Risk for Infection - Nursing Assessment and Nursing Diagnosis

Risk for Infection - Nursing Assessment and Nursing Diagnosis

Infection is an invasion of the body by pathogens or microorganisms capable of causing illness (Potter and Perry, 2005).

Some of the factors that trigger the risk of infection in patients by Potter and Perry (2005) are:

1) Agent
The agent causing the infection, the microorganism can enter because the agent itself or because the toxins are released.

2) Host
The hosts were infected, so even if there is an agent, if no one can be charged, there is no infection. Hosts are usually people or animals in accordance with the needs of the agent to survive or breed.

3) Environment
Environment, the environment around the agent and the host, such as temperature, humidity, sunlight, oxygen and so on. There are certain agents that can only survive or infect certain environmental conditions as well.


Signs and Symptoms

Signs and symptoms are common in infections (Smeltzer, 2002) as follows:

1. Rubor
Rubor or redness is first seen in areas that become inflamed. When inflammatory reactions arise, dilation of the arterioles that supply blood to areas of inflammation. So that more blood flows to local microcirculation and capillary stretch quickly filled with blood. This condition is called hyperemia or congestion, causing local red color because of acute inflammation.

2. Calor
Calor occur simultaneously with redness of acute inflammatory reactions. Calor is also caused by increased blood circulation. Because blood has a temperature of 37 degrees Celsius is channeled to the body surface inflamed to the area more than normal.

3. Dolor
Changes in local pH or local concentration of certain ions can stimulate nerve endings. Spending substances such as histamine or other bioactive can stimulate nerves. The pain is caused also by the pressure was rising due to swelling of inflamed tissue.

4. Tumor
Swelling partly due to hyperemia and mostly caused by the delivery of fluid and cells from the blood circulation into the interstitial tissues.

5. Functio Laesa
Functio laesa is a loss of function or a disturbance of function.


Diagnostic

Laboratory tests are directly related to the infection include a complete blood count that includes: hemoglobin, leukocytes, hematocrit, erythrocytes, platelets, MCH, MCHV, basophils, eosinophils, stem segments, lymphocytes, and monocytes, erythrocyte sedimentation rate (ESR), random blood glucose, and albumin.


Medical Management

1. Aseptic
Actions taken in health care. This term is used to describe all the work done to prevent the entry of microorganisms into the body that are likely to lead to infection. The end goal is to reduce or eliminate the number of microorganisms, both on the surface of animate objects and inanimate objects so that medical equipment can be safely used.

2. Antiseptic
Efforts to prevent infection by killing or inhibiting the growth of microorganisms on the skin and other body tissues.

3. Decontamination
Actions taken so that an inanimate object can be handled safely by health workers, particularly medical clearance officer before washing done. An example is the examination table, medical equipment and gloves contaminated with blood or body fluids when actions are performed.

4. Washing
The removal of all blood, body fluids, or any foreign objects such as dust and dirt.

5. Sterilization
The removal of all microorganisms (bacteria, fungi, parasites and viruses), including bacterial endospore of inanimate objects.

6. Disinfection
The removal of most (not all) of disease-causing microorganisms from inanimate objects. High-level disinfection is done by boiling or using chemical solutions. This action can eliminate all microorganisms except some bacterial endospore.


Nursing Assessment

1. Identity
Getting the patient identity data, including name, age, education, occupation, address, registration number, and medical diagnostics.

2. Health history

• The main complaints: Complaints are most felt by the patient to seek help.
• Health history now: What is being felt now.
• Past medical history : Is the possibility of patients had never had this disease or have ever been.
• Family health history: Covering hereditary diseases or non-communicable diseases.

3. The need for Bio-Psycho-Social-Spiritual.
Needs Bio-Psycho-Social-Spiritual include breathing, eating, drinking, elimination, motion and activity, rest - sleep, personal hygiene, temperature control, security and comfort, socialization and communication, achievement and productivity, knowledge, recreation and worship.

4. Physical Examination
a. General State
The general state include: general impression, awareness, posture, skin color, skin turgor, and personal hygiene.
b. Cardinal Symptoms
Cardinal symptoms include: temperature, pulse, blood pressure, and respiration.
c. Physical State
Includes examining the physical state of the head to the lower extremities.

