Fluid and Electrolyte Imbalances related to Chronic Kidney Disease (CKD)

Nursing Care Plan for Chronic Kidney Disease / Chronic Renal Failure

Definition

Chronic renal failure is usually the end result of loss of renal function gradually (Doenges, 1999; 626)

Chronic kidney failure occurs when the kidneys are not able to maintain an internal environment that is consistent with the life and recovery of function is not started. In most healthy individuals transition from status to chronic or persistent disease is very slow and wait a few years. (Barbara C. Long, 1996; 368)

Chronic renal failure or end stage renal disease (ESRD) is a progressive renal dysfunction and irreversible where the body's ability to maintain metabolism and failed fluid and electrolyte balance, causing uremia (urea retention and other nitrogen waste in the blood). (Brunner & Suddarth, 2001; 1448)

Chronic renal failure is a progressive development of renal failure and slow, usually lasts several years. (Price, 1992; 812)


Causes 

Causes of CRF according to Price, 1992; 817, divided into eight classes, among others:

1. Infections such as chronic pyelonephritis.
2. Inflammatory diseases such as glomerulonephritis.
3. Hypertensive vascular disease, such as benign nephrosclerosis, malignant nephrosclerosis, renal artery stenosis.
4. Connective tissue disorders such as systemic lupus erythematosus, polyarteritis nodosa, progressive systemic sclerosis
5. Congenital and hereditary disorders such as polycystic kidney disease, renal tubular acidosis.
6. Metabolic diseases such as: diabetes, gout, hyperparathyroidism, amyloidosis.
7. Toxic nephropathy, eg analgesic abuse, lead nephropathy.
8. Obstructive nephropathy, for example:

• Upper urinary tract: calculi neoplasm, fibrosis netroperitoneal.
• Lower urinary tract: prostatic hypertrophy, urethral stricture, congenital anomalies of the neck of the bladder and urethra.

Nursing Diagnosis for Chronic Kidney Disease (CKD) : Fluid and Electrolyte Imbalances related to edema, secondary : the liquid volume is not balanced, and therefore retention of Na and H2O

Goal :
Maintaining an ideal body weight without excess fluid

Outcomes:
no edema,
balance between input and output


Intervention:
1. Assess fluid status by measuring body weight per day, the balance of input and output, skin turgor vital signs

2. Limit fluid intake
R /: fluid restriction will determine ideal body weight, urine output, and response to therapy.

3. Explain to patients and families about the liquid restrictions.
R /: Understanding increase patient cooperation and families in the fluid restriction.

4. Instruct patient / teach the patient to record the use of fluids, especially income and output.
R /: To find out the balance of inputs and outputs.


Nursing Care Plan for Chronic Renal Failure - CRF

Nursing Diagnosis and Nursing Intervention for CRF - Chronic Renal Failure

Assessment and Nursing Diagnosis for UTI

Urinary Tract Infection

Urinary tract infection is the development of microorganisms in the urinary tract, but under normal circumstances does not contain bacteria, viruses, or other microorganisms. Urinary tract infections can occur anywhere, from the urethra, uterus bladder, ureters (fibromuskuler channel that drains urine from the kidney to the urinary contents) or kidney.

Symptoms of Urinary Tract Infection

• Frequent urination along with the feeling of need to urinate even though there may be a little urine to pass.
• Nocturia: Need to urinate at night.
• Urethritis: Discomfort, irritation or pain in meatus or a burning sensation along anyway urethra with urination (dysuria).
• Pain in the midline suprapubic region.
• Pyuria: Pus in urine or urethral discharge.
• Hematuria: Blood in the urine (not always visible to the eye, but often revealed during urine tests).
• Pyrexia: Mild fever
• Cloudy and foul-smelling urine

Nursing Assessment of Urinary Tract Infection

1. Physical examination : do head to toe
2. History or presence of risk factors :

• Is there a history of previous infections ?
• Is there a history of obstruction of the urinary tract ?

3. The presence of factors predisposing patients to nosocomial infections .

• What about mounting folley catheter ?
• Immobilization in a long time ?
• Is urinary incontinence occurs ?

