Hirschsprung's Disease - Nursing Diagnosis and Interventions

Hirschsprung's Disease - Nursing Diagnosis and Interventions

Hirschsprung's disease is a blockage of the large intestine due to improper muscle movement in the bowel. It is a congenital condition, which means it is present from birth.

Symptoms that may be present in newborns and infants include:

• Difficulty with bowel movements
• Failure to pass meconium shortly after birth
• Failure to pass a first stool within 24 - 48 hours after birth
• Infrequent but explosive stools
• Jaundice
• Poor feeding
• Poor weight gain
• Vomiting
• Watery diarrhea (in the newborn)

Symptoms in older children:

• Constipation that gradually gets worse
• Fecal impaction
• Malnutrition
• Slow growth
• Swollen belly

It is diagnosed by taking a small piece of tissue from the bowel to examine under a microscope. This is called a rectal biopsy. If the piece of tissue does not have any ganglion cells, this means Hirschsprung’s disease has been diagnosed.

Nursing Diagnosis and Interventions for Hirschsprung's Disease

1. Constipation related to obstruction
The inability of the colon to evacuate stool (Wong, Donna, 2004: 508)

Goal: Children can perform elimination with some adaptations to function normally and eliminations can be done.

Expected outcomes:

• Patients can perform elimination with some adaptation.
• There is an increased elimination pattern better.

Intervention:

• Provide assistance enema with 0.9% NaCl physiological fluids.
• Observation of vital signs and bowel every 2 hours.
• Observation expenditure per rectal stool: form, consistency, amount.
• Observations affecting intake patterns and stool consistency.
• Recommended for the diet that has been recommended.

2. Imbalanced Nutrition, Less Than Body Requirements related to the digestive tract, nausea and vomiting

Goal: The patient receives adequate nutrition in accordance with the recommended diet.

Expected outcomes:

• Weight loss patients according to age.
• Patient's skin turgor moist.
• Parents can choose the recommended foods.

Intervention

• Provide adequate nutrition in accordance with the recommended diet.
• Measure the child's body weight per day.
• Use alternate routes nutrition (such as NGT and parenteral) for those patients who had started to feel nauseous and vomiting.

3. Risk for Fluid Volume Deficit related to intake less (Betz, Cecily & Sowden 2002:197)

Goal: hydration status of patients can meet the body's needs.

Expected outcomes:

• Moist skin turgor.
• Fluid balance.

Intervention

• Provide adequate fluid intake in patients.
• Monitor signs turgor adequate body fluids, intake - output.
• Observation of increased nausea and vomiting, anticipated deficit of body fluids immediately.

4. Knowledge Deficit: about the disease process and treatment.

Goal: patients' knowledge about the disease to be more adequate

Expected outcomes:

• Knowledge of the patient and family about the disease, treatments and medications increased.

Intervention:

• Give a chance to the patient's family to ask for the things he wants to know in relation to the disease being treated.
• Assess family knowledge about Mega Colon.
• Assess family background.
• Explain about the disease process, diet, treatments, and medicines to the patient's family.
• Explain all the procedures that will be implemented and the benefits for patients.

Benign Prostatic Hyperplasia - Pre-Surgery and Post-Surgery Care

Benign Prostatic Hyperplasia - Pre-Surgery and Post-Surgery Care

Benign prostatic hyperplasia (BPH) is an enlarged prostate gland. The prostate gland surrounds the urethra, the tube that carries urine from the bladder out of the body. As the prostate gets bigger, it may squeeze or partly block the urethra. This often causes problems with urinating.

Benign prostatic hyperplasia is probably a normal part of the aging process in men, caused by changes in hormone balance and in cell growth.

Prostate enlargement is very common as men age -- symptoms usually develop around age 50 and by age 60, most men have some degree of BPH. At age 85, men have a 90% chance of having urination problems caused by BPH. It' s important to note that BPH is not cancer, and it does not put you at increased risk for developing prostate cancer.

Benign prostatic hyperplasia Pre-Surgery Care

Assess the client's anxiety, correcting misconceptions about the surgery and provide accurate information on the client:

• Type of surgery
• Type of anesthetics
• Cateter: Foley catheter, Continuous Bladder Irigation (CBI).

Pre-Surgery Preparation others are:

• Complete laboratory examination.
• Examination of the ECG
• Examination of Radiology.
• Examination Uroflowmetry: For people who do not wear a catheter.
• Installation of infusion and fasting.
• Shaving pubic hair and lavement.
• Giving antibiotics.
• Approval of Operations (Informed Concern).