• Inspection: examine the skin, mucous membrane color, general appearance, adequacy systemic circulation, breathing pattern, chest wall movement.
• Palpation: local tenderness, feeling a lump or axilla and breeast tissue, peripheral circulation, the peripheral pulse, skin temperature, color and capillary refill.
• Percussion: knowing abnormal fluid, the air in the lungs, or the working diaphragm.
• Auscultation: abnormal sounds, murmurs, as well as friction sound, or the sound of an extra breath.

Nursing Diagnoses

Risk for Infection

Definition: Having an increased risk of pathogenic organisms

Risk Factor:

Chronic Diseases

• Diabetes mellitus
• Obesity

Knowledge is not enough to avoid pathogen exposure.
Defence inadequate primary body.

• Impaired peristaltic
• Damage to skin integrity (intravenous catheterization, an invasive procedure)
• Changes in pH secretion
• Decrease in work ciliary
• Premature rupture of membranes
• Smoking
• Static body fluids
• Tissue trauma network (ie., trauma, tissue destruction)

Inadequate secondary defenses

• Decrease in hemoglobin
• Immunosuppression (ie., Immunity acquired is inadequate, pharmaceutical agents including immunosuppressants, steroids, monoclonal antibodies, immunomodulators)
• Leukopenia
• Suspension inflammatory response

Vaccination inadequate
Exposure to environmental pathogens which increased

• outbreak

Invasive procedures
Malnutrition

Nursing Care Plan for Bone Cancer

Nursing Care Plan for Bone Cancer

Tumor is the growth of new cells, abnormal, progressive, where the cells never become mature. The incidence of bone tumors when compared with other types of tumors are small, ie less than 1% of all tumors of human body. Malignant tumor, when tumor capable of spreading to other places (able to metastasize) and benign tumors say, if it is not able to metastasize. Lungs, is the organ most frequently seized by child spread of malignant tumors.

There are many different types of cancer. Cancers are usually named based on the type of cell that is affected. For example, lung cancer is caused by cells that are beyond the control of the shape of the lung, and breast cancer by cells that form the breast. A tumor is a collection of abnormal cells which accumulate together. However, not all tumors are cancerous. A tumor can be benign (not cancerous) or malignant (cancerous).

Benign tumors are usually less dangerous and not able to spread to other parts of the body. Malignant tumors are generally more serious and can spread to other areas in the body. The ability of cancer cells to leave their original location and moved to another location in the body is called metastasis. Metastasis can occur with cancer cells enter the blood stream or lymphatic system body to walk to other places in the body.

When cancer cells metastasize to other parts of the body, they are still called by the type of origin of the abnormal cells. For example, if a group of cells into diseased breast cancer and metastasizes to the bones, it is called metastatic breast cancer. Many different types of cancer are able to metastasize to the bones.

The types of the most common cancers that spread to the bones are lung, breast, prostate, thyroid, and kidney. Most of the time, when people have cancer in their bones, it is caused by cancer that has spread from elsewhere in the body to the bones. It is less common to have an original bone cancer, a cancer that arises from cells that make bone. It is important to determine whether the cancer is in the bone from elsewhere or from a cancer of the bone cells. The treatments for cancers that have metastasized to the bone based on the initial type of cancer.

Causes

Bone cancer is caused by a problem with the cells that form bone. More than 2,000 people are diagnosed in the U.S. each year with a bone tumor. Bone tumors occur most commonly in children and adolescents and are less common in the older adults. Cancer involving the bone in adults older are most commonly the result of metastatic spread from another tumor.

Signs and Symptoms

The most common symptom of bone tumors is pain. In most cases, the symptoms become gradually more severe with time. At first, the pain may only be present at night or with activity. Depending on the growth of tumor, those affected may have symptoms for weeks, months, or years before seeking medical advice. In some cases, a mass or lump may be felt in the bone or in the tissues surrounding the bone. Tumors in the leg, causing the patient to walk lame, whereas tumors in the arm cause pain when the arm is used to lift some object. Swelling of the tumor may feel warm and slightly flushed.

Classification

Based on the level of malignancy, there are 3 levels of malignant tumor stages, namely:

1. Stage I, when a low degree of malignancy.
2. Stage II, meaning the tumor has a high degree of malignancy.
3. Stage III, which means the tumor has spread.