4. Assessment of clinical manifestations of urinary tract infections

• How voiding pattern ? to detect the occurrence of UTI predisposing factors (encouragement, frequency, and amount)
• Is there dysuria ?
• Is there urgency ?
• Is there hesitancy ?
• Is there a pungent smell of urine ?
• How orine output of volume, color ( grayish ) and the concentration of urine ?
• Is there a suprapubic pain - usually on lower urinary tract infection ?
• Are there any pelvic pain or waist - usually the upper urinary tract infection ?
• Increased body temperature is usually in the upper urinary tract infections.

5. Psychological assessment of patients :
How feelings toward patients and treatment outcome measures that have been done ?
Is there any sense of shame or fear of recurrence of the disease.


Nursing Diagnosis of Urinary Tract Infection

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

2. Altered Urinary Elimination related to mechanical obstruction of the bladder or other urinary tract structures.

3. Deficient Knowledge: about condition, prognosis, and treatment needs related to lack of resources.

Pathophysiology of Herniated Nucleus Pulposus

Herniated intervertebral disc in all directions can occur due to trauma or physical stress. Herniated into the superior or inferior direction, through the cartilage plate into the vertebral body named as "Schmorl nodules" (usually found incidentally on radiological or autopsy picture). Most herniation occurs in the posterolateral direction with respect to the following factors: the nucleus pulposus which tend to be located further away in the posterior and the posterior longitudinal ligament which tends to reinforce the annulus fibrosus in the middle of the posterior. This event is also known by various other names such as rupture of the annulus fibrosus, Herniated Nucleus Pulposus, ruptured disc, pinched nerve and herniated discuc.

At first the nucleus pulposus, herniation occurs through a concentric ring the annulus fibrosus is torn, and causing another rings on the outside of a local stand still intact (Focal). Such a situation is called as Protusio Discus. If the process continues, the material nuclei will then slip out of the disc to the anterior ligament longitudinal posterior (disc herniation free fragment).

Usually protusio extraction posterolateral disc will hit the ipsilateral nerve root at the exit of nerves bag deva (eg disc herniation of L4 - L5 left will clamp the left L5 nerve root). Pinching the nerves will show symptoms and signs in accordance with the distribution redikuler innervation. Significant central disc herniation may involve some element of Cauda Equina on both sides, so that the display radiculopatia bilateral or even sphincter disorders such as urinary retention.

Discus hernia classification depends on the location of the affected is L5, pain that occurs in the sacroiliac joint, hip, lateral thigh and calf, medial leg (pain that radiates down the leg from the pelvis and is called Ishalgia)
Foot drop can lead to weakness and damage done dorsiflexion of the foot and toes or difficulty walking on heels, parastenia occurs in the distal lateral leg and foot middle toe between thumb. Atrophy is not clear, reflexes are usually not real, knee or ankle reflexes may be lost.

Clinical Manifestation of Systemic Lupus Erythematosus (SLE)

Course of the disease Systemic Lupus Erythematosus (SLE) is highly variable. The disease can arise suddenly accompanied by signs exposed to various systems in the body. Can also be chronic with symptoms in a system that gradually followed by symptoms that affected the immune system. In the chronic type there are remissions and exacerbations. Remission may last for years.

Onset of the disease can be spontaneous or preceded by precipitation factors such as sun exposure, viral infections / bacterial remedy. Each attack is usually accompanied by a clear common symptoms such as fever, poor appetite, weakness, weight loss, and irritability. The most prominent is fever, sometimes with chills.



Musculoskeletal symptoms

The most common symptom of SLE is; musculoskeletal symptoms, such as arthritis (93%). The most commonly affected are the proximal interphalangeal joints followed by knee, wrist, metacarpophalangeal, elbow and ankle. Besides swelling and pain may also include joint effusion. Arthritis is usually symmetrical, without causing deformity, contractures or ankylosis. Sometimes there are rheumatoid nodules. Vascular necrosis can occur in various places, and was found in patients receiving treatment with high-dose streroid. The most commonly affected is the femoral head.


