the same effect.

Hyperparathyroidism is characterized by excess PTH in the circulation. PTH mainly working on bone and kidney. In bone, PTH increases calcium resorption from the renal tubules Limen. Thereby reducing the excretion of calcium in urine. PTH also increases the active form of vitamin D3 in the kidneys, which in turn facilitates the uptake of calcium from food in the intestines. Hypercalcemia and hypophosphatemia thus compensatory, is abnormlitas biochemical detected through blood analysis. Serum PTH concentrations also increased. (Rumahorbor, Hotma, 1999)

Excess production of parathyroid hormone is accompanied by kidney failure can cause a wide range of bone disease, which often occurs tulng is osteitis fibrosa cystica, a disease of increased bone resorption due to increased levels of parathyroid hormone. Other bone diseases are also common in these patients, but did not appear in person. (Lawrence Kim, MD, 2005, section 5)

Excess amounts of PTH secretion causes hypercalcemia can cause direct effects on receptors in bone, intestinal tract, and kidneys. Physiologically PTH secretion is inhibited by high serum calcium ions. The mechanism is not active in the state of adenomas, or gland hyperplasia, hypersecretion of PTH which coincides with hypercalcemia. Reabsorption of calcium from bone and increased absorption from the gut is a direct effect of the increase in PTH.

At the time of serum calcium levels approaching 12 mg / dL, renal tubular reabsorption of calcium causing excessive hypercalciuria circumstances. This can increase the incidence nefrolithiasis, which raises can decreased creatinine clearance and renal failure. Elevated levels of extracellular calcium can be deposited on soft tissue. The pain arises due to calcified nodules form on the skin, subcutaneous tissues, tendons (calcific tendonitis), and cartilage (chondrocalcinosis). Vitamin D plays an important role in calcium metabolism by PTH causes needed to work in the target organ.

Clinical Manifestations of Hyperparathyroidism

Patients may not be, or have signs and symptoms due to the disruption of multiple organ systems. Symptoms of apathy, fatigue complaints, muscle weakness, nausea, vomiting, constipation, hypertension, and cardiac arrhythmias may occur: all this is related to elevated levels of calcium in the blood. Psychological manifestations may range from irritability and emotional state of neurosis to psychosis caused by the direct effect of calcium on the brain and nervous system. Increased calcium levels will decrease the potential excitation of nerve and muscle tissue.

Stone formation in one or both kidneys associated with increased excretion of calcium and phosphorus is one of the complications of primary hyperparathyroidism. Kidney damage caused by precipitation of calcium phosphate in the pelvis, and renal parenchyma resulting in kidney stones (renal calculi), obstruction, pyelonephritis and renal failure.

Musculoskeletal symptoms accompanying hyperparathyroidism may occur due to demineralization of bone or bone tumors, which appears in the form of benign giant cells due to excessive osteoclast growth. Patients may experience skeletal pain and tenderness, especially in the back and joints; pain when supporting the body; pathologic fractures; deformity, and shortening of the body. Bone loss associated with hyperparathyroidism is a risk factor for fracture.

The incidence of peptic ulcer and prankreatitis increased in hyperparathyroidism and can cause symptoms gastroitestinal. (Brunner & Suddath, 2001)

Anatomy and Physiology of Parathyroid Gland

Anatomy of the Parathyroid Gland

Parathyroid glands grown from endoderm tissue, ie, the third and fourth pharyngeus sulcus. Parathyroid glands from four pharyngeus sulcus tend to unite with the upper pole of the thyroid gland, parathyroid glands that form the cranial. Glands from third pharyngeus sulcus is part of caudal parathyroid glands, which are sometimes fused with the lower pole of thyroid. However, the position is often highly variable. Caudal portion of the parathyroid glands can be found in the posterolateral lower pole of the thyroid gland, or in the thymus, even in the mediastinum. Parathyroid glands sometimes found in the thyroid gland parenchyma. (R. Sjamsuhidajat, Wim de Jong, 2004, 695)

Normally there are four parathyroid glands in humans, which is located just behind the thyroid gland, two embedded in the superior pole of the thyroid gland and two in the inferior pole. However, the location of each of the parathyroid and the numbers can be quite varied, parathyroid tissue is sometimes found in the mediastinum.

Each of the parathyroid glands are approximately 6 millimeters, 3 millimeters wide and two millimeters thick and has a blackish brown fat macroscopic picture. Parathyroid gland contains mainly the adult primary cells (chief cells) containing Golgi apparatus striking plus the endoplasmic reticulum and secretory granules that synthesize and secrete parathyroid hormone (PTH). Tues oksifil fewer but larger granules containing oksifil and a large number of mitochondria in the cytoplasm In humans, before puberty is only rarely found, and after that the number of these cells increases with age, but the majority of young animals and humans, the cell is not found oksifil . Oksifil cell function is still unclear, these cells may be modified or the rest of the main cells that no longer secrete various hormones.

Physiology of the Parathyroid Gland

Parathyroid glands secrete parathyroid hormone (PTH), which together with Vitamin D3, and calcitonin regulate calcium levels in the blood. PTH synthesis is controlled by the plasma calcium levels, which inhibited the synthesis when high calcium levels and stimulated when calcium levels are low. PTH stimulates renal tubular reabsorption of calcium, increases the absorption of calcium in the small intestine, whereas inhibiting reabsorption of phosphate and calcium release from bone. So PTH will actively work on three major target point within the control of calcium homeostasis in the kidney, bone and intestine. (R. Sjamsuhidayat, Wim de Jong, 2004, 695)

Sunday, August 26, 2012

Nursing Diagnosis Knowledge Deficit - Gestational Diabetes Mellitus

Nursing Diagnosis for Gestational Diabetes Mellitus : Knowledge Deficit : the diabetic condition, prognosis and the need for action.

Expected outcomes:
  1. Participate in the management of diabetes during pregnancy.
  2. Expressing an understanding of the procedures, laboratory tests and activities involving the control of diabetes.
  3. Demonstrate proficiency own monitor and insulin administration.


1. Assess knowledge of the processes and actions, including the relationship of the disease with diet, exercise, stress and insulin requirements.
Rational: Gestational Diabetes Mellitus risk of glucose uptake in cells that are not effective, the use of fats and proteins for energy excessively and cellular dehydration when water flows out of the cell by hypertonic glucose concentration in serum.

2. Provide information about the workings and the adverse effects of insulin and review the reasons for avoiding oral hypoglycemic drugs.
Rationale: Metabolic Changes in prenatal causes insulin needs change. First trimester insulin requirement is low but becomes two times and four times during the second and third trimester. Although insulin does not cross the placenta, oral hypoglycemic agents and potential harm to the fetus.

3. Describe normal weight gain.
Rational: calorie restriction caused ketonemia can cause fetal damage and inhibit optimal protein utilization.

4. Provide information about the need for a light training program.
Rationale: Exercise after meals can help prevent hypoglycemia and stabilize glucose irregularities, unless there is excess glucose, which exercise can improve ketoacidosis.

