Knowledge Deficit - NCP Asthma Bronchiale

Bronchial asthma is the common asthma which is an inflammatory disease of airways that causes periodic attacks of coughing, wheezing (whistling sound from chest), breathlessness, and even chest congestion.

Signs and symptoms of bronchial asthma :
  • Shortness of breath or breathlessness even when talking, laughing or walking a little.
  • Tightness of chest
  • Wheezing (whistling sound from chest, mostly when you lie down)
  • Coughing and sometimes excessive cough which keeps one awake at night

Nursing Diagnosis for Bronchial Asthma: Knowledge Deficit: about the disease and treatment.

related to:
  • Lack of information.
  • Misinterpretation of information.
  • The lack of repetition of information.

Possible evidenced by:
  • Requests for disclosure of information.
  • Statement to worry.
  • Inaccuracies in following instructions.
  • The occurrence of complications that can be prevented.

Long-term goal:
  • Patient knowledge about things related to the illness increases.

Short-term goal:
  • The patient expressed understanding of the condition / disease process and treatment.
  • Patient identifying relationships signs / symptoms of the disease process and its relation to factor causes.
  • Patients initiating lifestyle changes and participate in treatment measures.

Nursing Interventions:
  1. Explain / repeat the explanation of the disease process. Encourage patients and families to ask about things that are not clear.
  2. Explain the rationale of breathing exercises as a good practice to continue.
  3. Discuss respiratory medication use, side effects and reactions that may arise.
  4. Discuss the factors that can improve the patient's condition such as humidity, wind, temperature extreme environment, cigarette smoke, aerosol, air pollution.
  5. Provide information about the danger of smoking on the lungs and encourage patients not to smoke.
  6. Encourage the patient / family to explore ways to control the factors that cause can worsen the patient's condition in and around the home.

Rational:
  1. Lowers anxiety and can lead to improved participation in the treatment plan.
  2. Breath lips and breath abdominal / diaphragmatic breathing muscle strengthening, helps minimize small airway collapse, and gives individuals the sense to control dyspnea. Exercise increases the tolerance of the general condition improves tolerance activity, muscle strength and healthy taste.
  3. Patients often have a lot of respiratory medicine at the same time that have similar side effects and potential drug interactions pathological happen. It is important for patients to understand the difference between the side effects interfere (continued medication) and adverse events (drug may be changed / stopped).
  4. Environmental factors can aggravate / cause / left bronchial irritation causing increased production of secret and airway resistance.
  5. Cessation of smoking can prevent / reduce the severity of asthma.
  6. In order to minimize / mitigate the invasion of the factors that can cause the patient's condition worsens.

Evaluation Criteria.
  1. Patients and families expressed an understanding of the condition / disease processes and actions.
  2. Identify the relationship sign / symptom of the disease process and connect with the causes.
  3. Making changes to lifestyle and participating in treatment programs.

Appendicitis - Causes, Symptoms, Diagnosis and Treatment

Definition of Appendicitis

Appendicitis is one of the most common causes of emergency abdominal surgery in the United States. Appendicitis generally affects people aged between 10 and 30, but it can strike at any age. Approximately 250,000 appendectomies are performed in the United States each year to treat appendicitis.

Appendicitis is swelling (inflammation) of the appendix. The appendix is a small, tube-like organ attached to the first part of the large intestine. It is located in the lower right part of the abdomen. It has no known function.

Causes of Appendicitis

Experts believe there are two likely causes:
  • Infection - a stomach infection may have found its way to the appendix.
  • Obstruction - a hard piece of stool may have got trapped in the appendix. The bacteria in the trapped stool may then have infected the appendix.

Symptoms of Appendicitis

The main symptom is pain in the abdomen, often on the right side. It is usually sudden gets worse over time. Other symptoms may include :
  • Swelling in the abdomen
  • Loss of appetite
  • Nausea and vomiting
  • Constipation or diarrhea
  • Inability to pass gas
  • Low fever

Not everyone with appendicitis has all these symptoms.

Diagnosis of Appendicitis

A diagnosis can be tricky, however, says Michael Payne, MD, a gastroenterologist with Cambridge Health Alliance, a Harvard-affiliated public healthcare system, in Cambridge, Mass. "It is a very common illness and many people don't have classic symptoms," he says. "We actually have to put our hands on a belly to see for sure."

Treatment of Appendicitis

If you do not have complications, a surgeon will usually remove your appendix soon after your doctor thinks you might have the condition. For information on this type of surgery, see: Appendectomy.

Because the tests used to diagnose appendicitis are not perfect, sometimes the operation will show that your appendix is normal. In that case, the surgeon will remove your appendix and explore the rest of your abdomen for other causes of your pain.

If a CT scan shows that you have an abscess from a ruptured appendix, you may be treated for infection. You will have your appendix removed after the infection and swelling have gone away.

