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Sunday, April 29, 2012

Chest Pain Nursing Diagnosis and Interventions

Chest Pain Nursing Diagnosis and InterventionsChest pain caused by heart burn is accompanied by a burning sensation. Chest pain, pressure or tightness that is not accompanied by a burning sensation is cause for immediate medical attention. Whenever chest pain is involved it is best to use caution.

Chest pain brings immediate thought of a heart attack. Heart problems are not the only causes of pain in the chest area.

A sudden pain is particularly alarming. It is true that chest pain may suggest heart disease. There are many other causes.

Nursing Diagnosis for Chest Pain

1. Acute pain related to tissue ischemia secondary to arterial occlusion, tissue inflammation.

2. Ineffective Tissue Perfusion: (heart muscle) related to decreased blood flow.

3. Activity intolerance related to imbalance between oxygen supply and metabolic needs of tissues.

Nursing Interventions for for Chest Pain

The principles of action:
  1. Bed rest (bed rest) with Fowler position / semi-Fowler.
  2. Perform 12 lead EKG, 24 lead if necessary.
  3. Observation of vital signs.
  4. Collaboration of oxygen and delivery of analgesic drugs and drug side effects observed.
  5. Install a drip and give peace to the client.
  6. Taking blood samples.
  7. Reduce environmental stimuli.
  8. Be calm in the works.
  9. Observe signs of complications

Related Articles :
Nursing Care Plan for Myocardial Infarction
Nursing Care Plan - Assessment, Diagnosis and Interventions for Acute Myocardial Infarction
Nursing Interventions: Acute Pain related to Acute Myocardial Infarction
Acute Myocardial Infarct (MI) Nursing Diagnosis Nanda

Assessment Nursing Care Plan for Chest Pain

Assessment Nursing Care Plan for Chest PainCommon signs and symptoms that accompany chest pain are:
  • Heartburn
  • Headache
  • Pain that is projected onto the arm, neck, back
  • Diaphoresis / sweating
  • Shortness of breath
  • Tachycardia
  • Pale
  • Difficulty sleeping (insomnia)
  • Nausea, vomiting, anorexia
  • Anxiety, nervous, focus on yourself
  • Weakness
  • The face tense, m erintih, crying
  • Changes in consciousness

Primary Assessment - Nursing Care Plan for Chest Pain

a. Airway
- How airway clearance?
- Is there any obstruction / accumulation of secretions in the airway?
- How to breath sounds, is there any additional breath sounds?

b. Breathing
- What is the pattern of breath? frequency? the depth and rhythm?
- What is the use of auxiliary respiratory muscles?
- Are there any additional breath sounds?

c. Circulation
- How does the peripheral arteries and carotid arteries? quality (content and voltage)
- How capillary refill, what there is akral cold, cyanosis or oliguria?
- Is there a decrease in consciousness?
- How vital signs? blood pressure, temperature, pulse, respiration?

2. Secondary Assessment - Nursing Care Plan for Chest Pain

Important things that need to be studied further in chest pain (coronary):

a. location of pain
Where to start, propagation (coronary chest pain: from the sternal border radiating to the neck, chin or shoulder to the left arm of the ulna)

b. The nature of pain
Feeling of fullness, heaviness such as seizures, squeezing, stabbing, choking / burning, etc..

c. Characteristics of pain
Degree of pain, duration, how many times arise in a given time period.

d. chronological pain
Beginning there is pain and progress in sequence

e. Circumstances at the time of the attack
Whether arising in times / circumstances

f. Factors that reinforce / relieve pain such as attitude / posture, movement, pressure, etc..

g. Other symptoms that may be present whether or not the relationship with chest pain.

Saturday, April 28, 2012

Nursing Care Plan for Peritonitis -Diagnosis and Interventions

Diagnosis and Interventions Nursing Care Plan Peritonitid

is the inflammation of the peritoneum (the membrane which surrounds the abdominal organs).

There are three types of peritonitis:
  1. Spontaneus-this type of peritonitis is caused by a liver or kidney failure.
  2. Secondary-is the inflammation of the peritoneum caused by another disease.The principal condition that causes secondary peritonitis is the spread of an infection from digestive organs or bowels.
  3. Dialysis associated-is a chronic inflammation of the peritoneum that occurs in persons which receive peritoneal dislysis.
Signs and Symptoms
  • Shock (neurogenic, hypovolemic or septic) occurred in some patients with generalized peritonitis.
  • Fever
  • Abdominal distension
  • Abdominal tenderness and rigidity of the local, diffuse, general atrophy, depending on the expansion of irritation peritonitis.
  • Bowel sounds inaudible to the general peritonitis may occur in areas far from the location of peritonitis.
  • Nausea
  • Vomiting
  • Decrease in peristalsis.

Nursing Assessment - Nursing Care Plan for Peritonitis

Equipment is performed in patients post laparotomy, is;
1. Respiratory
  • How does the respiratory tract, the type of breathing, respiratory sounds.
2. Circulation
  • Blood pressure, pulse, respiration, and temperature, skin color and capillary refill.
3. Nervous system: level of consciousness.

4. Dressing
  • Is there a tube, drainage?
  • Are there any signs of infection?
  • How wound healing?
5. Equipment
  • Monitor is installed.
  • Intravenous fluids or transfusions.
6. Sense of comfort
  • Pain, nausea, vomiting, patient positioning, and ventilation facilities.
7. Psychological: anxiety, mood after surgery.

Nursing Diagnosis Nursing Care Plan for Peritonitis

1. Acute pain: abdominal strain related to the existence of pain in the abdomen.

2. Risk for Inifecton related to the incision / wound laparotomy.

3. Risk for Fluid Volume Deficit related to the presence of fever, fluid intake a bit and spending that much.

Postoperative Peritonitis Nursing Interventions
  1. Monitor consciousness, vital signs, CVP, intake and output
  2. Observation and record the drain darai properties (color, number) drainage.
  3. In the set and move the position of the patient must be careful not to drain uprooted.
  4. A sterile surgical wound care.

1. Signs of peritonitis disappeared, including:
  • Normal body temperature
  • Normal pulse
  • Abdominal bloating
  • Normal peristaltic
  • Positive flatus
  • The positive bowel movement
2. Patients free of pain and can do the activity.
3. Patients free of postoperative complications.
4. Patients can maintain fluid and electrolyte balance and restore eating and drinking as usual.
5. Either the surgical wound.

Wednesday, April 25, 2012

Risk for Decreased Cardiac Output related to Tetralogy of Fallot

Risk for Decreased Cardiac Output related to Tetralogy of FallotNursing Diagnosis: Risk for Decreased Cardiac Output related to structural abnormalities of the heart

  • no decline in cardiac output
Expected outcomes are:
  • vital signs within normal limits,
  • free of symptoms of heart failure,
  • reported a decrease in episodes of dyspnoea,
  • participate in activities that reduce the heart's workload,
  • adequate urine output: 0.5 to 2 ml / kg body weight.