Mucocutaneous symptoms

Abnormalities of the skin, hair or mucous membrane was found in 85% of cases of SLE. Skin lesions are most commonly found in SLE is ; skin lesions of acute, subacute, discoid, and reticular livido .
Skin rash butterfly-shaped form rather edamatus erythema on the nose and cheeks. With proper treatment, this disorder can be healed without scarring. On the part of the body exposed to the sun can skin rash that occurs due to hypersensitivity. These lesions include acute skin lesions. Skin lesions typical subacute annular shaped.

Discoid lesions progressed through three stages: erythema, hyperkeratosis and atrophy . Usually presents as erythematous patches of elevated, covered by keratin scales with the blockage of the follicle. If it lasts longer be shaped silikatriks.
Vasculitis can cause ulceration of the skin in the form of small to large. Often also seemed bleeding and periungual erythema. Reticular Livido a mild form of vasculitis, it is often found in SLE.


Kidney

Renal insufficiency was found in 68% of cases of SLE. The most frequent manifestation is proteinuria or hematuria. Hypertension, renal failure nephrotic syndrome is rare, only found in 25% of cases of SLE urine showed abnormalities.
There are 2 kinds of pathological abnormalities in the kidneys, which diffuse lupus nephritis, and membranous lupus nephritis. Lupus nephritis is the most severe disorder. Usually appear clinically as nephrotic syndrome, hypertension and impaired renal function with moderate to severe. Membranous lupus nephritis are less common. Marked with nephrotic syndrome, impaired renal function and mild course of the disease may be rapid or slow but progressive.
Other renal abnormalities that may be found in SLE is chronic pyelonephritis, renal tuberculosis. Kidney failure is one cause of death chronic SLE.


Central Nervous

Disorders of central nervous system consists of two main abnormalities organic psychosis and convulsions.
Organic brain disease is usually found in conjunction with active SLE symptoms in others systems. Patients showing symptoms of hallucinations in addition to the typical symptoms of organic brain as difficult to calculate and could not recall the pictures ever seen.
Steroid psychosis also include organic brain syndrome which is clinically indistinguishable from lupus psychosis. The difference between the two can only be known by lowering or raising the dose of steroids used. Lupus psychosis improved if the steroid dose is increased and vice versa.
Seizures arising grandmal type normally included. Other abnormalities that may be found is aphasia, hemiplegia.


Eye

Eye disorders may include conjunctivitis, sub - conjunctival hemorrhage and the body sitoid in the retina.


Heart

Inflammation of various parts of the heart can occur, such as pericarditis, endocarditis and myocarditis. Chest pain and arrhythmia may occur as a result of these circumstances.


Lungs

Can occur in lupus pleurisy (inflammation of the lining of the lungs) and pleural effusion (accumulation of fluid between the lung and the wrapper). As a result of these events often arise chest pain and shortness of breath.

Gastrointestinal tract

Abdominal pain present in 25 % of cases of SLE , may be accompanied by nausea and diarrhea. Symptoms disappear quickly if systemic disorders receive adequate treatment. Pain that may arise due to the sterile peritonitis or arteritis of small blood vessels that lead to bowel mesentery and intestinal ulceration. Arteritis can also cause pancreatitis.


Hemic - Lymphatic

Lymph nodes are commonly affected are the axillary and cervical, with the characteristics of non-tender and soft. Splenomegaly other lymphoid organs is usually accompanied by an enlarged heart. Lien in the form of myocardial damage or thrombosis associated with lupus anticoagulant. Anemia can be found in the period of disease progression LES, which is mediated by the immune and non-immune.

Decreased Cardiac Output - Ventricular Septal Defect Care Plan

Ventricular Septal Defect

A ventricular septal defect (VSD) is a defect in the ventricular septum, the wall dividing the left and right ventricles of the heart.

A ventricular septal defect happens during pregnancy if the wall that forms between the two ventricles does not fully develop, leaving a hole. A ventricular septal defect is one type of congenital heart defect. Congenital means present at birth.

Decreased Cardiac output Definition

Inadequate blood pumped by the heart to meet metabolic demands of the body



Nursing Diagnosis : Decreased cardiac Output related to cardiac malformations.