Diagnostic Tests, Prevention and Treatment of Angina

Angina, or angina pectoris, is the medical term used to describe the temporary chest discomfort that occurs when the heart is not getting enough blood. The main cause of Angina pectoris is Coronary Artery Disease, due to atherosclerosis of the arteries feeding the heart. There is a weak relationship between severity of pain and degree of oxygen deprivation in the heart muscle. In some cases Angina can be extremely serious and has been known to cause death.

Angina is usually felt as:
  • pressure,
  • heaviness,
  • tightening,
  • squeezing, or
  • aching across the chest, particularly behind the breastbone.
This pain often radiates to the neck, jaw, arms, back, or even the teeth.

Patients may also suffer:
  • indigestion,
  • heartburn,
  • weakness,
  • sweating,
  • nausea,
  • cramping, and
  • shortness of breath.

Diagnostic Tests of Angina :
  • EKG (Electrocardiogram)
  • Stress Testing
  • Chest X Ray
  • Coronary Angiography and Cardiac Catheterization
  • Computed Tomography Angiography
  • Blood Tests


Prevention of Angina :

Healthy lifestyle choices can help prevent or delay angina and heart disease. To adopt a healthy lifestyle, you can:
  • Quit smoking and avoid secondhand smoke
  • Avoid angina triggers
  • Follow a healthy diet
  • Be physically active
  • Maintain a healthy weight
  • Learn ways to handle stress and relax
  • Take your medicines as your doctor prescribes


Treatmnet of Angina

Treatments for angina include lifestyle changes, medicines, medical procedures, cardiac rehabilitation (rehab), and other therapies. The main goals of treatment are to:

Reduce pain and discomfort and how often it occurs
Prevent or lower your risk for heart attack and death by treating your underlying heart condition

Lifestyle changes and medicines may be the only treatments needed if your symptoms are mild and aren't getting worse. If lifestyle changes and medicines don't control angina, you may need medical procedures or cardiac rehab.

Unstable angina is an emergency condition that requires treatment in a hospital.

Treatment of Acne Vulgaris

Acne vulgaris is a disorder of the pilosebaceous follicles found in the face and upper trunk. Acne vulgaris the most common form of acne; usually affects people from puberty to young adulthood. At puberty androgens increase the production of sebum from enlarged sebaceous glands that become blocked and infected with Propionibacterium acnes causing an inflammatory reaction.

Acne vulgaris is American's most common skin disease and is characterized by noninflammatory, open or closed comedones and by inflammatory papules, pustules, and nodules. Acne vulgaris typically affects the areas of skin with the densest population of sebaceous follicles; these areas include the face, the upper part of the chest, and the back.

The areas of the body most typically affected by acne are:
  • face
  • neck
  • chest
  • shoulders
  • upper arms
  • back
Acne is characterized by the presence of one or more of the following:
  • papules
  • pustules
  • blackheads
  • whiteheads or milia
  • nodules
  • cysts
Treatment of Acne Vulgaris

Treatment of Acne Vulgaris involves taking good care of the skin by washing the face with plain water several times in a day and avoiding intake of food like chocolates, fried items and alcohol. Patients can use a good topical agent for the treatment of Acne Vulgaris. For acne treatment peoples use Benzac AC cream also.

Azelex or its generic, AZELAIC ACID cream can be effectively used as a topical agent in case of mild to moderate Acne Vulgaris. The proper method to use Azelex cream is given below-

Skin is to be washed thoroughly and then patted dry. A thin film of this cream is then applied to the affected part, twice daily. The duration of treatment of Acne Vulgaris with Azelex cream depends on the severity of the case. Several patients can observe improvement in Acne Vulgaris within 3 – 4 weeks of starting treatment with this cream.

Reference :
http://www.easterndrugs.com/blog/acne/acne-vulgaris-treatment

Nursing Diagnosis related to Urinary Tract Infections

UTI or A urinary tract infection is an infection that can happen anywhere along the urinary tract.

Urinary tract infections have different names, depending on what part of the urinary tract is infected.
  • Bladder -- an infection in the bladder is also called cystitis or a bladder infection
  • Kidneys -- an infection of one or both kidneys is called pyelonephritis or a kidney infection
  • Ureters -- the tubes that take urine from each kidney to the bladder are only rarely the site of infection
  • Urethra -- an infection of the tube that empties urine from the bladder to the outside is called urethritis

Urinary tract infections (UTIs) are very common in women, babies and the elderly. The most common cause is a bacteria called Escherichia coli (E. coli), which usually lives in the digestive system and bowel. Infection can target the urethra, bladder or kidneys.