5. Provide information on the effects of pregnancy on diabetic conditions and future expectations.
Rationale: Increased knowledge can reduce fear, increase cooperation, and help reduce fetal complications.

6. Discuss recognize the signs of infection.
Rationale: It is important to seek medical attention early to avoid complications.

7. Encourage maintained home assessment on levels of serum glucose, insulin dose, diet and exercise.
Rationale: When reviewed by the practitioner care giver, the diary can be helpful for evaluation and treatment.

8. Aids to the study of glucose, are instructed to accompany it with milk 8 oz and check the glucose level in 15 minutes.
Rationale: The symptoms of hypoglycemia such as diaphoresis, tingling sensations and palpitations with glucose levels below 70 mg / in need of immediate action. The use of glucagon as a combination of milk may increase serum glucose levels without the risk of turning into hyperglycemia.

Definition, Causes, Symptoms and Pathophysiology of Diverticular Disease

Nursing Care Plan for Diverticular DiseaseDefinition of Diverticular Disease

Diverticular disease is a common condition that affects the digestive system. It occurs when a small bulge or pouch (usually called diverticula) form in the colon wall. Diverticular disease is a common disease suffered, but most people do not experience any symptoms. The disease is becoming increasingly common in the current one is getting old. Diverticular disease occurs when a small area of the intestinal lining to weaken and bulge or pouch formed over the years. This is known as diverticular. Diverticular mostly found at the bottom of the large intestine in some people even found at the bottom of the bowels.

Causes of Diverticular Disease

Low-fiber diet, particularly the lack of fruits and vegetables, and red meat and high fat is the main cause of diverticular disease. This is rare in vegetarians and in some parts of the world where high fiber intake. Field commonly affected bowel diverticular disease.

Symptoms of Diverticular Disease

The symptoms of diverticular disease are usually felt in the lower left abdomen. The pain can occur after eating. It may disappear after flatulence or bowel movements. Other symptoms include:
  • Bloating
  • Constipation
  • Diarrhea
  • Persistent abdominal pain and getting worse, starting from below the navel and then moves to the left side down (though it can appear on the right for Asians due to genetic differences)
  • Fever (high temperature)
  • Frequent urination and sometimes painful
  • Change in bowel habits
  • Nausea and vomiting
The pain and disturbed bowel function is lost and back again from time to time and found blood in the stool. This is due to the weakening of blood vessels in the diverticular. If the blood comes from the gut most often seen as blood in the stool. The blood that comes from a higher place in the digestive system, such as the abdomen, dirt tends to be black and live. Sometimes scar tissue forms around an inflamed diverticula, and this can lead to a narrowing or blockage of the intestine. If the diverticula widespread, they can cause the lining of the abdomen (peritoneum) becomes inflamed and swollen. This is called peritonitis.

Pathophysiology of Diverticular Disease

Diverticular disease is a term used to describe diverticulitis and diverticulosis. Diverticulosis refers to the yolk outside the intestinal mucosa of non-inflammatory. Divertikulisis is beyond yolk stuck or herniation of the intestinal mucosa muscle wrapping around the colon, usually the sigmoid colon. Diverticular disease is common in men and women and at the age of 45 years, and obese people. This case occurs in approximately one third of the population over 60 years old. Low-fiber diet linked to the occurrence of diverticular, because this diet lowers bulk in the stool and predispose to constipation. In the presence of muscle weakness in the colon, can improve intramular pressures that can cause diverticular formation. The cause of diverticulosis include intestinal atrophy or muscle weakness, increased intramural pressure, obesity, and chronic constipation. Diverticulosis occurs when food is not digested clog diverticulum, causing decreased blood supply to the area and trigger intestinal bacterial invasion into the diverticulum. Diverticula have a narrow intestinal lumen as a bottle neck. The weak point in the intestinal muscles there in the branches of blood vessels that penetrate the colonic wall. The weak point is creating intestinal protrusion area when there is an increase in intraluminal pressure. Diverticula often occur in the sigmoid colon due to high pressure in this area is needed to remove feces into the rectum. Diverticulitis may be acute or chronic. If not infected diverticula (diverticulosis), these lesions cause little problem. However, if the fecalith not watered and flowing of the diverticulum, fecalith can become trapped and cause irritation and inflammation (diverticulitis). Area inflamed clogged blood and can bleed. Diverticulitis can lead to perforation if the masses are trapped in the diverticulum erode the intestinal wall. Chronic Diverticulitis can lead to increased scarring and narrowing of the lumen of the intestine ultimately, potentially causing obstruction. Meckel's diverticulum is intestinal yolk formation, investigation of embryonic development found in the ilium of 10 cm from the cecum. Yolk is lined by gastric mucosa or pancreatic tissue may contain. Mucosal lining of the stomach sometimes cause ulceration and bleeding or perforation. In addition, the inflamed diverticula can and attached to the umbilicus by fibrous bands and became the focus of the selection of the intestine that causes obstruction. Action against the state include the diverticulum surgery.

Nursing Diagnosis for Suicide

Nursing Care Plan for Suicide


Suicide is any activity which, if not prevented can lead to death (Gail w. Stuart, Mental Nursing, 2007).

Suicide is the idea, signaling and suicide attempts, which often accompany depressive disorders and often occurs in adolescents (Harold Kaplan, Synopsis of Psychiatry, 1997).


Is universal: due to the inability of individuals to solve problems

Divided into:

1. Genetic factors (based on research):
  • 1.5 to 3 times more suicidal behavior occurs in individuals who are first-degree relatives of people with mood disorders / depression / who had made ​​a suicide attempt.
  • More common in monozygotic twins than in dizygotic twins.
2. Biological factors:
Usually due to chronic diseases / medical conditions, for example:
  • Stroke
  • Disorders / cognitive impairment (dementia)
  • Diabetes
  • Coronary artery disease
  • Cancer
  • HIV / AIDS
  • etc.
3. Psychosocial and Environmental Factors:
  • Theories Psychoanalytic / psychodynamic: Theory Freud, namely that the lost object associated with aggression and anger, negative feelings about themselves, and the last depression.
  • Cognitive Behavioral Theory: Theory Beck, the growing negative cognitive patterns, low self-regard
  • Environmental stressors: loss of family, deception, lack of social support systems.

Suicidal behavior is divided into 3 categories:

1. Suicide threats: there are verbal and non-verbal warnings, threats showed ambivalence someone to death, if not get a response it will be interpreted as support for the suicide.

2. Suicide attempts: all actions by individuals against self can lead to death if not prevented.

3. Suicide: going after missed or ignored warning signs, people who commit suicide do not even really want to die may be dead.

  • Despair
  • Self-blame
  • Feelings of failure and worthlessness
  • Oppression
  • Insomnia is settled
  • Weight loss
  • Speaking of slow, fatigue
  • Pulling away from the social environment
  • Suicidal thoughts and plans

Assessment of risk factors for suicidal behavior
  • Gender: increased risk in men
  • Age: older, more problems
  • Relationship Status: married to lower the risk, life itself is a problem.
  • Family history: increased if there is a family with attempted suicide / substance abuse.
  • Originator (life events that just happened): Loss of a loved one, unemployment, gets embarrassed in the social environment, etc..
  • Personality factors: more often the introverted personality / shut down.
  • Other: Studies show that the white race more at risk of suicidal behavior.