Nursing Interventions - Risk for Decreased Cardiac Output related to Tetralogy of Fallot:

1. Assess the pulse rate, respiration, blood pressure regularly every 4 hours.
R :/ Monitoring the change of heart circulation as early as possible.

2. Record the heart sounds.
R :/ Know of any changes in heart rhythm.

3. Assess changes in skin color of the cyanosis and pallor.
R :/ Pale showed a decrease in peripheral perfusion to inadequate cardiac output. Cyanosis occurs as a result of obstruction of blood flow to the ventricles.

4. Limit your activities adequately.
R :/ adequate rest is needed to improve the efficiency of cardiac contraction and oxygen consumption and reduce redundant work.

5. Monitor intake and output every 24 hours.
R :/ kidneys respond to decrease cardiac output by withholding the production of fluid and sodium.

6. Provide a quiet environment of psychological conditions.
R :/ emotional stress produces vasoconstriction which increases blood pressure and increased heart work.

Tuesday, April 24, 2012

Impaired Urinary Elimination related to Prostate Cancer

Nursing Diagnosis: Impaired Urinary Elimination related to mechanical obstruction: enlargement of the prostate, decompensated detrusor muscle, bladder's inability to contract

characterized by:
  • inability to empty the bladder,
  • incontinence,
  • bladder distention,
  • presence of residual urine.
  • Urinate smoothly, without any bladder distention.
  • Residues less than 50 ml of urine without any overflow.

Nursing Interventions for Prostate Cancer - Impaired Urinary Elimination:

  • Instruct the patient to urinate every 2-4 hours and when it is full
  • Inform patients about stress incontinence
  • Observation of the emission of urine, observe the size and strength
  • Monitor and record the time and amount of urination.
  • Observe the decrease in urine output and changes in emission
  • Percussion / palpation of the suprapubic area
  • Encourage take up to 3000 ml per day when there is no heart intolenransi
  • Monitor vital signs. Observation of hypertension, peripheral / dependent edema. Body weight was measured every day and keep intake and output accurately
  • Give cateter and perineal care
  • Give the bath seat as indicated
  • Give the medication as indicated
  • Antispasmodics such as oxybutynin chloride, rectal suppositories, antibiotics and antimicrobials, phenoxybenzamine.
  • Urinary catheterization or Foley catheter pairs as indicated
  • Monitor lab results just as BUN, creatinine, Elektrolite, urinalysis and culture.

Monday, April 23, 2012

3 Nursing Diagnosis and Interventions for Bladder Cancer

3 Nursing Diagnosis and Interventions for Bladder Cancer1. Nursing Diagnosis for Bladder Cancer: Risk for infection related to inadequate defenses, secondary and immune system (the effect of chemotherapy / radiation), malnutrition, invasive procedures.

  • Patients are able to identify and participate in infection prevention measures.
  • Showed no signs of infection and wound healing normally takes place.
Nursing Interventions for Bladder Cancer:
  • Wash hands before taking action. Visitors are also encouraged to do the same.
  • Maintain a good personal hygine
  • Monitor the temperature
  • Examine all the systems to look for signs of infection
  • Avoid / limit invasive procedures and maintain aseptic procedures
  • Collaborative
  • Give antibiotics when indicated.

2. Nursing Diagnosis for Bladder Cancer: Risk for Sexual Dysfunction related to deficit of knowledge / skills about alternative responses to health transition, decreased function / structure, the effects of treatment.

  • Patients may express its understanding of the effects of cancer and treatment on sexuality.
  • Maintaining sexual activity within your limits
Nursing Interventions for Bladder Cancer:
  • Discuss with patients and families about sexuality and the reaction process and its relationship with disease
  • Give advise on the effect of treatment on sexuality
  • Give privacy to the patient and her partner. Knock before entering.

3. Nursing Diagnosis for Bladder Cancer: Risk for Impaired Skin Integrity related to the effects of radiation and chemotherapy, immunologic deficits, decreased nutrient intake and anemia.

  • Patients can identify interventions related to specific conditions
  • Participate in the prevention of complications and accelerated healing
Nursing Interventions for Bladder Cancer:
  • Assess the integrity of the skin to see any side effects of cancer therapy, wound healing observed.
  • Instruct patient not to scratch the itch
  • Change the position of the patient on a regular basis
  • Give advise patients to avoid the use of skin creams, oils, powders without medical advice

Friday, April 20, 2012

Risk for Injury related to Parkinson's Disease

Parkinson's Disease

Parkinson's disease is a common disorder, that arises due to some imperfection, that amends the normal functioning of the central nervous system. Parkinson's disease is a complex Constellation of symptoms requiring the care of a neurologist. The prompt symptoms of the disease are problems related with movement like shaking, rigidity, slowness of movement and difficulty in walking and gait. As the disease progresses the patient suffers from cognitive impairment as well as behavioral problems.

Causes of Parkinson's disease. It is not clear as to what makes these nerve cells break down. But Scientists are doing a lot of research to look for the answer. Abnormal genes seem to lead to Parkinson's disease in some people. But so far, there is not enough proof to show That it is always Inherited.

Risk for Injury related to Parkinson's Disease

Nursing Diagnosis: Risk for injury related to decreased visual ability

Having given nursing care, patients are expected to express an understanding of the factors involved in possible injury.

Expected outcomes are:
Shows changes in lifestyle behaviors to reduce risk factors and to protect themselves from injury.

Nursing Interventions - Risk for Injury related to Parkinson's Disease

1. Reduce the risk of environmental harm from clients such as:
  • Lock the wheels of the bed.
  • Provide adequate lighting.
  • Down from the bed of the eye is not sore and a bed in low position.
  • Pairs of bed in low position.
  • Remove objects that easily falls (such as bins, seats without backrest)
  • Put your tools such as call bell, tissue, telephone, or controller, easily accessible place on the client side is not affected.
  • Encourage clients to use the handle of the bathroom if possible.
  • Clean the floors of small objects such as pins, pencils and needle.
2. Tell the client to change positions slowly.

3. Encourage clients to use adaptive equipment such as canes and walkers for ambulation as needed.

4. Tell the importance of using protective eyewear when performing high risk activities such as ambulation at night or when you are in the midst of children or pets.


1. Prevent dizziness
2. Prevent falls due to changes in depth perception. Object or objects may not be located in a visible place such as a client, who took over the center of gravity will change which will cause the client to fall.
3. Gave the source of stability.
4. Increase the sense of balance.
5. Prevent injury.

Thursday, April 19, 2012

Nursing Interventions for Self-Care Deficit - Bathing / Hygiene

Self-Care Deficit - Bathing / Hygiene


Circumstances where individuals have failed to implement or complete ability bathing / hygiene activities.