The symptoms of a bladder infection include:
  • Cloudy or bloody urine, which may have a foul or strong odor
  • Low fever (not everyone will have a fever)
  • Pain or burning with urination
  • Pressure or cramping in the lower abdomen (usually middle) or back
  • Strong need to urinate often, even right after the bladder has been emptied

If the infection spreads to kidneys, symptoms may include:
  • Chills and shaking or night sweats
  • Fatigue and a general ill feeling
  • Fever above 101 degrees Fahrenheit
  • Flank (side), back, or groin pain
  • Flushed, warm, or reddened skin
  • Mental changes or confusion (in the elderly, these symptoms often are the only signs of a UTI)
  • Nausea and vomiting
  • Severe abdominal pain (sometimes)

Although not always backed up by clinical research, some women have found the following suggestions useful in reducing their risk of developing urinary tract infections:
  • Drink plenty of water and other fluids to flush the urinary system.
  • Treat vaginal infections such as thrush or Trichomonas quickly.
  • Avoid using spermicide-containing products, particularly with a diaphragm contraceptive device.
  • Practice good hygiene.
  • Go to the toilet as soon as you feel the urge to urinate, rather than holding on.
  • Wipe yourself from front to back (urethra to anus) after going to the toilet.
  • Empty your bladder after sex.

Nursing Diagnosis for Urinary Tract Infections

1. Acute Pain
related to: inflammation and infection of the urethra, bladder and other urinary tract structures.

2. Impaired Urinary Elimination
related to: frequent urination, urgency, and hesitancy.

3. Disturbed Sleep Pattern
related to: pain and nocturia.

4. Hyperthermia
related to: the inflammatory reaction.

5. Imbalanced Nutrition, Less Than Body Requirements
related to: anorexia.

6. Risk for Fluid Volume Deficit
related to: excessive evaporation and vomiting.

7. Anxiety
related to: crisis situations, coping mechanisms are ineffective.

8. Knowledge Deficit: about condition, prognosis, and treatment needs
related to: the lack of resources.

Disturbed Sleep Pattern and Anxiety - NCP Gastritis


Gastritis is an inflammation of the stomach lining. Gastritis can last for only a short time (acute gastritis), or linger for months to years (chronic gastritis).

Risk Factors:
  • Infection with H. pylori
  • Acquired immunodeficiency syndrome (AIDS)
  • Any condition that requires relief from chronic pain using NSAIDS, such as chronic low back pain, fibromyalgia, or arthritis
  • Alcoholism
  • Cigarette smoking
  • Older age
  • Herpes simplex virus or cytomegalovirus
  • Inflammatory bowel disease

The most common causes of gastritis are:
  • Certain medications, such as aspirin, ibuprofen, or naproxen, when taken over a longer period of time
  • Drinking too much alcohol
  • Infection of the stomach with a bacteria called Helicobacter pylori

Less common causes are:
  • Autoimmune disorders (such as pernicious anemia)
  • Backflow of bile into the stomach (bile reflux)
  • Cocaine abuse
  • Eating or drinking caustic or corrosive substances (such as poisons)
  • Extreme stress
  • Viral infection, such as cytomegalovirus and herpes simplex virus, especially in people with a weak immune system

The most common symptoms of gastritis are stomach upset and pain. Other possible symptoms include:
  • Indigestion (dyspepsia)
  • Heartburn
  • Abdominal pain
  • Hiccups
  • Loss of appetite
  • Nausea
  • Vomiting, possibly of blood or material that looks like coffee grounds
  • Dark stools

Nursing Diagnosis and Interventions for Gastritis


1. Disturbed Sleep Pattern related to pain

Goal: sleep patterns back to normal

Expected outcomes: The improvement in sleep patterns

Nursing Intervention:

1) Perform assessment of the patient's sleep disorder problems, characteristics and causes lack of sleep.
R /: Provide basic information to determine a plan of nursing.

2) The state of the bed, the pillows were comfortable and clean.
R /: Improve comfort while sleeping.

3) Prepare for a night's sleep.
R /: Set the sleep pattern.

4) Collaboration drug delivery.
• Analgesic
R /: Relieve pain, increase comfort and improve the rest.


2. Anxiety related to lack of knowledge about the disease

Goal: Anxiety is reduced or lost

Expected outcomes: Looks relaxed and report anxiety is reduced at a rate that can be overcome.

Nursing Intervention:

1.) Assess the level of anxiety. Help patients identify coping skills that have been done successfully in the past.
R /: therapeutic intervention and participation in self-care, coping skills in the past to reduce anxiety.

2.) Suggest to express feelings. Give feedback.
R /: Make the therapeutic relationship. Helping people closest to identify problems that cause stress.

3.) Give an accurate and real information about what actions are performed.
R /: patient involvement in care planning provides a sense of control and help reduce anxiety.

4.) Provide quiet environment and rest.
R /: Move the patient from external stress, improve relaxation, help reduce anxiety.

5.) Encourage the patient / significant other to express concern, the behavior of concern.
R /: The act of support can help patients feel stress is reduced, allowing for directed energy on healing.

6.) Provide information about the disease process and anticipation of action.
R /: Knowing what to expect can reduce anxiety.

7.) Collaboration of sedative drugs.
R /: Can be used to reduce anxiety and facilitate rest.

Nursing Diagnosis for Peritonsillar Abscess


Nursing Care Plan

An abscess is a collection of pus in any part of the body that, in most cases, causes swelling and inflammation around it.

Peritonsillar abscess is a complication of tonsillitis. It is most often caused by a type of bacteria called group A beta-hemolytic streptococcus.