Diagnostic tests

1. Physical examination
2. DPL
3. X-Rays
4. Ct-Scan
5. MRI
6. biopsy
7. bone scan

Nursing Diagnosis for Bone Cancer

1. Anxiety related to change in health status.
2. Chronic Pain related to pathologic processes.
3. Imbalanced Nutrition Less Than Body Requirements related to hypermetabolic status with regard to cancer, the consequences of chemotherapy, and radiation effects.
4. Risk for Fluid Volume Excess related to damage to fluid intake.
5. Risk for Infection related to the inadequate immunosuppression, malnutrition and invasive procedures.
6. Risk for Impaired skin integrity related to radiation effects and changes in nutritional status.

Nursing Interventions for Bone Cancer

1. Encourage clients to express feelings and thoughts.
2. Increase a sense of calm and comfortable environment.
3. Determine history of pain.
4. Give a distraction relaxation techniques.
5. Monitor the nutrient intake every day.
6. Control of environmental factors and diet that will be provided.
7. Create a pleasant dining atmosphere.
8. Assess the factors that reduce appetite.
9. Monitor nausea and vomiting.
10. Monitor fluid input and output.
11. Assess vital signs.
12. Encourage increased fluid intake.
13. Increase rest.
14. Emphasize the importance of oral hygiene.
15. Assess the skin as often as possible.
16. Wash with warm water and mild soap.
17. Instruct the client to avoid any skin cream unless there is an indication of physicians.
18. Encourage the use of soft and loose clothing.

NCP Thromboangiitis Obliterans - Nursing Diagnosis and Interventions

NCP Thromboangiitis Obliterans - Nursing Diagnosis and Interventions

1. Acute Pain / Chronic Pain related to vasospasm / reperfusion disorders, ischemic / tissue damage.

Goal: Pain is reduced and tissue damage is not widespread.

Intervention:

• Record the characteristics of pain and paresthesias.
• Check the patient's vital signs.
• Discuss with the patient, how and why the pain inflicted.
• Help the patient identify trigger factor or situation example: smoking, exposure to cold and how to handle.
• Encourage the use of stress management techniques, entertainment activities.
• Soak the affected area in warm water.
• Give the room a warm, draft-free air, for example ventilation, air-conditioning, keep doors closed as indicated.
• Monitor drug effects and action.
• Collaboration: the medications as indicated, prepare surgical intervention when necessary.

Rational:

• Knowing the pain level.
• To monitor the general state of the client.
• That patients understand how to process pain.
• That patients understand the factors that influence pain.
• Used to divert the attention of the client.
• Warm water will make the blood vessels will dilate and blood flow.
• Avoid infection and keep the air hot.
• Determine the level of effectiveness of the drug.
• Administration of drugs to relieve pain.

2. Ineffective Tissue Perfusion is related to cessation of arterial blood flow

Intervention:

• Observation of skin color on the sick.
• Note the decrease in pulse.
• Evaluation of pain sensation parts, for example: sharp / shallow, hot / cold.
• View and examine the skin for ulceration, lesions, gangrene area.
• Recommended for proper nutrition and vitamins.
• Collaboration: the medications as indicated (vasodilator), example: drainage lesions for culture or sensitivity.

Rational:

• To see cyanosis or redness of the skin.
• Identify the severity of the cessation of arterial blood flow.
• Knowing levels, flavors, and forms of pain.
• Seeing how big a part that had gangrene.
• Proper nutrition and vitamin requirements are complete will increase the body's immune system.
• Giving obta vasodilator make the arteries dilate and blood flow.

3. Knowledge Deficit: the need to learn about the condition, treatment needs related to lack of knowledge / resources are not familiar with, wrong perception / misunderstood.

Intervention:

• Provide information to patients about the disease.
• Encourage clients to ask questions about the disease.
• Instruct to avoid exposure to cold.
• Preserve the environment at a temperature above 20.9 C eliminate cold flow.
• Discuss the possibility of moving to a warmer climate.
• Emphasize the importance of stopping smoking, provide information on local clinics / support group.
• Help the patient to create a method to avoid or alter discuss stress relaxation techniques.
• Emphasize the importance of viewing each day and do the right skin care.

Rational:

• Increase patients' knowledge about the disease.
• Knowing the client's level of curiosity about the disease.
• Cold temperatures make the constriction of the blood vessels and will aggravate the blockage of blood flow.
• Hot temperature makes blood vessels to maintain a state of dilatation.
• Avoid the severity of which will happen.
• That patients know and understand that smoking is a major contributing factor to the occurrence trombongitis.
• Distraction and relaxation techniques to make the patient more calm in responding.
• Avoid skin injury.