Lack of ability to bathe themselves (including washing the whole body, combing hair, brushing teeth, doing skin care and nails as well as the use of makeup)
  • Can not or no desire to wash the body or body parts.
  • Can not use the source water.
  • Inability to feel the need for hygiene measures.
Lack of ability to wear his own clothes (including underwear routine or special clothing, not the clothes the night)
  • Failure of the ability to use or release of clothes.
  • Inability to fasten clothing.
  • Inability to dress themselves satisfactorily.
Expected outcomes are:

Individuals will
1. Identifying the love of self-care activities.
2. Demonstrated that optimal hygiene in care after assistance is given.
3. Participate in physical and or verbal self-care activities
  • Carry out the shower activity at its optimal level.
  • Reported satisfaction with the achievements despite the limitations.
  • Connecting a feeling of comfort and satisfaction with the cleanliness of the body.
  • Demonstrate ability to use adaptive assistive devices.
  • Describe the factors that cause of the lack of ability to bathe.

Nursing Interventions for Self-Care Deficit - Bathing / Hygiene:

1. Encourage individuals to use corrective lenses or assistive devices are prescribed.

2. Keep the temperature warm bath; make sure the preferred water temperature of the individual.

3. Provide privacy for bathing routine.

4. Give all toiletries in a convenient boundary.

5. Provide security in the bathroom (eg, the floor is not slippery, handle bars, bells).

6. If the individual is able to physically push using the bath or shower, depending on the hospital facilities in preparation for return home.

7. Provide adaptive equipment if needed
  • Seat or no back seat while bathing
  • The holder of spongy long reach back or lower extremities
  • Place the handle on the bathroom wall
  • Board to move to a bath seat
  • Pad or mat that is not slippery
  • Dishwashing gloves with pockets for soap
  • Toothbrush that has been adapted
  • Shavers
  • Shower spray handle
8. To individual eyesight deficiencies
  • Place toiletries in the most appropriate location for the individual
  • Keep the call bell within easy reach
  • Give the same degree of privacy
  • Verbally inform yourself before entering or leaving the bath
  • Observation of the individual's ability to put all toiletries
  • Observation of the individual's ability to perform oral care, brushing her hair.
  • Provide a place to clean clothing that is easily accessible.
9. For individuals with missing limbs or pain
  • Bathe in the early morning or before bed at night.
  • Encourage individuals to use the mirror over the bath to observe the area of ​​skin that have paralise
  • Encourage individuals who experience limb amputation to observe the integrity of the skin is left for good.
  • Give only some supervision or assistance needed to learn to re-use or adaptation of limb defects
10. For individuals with cognitive decline
  • Give time to bathe consistent routine as part of a structured program to help reduce anxiety
  • Keep instructions simple and avoid distractions; orientation purposes of toiletries.
  • If the individual is unable to bathe the whole body, allow individuals to bathe a part of her body until it is; give positive feedback on the success
  • Monitoring activities carried out until the individual can safely perform tasks that are not supported
  • Encourage attention to the task, but be wary of fatigue that may increase anxiety
11. Ensure that the shower facilities available at home and help in determining if there are different needs for adaptation.

12. refer to the occupational therapy or social services to assist in obtaining necessary equipment.

Nursing Interventions for Fluid Volume Excess

Excess Fluid Volume


Circumstances where an individual experiencing or at risk of excess intracellular or interstitial fluid.

Major data
  • edema
  • tighten skin, shiny
Minor data
  • more inputs than outputs
  • shortness of breath
  • weight gain
Expected outcomes are:

Individuals will:
  1. Reveal the causative factors and prevention methods edema.
  2. showed a decrease of peripheral and sacral edema.

Nursing Interventions for Fluid Volume Excess

1. Assess input and diet habits that can support the retention of fluids

2. Encourage individuals to reduce salt intake

3. Teach individuals to
  • Read labels for sodium content
  • Avoid foods that are fun, canned, and frozen foods.
  • Cook without using salt and spices to add flavor (lemon, basil, mint)
  • Use vinegar to taste salt substitute soup, stew, etc.
4. Review of the evidence depends on the venostatis.

5. Keep the limb is edematous as high above the heart if possible (unless there are contraindications by heart failure)

6. Instruct the individual to avoid made ​​of jersey pants / girdle, knee-high pants, and crossed the lower leg and remained elevated leg exercises whenever possible.

7. To inadequate drainage:
  • Keep the limb elevated on pillows
  • Measure blood pressure in the arm that does not hurt
  • Do not give injections or intravenous fluids to enter the arms are sore.
  • Protect your arm is sore, from injury.
  • Encourage individuals to avoid strong detergents, carrying heavy bags, smoke, injuring the epidermis or nodule on the nail, reaching into a hot oven, use a jewelry or watches, or using a headband.
  • Warn people to see a doctor if the arms become red, swollen, or other hardware of the ordinary.
8. Protect the arm edema, from injury.

Nursing Care Plan for Hypothermia - Diagnosis and Interventions

Definition of Hypothermia:

Circumstances where an individual experiencing or at risk of decreased body temperature constantly below 35, 5 º C per-rectal because of the increased vulnerability to external factors.

Related factors:

Situational (personal, environmental)
  • related to the heat, rain, wind
  • related to clothes that do not fit with the climate
  • related to decreased circulation: extreme weight loss
  • related to alcohol consumption
  • related to dehydration
  • related to inactivity
Mayor data:
  • Temperatures below 35.5 º C per-rectal
  • Cold skin
  • Pallor (medium)
  • Chills (mild)
Minor data :
  • Mental disorder / sleepy / restless
  • Decrease in pulse and respiration
  • Cachexia / malnutrition
Expected outcomes are:

Individuals will:
  • Identifying risk factors for hypothermia.
  • Connecting method of maintaining the warmth / heat loss prevention.
  • Maintain body temperature within normal limits.

Nursing Interventions - Nursing Care Plan for Hypothermia :
  1. Teach clients to reduce exposure to the cold environment of the old.
  2. Explain to family members that neonates, infants and the elderly are more susceptible to heat loss.
  3. Teach early signs of hypothermia: skin cold, pale, shivering.
  4. Explain the need to drink 8-10 glasses of water each day
  5. Explain the need to avoid alcohol in very cold weather.
  6. Teach for extra wear.

10 Nursing Care Plan for Liver Cirrhosis : Diagnosis

Nursing Care Plan for Liver Cirrhosis

Liver cirrhosis
is a degenerative inflammatory disease that results in hardening and scarring of liver cells. The loss of liver cells interferes with the organ's ability to process nutrients, hormones, and drugs and slows the production of protein other important substances manufactured in the liver. Liver becomes unable to function properly due to the scarred tissue, which prevents the normal passage of blood through the liver.