Peritonsillar abscess is usually a disease of older children, adolescents, and young adults. It has become uncommon with the use of antibiotics to treat tonsillitis.

Peritonsillar abscesses (PTAs) are common infections of the head and neck region and comprise approximately 30% of soft tissue head and neck abscesses. Physicians must be aware of the typical clinical presentation and diagnostic strategies in order to quickly diagnose and appropriately treat these patients to prevent complications and further propagation of the infectious process.

Risk factors:
  • Previous tonsillitis
  • Chronic or recurrent tonsillitis
  • May be preceded by a viral respiratory tract infection
  • Immune deficiency
  • Recent dental work
  • Alcohol abuse
  • Cocaine abuse

Symptoms of peritonsillar abscess include:
  • Chills
  • Difficulty opening the mouth, and pain with opening the mouth
  • Difficulty swallowing
  • Drooling or inability to swallow saliva
  • Facial swelling
  • Fever
  • Headache
  • Muffled voice
  • Sore throat (may be severe and is usually on one side)
  • Tender glands of the jaw and throat

If the infection is caught early, you will be given antibiotics. More likely, if an abscess has developed, it will need to be drained with a needle or by cutting it open. You will be given pain medicine before this is done.

Sometimes, at the same time the abscess is drained, the tonsils will be removed. In this case, you will be put to sleep with anesthesia.

Nursing Diagnosis for Peritonsillar Abscess

According to Herdman (2007), nursing diagnosis for abscess are:
  1. Acute Pain related to injury biological agents.
  2. Hyperthermia related to the disease process.
  3. Impaired Skin Integrity related to tissue trauma.

Nursing Diagnosis and Intervention for Glaucoma


Nursing Care Plan for Glaucoma

1. Chronic Pain
related to an increase in intra-ocular pressure (IOP)
characterized by: nausea and vomiting.
Goal: Pain is lost or reduced
Expected outcomes:
  • demonstrate knowledge of assessment and how to control the pain.
  • patients say the pain is reduced / lost
  • relaxed facial expression

Intervention:
  • Assess the type and location of pain intensity.
  • Assess the level of pain scale to determine the analgesic dose.
  • Encourage rest in bed in a quiet room.
  • Set Fowler position 30 degrees or in a comfortable position.
  • Avoid nausea, vomiting, as this will increase the IOP.
  • Divert attention to the things that are fun.
  • Give analgesics as directed.

2. Impaired sensory perception: visual
related to interference admission; disorders organ status
characterized by: progressive visual field loss.
Goal: The use of optimum vision.
Expected outcomes:
  • Patients will participate in a treatment program.
  • Patients will maintain visual acuity field without further loss.

Intervention:
  • Make sure the degree / type of vision loss.
  • Encourage express feelings about losing / possible loss of vision.
  • Indicate giving eye drops, instance count drops, follow the schedule, not one dose.
  • Take action to help the patient deal with limited vision, for example, reduce clutter, arrange furniture, turning the head to remind the subject looks, fix dim light and night vision problems.
  • Collaboration drugs in accordance with indications.

3. Anxiety
related to physiological factors, changes in health status, presence of pain, the possibility / reality of vision loss
characterized by fear, doubt, expressed concerns about changes in life events.
Goal: lost or reduced anxiety
Expected outcomes:
  • Patients seemed relaxed and report anxiety levels decreased to overcome.
  • Patients demonstrated problem-solving skills.
  • Patients using resources effectively

Intervention:
  • Assess the level of anxiety, the degree of experience of pain / symptoms develop suddenly and the current state of knowledge.
  • Provide accurate information and honest. Discuss the possibility that monitoring and treatment to prevent additional vision loss.
  • Encourage the patient to recognize the problem and expressing feelings.
  • Identify sources / people who helped.
4. Knowledge Deficit (learning need) regarding condition, prognosis, and treatment
related to low exposure / do not know the source, less given, one interpretation
characterized by: a question, a statement misperception, not follow instructions accurately, a complication that can be prevented.
Goal: The client knows about the condition, prognosis and treatment.
Expected outcomes:
  • The patient expressed understanding of the condition, prognosis, and treatment.
  • Identify the relationship between symptoms / signs with the disease process.
  • Perform the procedure correctly and explain the reason for the action.

Intervention:
  • Discuss the need to use identification.
  • Indicate the correct techniques ophthalmic administration.
  • Allow the patient to repeat the action.
  • Assess the importance of maintaining a medication schedule, eg eye drops. Discuss medications that should be avoided.
  • Identify side effects / adverse reactions from treatment (decreased appetite, nausea / vomiting, weakness,
  • irregular heart etc..
  • Encourage patients to make necessary changes in lifestyle.
  • Push avoid activities such as heavy lifting / pushing, wearing a tight and narrow.
  • Discuss considerations diet, adequate fluids and canola.
  • Emphasize routine inspection.
  • Encourage family members to check regularly sign of glaucoma.