Goal:

• Decreased cardiac output does not occur

Interventions:

1. Observation quality and strength of heart rate, peripheral pulses, skin color and warmth
2. Enforce the degree of cyanosis (eg, mucous membrane color degrees of finger)
3. Give digitalis medications appropriate order.
4. Give diuretic medications appropriate order.

Rationale:

1. Provide data for the evaluation of interventions and enable early detection of complications.
2. Determine the development of the client's condition and determine appropriate interventions.
3. Digitalis drugs that strengthen the heart muscle contractility increases cardiac output / clients at least able to adapt to the situation.
4. Reduce excess fluid in the body pile so the heart will be lighter.

NANDA Decreased Cardiac Output

Acute Pain - Nursing Care Plan for Hypertensive Heart Disease

Hypertensive Heart Disease

Hypertensive heart disease includes a number of complications of systemic arterial hypertension or high blood pressure that affect the heart.

Symptoms of heart failure include:

• Shortness of breath
• Swelling in the feet, ankles, or abdomen
• Difficulty sleeping flat in bed
• Bloating
• Irregular pulse
• Nausea
• Fatigue
• Greater need to urinate at night

Symptoms of ischemic heart disease may include:

• Chest pain which may radiate (travel) to the arms, back, neck, or jaw
• Chest pain with nausea, sweating, shortness of breath, and dizziness; these associated symptoms may also occur without chest pain
• Irregular pulse
• Fatigue and weakness

Acute Pain Definition

Pain is whatever the experiencing person says it is, existing whenever the person says it does (McCaffery, 1968); an unpleasant sensory and emotional experience arising from actual or potential tissue damage or described in terms of such damage (International Association for the Study of Pain) sudden or slow onset of any intensity from mild to severe with an anticipated or predictable end and a duration of  less than 6 months.



Nursing Care Plan for Hypertensive Heart Disease

Acute Pain (headache) related to increased cerebral vascular pressure.


Goal :

• Client reported pain / discomfort disappeared / controlled .

Interventions and Rationale :

1. Maintain bed rest during the acute phase.

2. Give non-pharmacological measures to eliminate headaches eg, a cold compress on the forehead, back and neck massage, quiet, dim the room lights room lights, relaxation techniques (manual imagination, disktraksi) and leisure time activities.

3. Eliminate / minimize vasoconstriction activity that can increase headache eg, straining during defecation, coughing and bending length.

4. Assist patients in ambulation as needed.

5. Give liquids, soft foods, regular oral care in the event of bleeding nose or nasal pack has been done to stop the bleeding.

Rationale:

1. Minimize stimulation / promote relaxation.

2. Actions that reduce cerebral vascular pressure and the slow / block sympathetic response is effective in relieving headaches and complications.

3. Activities that increase vasoconstriction causing headaches in an increase in cerebral vascular pressure.

4. Dizziness and blurred vision often associated with pain kepala.pasien can also experience episodes of postural hypotension.

5. Increase the general comfort, compress the nose can interfere with swallowing or breathing requires mouth, causing stagnation oral secretions and mucous membranes dry out.

Physical Examination for Congestive Heart Failure (CHF)

Nursing Care Plan for Congestive Heart Failure - CHF

Benefits, Role and Function of Nurse Home Care

Benefits of Nursing Home Care

1. For Clients and Families:

• Program Home Care (HC) can help offset the cost of hospitalization is more expensive, because it can reduce the cost of patient accommodation, transportation and consumption of the family.
• Strengthen family ties, because it can always close when a family member is ill.
• Feel more comfortable being home alone.
• The number of women working outside the home, so the task of caring for the sick mother who is usually done because it is hampered by the presence of a nurse to replace it.

2. For Nurses:

• Provide variety of work environments, so it is not saturated with the environment remains the same.
• Get to know the client and their environment well, so that health education is given in accordance with the client's situation and condition of the house, so the nurse job satisfaction will increase.
• Data and interests of patients.

3. For the Hospital:

• Making the hospital became more famous with the home care service does.
• To evaluate the terms of the service that has been done.
• To promote the hospital to the community.