Some main physical indications of liver cirrhosis are jaundice and yellow discoloration of the skin. However, patients do display some other symptoms such as itching, which is medically termed as pruitus and fatigue. There are many reasons behind liver cirrhosis condition; some of the main ones are extreme alcohol intake, hepatitis B and C infections, and fatty liver, exposure to insecticides.

The most common symptoms are loss of appetite, loss of body weight, nausea, pain in abdominal area in the location of liver, weakness in body and itchy skin. Severe conditions include yellow discoloration of skin, cramps, mental imbalance and confusion and difficulty in absorption of alcohol and drugs.

10 Nursing Diagnosis for Liver Cirrhosis

1. Imbalanced Nutrition Less Than Body Requirements related to anorexia.

2. Activity Intolerance related to muscle weakness.

3. Fluid and electrolyte imbalances related to portal hypertension.

4. Ineffective Tissue Perfusion related to hematemesis and melena.

5. Anxiety related to hematemesis and melena.

6. Ineffective Breathing Pattern related to decreased lung expansion.

7. Impaired Verbal Communication related to neurological disturbances talking.

8. Risk for injury related to uncontrolled movements.

9. Impaire Physical Mobility related to the effect of muscle stiffness.

10. Self-care deficit related to a state of coma.

Wednesday, April 18, 2012

Management of Osteoarthritis

Nursing Management of OsteoarthritisOsteoarthritis is known as degenerative joint disease or osteoartrosis (even if there is inflammation) is a joint disorder that most commonly found and often lead to disability. (Smeltzer, Suzanne C, 2002 - 1087)

Nursing Management of Osteoarthritis

1. Drugs

Until now there has been no specific drug that is typical for osteoarthritis, because pathogenesis is unclear, given medication intended to reduce pain, improve mobility and reduce disability. Anti inflamasinon drugs as analgesics and steroids work while reducing synovitis, although not able to fix or stop the pathological process of osteoarthritis.

2. Protection of joints

Osteoarthritis may arise or be strengthened due to poor body mechanism. To avoid excessive activity in diseased joints. The use of a cane, power tools that can simplify the joint work is also noteworthy. Excessive load on the knee because the legs are bent (pronatio).

3. Diet

Diet to lose weight osteoarthritis patients who are obese should be a major program of treatment of osteoarthritis. Weight loss can often reduce the incidence of complaints and inflammation.

4. Psychosocial support

Osteoarthritis of the psychosocial support needed by patients because it is chronic and the resulting inability. On one hand the patient wants to hide his inability, on the other hand he wants other people also think of the disease. Osteoarthritis patients are often reluctant to use auxiliary tools for psychological factors.

5. Sexual Issues

Sexual harassment can be found in patients with osteoarthritis, especially in the spine, hip and knee. Often the discussion because it has to start from the doctors because patients often are reluctant to say it.

6. Physiotherapy

Physiotherapy plays an important role in the management of osteoarthritis, which includes the use of heat and cold and the proper exercise program. The use of heat that is given before the remedy exercises reduce pain and stiffness. In the active joints should be cold and rub medications should not be used prior to heating. A variety of heat sources can be used as Hidrokolator, electric pads, ultrasonic, infrared, paraffin bath and a shower of hot showers.

Training program aims to improve joint motion and strengthen the muscles around the joint is usually atrophic in osteoarthritis. Isometric exercise is better than isotonic because it reduces the stress on the joints. Cartilage and bone atrophy that occurs in the paralyzed limbs arise due to the reduced load to the joints because of muscle contraction. Therefore, periarticular muscles play an important role to the protection of vulnerable joints of the load, the strengthening of these muscles is important.

7. Operation

Surgery should be considered in patients with osteoarthritis of the real joint damage with persistent pain and weakness of the function. Action taken is not a straight osteotomy to correct or discrepancy, joint debridement to remove fragments of the joint cartilage, osteophytes cleaning.

Nursing Diagnosis for Pain (Acute / Chronic) related to Osteoarthritis

Nursing Diagnosis for Pain (Acute / Chronic) related to Osteoarthritis
Osteoarthritis (OA) is the most common form of arthritis and affects more than 20 million Americans. Osteoarthritis is a serious and painful condition. It is a condition that adversely affects hyaline articular cartilage, the tough gristle that caps the ends of long bones. This degenerative disease of the joints can result in considerable pain, the loss of cartilage as well as varying levels of tenderness.

Symptoms of Osteoarthritis (OA)
1. Mild or acute pain after a simple or even a difficult activity.
2. Great distress and discomfort, specifically when the weather changes.
3. Emergence of lumps in middle finger and at the bottom of the thumb.

Nursing Diagnosis: Pain (Acute / Chronic) related to distention of the tissues by the accumulation of fluid / inflammation, joint destruction.

Nursing Interventions for Osteoarthritis - Pain (Acute / Chronic)

  • Assess complaints of pain; note the location and intensity of pain (scale 0-10). Note that accelerating factors and signs of non-verbal pain.
  • Give a hard mattress, a small pillow. Elevate the bed when a client needs to rest / sleep.
  • Help clients take a comfortable position when sleeping or sitting in a chair. Depth of bed rest as indicated.
  • Monitor the use of pillows.
  • Encourage clients to frequently change positions.
  • Help clients to a warm bath at the time of waking.
  • Help clients to a warm compress on the sore joints several times a day.
  • Monitor the temperature compress.
  • Give a gentle massage.
  • Encourage the use of stress management techniques such as progressive relaxation bio feedback therapeutic touch, visualization, self hypnosis imagination guidance and control of breath.
  • Engage in entertainment activities appropriate to individual situations.
  • Give the drug before the activity / planned exercise as directed.
  • Help clients with physical therapy.
Expected outcomes / evaluation criteria
  • The pain showed reduced or controlled
  • Looks relaxed, can rest, sleep and ability to participate in appropriate activities.
  • Follow the treatment program.
  • Using the skills of relaxation and entertainment activities in a pain control program.

Nursing Care Plan for Pain
Nursing Diagnosis for Pain (Acute / Chronic)
Acute Pain / Chronic Pain - Rheumatoid Arthritis Nursing Care Plan
Acute Pain and Anxiety NCP for Peritonitis
Nursing Interventions Acute Pain related to Uterine Fibroids
4 Theory of Pain
Acute Pain - NCP for Urinary Tract Infection

Causes and Symptoms of Osteoarthritis

Causes and Symptoms of OsteoarthritisCauses of Osteoarthritis

1. Age
Physical and biochemical changes that occur, in line with increasing age with a reduction in the amount of collagen and water content, and sediment shaped yellow pigment.

2. Wear and tear
Excessive use of joints could theoretically damage the joint cartilage through two mechanisms, namely erosion and degeneration process because the material must contain.

3. Obesity
Factors of obesity will increase the burden on the joint support of body weight, whereas pain or disability caused by osteoarthritis cause someone becomes inactive and can add to obesity.