Nursing Diagnosis for Suicide
  1. Anxiety
  2. Adjustment disorder
  3. Low Self-Esteem
  4. Ineffective individual coping
  5. Ineffective family coping
  6. Disturbed Sleep Pattern
  7. Social isolation
  8. Disturbed Thought Processes
  9. Risk for Violence: Self-Directed

Saturday, August 25, 2012

Nursing Care Plan for Brain Tumor


Brain tumors are lesions because there is pressure both benign and malignant space that grows in the brain, meninges and the skull.

  • History of head trauma
  • Genetic factors
  • Exposure to chemicals that are carsinogenik
  • Certain viruses

Brain tumors occur because of proliferation or growth of abnormal cells very rapidly in areas central nervous system (CNS). These cells will continue to evolve urge healthy brain tissue around it, causing neurological disturbances (focal disruption caused by the tumor and increased intracranial pressure).

Clinical manifestations
a. Headache
The pain is deep, constant, dull and sometimes it is terrific. Usually most severe in the morning and aggravated during activity, which usually causes an increase in intra-cranial pressure is coughing, bending and straining.

b. Nausea and vomiting
As a result of stimulation of the medulla oblongata

c. Papilledema
Venous stasis causing swelling of optic nerve papilla.

Nursing Care Plan for Brain Tumor

Nursing Assessment

a. Identification of risk factors for exposure to radiation or chemicals that are carcinogenic.

b. Identify the signs and symptoms are: headache, vomiting, and decreased vision or double vision.

c. Identify any changes in client behavior.

d. Observation of hemiparese or hemiplegia.

e. Changes in sensation: hyperesthesia, paresthesia.

f. Observation of sensory changes: asteregnosis (not able to feel the sharp edges), agnosia (not able to recognize objects in general), apraxia (not being able to use the tool properly), agraphia (can not write).

g. Observation of vital signs and level of consciousness.

h. Observation circumstances fluid and electrolyte balance.

i. Psychosocial: personality and behavioral changes, difficulty making decisions, anxiety and fear of hospitalization, diagnostic tests and surgical procedures, a change in the role.

Nursing Diagnosis for Brain Tumor

1. Ineffective tissue perfusion related to circulatory damage caused by a tumor suppression.

2. Pain (Acute / Chronic) related to increased intracranial pressure.

3. Knowledge Deficit: the condition and treatment needs related to the inability to know the information.

Typhoid Fever - 5 Nursing Diagnosis and Interventions

Nursing Care Plan for Typhoid Fever : Nursing Diagnosis and Interventions

1. Activity intolerance related to mandatory bed rest.

1) Provide assistance to meet their daily needs such as food, drink, change clothes and watch oral hygiene, hair, genetalia, and nails.
Rationale: To provide assistance to the client to avoid the onset of complications associated with the movement who violate program bedrest.

2) Involve the family in the fulfillment of ADL.
Rationale: Participation family is very important to facilitate the nursing process and prevent further complications.

3) Explain the purpose of bed rest to prevent complications and speed up the healing process.
Rationale: Rest decrease intestinal mobility also decreases the rate of metabolism and infection.

2. Risk for fluid volume deficit related to the intake is less, nausea, vomiting / excessive spending, diarrhea, body heat.

1) Monitor the status of hydration (moisture of mucous membranes, skin turgor, adequate pulse, blood pressure orthostatic) if needed.
Rationale: Changes in hydration status, mucous membranes, skin turgor describe the severity of dehydration.

2) Monitor vital signs
Rationale: Changes in vital signs to describe the general state of the client.

3) Monitor the input of food / liquid and count daily calorie intake.
Rationale: Provides guidelines to replace fluids.

4) Encourage the family to help patients eat.
Rationale: Family as the driving fluid needs of clients.

5) Collaborate with other medical team for IV fluid administration.
Rationale: Giving IV fluids to meet fluid needs.

3. Imbalanced Nutrition, Less Than Body Requirements
related to less intake due to nausea, vomiting, anorexia, or diarrhea due to excessive output.

1) Monitor the amount of nutrients and calories.
Rationale: Knowing the cause of the less intake so as to determine appropriate and effective intervention.

2) Monitor the weight loss.
Rational: Cleanliness nutrients can be known through increased weight 500 g / week.

3) Monitor the environment during the meal.
Rationale: A comfortable environment can reduce stress and more conducive to eating.

4) Monitor nausea and vomiting.
Rationale: Nausea and vomiting affect nutrition.

5) Involve the family in the client's nutritional needs.
Rationale: Increasing the role of the family in nutrition to accelerate the healing process.

6) Instruct the patient to enhance the protein and vitamin C.
Rationale: Protein and vitamin C to meet nutritional needs.

7) Provide food selected.
Rational: To assist in fulfilling the nutritional needs.

8) Collaboration with a nutritionist to determine the amount of calories and nutrients it needs patients.
Rationale: Helps in the healing process.

4. Acute pain related to inflammation of the small intestine.

1) Assess the level of pain, location, duration, intensity and characteristics of pain.
Rationale: Changes in the characteristics of the pain may indicate the spread of diseases / complications occur.

2) Review the factors that increase pain and decrease pain.
Rational: It can pinpoint the factors that trigger or aggravate (such as stress, food intolerance) or identify the occurrence of complications, as well as help in making the diagnosis and therapeutic needs.

3) Give warm compresses on the area of pain.
Rationale: For the pain disappeared.

4) Collaborate with other medical team in the delivery of analgesics.
Rational: Analgesic can help reduce pain.

5. Knowledge Deficit: conditions of disease, treatment and prognosis needs related to lack of information or inadequate information.

1) Assess the extent of knowledge of the client's family about his illness.
Rationale: Knowing the mother's knowledge about the disease typhoid fever.

2) Give health education about the disease and treatment of clients.
Rationale: In order for the client's mother found out about the disease typhoid fever, causes, signs and symptoms, as well as the care and treatment of typhoid fever.

3) Give the family an opportunity to ask if there is not yet understood.
Rationale: In order to understand more about the family disease.

Nursing Assessment of Typhoid Fever by Doenges

Nursing Assessment According to Doenges (1999: 476-485) are:

a. Activity and Rest.
Symptoms: weakness, fatigue, malaise, feeling anxious and anxiety, restriction of activities / work in relation to the disease process.

b. circulation
Signs: Tachycardia (fever response, the inflammatory process and pain), relative bradycardia, hypotension including postural, skin / mucous membranes poor turgor, dry, dirty tongue.

c. Ego integrity
Symptoms: Anxiety, emotional, upset eg feelings of helplessness / no hope.
Signs: Refuse, narrowed attention.

d. elimination
Symptoms: Diarrhea / constipation.
Signs: Decreased bowel / no peristalsis increased in constipated / a peristaltic.

e. Food / fluid
Symptoms: Anorexia, nausea and vomiting.
Signs: Decreased subcutaneous fat, weakness, muscle tone and poor skin turgor, mucous membranes pale.

f. Hygiene
Signs: The inability to maintain self-care, body odor.

g. Pain / comfort
Symptoms: Hepatomegaly, Spenomegali, epigastric pain.
Symptoms: Tenderness in the right hipokondilium or epigastrium.

h. security
Symptoms: Increased body temperature of 38 C - 40 C, blurred vision, mental delirium / psychosis.

i. Social interaction
Symptoms: Decreased relationships with others, relating to conditions in nature.

j. Counseling / Learning
Symptoms: A family history of inflammatory bowel diseased.