Benign Prostatic Hyperplasia - Post-Surgery Care

Post-Surgery Care is basically the same as for other patients, namely: monitoring of respiration, circulation and awareness of the patient:

1. Monitoring of respiration

• Airway: Clear the airway, the position of the head of extensions
• Breathing: Provide oxygen as needed, observation of respiratory
• Circulation: measuring blood pressure, pulse, body temperature, breathing, awareness and urine production in the early phase (6 hours) post-operative must be monitored every hour and should be recorded.

• When the initial phase is stable, monitor / interval can be 3 hours.
• When blood pressure drops, pulse increases (small), dark red urine production should be wary of bleeding: Hb checks immediately and inform doctors.
• Tensions increased and decreased pulse (bradycardia), decreased potassium levels, anxiety or delirium should be wary: immediately report the doctor.
• If urine output decreased / not out, looking for the cause is clogged by a blood clot catheter, urinary retention occur in the bladder: report physician,
• If necessary checks blood gas analysis
• Is there pallor, bluish.
• Check lab: Hb, RFT, Na / K and a urine culture.

2. Giving Antibiotics

3. Catheter care
Urethral catheter that is placed on postoperative prostate, namely folley 3 hole catheter (Catheter Tree Way), size 24 Fr.
The three holes are useless:

1. To fill the balloon, between 30-40 ml of fluid.
2. To undertake irrigation / spoling.
3. To discharge (urine and fluid spoling).

Fluid And Electrolyte Imbalances related to Hyperemesis Gravidarum

Fluid And Electrolyte Imbalances related to Hyperemesis Gravidarum

Hyperemesis gravidarum is a condition characterized by severe nausea, vomiting, weight loss, and electrolyte disturbance. Malnutrition and other serious complications such as fluid or electrolyte imbalances may result.

The majority of pregnant women experience some type of morning sickness (70 – 80%). Nausea and vomiting of pregnancy (NVP), more widely known as morning sickness, is a common condition of pregnancy. Many researchers believe that NVP should be regarded as a continuum of symptoms that may impact an affected woman's physical, mental and social well-being to varying degrees.

Signs and symptoms:

• Severe nausea and vomiting
• Food aversions
• Decrease in urination
• Dehydration
• Weight loss of 5% or more of pre-pregnancy weight
• Headaches
• Confusion
• Fainting
• Extreme fatigue
• Low blood pressure
• Rapid heart rate
• Jaundice
• Loss of skin elasticity
• Secondary anxiety/depression

Nursing Diagnosis for Hyperemesis Gravidarum : Fluid And Electrolyte Imbalances related to active fluid loss

Goal:

• Mucous membranes moist
• CRT is less than 3 seconds
• Normal vital signs

Nursing Interventions:

1. Monitor and record vital signs every 2 hours as needed or as often as possible until stable. Then monitor and record vital signs every 4 hours.
Rational: Tachycardia, dyspnea, or hypotension may indicate a lack of fluid volume or electrolyte imbalance.

2. Measure intake and output every 1 to 4 hours. Record and report significant changes including urine, feces, vomit, wound drainage, nasogastric drainage, chest tube drainage, and output another.
Rationale: Urine output low and high urine specific gravity indicates hypovolemia.

3. Measure the weight of the patient at the same time every day.
Rationale: To provide data that is more accurate and consistent. Weight loss is a good indicator of fluid status.

4. Assess skin turgor and mucous membranes of the mouth every 8 hours.
Rationale: To check dehydration.

5. Give careful oral care every 4 hours.
Rationale: To avoid dehydration of the mucous membrane.

6. Check the specific gravity of urine every 8 hours.
Rationale: Increased urine specific gravity may indicate dehydration.

Cataract - Risk for Injury and Acute Pain

Cataract - Risk for Injury and Acute Pain

Nursing Diagnosis for Cataract : Risk for injury related to an increase in intraocular pressure (IOP), hemorrhage, vitreous loss.

Expected outcomes:

• Clients can mention the factors that lead to injury.
• Clients do not do activities that increase the risk of injury.

Intervention:

1. Talk about pain, activity limitation and bandaging the eyes.
R /: Improving cooperation and the necessary restrictions.

2. Put the client on a low bed and recommended to restrict the movement of abrupt or sudden and excessive head move.
R /: Absolute rest was given only a few minutes to one or two hours post-surgery, or one night if there are complications.

3. Assist patients in activity during the resting phase.
R /: Prevent or reduce the risk of injury complications.

4. Teach client to avoid any action that could cause injury.
R /: Measures to increase IOP and cause structural damage to eye post-surgery:

• Straining (Valsalva maneuver)
• Moving the head suddenly
• Bending too long
• cough

5. Observe the condition of the eye: injury protruding, bulging anterior chamber, sudden pain every 6 hours or as needed at the beginning of the operation.
R /: Various conditions such as cuts stand, booth protruding eyes, sudden pain, hyperemia may indicate postoperative eye injury. If sight seeing floating objects (floaters) or dark spots may be attributed retinal detachments.