Tuberculous Spondylitis - 11 Functional Health Patterns


Assessment is an early stage and the foundation of the nursing process. The assessment is done carefully to know the client's problems, in order to give direction to nursing actions. The success of the nursing process is highly dependent on the accuracy and precision in the assessment phase. Assessment phase consists of three activities, namely: data collection, data grouping, formulation of nursing diagnoses. (Lismidar 1990: 1)

The data collection

In technical data collection is done through anamnesis either on the client, family and those closest to the client. Physical examination done by way of, inspection, palpation, percussion and auscultation.

1. Identity of clients includes: name, age, sex, occupation, marital status, religion, ethnicity, education, address, date / time entered hospital and medical diagnostics.

2. History of present illness

The main complaint the client tuberculous spondylitis / pott disease are pain in the lower back, thus encouraging the client to the hospital for treatment. At the beginning of radicular pain can be found surrounding the chest or abdomen. Pain is felt up at night and weight gain especially during the movement of the spine. In addition to the main complaint the client can complain, decreased appetite, body feels weak, sweating and weight loss.

3. History of previous illness

On the occurrence of tuberculous spondylitis is usually preceded by the client in the history of ever suffered from pulmonary tuberculosis.

4. Family health history

On the client with tuberculous spondylitis disease one of the causes is the client or former contact with other patients who suffer from tuberculosis or the family environment is suffering from infectious diseases.

5. Psychosocial history

Clients will feel anxious about the disease in the suffering, so it looks sad, with a lack of knowledge about the disease, treatment and care against the patient will feel fear and anxiety grew so emotionally unstable and would not affect the socialization of the patient.


Tuberculous Spondylitis - 11 Functional Health Patterns

1. Health Perception/Health Management

The existence of medical treatment and hospital care will affect the client's perception about the habits of taking care of themselves, that is because not all clients understand the true course of their illness. So that created a false perception of health care. And also the possibility of the presence of a history of the state of housing, nutrition and economic levels that affect client health state clients.

2. Nutritional Metabolic Pattern

As a result of the disease process client felt his body became weak and amnesia. While the need for increasing the body's metabolism, so that the client will experience a disruption in nutritional status.

3. Elimination patterns

Clients will experience a change in the way the original elimination could to the bathroom, because of weakness and pain in the back and carrying on with the stylist immobilization treatment, so if you like bowel and bladder should be in bed with a tool. With the change in the client is not accustomed to so it will interfere with the process of elimination.

4. Activity Patterns

Due to physical weakness and pain in the back and managed care immobilization would cause the client to limit physical activity and diminished ability to perform physical activity.

5. Sleep and Rest Patterns

There is pain in the back and the changes in the environment or the effects of hospitalization will cause problems in fulfilling the need for sleep and rest.

6. Role Relationship Pattern

Since the sick and hospitalized clients to change roles or unable to take on the role as where it should be, whether it is the role of the family or community. This disruption affects interpersonal relationships.

7. Self-Perception-Self-Concept Pattern

Clients with tuberculosis spondylitis often feel ashamed of her body shape and sometimes isolating themselves.

8. Sensory and Cognitive Patterns

Sensory function was not impaired clients unless there is complications of paraplegia.

9. Sexual Reproduction Patterns

Sexual needs of clients in terms of the act of intercourse will be disrupted for a while, because in the hospital. But in terms of the outpouring of love and attention from her partner by way of day-to-day care is not interrupted or can be implemented.

10. Stress Patterns

In response to stress for clients who do not understand the disease, will experience stress. To overcome the anxiety that creates a feeling of stress, clients will be wondering about the disease to reduce stress.

11. Value / Belief Pattern

On the client who in their daily lives are always obedient to practice, then during his illness he would run well worship according to his ability. In this case worship for those on the run as well as the handling of stress by believing in god.

Chronic Pain and Body Image Disturbance - NCP Tuberculous Spondylitis

Chronic Pain and Body Image Disturbance - NCP Tuberculous Spondylitis


Pott disease, also known as tuberculous spondylitis is a rare infectious disease of the spine which is typically caused by an extraspinal infection. Pott's disease is often experienced as a local phenomenon that begins in the thoracic section of the spinal column. Pott’s Disease is a combination of osteomyelitis and arthritis which involves multiple vertebrae.

Back pain is the earliest and most common symptom. Patients with Pott’s disease usually experience back pain for weeks before seeking treatment and the pain caused by spinal TB can present as spinal or radicular. Although both the thoracic and lumbar spinal segments are nearly equally affected, the thoracic spine is frequently reported as the most common site of involvement. Together, thoracic and lumbar involvement comprise of 80-90% of spinal TB sites.

Neurologic abnormalities occur in 50% of cases and can include spinal cord compression with the following: paraplegia, paresis, impaired sensation, nerve root pain, cauda equina syndrome.

Fortunately, there are several ways to determine if tuberculosis spondylitis is the root cause of the symptoms. Blood tests can help determine if there is an elevation in the rate of erythrocyte sedimentation. A bone scan will determine if there is some indication of problems, which may lead to the scheduling of a bone biopsy. Conducting a CT scan as well as a radiograph of the spine is also likely to provide valuable information about the presence and current status of the disease.