4. Trauma
Physical activity can lead to osteoarthritis is a trauma that causes damage to the structure and biomechanical integrity of these joints.

5. Descent
Heberden nodes is one form of osteoarthritis is usually found in men with both parents affected by osteoarthritis, while the women, only one of the parents affected.

6. Arthritis disease other
Infections (arthritis rematord; acute infection, chronic infection) cause inflammatory reactions and destruction of enzymes by the cartilage matrix and synovial membrane of inflammatory cells.

7. Joint Mallignment
Acromegaly due to the influence of hormones on growth, the cartilage will spring up and cause the joint to become unstable / balanced so as to accelerate the process of degeneration.

8. Endocrine diseases
In hyperthyroidism, there is the production of water and salts excessive proteglikan backer on the entire network so that the physical properties of cartilage damage, ligament, tendon, synovial, and skin. In diabetes mellitus, glucose will cause production to decline proteaglikan.

9. Deposit in the joint cartilage
Haemochromatosis, Wilson disease, akronotis, calcium pyrophosphate can precipitate hemosiderin, copper polymers, hemogentisis acid, monosodium urate crystals / pyrophosphate in cartilage.

Clinical symptoms of osteoarthritis :

1. Joints Pain
An overview of primary osteoarthritis, the pain will increase when it is doing something physical activity.

2. Stiffness and limited motion
It usually lasts 15-30 minutes and occur after a break or when starting a physical activity.

3. Inflammation
Secondary synovitis, tissue pH decreased, the collection of fluid in the joint space will cause swelling and stretching of the joints are all these hoops will cause pain.

4. Mechanical
Pain will usually be much more pronounced after a long time and will decrease the activity at rest. Maybe something to do with the circumstances that have advanced disease where the cartilage has been damaged. Pain is usually located on the affected joint but can be spread, for example on coxae osteoarthritis pain may be felt in the knees, buttocks next lateril, and upper limbs. Pain can occur when cold, but this has yet to be known.

5. Swollen joints
Swelling of the joints is an inflammatory reaction as collection of fluid in the joint space is usually palpable heat in the absence of milking.

6. Deformity
Caused by local distruksi cartilage.

7. Disfunction
Arising from the incongruity between the bones forming the joint.

Tuesday, April 17, 2012

Nursing Diagnosis: Acute Pain related to Testicular Cancer

Nursing Diagnosis and Interventions : Acute Pain related to Testicular Cancer

Testicular cancer

Testicular cancer is a form of cancer that can be located in either or both of a man's testicles. Also referred to as the testes or the gonads, the testicles are located in the scrotum that is a sack like area found under the penis.

Testicular cancer occurs most often in men between the ages of 20 and 39, and is the most common form of solid tumour in men between the ages of 15 and 34. It may also occur in young boys, but only about 3% of all testicular cancer is found in this group. Tumors usually occur in one testicle, however, 2-3% of tumors can occur in both testicles, either simultaneously or at a later date.

Signs and Symptoms

The first sign is usually a firm, pain, smooth testicular mass which is sometimes accompanied by a feeling of heaviness in the testicles. Other symptoms of testicular cancer include: a feeling of swelling in the scrotum, discomfort or pain in the scrotum, ache in the lower back, pelvis or groin area, collection of fluid in the scrotum, gynecomastia and nipple tenderness. In advanced stages symptoms include: ureteral obstruction, abdominal mass, coughing, shortness of breath, weight loss, fatigue, pallor and lethargy.

Nursing Diagnosis for Testicular Cancer : Acute Pain related to the disease process (suppression / destruction of nerve tissue, infiltration of the nerve supply systems, neural pathway obstruction, inflammation), the side effects of cancer therapy.

  • Clients are able to control pain through activity.
  • Reported pain experienced.
  • Follow the treatment program.
  • Demonstrate techniques of relaxation and diversion of pain through activities that may be.
Nursing Interventions for Testicular Cancer - Acute Pain
  • Determine the pain history, location, duration and intensity.
  • Evaluation of therapies: surgery, radiation, chemotherapy, bio-therapy, teach clients and families on how to deal with it.
  • Give the transfer of such repositioning and fun activities such as listening to music or watching TV
  • Recommends stress management techniques (relaxation techniques, visualization, guidance), happy, and provide therapeutic touch.
  • Evaluation of pain, provide treatment if necessary.
  • Disusikan pain management by physicians and also with clients.
  • Give analgesics as indicated.
  • Provide information needed for planning care.
  • To find appropriate therapy is carried out or not, or even complications.
  • To enhance client comfort by diverting attention from pain.
  • Enhance self-control over side effects by lowering stress and anxiety.
  • To find out the effectiveness of pain management, pain level and to what extent the client is able to hold him and know the needs of the client will be anti-pain medication.
  • In order for a given therapeutic target.
  • To overcome the pain.

Anxiety related to Testicular Cancer

Nursing Care Plan for Testicular Cancer : Diagnosis and Interventions : Anxiety

Testicular cancer
is the growth of malignant cells in the testes (testicles), which can cause enlarged testicles or cause a lump in the scrotum (the scrotum).

Testicular cancer, which ranks first in cancer deaths among men in the age group 20 to 35 years, is the most common cancer in men aged 15 to 35 years and is the second most common malignancy in the age group 35 years to 39 years .

Nursing Diagnosis: Anxiety related to crisis situations (cancer), health change, socio-economics, the role and functions, form interaction, preparation of death, separation of families.

  • Clients can relieve anxiety.
  • Relax and be able to see himself objectively.
  • Demonstrate effective coping and able to participate in treatment.
Nursing Interventions - Anxiety related to Testicular Cancer:
  • Determine the client's experience prior to the illness.
  • Provide accurate information about prognosis.
  • Give the client an opportunity to express anger, fear, confrontation. Give reasonable information to the emotions and expressions accordingly.
  • Explain the treatment, the purpose and side effects. Help clients prepare for treatment.
  • Note the ineffective coping such as lack of social interaction, helpless.
  • Encourage to develop interaction with the support system.
  • Provide a quiet and comfortable environment.
  • Maintain contact with clients, talk and touch with the fair.
  • Data about previous client experience will provide a basis for counseling and avoid duplication.
  • Provision of information to assist clients in understanding the disease process.
  • Can reduce client anxiety.
  • Assist clients in understanding the need for treatment and side effects.
  • Knowing the client's coping patterns and explore and resolve / provide solutions in an effort to increase the strength in dealing with anxiety.
  • So that clients get the support from the nearest person / family.
  • Providing the opportunity for clients to think / contemplate / rest.
  • Clients gain the confidence and belief that he is really in for help.