Nursing Diagnosis for Cataract : Acute Pain related to postoperative wound.

Goal: decrease pain, loss and control.

Expected outcomes:

• Clients demonstrated pain reduction techniques.
• Clients reported pain decreased or disappeared.

Intervention:

1. Assess the degree of pain every day.
R /: Normally pain occurs in less than five days after surgery and gradually disappear. Pain may increase due to increased IOP 2-3 days post-surgery. Pain suddenly showed massive increase in IOP.

2. Instruct to report the development of pain every day, or as soon as an increase in sudden pain.
R /: Improve collaboration; provide security to increase psychological support.

3. Encourage clients to not do any sudden movements that can provoke pain.
R /: Some of the activities the client can increase the pain as sudden movement, bent, rubbed his eyes, coughing, straining.

4. Teach distraction and relaxation techniques.
R /: Reduce stress, reduce pain.

5. Perform collaborative action for topical or systemic analgesic administration.
R /: Reduce pain by increasing pain threshold.

Successful Recovery from Depression

Successful Recovery from Depression

Depression is a disorder of the brain. Depression is a state of low mood and aversion to activity that can have a negative effect on a person's thoughts, behavior, feelings, world view, and physical well-being.

There are a variety of causes, including genetic, environmental, psychological, and biochemical factors. Some types of depression run in families. In some families, major depression also seems to occur generation after generation. However, it can also occur in people who have no family history of depression. Whether inherited or not, major depressive disorder is often associated with changes in brain structures or brain function.

In recent years, researchers have shown that physical changes in the body can be accompanied by mental changes as well. Medical illnesses such as stroke, a heart attack, cancer, Parkinson’s disease, and hormonal disorders can cause depressive illness, making the sick person apathetic and unwilling to care for his or her physical needs, thus prolonging the recovery period.

Depression is a severe disorder, and one that can often go undetected in some people’s lives because it can creep up on you. Depression doesn’t need to strike all at once; it can be a gradual and nearly unnoticeable withdrawal from your active life and enjoyment of living. Or it can be caused by a clear event, such as the breakup of a long-term relationship, a divorce, family problems, etc. Finding and understanding the causes of depression isn’t nearly as important as getting appropriate and effective treatment for it.


Symptoms of depression can include:

• Persistent sad, anxious, or "empty" mood
• Feelings of hopelessness, pessimism
• Feelings of guilt, worthlessness, helplessness
• Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex
• Decreased energy, fatigue, being "slowed down"
• Difficulty concentrating, remembering, or making decisions
• Insomnia, early-morning awakening, or oversleeping
• Appetite and/or weight loss or overeating and weight gain
• Thoughts of death or suicide; suicide attempts
• Restlessness, irritability
• Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain

People who are depressed are more likely to use alcohol or illegal substances.

Complications of depression also include:

• Increased risk of health problems
• Suicide

Successful recovery from depression

1. Identify the signs of depression

Being able to determine if you have signs of depression is the essential first step towards combating this emotional problem. Listed below are signs associated with depression, and if you have some of these, then it will be best to start seeking for professional help.

2. Establish supportive and healthy relationship

Now is perhaps the best time to get support from people you love and trust, as they play a big role in encouraging you to lift up your spirit a little higher. Recovering from depression is difficult to do and maintain on your own, as loneliness can only make it even worse for you. At first, you may feel that reaching out to friends and family can be exhausting and overwhelming but just stay focused and always remember that people around you care a lot for you.

3.Start doing things that you previously enjoy doing.

The next great way on coping with depression is try to do things, no matter how small they are, that truly make you happy about yourself. If you were into arts before, why not do artworks where you can express your feeling? If you enjoy music, try to listen to songs about depression such as Beautiful World by Carolina Liar, Any Man in America by Blue October, Counting Crows' Come Around, Crescent Noon by the Carpenters and a lot more. Listening to them can somehow make you realize that you are not alone in this battle, thus inspiring you even more to get through with it with flying colors.

4. Learn how to take care of yourself again

This is a basic step on how to deal with depression that you can easily follow. Some of the healthy habits you can start doing without costing you a lot are:

• Get 8 hours of sleep
• Exercise. Take a short walk or jog every day.
• Get out. Feel a little sunlight every morning.
• Eat healthy.
• Learn some few relaxation techniques.