Nursing Diagnosis and Interventions for Tuberculous Spondylitis / Pott disease

1. Chronic Pain: joints and muscles related to the inflammation of the joints.

Goal:
  • Comfortable feeling fulfilled
  • Pain is reduced / lost

Expected outcomes:
  • Clients reported a decrease in pain.
  • Demonstrate behavior that is more relaxed.
  • Demonstrate skills in the study of pain reduction with increasing success.

Interventions:
  • Assess the location, intensity and type of pain; observations on the progress of pain to a new area.
  • Provide appropriate analgesic therapy clinicians and examine its effectiveness against pain.
  • Use the back brace or corset when it is planned that way.
  • Give encouragement to change positions frequently to light and enhance a sense of comfort.
  • Teach and assist in alternative pain management techniques.

Rational :
  • Pain is a subject of experience that can only be defined by the client themselves.
  • Analgesics are drugs to reduce pain and how it reacts to pain clients.
  • Corset to maintain the spine.
  • With the change-change positions so that the muscles do not keep that muscle spasm and tension becomes limp and reduced pain.
  • Alternative methods such as relaxation times faster relief of pain or to distract the client so that the pain is reduced.
2. Body Image Disturbance related to disorders of body structures.

Goal: Clients can express their feelings and be able to use adaptive coping.

Expected outcomes : Clients can express feelings / care and use positive coping skills to address the image.

Interventions:
  • Give the client a chance to express feelings. Nurses must listen attentively.
  • With clients looking for alternative positive coping.
  • Develop communication and building relationships between families and friends as well as clients provide recreational activities and games in order to cope with changes in body image.

Rational:
  • Improving self-esteem and foster client relationships of mutual trust and the expression of feelings of self-acceptance can help.
  • Support nurses on the client can increase client confidence.
  • Providing encouragement for clients to view themselves in a positive way and not feel low self esteem.

Tuberculous Spondylitis - 11 Functional Health Patterns

Prevention and Treatment of Buerger Disease (Thromboangiitis Obliterans)


Thromboangiitis obliterans or Buerger Disease is a rare disease in which blood vessels of the hands and feet become blocked. It is a non-atherosclerotic inflammatory disease affecting small and medium sized arteries and veins of upper and lower extremities. This eventually damages or destroys skin tissues and may lead to infection and gangrene. Buerger's disease usually first shows in the hands and feet and may eventually affect larger areas of your arms and legs.

Buerger disease is characterized by the absence or minimal presence of atheromas, segmental vascular inflammation, vasoocclusive phenomenon, and involvement of small- and medium-sized arteries and veins of the upper and lower extremities.

The first reported case of thromboangiitis obliterans was described in Germany by von Winiwarter in an 1879 article titled "A strange form of endarteritis and endophlebitis with gangrene of the feet. Buerger's disease is rare in the United States, but is more common in the Middle East and Far East. Buerger's disease usually affects men younger than 40 years of age, though it's becoming more common in women.

Symptoms:
  • Hands or feet may be pale, red, or bluish
  • Hands or feet may feel cold
  • Pain in the hands and feet : Acute, severe, Burning or tingling, Often occurring at rest
  • Pain in the legs, ankles, or feet when walking (intermittent claudication) : Often located in the arch of the foot
  • Skin changes or ulcers on hands or feet

Note: Symptoms may worsen with exposure to cold or with emotional stress. Usually, two or more limbs are affected.


Prevention of Buerger Disease (Thromboangiitis Obliterans)

Those with a history of Raynaud's disease or thromboangiitis obliterans should avoid all tobacco use.


Treatment of Buerger Disease (Thromboangiitis Obliterans)
  • There is no cure for thromboangiitis obliterans. The goal of treatment is to control symptoms.
  • The patient must stop using tobacco and should avoid cold temperatures and other conditions that reduce circulation to the hands and feet.
  • Applying warmth and exercising gently may help increase circulation.
  • Cutting the nerves to the area (surgical sympathectomy) may help control pain. Aspirin and vasodilators may also used. It may be necessary to amputate the hand or foot if infection or widespread tissue death occurs.

Nursing Care Plan for Osteomalacia


Osteomalacia

A. Basic Concepts of Medical

1. Definition

Osteomalacia or soft bones is softening of the bones due to a lack of vitamin D or a problem with the body's ability to break down and use this vitamin. It causes severe bone pain and muscle weakness.