Friday, August 24, 2012

Gastritis Nursing Concepts - Assessment

Assessments were conducted in patients with gastritis include:
  1. Activity / Rest
    • Signs: tachycardia, tachypnea / hyperventilation (in response to activity)
    • Symptoms: weakness, fatigue

  2. Circulation
    • Symptoms:
      • hypotension (including postural)
      • tachycardia, dysrhythmias (hypovolemia / hypoxemia)
      • weakness / weak peripheral pulses
        capillary refill underlayer / slowly (vasoconstriction)
      • skin color: pale, cyanosis (depending on the amount of blood loss)
      • weakness of skin / mucous membranes = sweating (shows status of shock, acute pain, psychological responses)

  3. Ego integrity
    • Signs: signs of anxiety, such as: anxiety, pallor, sweating, attention narrows, shaking, trembling voice.
    • Symptoms: acute or chronic stress factors (financial, labor relations), feeling helpless.

  4. Elimination
    • Signs:
      • Abdominal tenderness, distention
      • Bowel sounds: often hyperactive during bleeding, hypoactive after bleeding.
      • Stool Characteristics : diarrhea, blood dark, brownish or sometimes bright red, frothy, foul smell (steatorrhoea). Constipation can occur (changes in diet, use of antacids).
      • Urine output: decreased, concentrated.

    • Symptoms: a history of previous hospitalization for gastro intestinal bleeding or GI related problems, eg wound peptic / gastric, gastritis, gastric surgery, gastric irradiation area. Changes in bowel habit / characteristic stool.

  5. Food / fluid
    • Symptoms:
      • Vomiting: color: dark coffee or bright red, with or without blood clots.
      • Dry mucous membranes, decreased mucous production, poor skin turgor (chronic bleeding).

    • Symptoms:
      • Anorexia, nausea, vomiting (vomiting which extends suspected pyloric obstruction in relation to the outside of the duodenal injury).
      • Problems swallowing: hiccup
      • Heartburn, belching sour smell, nausea / vomiting

  6. Neurosensory
    • Symptoms:
      • Feeling beat, dizziness / light headaches, weakness.
      • Mental status: level of consciousness can be disturbed, ranges from slightly inclined sleeping, disorientation / confusion, fainting and coma (depending on the volume of circulation / oxygenation).

  7. Pain / Leisure
    • Signs: wrinkled face, be careful in the area of ​​pain, pallor, sweating, narrowed attention.
    • Symptoms: pain, described as sharp, shallow, burning, pain, sudden severe pain can be accompanied by perforation. Sense of discomfort / distress faint after eating a lot and lost a meal (acute gastritis). Pain epigastrum left till the middle / back or spreading to occur 1-2 hours after eating and lost with antacids (gastric ulcer). Pain epigastrum left until / or spread to the back occurred about 4 hours after eating when the stomach is empty and relieved by food or antacids (duodenal ulcer). There was no pain (esofegeal varices or gastritis).
      Trigger factors: food, cigarettes, alcohol, use of certain drugs (salicylates, reserpine, antibiotics, ibuprofen), psychological stressors.

  8. Security
    • Signs: an increase in temperature, spider angioma, palmar erythema (indicating cirrhosis / portal hypertension)
    • Symptoms: allergies to medications / sensitive eg ASA

  9. Counseling / Learning
    • Symptoms: the use of prescription / OTC containing ASA, alcohol, steroids. NSAIDs cause GI bleeding. Complaints can be accepted at this time due to (eg anemia) or diagnoses unrelated (eg, head trauma), intestinal flu, or episodes of severe vomiting. Long health problems eg cirrhosis, alcoholism, hepatitis, eating disorders (Doengoes, 1999, p: 455).

Gastritis Nursing Diagnosis and Nursing Interventions

Management of Acute Gastritis and Chronic Gastritis

Management of Acute Gastritis and Chronic Gastritis

Gastritis is inflammation of the gastric mucosa.

Gastritis is divided into 2, namely:
  1. Acute gastritis
    One form of acute gastritis are frequently encountered in the clinic is acute erosive gastritis. Acute erosive gastritis is an acute inflammation of the gastric mucosa to erosive damage. Called when the erosive damage is not deeper than the muscularis mucosa.

  2. Chronic gastritis
    Chronic gastritis is an inflammation of the chronic gastric mucosal surface.
    Chronic gastritis is an inflammation of the mucosal surface of the stomach caused by either prolonged benign and malignant gastric ulcers or by bacteria helicobacter pylori. (Brunner and Suddart, 2000, p: 188).


The cause of gastritis is an anti-inflammatory analgesic drugs, especially aspirin; chemicals, such lisol; smoking; alcohol; physical stress caused by burns, sepsis, trauma, surgery, respiratory failure, kidney failure, damage to the central nervous system; gastrointestinal reflux (Inayah , 2004, p: 58).

Gastritis can also be caused by medications, especially aspirin and non-steroidal anti-inflammatory drugs (NSAIDs), can also be caused by impaired microcirculation of the gastric mucosa such as trauma, burns and sepsis (Mansjoer, Arif, 1999, p: 492).

Gastritis Clinical Manifestations

Dyspepsia syndromes such as epigastric pain, nausea, bloating and vomiting is one of the complaints that often arise. Gastrointestinal bleeding was also found in the form of hematemesis and melena, followed by signs of anemia after bleeding. Usually if done anamnesa deeper, there is a history of the use of drugs or certain chemicals. Patients with gastritis also accompanied by dizziness, weakness and discomfort in the abdomen (Mansjoer, Arif, 1999, p: 492-493).

Management of Gastritis

Treatment of gastritis include:
  1. Overcoming medical emergencies occur.
  2. Overcoming or avoiding the cause if it can be found.
  3. Giving drugs antacids or gastric ulcer medications to another.

In gastritis, management can be done by:

Management of Acute Gastritis
  • Instruct patient to avoid alcohol.
  • If the patient is able to eat by mouth nutritious diet is recommended.
  • If symptoms persist, fluids should be given parenterally.
  • If bleeding occurs, do gastromfestinal channel management to hemorrhage.
  • To neutralize the acids commonly used antacids.
  • To neutralize the alkali used diluted lemon juice or vinegar diluted.
  • Emergency surgery may be needed to remove gangrene or perforation.
  • The reaction needed to overcome obstruction gastric pylorus.

Management of Chronic Gastritis
  • Can be overcome by modifying the patient's diet, eating soft diet was given little but more often.
  • reduce stress
  • H. Pylori treated with antibiotics.