Monday, April 16, 2012

Impaired Physical Mobility - Ineffective Cerebral Tissue Perfusion related to CVA / Stroke

Nursing Diagnosis and Nursing Interventions for CVA / Stroke

1. Nursing Diagnosis: Impaired Physical Mobility related to the function of neurological damage.

Nursing Interventions:
  • Assess the functional capabilities and severity of abnormalities.
  • Maintain body alignment (using a board bed, air mattress or a standard board as indicated.
  • Turn and change position every 2 hours.
  • Elevate the extremity pain with pillows.
  • Perform range of motion exercises for all active or passive limb every 2 hours to 4 hours.
  • Encourage hands, fingers and leg exercises.
  • Give the patient as indicated ancillary equipment.
  • Encourage the patient to perform activities of daily needs.
  • Start to order a progressive ambulation aids to sit in a balanced position from the procedures to move from bed to a chair to reach equilibrium.
  • Consult with the physician and the treatment (Tucker, 1998).

2. Nursing Diagnosis: Ineffective Cerebral Tissue Perfusion related to interruption of blood flow, occlusive disorders, hemorrhage, cerebral vasospasm, cerebral edema.

Nursing Interventions:
  • Monitor or record the neurological status as often as possible and compare it to standard or normal state.
  • Monitor vital signs.
  • Record the data changes such as the blindness of vision, or visual field disturbances in perception.
  • Assess the higher functions, such as speech function.
  • Put your head slightly elevated position and the anatomical position (neutral).
  • Maintain a state of bed rest, creating a peaceful environment, limit the activities of visitors or patients as indicated.
  • Help prevent the occurrence of straining during defecation and breathing force (continuous cough).
  • Collaboration in pembarian oxygen and drugs as indicated (Doenges, 2000).

Saturday, April 14, 2012

7 Nursing Diagnosis for Cellulitis

Nursing Care Plan for Cellulitis

is a skin infection brought by certain types of microorganism. The bacteria called Staphylococcus aureus and Group A Streptococcus are usually responsible for this kind of infection.

Streptococci and Staphylococci can enter the skin to cause cellulitis infection through scrapes, cuts, wounds, blisters, insect bites and ulcers and find their way into the dermal and subcutaneous layers of the skin.

Typical symptoms that indicate a cellulitis infection include sudden reddish swelling of the skin, headache, nausea,fever along with multiple small reddish colored dots appearing on the surface of the skin.

Cellulitis caused by the Group A beta-hemolytic streptococci is rapid spreading because of the enzymes produced by the bacteria that breaks down the cellular components responsible for localized infection.

Nursing Diagnosis for Cellulitis

7 Nursing Diagnosis for Cellulitis

1. Acute pain related to irritation of the skin, impaired skin integrity, ischemic tissue.

2. Impaired Skin Integrity related to the presence of gangrene in the extremities.

3. Anxiety related to lack of knowledge about the disease.

4. Imbalanced Nutrition Less Than Body Requirements related to poor food intake.

5. Disturbed Body Image related to changes in the form of one limb.

6. Sleep Pattern Disturbance related to pain in a leg wound.

7. Knowledge Deficit: the prevention of symptoms and treatment of conditions related to inadequate information.

Imbalanced Nutrition Less Than Body Requirements related to Anemia

Anemia Nursing Care PlanNursing Diagnosis: Imbalanced Nutrition Less Than Body Requirements

Definition: lack of nutritional intake to meet the metabolic needs of the body.

Defining characteristics:
  • Weight 20% or more below the ideal
  • Reports of food intake is less than the RDA (Recomended Daily Allowance)
  • Pale mucous membranes and conjunctiva
  • Weakness of the muscles used for swallowing / chewing
  • Injury, inflammation of the oral cavity
  • Easy to feel full, shortly after the chewing of food
  • Reported or the fact of lack of food
  • Reported a change in taste sensation
  • Feeling of inability to chew food
  • misconceptions
  • Losing weight with enough food
  • Reluctance to eat
  • Cramps in the abdomen
  • Poor muscle tone
  • Abdominal pain with or without pathology
  • Less interest in food
  • Capillary blood vessels from fragile
  • And diarrhea or steatorrhea
  • Hair loss is pretty much (loss)
  • Hyperactive bowel sounds
  • Lack of information, misinformation
Related factors:
  • Inability to enter or digest food or absorb nutrients associated with biological factors, psychological or economic.

Nursing Diagnosis for Anemia: Imbalanced Nutrition Less Than Body Requirements related to inability to absorb nutrients associated with biological factors

Nutritional Status
  • Intake of nutrients (nutrients) is adequate
  • Adequate food and fluid intake
  • Adequate energy
  • According to body mass
  • Weight according to age
  • The size of the nutritional needs of the biochemistry within normal range

Nutrient Management
  • The review of food allergy
  • Collaboration with a dietitian to determine the amount of calories and nutrients it needs patients.
  • Increase consumption of protein and vitamin C
  • Give the substance of the sugar
  • Make sure eat a diet containing high fiber to prevent constipation
  • Monitor the amount of nutrients and calories
  • Provide information about the nutritional needs
  • Assess the patient's ability to get the nutrients it needs
Nutrition Monitor
  • Monitor change in body weight
  • Monitor the type and amount of activity is usually done
  • Monitor the environment for food
  • Schedule of treatment and no action during a meal
  • Monitor skin turgor
  • Monitor drought, dull hair, and brittle
  • Monitor nausea and vomiting
  • Monitor levels of albumin, total protein, hemoglobin, and hematocrit levels
  • Monitor pallor, redness, and dryness of the conjunctival tissue
  • Monitor intake of calories and nuntrisi
  • Note the presence of edema, hiperemik, hypertonic papillae of the tongue and oral cavity.
  • Record if the magenta-colored tongue, scarlet

Thursday, April 12, 2012

3 Nursing Care Plan Diabetes Mellitus - Diagnosis, Interventions and Rational

Nursing Diagnosis for Diabetes Mellitus
1. Nursing Diagnosis : Fluid Volume Deficit related to osmotic diuresis.

Demonstrate adequate hydration evidenced by stable vital signs, palpable peripheral pulse, skin turgor and capillary refill well, individually appropriate urinary output, and electrolyte levels within normal limits.

Nursing Intervention:
1.) Monitor vital signs.
Rational: hypovolemia can be manifested by hypotension and tachycardia.
2.) Assess peripheral pulses, capillary refill, skin turgor, and mucous membranes.
Rational: This is an indicator of the level of dehydration, or an adequate circulating volume.
3.) Monitor input and output, record the specific gravity of urine.
Rational: To provide estimates of the need for fluid replacement, renal function, and effectiveness of the therapy given.
4.) Measure weight every day.
Rational: To provide the best assessment of fluid status of ongoing and further to provide a replacement fluid.
5.) Provide fluid therapy as indicated.
Rational: The type and amount of liquid depends on the degree of lack of fluids and the response of individual patients.