Role and Function of Nurse Home Care

1. Case manager: manage and collaborate on services, with the function:

• Identifying the needs of patients and families.
• Service plan.
• Coordinate team activities.
• Monitor the quality of service.

2. Executing: provide direct care and services to evaluate the function:

• Conduct a comprehensive assessment.
• Nursing plan.
• Nursing action.
• Observe the patient's condition.
• Assist patients in developing effective coping behavior.
• Involving the family in the service.
• Guiding all members of the family in health care.
• To evaluate the nursing care.
• Documenting nursing care.

Principles of Nursing Home Care

Home care services in order to run smoothly, it is worth noting some of the principles in the service of home care.

Home health care nursing services are provided to patients in the home, which is a synthesis of community nursing services and specific technical skills that come from a particular medical specialty, the individual-focused nursing care to involve the family, with the aim of curing, maintain and improve health physical, mental / emotional patient.

Principles of Home Care, include:

1. Management carried out by the home care nurse.
2. Implementing Home Care is comprised of the existing health professions (doctors, midwives, nurses, dietitians, pharmacists, sanitarian and other professional personnel).
3. Apply the concept as a basis in the decision-making practices.
4. Collect data systematically, accurately and Comprehensive.
5. Using data from assessment and examination results in establishing the diagnosis.
6. Develop a nursing plan based on needs.
7. Provide complete service consisting of preventive, curative, promotive and rehabilitaif.
8. Evaluate the response of patients and their families in nursing interventions, medical and others.
9. Responsible for quality services through management.
10. Maintain and ensure good relationships between team members.
11. Developing a professional capacity.
12. Participate in research activities for the development of home care.
13. Using the code of professional conduct in performing services in home care.

Physical Examination (Head to Toe)

1. Hair and Head

• Inspection: black hair, brown, blonde, smelling.
• Palpation: Easy to fall, scalp dirty, smelly generally indicates the level of a person's hygiene.

2. Skin hydration forehead area

• Palpation: Pressing your thumb on the forehead skin, because they have the basic bones. Dehydration can be found on the "finger print" on the skin of the forehead.

3. Palpebrae

• Inspection: Can be visible buildup of fluid or edema in the palpebrae, but it may also appear sunken in dehydrated patients.
• Palpation: With the touch by using three fingers on palpebrae to sense whether there is a buildup of fluid, or patient dehydration when palpable concave.

4. Sclera and Conjungtiva

• Icterus sclera appear more clearly than in the skin. Check the sclera with palpation technique using both fingers pull palpebrae, the patient looked down inflammation in conjungtiva bulbi, or conjungtiva palpebrae. Anemic state can be checked on pale colors conjungtiva inferior palpebrae.

5. Intra Ocular Pressure

• With two index fingers, check to compare IOP ball left and right eye by changing the pressure in the eyeball with closed eyelids general awareness of glaucoma on patients aged more than 40 years.

6. Nose

• Inspection: Nose symmetrical, the cavity examined whether there is dirt nose, polyps or swelling.

7. Hygiene of the oral cavity, teeth, tongue, tonsils and pharynk

• Oral cavity: bad breath examined, mocosa inflammation (stomatitis), and the aphtae.
• Dental examination: checked the food, tartar, caries, root rest, missing teeth, bleeding, abscess, foreign body, (false teeth), the state of the gums, inflamed.
• Tongue: dirty / coated, will be found in the state: the lack of oral hygiene, typhoid fever, do not like to eat, coma patients, note the type hipertemik tongue that can be encountered in patients typoid fever.
• Tonsils: measured.
• Tonsils examined whether there is swelling or not.
• Pharinx: back wall oro pharynx examined for inflammation, enlarged adenoids, and lenders / secret that there

8. Cervical lymph nodes

• Enlarged lymph nodes can occur due to infection, toxoplasmosis infection provide symptomatic enlarged neck lymph.

9. Thyroid gland

• Inspection : shape and size when enlargement was real.
• Palpation : one hand or two hands on the side of the back, fingers touching the surface of the gland and the patient is asked to swallow feel if there is any swelling of the surrounding tissues.