2. Etiology

The causes of adult osteomalacia are varied, but ultimately result in a vitamin D deficiency:
  • Insufficient nutritional quantities or faulty metabolism of vitamin D or phosphorus
  • Renal tubular acidosis
  • Malnutrition during pregnancy
  • Malabsorption syndrome
  • Hypophosphatemia
  • Chronic renal failure
  • Tumor-induced osteomalacia
  • Long-term anticonvulsant therapy
  • Coeliac disease
  • Cadmium poisoning, Itai-itai disease

3. Symptoms
  • Bone fractures that happen without a real injury
  • Muscle weakness
  • Widespread bone pain, especially in the hips

Symptoms may also occur due to low calcium levels. These include:
  • Numbness around the mouth
  • Numbness of the arms and legs
  • Spasms of the hands or feet

4.Evaluasi Diagnostic
In the photo x - ray commonly seen deficiency of bone mineral is very real. Based on the vertebrae with compression fractures may indicate pain at the end vertebra. Laboratory tests showed slow average serum calcium and phosphorus as well as the lack of increase in the number of alkaline phosfat. Urinary excretion of calcium and creatinine slow.


B. Basic Concepts in Nursing Care Plan for Osteomalacia

1. Assessment

Patients with osteomalacia often complain of bone pain is usually in the lower back and extremities mingled weakness. Overview of discomfort still vague, the patient may have a fracture, during the interview, inform about the real problems are in connection with the disease (malabsorption syndrome), and dietary habits can be known.

On physical examination, deformity skletal noted, spinal deformity, and deformity of the long bones are bent unfamiliarity may give the appearance of the patient and how to run a lackluster / weak. There may be muscle weakness, patients may be unhappy with the performance.

2. Nursing Diagnosis for Osteomalacia

Based on assessment data, nursing diagnoses primary that may occur, including the following:
  1. Acute Pain related to weakness and possible fracture.
  2. Knowledge Deficit: about the disease process and treatment procedures.
  3. Disturbance of self-concept related to swelling in the legs, gait sluggish / weak, and spinal deformity.
Nursing Management of Osteomalacia

The Occurrence / Mechanisms of Edema

Edema or swollen is increased extracellular fluid volume and extravascular (interstitial fluid) are accompanied by abnormal accumulation of fluid in the sidelines of the tissue and serous cavities (loose connective tissue and body cavities). Edema can be local and general.

Localized edema, as happens only in the abdominal cavity (hydroperitoneum or ascites), the chest cavity (hydrothorax), under the skin (subcutaneous edema or anasarca hidops), pericardium of the heart, (hydropericardium) or in the lungs (pulmonary edema ). While edema is characterized by the occurrence of edema fluid collection in many places, called general edema.

Edema fluid, transudates termed, has a specific gravity and low protein content, clear colorless or yellowish clear, and it is a watery liquid or like gelatin when it contains within it a number of plasma fibrinogen.

The cause of edema is the presence of congestion, lymphatic obstruction, increased capillary permeability, hipoproteinemia, colloid osmotic pressure and sodium and water retention.

Mechanisms of Edema

1. Congestion

On the condition that clogged veins (congestion), an increase in intravascular hydrostatic pressure (the pressure that drives blood flow in vascular, by the work of the heart pump) causing leakage of plasma fluid into the interstitium. Plasma fluid will fill the sidelines of loose connective tissue and body cavities (edema).

2. Lymphatic obstruction

In the event of interruption of the nodes in an area (obstruction / blockage), the body fluid derived from blood plasma and the metabolism goes into the lymph channels will be buried (lymphoedema). Lymphoedema is often caused by radical mastectomy to remove a malignant tumor in the breast or the result of a malignant tumor infiltrated lymph nodes and channels. In addition, the channel and inguinal glands are inflamed due to filarial infestation can also cause edema of the scrotum and legs (disease filariasis / elephantiasis).

3. Increased capillary permeability

Capillary endothelium is a semi-permeable membrane that can be traversed by water and electrolytes freely, whereas plasma protein can only be through little or limited. Blood osmotic pressure greater than in lymph.
Power depends on the permeability of these substances that bind to the endothelial cells. In certain circumstances, for example due to the influence of the work of the endothelial toxin, can increase capillary permeability. As a result, plasma proteins exit the capillaries, so that the colloidal osmotic pressure of blood decreases, and vice versa interstitium fluid osmotic pressure increases. This resulted in the more fluid that leaves the capillaries and causing edema. Increased capillary permeability may occur in conditions of severe infections and anaphylactic reactions.

4. Hipoproteinemia

The reduced amount of blood protein (hipoproteinemia) cause low water holding capacity of the remaining plasma proteins, so that the liquid plasma vascular leak out, as the edema fluid. Hipoproteinemia condition may result from chronic blood loss by Haemonchus contortus worms that suck the blood in the gastric mucous glands (abomasum) and caused damage to the kidneys that cause symptoms of albuminuria (proteinuria, blood protein albumin out with urine) prolonged. This usually results in edema Hipoproteinemia general.

5. Colloid osmotic pressure

Colloid osmotic pressure in the tissues usually very small, so it can not resist osmotic pressure contained in the blood. But in certain circumstances the amount of protein in the tissue can be raised, for example, if increased capillary permeability. In this case the osmotic pressure can cause tissue edema.
Plasma fluid filtration also got resistance from line pressure (tissue tension). This pressure varies in different tissues. In a tenuous subcutis tissue such as eyelids, the pressure is very low, therefore the place is easily arise edema.