2. Nursing Diagnosis : Imbalanced Nutrition Less than Body Requirments related to insufficiency of insulin, decreased oral input.

Digest the amount of calories / nutrients right
Shows the energy level is usually
Stable or increasing weight.

Nursing Intervention:
1.) Determine the patient's diet and eating patterns and compared with food that can be spent by the patient.
Rationale: Identify deficiencies and deviations from the therapeutic needs.
2.) Weigh weight per day or as indicated.
Rational: Assessing an adequate food intake (including absorption and utilization).
3.) Identification of preferred food / desired include the needs of ethnic / cultural.
Rational: If the patient's food preferences can be included in meal planning, this cooperation can be pursued after discharge.
4.) Involve patients in planning the family meal as indicated.
Rationale: Increase the sense of involvement; provide information on the family to understand the patient's nutrition.
5.) Give regular insulin treatment as indicated.
Rational: regular insulin has a rapid onset and quickly and therefore can help move glucose into cells.

c. Nursing Diagnosis : Risk for Infection related to hyperglikemia.

Identify interventions to prevent / reduce the risk of infection.
Demonstrate techniques, lifestyle changes to prevent infection.

Nursing Intervention:
1). Observed signs of infection and inflammation.
Rationale: Patients may be entered with an infection that usually has sparked a state of ketoacidosis or may have nosocomial infections.
2). Improve efforts to prevention by good hand washing for all people in contact with patients including the patients themselves.
Rationale: Prevents cross infection.
3). Maintain aseptic technique in invasive procedures.
Rational: high glucose levels in blood would be the best medium for the growth of germs.
4). Give your skin with regular care and earnest.
Rational: the peripheral circulation may be disturbed that puts patients at increased risk of damage to the skin / skin irritation and infection.
5). Make changes to the position, effective coughing and encourage deep breathing.
Rational: memventilasi Assist in all areas and mobilize pulmonary secretions.

Healthy Diet for Diabetes Mellitus
Nursing Diagnosis and Nursing Intervention for Diabetes Mellitus
Nursing Care Plan for Diabetes Mellitus
12 Nursing Diagnosis for Diabetes Mellitus
Nursing Care Plan for Diabetes Mellitus
Nursing Intervention for Diabetes Mellitus - Deficient Fluid volume

Acute Pain related to Headache

Nursing Diagnosis for Headache. Nursing Interventions for Acute Pain related to Headaches.

Acute pain related to stess and tension, irritation / nerve pressure, vasospasm, increased intracranial pressures.

Nursing Interventions for Acute Pain related to Headache:
  1. Make sure the duration / episode problems, who have been consulted, and drug and / or what therapy was used.
  2. Thorough complaints of pain, record the intensity (with a scale of 0-10), characteristics (eg, heavy, throbbing, constant) location, duration, factors that aggravate or relieve.
  3. Note the possible pathophysiological characteristic, such as brain / meningeal / sinus infection, cervical trauma, hypertension, or trauma.
  4. Observe for nonverbal signs of pain, are like: facial expression, posture, restlessness, crying / grimacing, withdrawal, diaphoresis, changes in heart rate / breathing, blood pressure.
  5. Assess the relationship of physical factors / emotional state of a person.
  6. Evaluation of pain behavior
  7. Note the influence of pain such as: loss of interest in life, decreased activity, weight loss.
  8. Assess the degree of making a false step in person from the patient, such as isolating themselves.
  9. Determine the issue of a second party to the patient / significant others, such as insurance, spouse / family
  10. Discuss the physiological dynamics of tension / anxiety with patients / people nearby.
  11. Instruct patient to report pain immediately if the pain arises.
  12. Place on a rather dark room according to the indication.
  13. Suggest to rest in a quiet room.
  14. Give cold compress on the head.
  15. Give the hot moist compress / dry on the head, neck, arms as needed.
  16. Massage the head / neck / arm if the patient can tolerate the touch.
  17. Use the techniques of therapeutic touch, visualization, biofeedback, hypnosis itself, and stress reduction and relaxation techniques to another.
  18. Instruct the patient to use a positive statement "I am cured, I'm relaxing, I love this life". Instruct the patient to be aware of the external-internal dialogue and say "stop" or "delay" if it comes up negative thoughts.
  19. Observe for nausea / vomiting. Give the ice, drinks containing carbonate as indicated.

Health Counseling of Gastritis

Health Counseling of Gastritis

1. General Purpose
  • To change, control or eliminate all physical complaints of gastritis that occurs that gives the client a bad influence on their daily activities.
2. Special Purpose
  • Having given an explanation of gastritis, the patient is able to:
  • Explain what is gastritis
  • Explain the classification of gastritis
  • Explain the tips in preventing and overcoming gastritis
  • Explaining the importance of information about gastritis
3. The Material
  • Definition of gastritis
  • Classification of gastritis
  • Signs of gastritis
  • The cause of gastritis
  • What things are done for the medium and treating gastritis.
4. Method
  • Lectures, and question and answer
5. Tools
  • leaflets

Health Counseling Process for Gastritis

1. Pre Interactions
Setting up a counseling unit events and leaflets.

2. Health Counseling
  • Introduction
  • Determine the time of contract
  • Provide greeting
  • Explain the material
  • Provide an opportunity to ask questions.
  • Again concluded that the explanation has been given.
3. Termination
Thank you and greetings


a. Evaluation of structures
  • Readiness of the media include:
  • Leaflets, Flipchart, Microphone.
  • the timing
  • determination of the place
  • Notice to residents
  • Organizing a small committee of community
b. Evaluation process
  • Health Working Group on time
  • Outreach activities running order.
  • Health Working Group to ask questions
  • Health Working Group to follow the activities to complete.
c. Evaluation Results
  • Health Working Group can be answered correctly 75% of the extension question.

Tuesday, April 10, 2012

Impaired Physical Mobility related to Rheumatoid Arthritis

Rheumatoid Arthritis

Nursing Diagnosis : Impaired Physical Mobility

related to:
  • Skeletal deformities
  • Pain
  • Inconvenience
  • Activity intolerance
  • Decreased muscle strength.
Characterized by:
  • Reluctance to try moving / inability to move in with their own physical environment
  • Limit the range of motion, imbalance of coordination, decreased muscle strength / control and mass (advanced stage).
Expected results, patients will:
  • Maintain the function of the position with the absence / limitation contractures.
  • Maintain or improve strength and function of and / or compensation of the body.
  • Demonstrate techniques / behaviors that allow the activity.

Nursing Interventions for Impaired Physical Mobility related to Rheumatoid ArthritisNursing Interventions Impaired Physical Mobility related to Rheumatoid Arthritis

1. Evaluation / continue monitoring the level of inflammation / pain in the joints
Rationale: The level of activity / exercise depends on the development / resolution of the inflammatory peoses.