10 . Abdomen

• Inspection : the inspection needs to be listened to if abdomen swollen / bulging or flat, edges or protruding belly , protruding umbilicus or not , whether there is a shadow venous observe , observe whether the abdominal area looks lumps of mass . Report form and the positioning.
• Auscultation : bowel peristaltic hear , normal range 5-35 times per minute : peristaltic sounds were loud and long called borborygmi , found in gastroenteritis or intestinal obstruction in the early stages . Reduced peristaltic encountered in paralytic ileus . If after 5 minutes there was no sound peristaltic , at all , then we say peristaltic negative ( in patients post- surgery ).
• Palpation : palpate prior to first ask the patient whether the pain area if there is then it should be palpated last , general palpation of the entire abdominal wall to see if there are common pain ( peritonitis , pancreatitis ) . Then look for the presence or absence of palpability mass / lump ( tumor ) . Check also turgor Kullit stomach to assess patient hydration . After that check the pressure region suprapubika ( cystitis ) , Burney MC point ( appendicitis ) , region epigastrica ( gastritis ) , and region iliaca ( adnexitis ) then in particular we palpate the liver. Palpation of the liver is done with the right hand and fingers , starting from the bottom right kuadrant , gradually rising to the rhythm of the breath . Feel for any enlargement of the liver or not .

11. Anus

• Position the patient lying on her side with knees bent stick to the stomach / chest
• Examined the :

• Hemhoroid externa
• Fisurra
• Fistula
• Signs of malignancy

Clinical Manifestations of Tuberculosis

Tuberculosis is often called "the great imitator" is a disease that has many similarities with other diseases are also common symptoms such as weakness and fever. In some patients the symptoms are not clear so overlooked sometimes even asymptomatic.

Clinical Manifestations of pulmonary tuberculosis can be divided into 2 groups, symptoms of respiratory and systemic symptoms:

1. Respiratory symptoms, including:

a. Cough
Most cough symptoms arise early and is a disorder that most often complained. At first is non-productive, then phlegm, even mixed with blood, when there is tissue damage.

b. Coughing up blood
Blood in the sputum varied issued, may appear in the form of lines or patches of sputum, or blood clots in the amount of fresh blood very much. Coughing up blood occurs due to rupture of blood vessels. Severity of coughing up blood depends on the size of a ruptured blood vessel.

c. Shortness of breath
These symptoms are found when the damage is extensive lung parenchyma or because there are things that accompany such as pleural effusion, pneumothorax, anemia and others.

d. Chest pain
Chest pain in pulmonary TB include pleuritic pain is mild. These symptoms occur when the neural systems in the pleural exposed.

2. Systemic symptoms, include:

a. Fever
Is a common symptom that usually occur in the afternoon and evening influenza like fever, and intermittent attacks grew longer being free period shorter attack.

b. Other systemic symptoms
Other systemic symptoms are night sweats, anorexia, weight loss and malaise.
Gradual onset of symptoms is usually within a few weeks and months, but with the appearance of acute cough, heat, shortness of breath although rare can also arise resemble symptoms of pneumonia.

We must make sure that the bleeding from the nasopharynx by way of distinguishing characteristics as follows:
1. Coughing up blood

• Coughed blood with a burning sensation in the throat.
• Frothy blood mixed with air.
• Pink fresh blood.
• Blood is alkaline.
• Anemia is sometimes the case.
• Benzidine test negative.

2. Vomiting blood

• Blood spewed by nausea.
• Blood mixed with leftovers.
• Black blood, because stomach acid mixed.
• Blood is acidic.
• Anemia often occurs.
• Benzidine test positive.

3. Epistaxis

• Blood dripped from his nose.
• Cough out slowly sometimes.
• Fresh red blood.
• Blood is alkaline.
• Anemia is rare.

Impaired Physical Mobility - NCP for Guillain-Barre Syndrome

Nursing Care Plan for Guillain-Barre Syndrome

Guillain-Barre syndrome or GBS is a severe inflammatory disorder of the peripheral nerves.