Sunday, August 12, 2012

Why does Coffee Cause Gastritis?

According Warianto (2011), coffee is a drink that consists of different types of materials and chemicals; including fats, carbohydrates, amino acids, vegetable acid called phenol, vitamins and minerals.

Coffee is known to stimulate the stomach to produce stomach acid, creating an environment that is more acidic and can irritate the stomach. There are two elements that can affect the health of the stomach and the stomach lining, namely caffeine and chlorogenic acid.

The study, published in Gastroenterology found that various factors such as acidity, caffeine or other mineral deposits in the coffee can trigger high stomach acid. So that no single component should be responsible (Anonymous, 2011).

Caffeine can cause stimulation of the central nervous system (brain), respiratory system and cardiovascular system. Therefore, no wonder every cup of coffee in reasonable amounts (1-3 cups), your body feels refreshed, excited, thinking power more quickly, not easily tired or sleepy. Caffeine can cause central nervous system stimulation, thereby increasing the activity of the stomach and gastrin on gastric secretion and pepsin. The hormone gastrin released by stomach has the effect of gastric secretion which is very acidic sap of the gastric fundus. Increased secretion of acid can cause irritation and inflammation of the gastric mucosa (Okviani, 2011).

Thus, digestive disorders are vulnerable are often owned by people who drink coffee are gastritis (inflammation of the lining of the stomach). Some people who have digestive problems and discomfort in the abdomen or stomach are usually advised to avoid or limit drinking coffee, so the condition is not worse. (Warianto, 2011).

Eating Patterns that Cause Gastritis

According to Farida Yayuk Baliwati (2004), the occurrence of gastritis can be caused by bad diet and irregular, the frequency of meals, type and amount of food, so that the stomach becomes sensitive when stomach acid to rise.

1. Frequency of Eating

Frequency of eating is the number of daily feeding in both qualitative and quantitative. Processed foods naturally in the body through the digestive tools from the mouth to the small intestine. Old food in the stomach depends on the nature and type of food. If on average, usually between 3-4 hours empty stomach. This feeding schedule was then fit to empty the stomach (Okviani, 2011).

People who have irregular eating patterns susceptible to disease gastritis. At the time of the stomach should be filled, but left empty, or delayed filling, sour stomach will digest the mucosal lining of the stomach, causing pain (Ester, 2001).

Naturally, the stomach will continue to produce acid in the stomach every time a small amount, after 4-6 hours after meal blood glucose levels usually have much absorbed and used up, so the body will feel hungry and when it is stimulated gastric acid number. If someone is late to eat up to 2-3 hours, then the stomach acid produced and over-the more so that it can irritate the gastric mucosa and cause pain around the epigastrium (Baliwati, 2004).

Irregular eating habits will make it difficult to adapt to the stomach. If it is prolonged, excessive production of stomach acid so it can be irritating to the mucosal lining of the stomach and may progress to peptic ulcer. This can cause intense pain and nausea. These symptoms can go up into the esophagus causing a burning sensation burning (Nadesul, 2005). Gastric acid production is affected by the regulation include cephalic, the setting up by the brain. The presence of food in the mouth will reflexively stimulate gastric acid secretion. In humans, seeing and thinking about food can stimulate gastric acid secretion (Ganong 2001).

2. Type of Food

Type of food is a variation of a food that if eaten, digested, and absorbed at least the arrangement will result in a healthy and balanced menu. Provides a variety of foods depends on the person, certain foods can cause indigestion, as well as spicy foods (Okviani, 2011).

Consuming excessive spicy foods, will stimulate the digestive system, especially the stomach and intestines to contract. This will cause a burning sensation and pain in the gut is accompanied by nausea and vomiting. The symptoms are making people increasingly reduced appetite. When the habit of eating spicy food more than once a week for at least 6 months left to constantly irritate the stomach known as gastritis (Okviani, 2011).

Gastritis can be caused also from the foods that do not match. Certain foods that can cause gastritis, such as raw fruit, raw meat, curry, and food containing cream or butter. Not that the food is not digested, but because the stomach takes longer to digest food gets forward earlier and slow The rest of his intestines. As a result, the stomach contents and gastric acid stay in your stomach for a long time before passing into the duodenum and spent acid causes a burning sensation in the pit of the stomach and can irritate (Iskandar, 2009).

3. The Portion or Amount of Food

The portion or amount of food, as well as the dose is a measure of food consumed at each meal. Everyone must eat foods in the correct amount of fuel for all the needs of the body. If excessive food consumption, the excess will be stored in the body and cause obesity (overweight). In addition, food in large portions may lead to reflux of stomach contents, which in turn makes the power of the stomach wall decreased. Such conditions can lead to inflammation or injury to the stomach (Baliwati, 2004).

Sunday, July 29, 2012

Nursing Management of Sleep Disorders in the Elderly

Nursing Management of Sleep Disorders in the ElderlyThe following Nursing Management of Sleep Disorders in the Elderly

1. Primary Prevention
  • Fully asleep, but not excessive, in order to feel fresh and healthy the next day, restriction of sleep can amplify sleep, excessive time in bed seem related to fragmented sleep and shallow.
  • Regular waking time in the morning, strengthens the circadian cycle and lead to a regular sleep onset.
  • Stable amount of exercise each day can deepen sleep, but exercise is only performed occasionally can not improve sleep the following night.
  • Noises can interfere with sleep, even if the sound does not wake a sleeping person and can not remember in the morning. Soundproof the bedroom can help sleep for people who have to sleep near the noise.
  • Although the room is too warm can interfere with sleep, but there is no evidence to suggest that the room is too cold can help you sleep.
  • Hunger interferes with sleep.
  • Sleeping pills may sometimes be used to advantage, but that chronic use, are not effective in most patients with insomnia.
  • Caffeine can interfere with sleep in the day, though at those who think so.
  • Alcohol helps tense people fall asleep more easily to help, but sleep is then intermittent.
  • People who feel angry and frustrated because they could not sleep, trying hard not to fall asleep but should turn on the lights and do other things differently.
  • Chronic tobacco use can interfere with sleep.
Another act of primary prevention include:
  • Mattress that allows the proper body alignment.
  • Room temperature should be cold enough (less than 24C), so feel comfortable
  • Caloric intake should be at least at bedtime.
  • Moderate exercise during the day or in the evening is the recommended.

2. Secondary Prevention

Assessment by the nurse should include the following factors:
  • How well the elderly are at home sleeping?
  • When the elderly go to bed and wake up?
  • Any habit that happens at bedtime?
  • How many the amount of and exercises who done every day?
  • Is the best position is preferred when in bed?
  • What kind of environment is preferred treason?
  • What is the temperature like?
  • How much ventilation is desired?
  • What activities are carried out several hours before bedtime?
  • What are the medications sleeping or other medications which used when ahead of the sleep are routinely?
  • How much time is spent in the hobby?
  • Perceptions of life satisfaction and health status?
As always, validate the assessment history with family members or caregivers is essential to ensure the accuracy and assessment.