6. Sodium and water retention

Sodium retention occurs when the urinary excretion of sodium is smaller than that in (intake). Because sodium concentration rises, there will be hipertonia. Hipertonia causes water to be detained, so the amount of extracellular fluid and extravascular (interstitium fluid) increases. The result is edema.
Sodium and water retention can be caused by hormonal factors (increased aldosterone in hepatic cirrhosis and nephrotic syndrome and in patients who received treatment with ACTH, testosterone, progesterone or estrogen).

Nursing Interventions for Anemia

Pediatric Care Plan Anemia

Anemia is a clinical condition in which total number of red blood cells or the quantity of hemoglobin in blood declines than the normal level so the oxygen binding ability of hemoglobin is decreased. Women are at higher risk of developing anemia than men. People who have other diseases such as cancer have a higher tendency to develop anemia. Anemia can become a very serious condition which can be dangerous. Anemia can also be acute or chronic in nature.

Hemoglobin present inside the red blood cells normally carries oxygen from lungs to the tissues and anemia causes hypoxia in organs. As all human cells are dependent upon oxygen for survival, anemia can lead to a wide variety of symptoms depending upon degree of destruction caused. There is a relationship between anemia and the kidneys, bone marrow and nutritional deficiencies in the body. When the kidneys are not working well or you are malnourished, this will affect your red blood cell count. Since red blood cells are made in the bone marrow the health of bone marrow is very important.


A complete blood count is typically used for the diagnosis of anemia. Apart from determining the number of red blood cells and hemoglobin levels automatic counters also measure the size of red blood cells by using flow cytometry which gives a clear picture of anemia. Examination of a stained blood smear under microscope also gives a clear cut idea about this disease. Reticulocyte count and kinetic approach are very commonly used in diagnosis. A recticulocyte count is actually a quantitative measure of bone marrow's production of new red blood cells. If automated blood count is not available then reticulocyte count can be taken into consideration for disease diagnosis.

Nursing Interventions for Anemia

1. Adequate tissue perfusion
  • Monitor vital signs, capillary refill, skin color, mucous membranes.
  • Raising the head position in bed.
  • Examine and document the presence of pain.
  • Observation of verbal response delay, confusion, or anxiety.
  • Observing and documenting the existence of the cold.
  • Maintain ambient temperature to keep warm the body needs.
  • Provide oxygen as needed.

2. Supporting children remain tolerant of activity
  • Assess the child's ability to perform physical activities in accordance with the conditions and development of children assignment.
  • Monitoring vital signs during and after activity, and noted a physiological response to activity (increased heart rate increased blood pressure, or rapid breathing).
  • Provide information to the patient or family to stop doing the activity, if any symptoms of increased heart rate, increased blood pressure, rapid breathing, dizziness or fatigue).
  • Provide support to the child to perform daily activities in accordance with the child's ability.
  • Teach the parents of patients, the technique gives reinforcement to the participation of children in the home.
  • Make a schedule of activities with the children and families by involving other health team.
  • Explain and provide recommendations to the school about the child's ability to perform the activity, the ability to monitor activity on a regular basis and explain to parents and schools.

3. Adequate nutritional needs
  • Allowing children to eat foods that can be tolerated child, plan to improve the quality of nutrition at child's appetite increases.
  • Give food accompanied by nutritional supplements to improve nutrient intake.
  • Allowing children to be involved in the preparation and selection of food.
  • Evaluate the child's weight every day.

Knowledge Deficit - Headache


A headache or cephalalgia is pain or discomfort in the head, scalp, or neck. It can be a symptom of a number of different conditions of the head and neck. Serious causes of headaches are very rare. Most people with headaches can feel much better by making lifestyle changes, learning ways to relax, and sometimes by taking medications.

There are a number of different classification systems for headaches. Headache is a non-specific symptom, which means that it has many possible causes. Treatment of a headache depends on the underlying etiology or cause, but commonly involves analgesics.

Nursing Diagnosis for Headache :
Knowledge Deficit : about the condition and treatment needs related to lack of recall, did not know the information, cognitive limitations.

Nursing Intervention :
  1. Discuss individual etiology of headache if known.
  2. Assist patients in identifying possible predisposing factors, such as emotional stress, excessive temperatures, food allergies / specific environment.
  3. Discuss about drugs and their side effects. The return value is the need to reduce / stop the treatment as indicated.
  4. Instruct patient / significant other in doing the activity / exercise, food intake, and the action raises a sense of comfort, such as massage and so on.
  5. Discuss about the position / location of a normal body.
  6. Instruct the patient / significant other to make time to relaxation and fun.
  7. Advise to use brain activity correctly, loving and laughing / smiling.
  8. Suggest use music that is fun.
  9. Instruct the patient to observe experienced headaches and related factors, or factors of precipitation.
  10. Provide written information / instructions sort of record.
  11. Identify and discuss the emergence of a hazard that is not real and / or therapy is not a medical treatment.