Guillain-Barre Syndrome is an inflammatory disorder in which the body's immune system attacks the nerves, causing severe weakness and numbness and eventually leading to muscular paralysis.

The symptoms of Guillain-Barre syndrome are lack of feeling, weakness or itchiness in arms or legs, and possible loss of feeling and movement in the upper body, face, arms and legs. The symptoms can remain in this phase and can cause little difficulty in walking. However, in some cases the illness can progress resulting in entire paralysis of arms and legs.

Nursing Diagnosis: Impaired Physical Mobility related to neuromuscular damage

Goals:
To maintain the position of function with no complications (contractures, pressure sores).

Outcomes:
Clients can improve the strength and function of the affected part

Nursing Interventions and Rationale:
1. Assess motor strength / functional ability by using a scale of 0-5.
R / Define the development / re-emergence of signs that hinder the achievement of goals / expectations of the patient.

2. Give the patient a position that causes a sense of comfort. Make changes to the position on a regular schedule as needed on an individual basis.
R / Reduce fatigue, increase relaxation. Reduce the risk of ischemia / damage to the skin.

3. Chock extremities and joints with a pillow.
R / Maintain extremity in a physiological position, prevent contractures.

4. Perform passive range of motion exercises. Avoid active exercise during the acute phase.
R / Stimulates circulation, improve muscle tone and increase joint mobilization.

5. Coordinate care provided and the period of uninterrupted rest.
R / Excessive use of muscles can increase the time it takes to remielinisasi, arena may extend the time for healing.

6. Encourage you to do the exercise that continues to be developed and depend on individual tolerance.
R / exercise activities in the affected areas gradually improved / fixed, improve organ function normally and have a positive psychological effect

7. Give lubrication / oil artificially within their needs.
R / Prevent from drying the client's body.

Collaboration

1. Confirm with / refer gets physical therapy / occupational therapy.
R / Helpful in creating individual muscle strength / exercise conditioned and running training programs and identify tools to maintain the mobilization and independence in performing daily activities.

Disturbed Body Image - Nursing Care Plan for Brain Tumor

A brain tumor is an intracranial solid neoplasm, a tumor within the brain or the central spinal canal.

The most common primary brain tumors are:

• Gliomas (50.4%)
• Meningiomas (20.8%)
• Pituitary adenomas (15%)
• Nerve sheath tumors (8%)

The most frequent symptoms of brain tumors include:

• Headaches that tend to be worse in the morning and ease during the day
• Seizures or convulsions
• Nausea or vomiting
• Weakness or loss of feeling in the arms or legs
• Stumbling or lack of coordination in walking
• Abnormal eye movements or changes in vision
• Drowsiness
• Changes in personality or memory
• Changes in speech

Nursing Care Plan for Brain Tumor

Nursing Diagnosis : Disturbed Body Image related to hair loss, and changes in the structure and function of the body.

Goal:

• Patients express a positive self-image with the criteria of patients receiving changes to body image.

Interventions:

1. Assess the patient's reaction to body changes.
2. Observation of patient social interaction.
3. Maintain a therapeutic relationship with the patient.
4. Instruct the patient to open communication with health care or other important person.
5. Help patients find effective coping about body image.

Rational:

1. Determine the patient's reaction to changes in body image.
2. Social withdrawal may occur due to rejection.
3. Facilitate a therapeutic relationship that is open.
4. Expression of fears openly to reduce anxiety.
5. Help patients find coping strategies that can reduce anxiety and fear.

Risk for Injury - Multiple Sclerosis Care Plan

Multiple Sclerosis (MS) is a progressive and chronic disease that attacks the central nervous system.

More than 2.5 million people around the world are said to be affected by multiple sclerosis. Disease onset is usually seen more in young adults, and it is more common in women. Almost 98% of the MS population is Caucasian. MS is generally more common in people living in temperate zones.

MS can be difficult to diagnose since its signs and symptoms may be similar to other conditions. A number of specialized tests may be necessary for accurate diagnosis. Medical organizations have set diagnostic criteria to standardize the process. Currently diagnosis is based on The McDonald criteria which focus on a demonstration with clinical, laboratory and radiological data.