4. Anxiety related to the action procedure to be performed

Intervention:

• Describe the action procedure to be performed.
• Explain the importance of actions to be taken.
• Observation of vital signs.
• Give comfort to the patient.
• Reassure the patient that the action to be performed is the best course of action.
• Reassure the patient that the procedure acts to be performed safely.
• Collaboration with physicians for the provision of drugs.

Rational:

• Increase patients' knowledge about action procedure.
• In order for patients to understand why the need for that action.
• Knowing the general state of the client.
• Patients will feel calm and do not worry with action procedures to be performed.
• Reduce the level of anxiety on the client.
• Reduce negarif thinking about an act procedures.
• To create a calm and reduce anxiety levels.

Assessment and Nursing Diagnosis for Malignant Lymphoma

Assessment and Nursing Diagnosis for Malignant Lymphoma

Lymphomas are a group of cancers in which cells of the lymphatic system become abnormal and start to grow uncontrollably. Because there is lymph tissue in many parts of the body, lymphomas can start in almost any organ of the body.

Primary malignant lymphoma: The excessive proliferation of lymphocytes which forms part of the immune system. Primary cancers refer to the fact that the cancer originated in the lymph cells rather than having metastasized. More detailed information about the symptoms, causes, and treatments of Primary malignant lymphoma is available below.


Nursing Assessment for Malignant Lymphoma

Assessment at the client's malignant lymphoma by Doenges, (1999) obtained the following data:

1. Activity / rest

• Symptoms: fatigue, weakness, or general malaise, loss of productivity and decreased exercise tolerance.
• Signs: decreased strength, shoulders slumped, walking slowly, and other signs that show fatigue.

2. Circulation

• Symptoms: palpitations, angina / chest pain.
• Signs: tachycardia, dysrhythmias, cyanosis face and neck (venous drainage obstruction due to enlarged lymph nodes is a rare occurrence), scleral jaundice, and general jaundice, liver damage and in connection with bile duct obstruction by enlarged lymph nodes, pallor (anemia), diaphoresis , night sweats.

3. Ego integrity

• Symptoms: stress factor, fear / anxiety in connection with the diagnosis and possible fear of death, diagnostic tests and treatment modalities (chemotherapy and radiation therapy).
• Signs: various behaviors, such as angry, withdrawn, passive.

4. Elimination

• Symptoms: changes in urine and stool characteristics, history of intussusception obstruction, or malabsorption syndrome (infiltration of retro-peritoneal lymph nodes)
• Signs: tenderness in the right upper quadrant on palpation and enlargement (hepatomegaly), tenderness in the left upper quadrant on palpation and enlargement (splenomegaly), decreased urine output, dark urine, anuria (urethral obstruction / fail ginja), bowel dysfunction, and bladder.

5. Food / fluid

• Symptoms: anorexia / loss of appetite, dysphagia (esophageal pressure) weight loss.
• Signs: swelling of the face, neck, jaw, or right hand (secondary to superior vena cava compensated by enlarged lymph nodes), lower extremity edema in relation to the inferior vena cava obstruction of intra-abdominal lymph node enlargement (non-Hodgkin), ascites (obstruction in vena cava inferior with respect to intra-abdominal lymph node enlargement)

6. Neurosensory

• Symptoms: nerve pain (neuralgia) indicates nerve root compression by enlarged lymph nodes in the brachial, lumbar, and sacral plexus, muscle weakness, paresthesias.
• Signs: mental status; lethargy, withdrawal, lack of interest in the general vicinity, paraplegia (spinal stem compression from vertebral tubauh, discus involvement in compression / degeneration or compression of the blood supply to the spinal rod)

7. Pain / comfort

• Symptoms: tenderness / pain on the affected lymph nodes, eg at about mediastinum, chest pain, back pain (vertebral compression) general bone pain (bone involvement limfomatus), pain in the affected area immediately after drinking alcohol.
• Mark: a focus on self, cautious behavior.

8. Breathing

• Symptoms: dyspnea at work or rest; chest pain
• Symptoms: dyspnea; tachycardia, dry non-productive cough, respiratory distress signal; increased respiratory rate and depth, use of accessory muscles, stridor, cyanosis, husky / laryngeal paralysis (pressure of enlarged nodes in laryngeal nerve).