Diary of sleep is the best way of assessment for the elderly. This information provides an accurate record of trouble sleeping. To get a true picture of sleep disturbance experienced by the elderly at home or in health facilities, daily records were made 3 to 4 weeks. Records shall include the following factors:
  • How often the help given to prescribe pain, unable to sleep or use the bathroom.
  • When the person gets out of bed?
  • How many times a person is awake or asleep at the time observed by the nurse or care giver.
  • Confusion or disorientation occur.
  • The use of sleeping pills.
  • Estimated person gets up in the morning.
3. Tertiary Prevention

If there is a sleep disorder such as Sleep Apnea life threatening, the condition of patients requiring rehabilitation through measures such as removal of the tissue that blocks the mouth, which affect the airway. Today many sleep disorders centers are available throughout the country to help evaluate sleep disorders. These places are usually associated with clinical and medical research institutes or universities, complete with medical devices that can detect sophisticated electrical recording in the brain and airway obstruction. These data to help the best treatment for sleep difficulties and rehabilitation of the elderly.

Causes and Symptoms of Sleep Disorders (Insomnia) in the Elderly

Causes and Symptoms of Sleep Disorders Insomnia in the ElderlyUnderstanding of Sleep Disorders (Insomnia)

Sleep Disorders (Insomnia) is difficult to sleep or difficulty staying asleep, or sleep disorders that make people feel not enough sleep during waking.

Sleep disorders not only shows the indication of a mental disorder and that early, but it is a complaint of nearly 30% of patients who went to the doctor, due to:
  1. Extrinsic factors (external) eg less tranquil environment.
  2. Intrinsic factors, such as can be organic and psychogenic.
    • Organic, for example: pain, itching and certain diseases that create anxiety.
    • Psychogenic, eg depression, anxiety and irritability.
Elderly with depression, stroke, heart disease, lung disease, diabetes, arthritis, or hypertension is often reported that poor sleep quality and sleep duration is less, when compared with the healthy elderly. Sleep disorders can increase the overall cost of illness. Sleep disorders are also known to cause significant morbidity. There are some serious consequences of sleep disorders in the elderly such as excessive daytime sleepiness, impaired attention and memory, mood depression, frequent falls, improper use of hypnotics, and decreased quality of life. Mortality, heart disease and cancer were higher in the old man sleep more than 9 hours or less than 6 hours per day when compared with the old man sleeping between 7-8 hours per day.

Causes of Sleep Disorders (Insomnia)

Sleep disturbance is not a disease but a symptom that has many causes, such as emotional disorders, physical disorders and drug use. Trouble sleeping is often the case, either at a young age and old age, and often occur together with emotional disorders like anxiety, restlessness, depression or fear. Sometimes a person have trouble sleeping simply because the body and brain is tired. Pattern in the early morning wake up more often found in the elderly. Some people fall asleep normally but wake up several hours later and it is difficult to fall asleep again. Sometimes they sleep in a state of restless sleep and was not satisfied. Woke up at dawn, at any age, is a sign of depression. People who may have disturbed sleep patterns are reversed sleep rhythm, their sleep is not the time to sleep and wake up at bedtime.

In addition, the following behavior can also cause sleep disorders in some people:
  • Lack of sleep hygiene in general (washing face, etc.?)
  • Concerns can not sleep
  • Excessive caffeine consumption
  • Drinking alcohol before bed
  • Smoke before bed
  • Nap / afternoon excessive
  • Schedule of sleep / wake irregularities

Symptoms of of Sleep Disorders (Insomnia)

Patients find it difficult to sleep or lie awake at night and feel tired all day.

Sleep disorders can be experienced with various ways:
  • difficult to sleep
  • there is no problem to sleep, but had difficulty staying asleep (frequent waking)
  • waking up too early
Difficulty sleeping is just one of several symptoms of insomnia. Symptoms experienced during the day is:
  • drowsiness
  • restless
  • difficulty concentrating
  • It's hard to remember
  • irritable
Presumptive etiology, sleep disorders are divided into four groups, namely, primary sleep disorders, sleep disorders due to other mental disorders, sleep disorders due to general medical conditions, and sleep disorders induced by substance. Sleep-wake disorders can be caused by physiological changes such as the normal aging process. History of sleep problems, sleep hygiene today, history of drug use, partner reports, records of sleep, and nighttime polisomnogram need to be evaluated in the elderly who complain of sleep disorders. Complaints of sleep disturbance that is often expressed by the elderly are insomnia, sleep rhythm disorders, and sleep apnea.

Wednesday, July 25, 2012

Physical Examination on Hydrocephalus


Hydrocephalusis a condition caused by an unbalanced production and absorption of cerebrospinal fluid within the ventricular system. When production is greater than absorption, cerebrospinal fluid accumulates in the ventricular system.

Causes of hydrocephalus include:
  • Congenital abnormalities
  • Infection
  • Neoplasms
  • Bleeding.

Physical examination on Hydrocephalus

Usually a myelomeningocele, head circumference measurements (Occipitofrontal)

On hydrocephalus obtained:

Early signs:

  • Cockeye
  • Headache
  • Irritable
  • Weary
  • Cry if picked up, and silent when lying
  • Nausea and vomiting is projectile
  • See twins
  • Ataxia
  • Development was slow
  • Pupillary edema
  • Pupillary response to light is slow and not equal
  • Usually followed: altered levels of consciousness, opistotonus and spastic in the lower extremities
  • Difficulty in feeding and swallowing
  • Cardio pulmonary disorders
Following Signs :
  • Headache followed by vomiting
  • Pupillary edema
  • Strabismus
  • Increased blood pressure
  • The pulse is slow
  • Respiratory disorders
  • Convulsions
  • Lethargy
  • Nausea, Vomiting
  • Extrapyramidal signs / ataxia
  • Irritable
  • Tired, weary
  • Apathetic
  • Confusion
  • Often times incoherent
  • Blindness

Nursing Diagnosis and Interventions for Menstruation Disorders - Dysmenorrhea

Nursing Care Plan for DysmenorrheaNursing Diagnosis for Dysmenorrhea

Dysmenorrhea is defined as a condition of severe uterine pain during menstruation. All women experience an irregular period once in awhile during their child bearing years. Some women may experience periodic pains during or prior to, or after menstrual periods in the lower abdomen as resulting of over production of certain hormones in the prostaglandins family.

Primary dysmenorrhea is due to disordered or too much prostaglandin production through the secretory endometrium of the uterus within the absence of a structural lesion.

Dysmenorrhea (painful menstruation) can also include symptoms such as headache, fatigue, bloating, and even nausea, vomiting, and/or diarrhea.

Dysmenorrhea can be treated with a variety of drugs, including pain relievers, sedatives, antispasmodics, prostaglandin inhibitors, and oral contraceptives.