2. Keep the rest - bed rest / sit, if necessary schedule of activities to provide a continuous period of rest and sleep at night undisturbed.
Rational: Rest of systemic, recommended during the acute exacerbation phase of disease and all that is important to retain the power to prevent fatigue.

3. Assist with range of motion active / passive, and resistive exercises as well as isometris if possible.
Rationale: Maintaining / improving joint function, muscle strength and general stamina.
Note: Inadequate training cause joint stiffness, hence the excessive activity can damage the joints.

4. Change positions frequently with sufficient number of personnel. Demonstrate / aids removal techniques and the use of mobility aid, eg, trapeze
Rationale: Eliminates pressure on the tissue and increase circulation. Facilitate patient self-care and independence. Proper removal techniques can prevent skin abrasion tear.

5. Position with pillows, sand bags, rolls trokanter, splint, brace
Rationale: Increasing the stability (reduce the risk of injury) and memerptahankan necessary joint position and body alignment, reduced contractor.

6. Use a small pillow / thin under the neck.
Rationale: Prevent flexion of the neck.

7. Encourage patients to maintain an upright posture and sitting height, standing, and walking
Rational: To maximize joint function and maintain mobility.

8. Provide a safe environment, for example, raise the chair, use the handrails on the toilet, use a wheelchair.
Rational: Avoiding injuries due to accidents / falls.

9. Collaboration: consul with physiotherapy.
Rational: Useful in formulating training programs / activities based on individual needs and in identifying the tool.

10. Collaboration: Provide foam mat / converter pressure.
Rational: Reduce pressure on fragile tissue to reduce the risk of immobility.

11. Collaboration: Giving drugs as indicated.
Rational: It may be necessary to suppress the acute inflammatory system.

Nursing Interventions for Pain (Acute / Chronic) related to Rheumatoid Arthritis

Nursing Diagnosis for Rheumatoid Arthritis: Pain (Acute / Chronic)

related to:
  • Tissue distension by accumulation of fluid / inflammatory process
  • Joint destruction.
Characterized by:
  • Complaints of pain, discomfort, fatigue.
  • Focusing on self / narrowing of focus
  • Distraction behavior / response of autonomic
  • Behavior is deliberate / protect
Expected results:
  • Showed pain relief / control
  • Looks relaxed, sleep / rest and participate in activities according to ability.
  • Follow the program prescribed pharmacological
  • Combining the skills of relaxation and entertainment activities in a pain control program.

Nursing Interventions for Pain (Acute / Chronic) related to Rheumatoid ArthritisNursing Interventions - Pain (Acute / Chronic) for Rheumatoid Arthritis

1. Investigate complaints of pain, record the location and intensity (scale 0-10). Write down the factors that speed up, and signs of non-verbal pain.
Rational: To assist in determining the need for pain management and program effectiveness

2. Give the mat, small pillow. Elevate the bed linen as needed
Rational: a soft mattress, pillow that would prevent maintenance of proper body alignment, placing stress on the joints that hurt. Elevation of the bed linen reduce pressure on the inflamed joint / pain.

3. Place / monitor the use of pillows
Rational: Resting sore joints and maintain a neutral position. Use of the brace can reduce pain and can reduce damage to the joints

4. Encourage to frequently change positions. Helps to move in bed, prop joint pain above and below, avoid jerky movements.
Rational: To prevent the occurrence of general fatigue and joint stiffness. Stabilize joints, reduce the movement / joint pain.

5. Instruct the patient to a warm bath or shower at the time of waking and / or at bedtime. Provide a warm washcloth to compress the joints are sore several times a day. Monitor the temperature of the water compresses, baths, and so forth.
Rational: The heat increases muscle relaxation, and mobility, reduce pain and stiffness in the morning release. Sensitivity to heat can be removed and dermal wounds can be healed.

6. Give a gentle massage
Rationale: Increase relaxation / reducing pain.

7. Encourage the use of stress management techniques, such as progressive relaxation, therapeutic touch, biofeed back, visualization, imagination guidelines, self hypnosis, and breath control.
Rationale: Increase relaxation, gives a sense of control and may increase the coping abilities

8. Engage in entertainment activities appropriate to individual situations.
Rational: To focus attention again, provide stimulation, and increased self-confidence and feeling healthy.

9. Give the drug before the activity / planned exercise as directed.
Rationale: Increase relaxation, reduce muscle tension / spasm, making it easy to participate in therapy.

10. Collaboration: Give medicines as directed.
Rational: As an anti-inflammatory and mild analgesic effect in reducing stiffness and improve mobility.

11. Give ice-cold compress if needed
Rational: The cold can relieve pain and swelling during the acute period.

Clinical Manifestations of Rheumatoid Arthritis

There are several clinical manifestations are commonly found in patients with Rheumatoid Arthritis. Clinical manifestations do not have to appear simultaneously at the same time because this disease has Clinical manifestations are highly variable.

1. Constitutional symptoms such as fatigue, poor appetite, weight loss and fever. Sometimes fatigue can be so great.

2. Symmetrical polyarthritis (inflammation of the joints on the left and right), especially in peripheral joints, including joints in the hand, but usually does not involve the joints between the fingers and toes. Almost all diarthrodial joints (joints that can be moved freely) can be attacked.

3. Stiffness in the morning for more than 1 hour, can be general, but especially to attack the joints. Stiffness is different from the joint stiffness in osteoarthritis (inflammation of bone and joints), which usually only lasts for a few minutes and for less than 1 hour.

Clinical Manifestations of Rheumatoid Arthritis4. Erosive arthritis is the hallmark of this disease on radiological picture. Chronic joint inflammation that lead to the erosion of the bone edge.

5. Deformity: destruction of the supporting structure of the joint with the course of the disease. Ulnar deviation of fingers or shift, the shift in the bone joints in the palm of the hand and finger, boutonniere deformity, swan neck and hands are some of the deformities that are often encountered in patients. There is a knob on the head of the metatarsal foot, arising from the secondary metatarsal subluxation. Large joints can also be attacked and suffered a reduction in the ability to move, especially in the extension movement.

6. Rheumatoid nodules subcutaneous mass was found in about one third of adult patients with rheumatoid arthritis. The most frequent location of this deformity is the exchange olekranon (elbow joint) or along the extensor surfaces of arms, however bulge) may also occur in other places. The existence of these nodules are usually an indication of an active disease and more severe.

7. Extra-articular manifestations (excluding joints) rheumatism can also invade other organs outside the joint. As the eye: keratoconjunctivitis sicca which is Sjögren's syndrome, cardiovascular system may resemble a severe constrictive pericarditis, inflamatif lesions resembling rheumatoid nodules can be found on the myocardium and cardiac valves, these lesions can lead to valve dysfunction, a phenomenon embolissasi, conduction disturbances and cardiomyopathy.