9. Security

• Symptoms: a history of frequent / infection, mononukleus history, history of ulcer / perforation gastric bleeding, fever, night sweats without chills, redness / general pruritus
• Symptoms: fever settled without any symptoms of infection, lymph node symmetric, no pain, swollen / enlarged, enlarged tonsils, general pruritus, most areas of melanin pigmentation loss (vitilago).

Nursing Diagnosis for Malignant Lymphoma

Once the data is collected, followed by analysis of the data to determine nursing diagnoses.

According Doenges (1999), nursing diagnoses in clients with postoperative laparotomy + biopsy, with an indication of malignant lymphomas as follows:

1. Risk for Infection related to invasive procedures, the surgical incision.

2. Risk for Fluid Volume Deficit related to excessive loss, ie: vomiting, bleeding, diarrhea.

3. Acute Pain related to the surgical incision.

4. Activity Intolerance related to general weakness, decreased energy reserves, increase the metabolic rate of the production of massive leukocytes.

5. Constipation or Diarrhea related to decreased dietary input, change the digestive process.

6. Risk for Impaired Skin Integrity related to decreased blood and nutrients to the tissues, secondary surgery.

7. Knowledge Deficit related to lack of accurate information about home care.

Nursing Care Plan for Diabetes Mellitus - 5 Diagnosis Interventions

Nursing Care Plan for Diabetes Mellitus - 5 Diagnosis Interventions

Assessment for Diabetes Mellitus

Assessment is the first step in the nursing process and basic overall.

Assessment of patients with diabetes mellitus (Doenges, 1999) include:

a. Activity / Rest
Symptoms: weakness, fatigue, difficulty moving / walking, muscle cramps, decreased muscle tone.
Signs: decreased muscle strength.

b. Circulation
Symptoms: ulcers on the legs, a long healing process, tingling / numbness in the extremities.
Signs: skin hot, dry and reddish.

c. Ego integrity
Symptoms: depend on others.
Signs: anxiety, sensitive stimuli.

d. Elimination
Symptoms: changes in the pattern of urination (polyuria), nocturia
Signs: dilute urine, pale dry, poliurine.

e. Food / fluid
Symptoms: loss of appetite, nausea / vomiting, do not follow the diet, weight loss.
Symptoms: dry skin / scaly, ugly turgor.

f. Pain / comfort
Symptoms: pain in the ulcer wound
Signs: face grimacing with palpitations, looks very carefully.

g. Security
Symptoms: dry skin, itching, skin ulcers.
Symptoms: fever, diaphoresis, damaged skin, lesion / ulceration

h. Counseling / learning
Symptoms: family risk factors diabetes, heart disease, stroke, hypertension, long healing. The use of drugs such as steroids, diuretics (thiazides): diantin and phenobarbital (may increase blood glucose levels).


Nursing Diagnosis for Diabetes Mellitus

Nursing diagnoses in patients with diabetes mellitus (Doenges, 1999) are:

1. Fluid Volume Deficit related to osmotic diuresis, gastric loss, excessive diarrhea, nausea, vomiting, limited input, mental mess.
2. Imbalanced Nutrition, Less Than Body Requirements related to insulin insufficiency, decreased oral input: anorexia, nausea, a full stomach, abdominal pain, change in consciousness: hypermetabolism status, the release of stress hormones.
3. Risk for Infection related to inadequate peripheral defense, changes in circulation, high blood sugar levels, invasive procedures and skin damage.
4. Fatigue related to decreased metabolic energy production, changes in blood chemistry, insulin insufficiency, increased energy demand, hypermetabolism status status / infection.
5. Knowledge Deficit: about condition, prognosis and treatment needs related to misinterpretation of information / do not know the source of information.

Nursing Intervention and Implementation
for Diabetes Mellitus

Intervention is planning nursing actions that will be implemented to address the problem in accordance with the nursing diagnoses.

Implementation is the realization of management and nursing plans that had been developed at the planning stage.

Nursing Intervention and implementation in patients with diabetes mellitus (Doenges, 1999) include:

1). Fluid Volume Deficit

Expected outcomes:
Patients showed an improvement in fluid balance,
the criteria; spending adequate urine (normal range), vital signs stable, clear peripheral pulse pressure, good skin turgor, capillary refill well and mucous membranes moist or wet.