Nursing Diagnosis and Interventions for Menstruation Disorders - Dysmenorrhea
  1. Acute Pain related to increased uterine contractility, hypersensitivity
  2. Imbalanced Nutrition Less Than Body Requirements related to the nausea, vomiting.
  3. Ineffective individual coping related to emotional excess.
Nursing Interventions for Dysmenorrhea

1. Acute Pain related to increased uterine contractility, hypersensitivity.

Goal: pain reduced client

Nursing Interventions:
1. Warm the abdomen.
Rational: may cause vasodilation and reduce the spasmodic contractions of the uterus.

2. Massage the abdominal area that feels pain.
Rational: reduce pain due to the stimulus of therapeutic touch.

3. Perform light exercise
Rational: it can improve blood flow to the uterus and muscle tone.

4. Perform relaxation techniques.
Rational: reduce the pressure to get relaxed.

5. Give the natural diuresis (vitamin) sleep and rest.
Rational: reduce congestion.

2. Ineffective individual coping related to emotional excess.

Nursing Interventions:
1. Assess client's understanding of her illness.
Rational: maternal anxiety of the pain will be greatly influenced by knowledge.

2. Determine the additional stress that accompanies it.
Rational: stress can impair the autonomic nervous response, so it is feared to increase the pain.

3. Provide an opportunity to discuss how the pain.

4. Help clients identify coping skills during the period covered.
Rational: the use of behavior management techniques can help clients adapt to the pain they experienced.

5. Give the period of sleep or rest.
Rational: the pain and fatigue due to spending a lot of body fluids tends to be a problem that must mean a lot of the body tends to be significant problems that must be addressed immediately.

6. Push the skills of stress, such as relaxation techniques, visualization, guidance, imagination and deep breathing exercises.
Rational: it can reduce pain and distract the client to pain.

Risk for Injury Nursing Care Plan Preeclampsia

Risk for Injury Nursing Care Plan PreeclampsiaNursing Care Plan Preeclampsia

There are certain conditions that arise during the pregnancy that can lead to a high incidence of birth injuries. One of those conditions is preeclampsia. It is important that the mum is given the right treatment before the birth so that the risk of injury is minimized in the majority of cases. It is said that about seven out of one thousand babies suffer birth injuries.

Preeclampsia signs can persist for as long as 3 months after birth but usually disappear entirely in most women.

If preeclampsia is left untreated the blood pressure can become so high that the woman is at increased risk of seizures. Symptoms of preeclampsia are right upper abdominal pain, headache, disturbance in vision and alteration in mental state. Permanent injury to the brain, liver and kidneys have been reported in uncontrolled preeclampsia. Reduced placental blood flow leads to less oxygen and nutrient supply to the baby. Fetal growth slows and a preterm delivery is associated with breathing difficulties for the baby when it is born.

Risk Factors For Preeclampsia
  • Previous kidney disease.
  • Teenage mothers and women over 35 year of age.
  • Twins or more.
  • History of Lupus.
  • Assisted reproduction.
  • Barrier methods of contraception.
  • First pregnancy or first pregnancy with a new partner.
  • History of diabetes.
  • Presence of essential hypertension (high blood pressure).

Nursing Diagnosis for Preeclampsia : Risk for Injury: the fetus is related to an inadequate blood perfusion to the plasma

Goal: Injury did not occur in the fetus

Nursing Interventions for Preeclampsia:

1. Instruct the patient to Rest
Rational: By resting the client, is expected to decrease the body's metabolism and blood circulation to the placenta to be more adequate to the need of oxygen to the fetus can be met.

2. Encourage clients to sleep on their left
Rationale: With the left side sleeping is expected vena cava on the right is not depressed by the enlarged uterus so that the flow palasenta darh to be smooth.

3. Monitor blood pressure
Rationale: The client can monitor blood pressure condition known as placental blood flow to high blood pressure, blood flow to the placenta is reduced so that the supply of oxygen to the fetus is reduced.

4. Monitor the client's heart sounds
Rational: By monitoring the fetal heart sounds can be known to the state of the fetal heart is weak or declining indicating reduced supply of oxygen to the placenta so that action can be planned in advance.

5. Give anti-hypertensive drugs will lower the tone of the arteries and cause a decrease in cardiac afterload by vasodilatation of blood vessels so that blood pressure down.
Rationale: By decreasing blood pressure so that blood flow to the placenta becomes more adequate.

Nursing Diagnosis for Preeclampsia

Nursing Diagnosis for PreeclampsiaNursing Care Plan for Preeclampsia

Preeclampsia is a collection of symptoms that occur in pregnant women, maternity and childbirth consisting of hypertension, edema and proteinuria, but show no signs of vascular abnormalities or hypertension before, while the symptoms usually appear after age 28 weeks gestation or more.

Predisposing factors
  • Molahidatidosa
  • Diabetes mellitus
  • Multiple pregnancy
  • Hydrops fetalis
  • Obesity
  • Age over 35 years
Clinical manifestations

Signs of preeclampsia usually arise in the order: excessive weight gain, followed by edema, hypertension, and proteinuria eventually. In the mild pre-eclampsia found no subjective symptoms. In the severe pre eclampsia found in the area prontal headache, diplopia, blurred vision, pain in the epigastric region, nausea or vomiting. These symptoms are often found in pre-eclampsia is increased and is an indication that eclampsia will occur.

Diagnosis :
  • Clinical features: excessive weight gain, edema, hypertension, and proteinuria occur.
  • Subjective symptoms: headache frontal area, epigastric pain; impaired visual acuity; blurred vision, scotoma, diplopia; nausea and vomiting.
  • Other cerebral disorders: increased reflexes, and not quietly.
  • Examination: high blood pressure, reflexes increased and proteinuria in the laboratory.

Nursing Diagnosis for Preeclampsia
  1. Ineffective Cerebral Tissue Perfusion related to decreased cardiac output secondary to vascular vasopasme.
  2. Impaired Gas Exchange related to accumulation of fluid in the lungs: pulmonary edema.
  3. Decreased Cardiac Output related to decreased venous return, cardiac trouble.
  4. Excess Fluid Volume related to glomerular function impairment secondary to the decrease of cardiac output.
  5. Activity Intolerance related to weakness.
  6. Impaired Urinary Elimination related to impaired glomerular filtration: anuria and oliguria.
  7. Imbalanced Nutrition Less Than Body Requirements related to inadequate intake.
  8. Acute Pain related to injury of biological agents: Hydrogen ion accumulation and an increase in HCl.
  9. Risk for Injury: the mother related to diplopia, increased intra-cranial: seizures.
  10. Knowledge Deficit: the management of therapy and treatment related to misinterpretation of information.

Saturday, June 30, 2012

Effective Cough - Definition, Purpose and Method

Definition of Effective CoughDefinition, Purpose of Effective Cough and Method of Effective Cough

Definition of Effective Cough

Effective cough is a necessary action to clear secretions. (Hudak & Gallo, 1997:494).

