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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.