Intervention / Implementation:
1. Monitor vital signs, note the presence of orthostatic blood pressure.
R: Hypovolemia can be manifested by hypotension and tachycardia.

2. Assess breathing and breath patterns.
R: The lungs secrete carbonic acid is produced through respiration compensated respiratory alkalosis, the state of ketoacidosis.

3. Assess temperature, color and moisture.
R: Fever, chills, and diaphoresis is common in the infection process. Fever with skin redness, dry, maybe a picture of dehydration.

4. Assess peripheral pulses, capillary refill, skin turgor and mucous membranes.
R: Is an indicator of the level of dehydration or adequate circulating volume.

5. Monitor intake and output. Record the urine specific gravity.
R: Provide the estimated need for fluid replacement, renal function and the effectiveness of a given therapy.

6. Measure body weight every day.
R: Provide the best results of the assessment of the status of ongoing fluid and further in giving replacement fluids.

7. Collaboration fluid therapy as indicated
R: Type and amount of fluid depends on the degree of dehydration and individual patient response.


2). Imbalanced Nutrition, Less Than Body Requirements

Goal: weight can be increased with normal laboratory values ​​and no signs of malnutrition.

Expected outcomes:
Patients are able to express an understanding of substance abuse, decrease the amount of intake (diet on nutritional status).
Demonstrate behaviors, lifestyle changes to improve and maintain a proper weight.

Intervention / Implementation:

1. Measure body weight per day as indicated.
R: Knowing eating adequate income.

2. Determine the diet program and diet of patients compared with food that can be spent on the patient.
R: Identify deviations from the requirements.

3. Auscultation of bowel sounds, record the presence of abdominal pain / abdominal bloating, nausea, vomiting, keep fasting as indicated.
R: Influence of intervention options.

4. Observation of the signs of hypoglycemia, such as changes in level of consciousness, cold / humid, rapid pulse, hunger and dizziness.
R: Potentially life-threatening, which must be multiplied and handled appropriately.

5. Collaboration in the delivery of insulin, blood sugar tests and diet.
R: It is useful to control blood sugar levels.


3). Risk for Infection

Goal: Infection does not occur.

Expeected outcomes:
Identify individual risk factors and potential interventions to reduce infection.
Maintain a safe aseptic environment.

Intervention / Implementation

1. Observation for signs of infection and inflammation such as fever, redness, pus in the wound, purulent sputum, urine color cloudy and foggy.
R: incoming patients with infections that normally might have been able to trigger a state ketosidosis or nosocomial infections.

2. Increase prevention efforts by performing good hand washing, each contact on all items related to the patient, including his or her own patients.
R: prevention of nosocomial infections.

3. Maintain aseptic technique in invasive procedures (such as infusion, catheter folley, etc.).
R: Glucose levels in the blood will be the best medium for the growth of germs.

4. Attach catheter / perineal care do well.
R: Reduce the risk of urinary tract infection.

5. Give skin care with regular and earnest. Massage depressed bone area, keep skin dry, dry linen and tight (not wrinkled).
R: peripheral circulation can be impaired which puts patients at increased risk of damage to the skin / eye irritation and infection.

6. Position the patient in semi-Fowler position.
R: Makes it easy for the lung to expand, lowering the risk of hypoventilation.

7. Collaboration antibiotics as indicated.
R: penenganan early can help prevent the onset of sepsis.

4. Fatigue - NCP Diabetes Mellitus

5. Knowledge Deficit

Goal: patient expressed understanding of the conditions, procedures and effects of the treatment process.

Expected outcomes:
Perform the necessary procedures and explain the rationale of an action.
Initiate the necessary lifestyle changes and participate in treatment regimen.

Intervention / Implementation:
1. Assess the level of knowledge of the client and family about the disease.
R: Find out how much experience and knowledge of the client and family about the disease.

2. Give an explanation to the client about diseases and conditions now.
R: By knowing the diseases and conditions now, clients and their families will feel calm and reduce anxiety.

3. Encourage clients and families to pay attention to her diet.
R: Diet and proper diet helps the healing process.

4. Ask the client and reiterated family of materials that have been given.
R: Knowing how much understanding of clients and their families and assess the success of the action taken.