Coughing is also a common symptom of respiratory disease. Stimuli that normally cause a cough is the stimulation of mechanical, chemical and inflammation. Each of the respiratory tract inflammation with or without exudate can lead to cough. Chronic bronchitis, asthma, tuberculosis (pulmonary tuberculosis) and pneumonia is a disease that typically have a cough as a symptom of which is striking. (Wilson, 2006:773-774)

Indications of Effective Cough

According to Wilson (2006:773-774) Effective Cough, performed on patients such as:
  1. Chronic bronchitis
  2. Asthma
  3. Pulmonary tuberculosis (TB).
  4. Pneumonia
  5. Emphysema
Purpose of Effective Cough

Effective coughing and deep breathing is an effective cough techniques which emphasize maximal inspiration, the beginning of expiration, which aims to:
  1. Stimulate opening collateral system.
  2. Improve the distribution of ventilation.
  3. Increase lung volume and airway to facilitate cleaning. (Jenkins, 1996)
  4. Increase lung expansion.
  5. Mobilization of secretions.
  6. Prevent the side effects of secretion retention (pneumonia, Ateletaksis and fever).
(Hudak & Gallo, 1997:494)

Method of Effective Cough
  1. Sit up straight.
  2. Then inhale deeply, 2 times slowly through your nose and exhale through the mouth.
  3. Inhale the third time and hold your breath for a count to 3, with a strong cough 2 or 3 times in a row without having to inhale again during coughing.
  4. Continue to exercise as much as 2-3 times cough on waking.
  5. Repeat as needed.
(Bangerd, 2011)

Definition, Causes, Signs and Symptoms of Urinary Tract Infection

Definition of UTI, Causes of UTI, Signs and Symptoms of Urinary Tract InfectionDefinition and Causes of Urinary Tract Infection (UTI)

Urinary Tract Infection (UTI) is a condition of inflamed urinary system due to bacterial infection. The infection generally starts from the estuarine section urinary infection and the urethra (urethritis) but if not addressed properly then the infection will spread to the bladder (cystitis), ureters (urethritis) and even up to the kidneys (pyelonephritis) (Suciadi, 2010:34).

The types of microorganisms that cause UTI, according to Sudoyo (2006:564) are:
  1. Escherichia Coli: 90% of the cause of uncomplicated UTI (simple)
  2. Pseudomonas, Proteus, Klebsiella: the cause of complicated UTI
  3. Enterobacter, staphylococcus epidemidis, enterococci, and-others.
Trigger UTI in the elderly by Tessy (2001) are:
  1. The remaining urine in the bladder is increased due to the emptying of the bladder is less effective.
  2. The mobility decreases.
  3. Nutrition is often poor.
  4. Decreased immune system, both cellular and humoral.
  5. The existence of barriers to the flow of urine.
  6. Loss of bactericidal effect of secretions of the prostate.
Signs and symptoms of Urinary Tract Infection (UTI)
  1. The pain during urination.
  2. Acute Pain : Abdominal pain and lower middle.
  3. Colored urine is cloudy and there was blood.
  4. Low back pain.
  5. Fever to chills.
  6. Nausea and vomiting.
Signs and symptoms of UTI at the bottom, according to Smeltzer (2008), namely:
  1. Pain is a frequent and burning sensation when urinating.
  2. Spasm in the bladder and suprapubic area.
  3. Haematuria.
  4. Back pain can occur.
Signs and symptoms of upper UTI, according to Smeltzer (2008), namely:
  1. Fever and chills.
  2. Pelvic and hip pain.
  3. Pain when urinating.
  4. Malaise and dizziness.
  5. Nausea and vomiting.
Prevention of Urinary Tract Infection (UTI)
  1. Get used to drinking enough water each day, which is 8 glasses a day.
  2. Avoid the habit of holding urine.
  3. For women, avoid the habit of washing the genitals with a variety of cosmetic products that are not clear or wipe with toilet water of questionable cleanliness.
  4. Get used to wipe with the direction from front to rear direction.
  5. Get used to relate in a healthy way, women should get used to urinate after intercourse.
  6. Keep your genital area.
  7. Replace the pads when you are menstruating regularly.
  8. Replace regular diaper.
  9. Wear underwear made ​​from a comfortable and not too tight
  10. Check urine regularly during pregnancy.
  11. Complete treatment if you have prostate disease or urinary tract stones.
(Suciadi, 2010:65).

How to Resolve Complaints of Menopause and How to Slow Down of Menopause

How to Resolve Complaints of Menopause and How to Slow Down of Menopausea. Complaints arising from changes in menopause can be treated with drugs that are replacing the functions of estrogen. It aims to repair cells that suffered a setback.

b. Consuming vitamin that serves to inhibit the aging process.

c. Adequate exercise and age-appropriate is one way to nourish the physical. With exercise the body will be protected from diseases that are vulnerable in the face by the elderly.

d. Eat a balanced diet and as needed, avoid fatty foods. Expand to eat vegetables and fruits that can help the body's metabolic processes.

e. Doing a hobby that can support health can make distracting from menopausal complaints.

f. Keep working for menopausal women to maintain a sense of confidence.

g. Engage in social religious activities.

h. Familiarization with the environment.

i. Get together with people who have similar problems to a variety of experiences and knowledge.

j. Communicate with her ​​husband and family so they can provide good support.


Nutrients that can help reduce menopausal complaints:

1) Omega 3 fatty acid that serves to prevent the occurrence of depression.

2) Folic acid works to prevent the occurrence of depression.

3) Iron to increase blood hemoglobin.

4) Calcium to reduce complaints of hot flushes and osteoporosis.

5) Vitamin D to reduce the complaints of the skin and bones.

6) Sources: Fatty fish, green leafy vegetables, orange juice, red meat, beans, spinach, raisins, cereal. Low-fat milk and other dairy products, canned fish, anchovies, tuna, salmon, etc..

The main treatment of the menopause is to provide external terapy hormone estrogen known as Hormone Replacement Therapy (HRT). Principles of administration are:

a. Women who still have a uterus, given the combination of estrogen and progesterone, the addition of progesterone is intended to avoid the risk of endometrial cancer.

b. Women who had been without a uterus, estrogen is given alone to continue.

c. Who are still menstruating woman, estrogen is given in a sequential way.

d. Women who still want occur menstruation, given a continue.

e. Types of estrogen and progesterone that is given is natural.

f. Early provision should be provided with a low dose.

Menopause sometimes make most women become anxious, when in fact it need not be feared, since the onset of menopause can actually slow down the setting up and start living healthy. Preparations include:

a. Exercise regularly and continuously to improve physical strength and bone strength. Exercise you can do include walking, jogging and calisthenics.

b. Eating foods that contain lots of calcium may reduce the risk of bone loss or osteoporosis. Calcium is found in many high-calcium milk, many in high-calcium found in milk, cheese and nuts.

c. Eating foods that contain lots of vitamins to improve health and endurance. Vitamins are found in vegetables and fruits.

d. Reduce the consumption of drinks that contain lots of caffeine, for example, include coffee, tea and soft drinks. Because these drinks can inhibit the absorption of calcium and iron.

e. Not consume alcohol and cigarettes because both of these can accelerate the occurrence of menopause and boost the risk of osteoporosis.

f. Eating foods that contain lots of calcium may reduce the risk of bone loss or osteoporosis. Calcium, cheese and nuts.

g. Consuming a lot of eating
(Wahyunita, 2010:100)