Nursing Diagnosis for Multiple Sclerosis : Risk for Injury
related to :

• sensory impairment and vision,
• effects of prolonged bed rest and spastic weakness.

Goal :
Risk for Injury did not occur

Outcomes:

1. Clients want to participate to the prevention of trauma.
2. Decubitus : no.
3. Joint contractures : no.
4. Clients do not fall out of bed.

Intervention and Rational :
1. Maintain bed rest and immobilization as indicated.
Rational : Minimize the pain caused by stimulation of grit between the bone fragments with the surrounding soft tissue.

2. Give goggles that fit with the client.
Rational : Eye shields or goggles cover implus can be used to block vision in one eye when a client is experiencing diplopia or double vision.

3. Minimize the effects of immobility.
Rational: Because physical activity and immobilization often occur in multiple sclerosis, the complications which connect with immobilization and rare covers to prevent pressure sores.

4. Modification of injury prevention.
Rational: Injury prevention is done on the client if the motor dysfunction of multiple sclerosis causes no problems in coordination and any stiffness or if there's ataxia, the risk of falling.

5. Environmental modifications.
Rational: the inability to cope, to encourage clients with empty legs on a vast space to provide a broad base and to improve the ability to walk steadily.

6. Teach walking technique.
Rational: if the loss of sensation to the body position, encourage clients to see the foot while walking.

7. Provide occupational therapy.
Rational: Occupational therapy is a resource that helps individuals to provide advice and assistance to ensure increased independence.

8. Minimize the risk of decubitus.
Rational: Because of sensory loss can lead to increased loss of motoric move. Continue to be addressed to inegritas decubitus skin. Wheelchair use increases the risk.

9. Distal section of skin inspection, every day (monitor skin and mucous membranes to irritation, redness, or blisters).
Rational : early detection of circulatory disorders and loss of sensation of the high risk of damage to skin integrity possible complications of immobilization.

10. Minimize spasticity and contractures .
Rational : Muscle spasticity is common and occurs at an advanced stage , which is visible in the form of heavy addukor on hips, with a spasm of the hip and knee flexors.

11. Teach exercise techniques.
Rational: Exercise every day to strengthen the muscles supplied to minimize joint contractures. Special attention is given to the thigh muscles, the gastrocnemius muscle, adductor, biceps and wrists, and fingers flexors.

12. Maintain a 90-degree joints of the foot board.
Rational: The soles of the feet in position 90 degrees to prevent footdrop.

13. Evaluation of signs / symptoms of the expansion of tissue injury (inflammation of local / systemic, just as increased pain, edema and fever).
Rational: Assessing the development of the client's problem.

Fluid Volume Deficit related to Diabetic Ketoacidosis Care Plan

Diabetic ketoacidosis is a complication of diabetes. It is a result of relative insulin deficiency and is a rare feature of acromegaly, in which the chemical balance of the body becomes far too acidic, and starts a dangerous condition in which the body starts to break down fats for fuel because it has no insulin to allow it to use glucose.

Diabetic Ketoacidosis is unclear or arbitrary, when the case is severe, you may have difficulty breathing, your brain may swell (cerebral edema), and there is a risk of coma, the loss of life due to diabetic ketoacidosis is distinctly linked to the delay in the institution of the appropriate therapy in a hospital setting.

Outward signs and symptoms of DKA include the following; eyeballs are soft and appear sunken, skin turgor is poor, the person is very pale, cold, clammy, and exhibits deep rapid respirations, an effort the body makes to eliminate excess carbon dioxide.


Nursing Care Plan for Diabetic Ketoacidosis

Nursing Diagnosis : Fluid volume deficit related to excessive secretion of fluid ( osmotic diuresis ) due to hyperglycemia.

Outcomes:

• Vital signs within normal limits
• Peripheral pulse can be palpated
• Skin turgor and capillary refill good
• Balance urine output
• Normal electrolyte levels
• Blood sugar while : normal

Iintervention:
1. Observation intake and output of fluids every hour.
2. Observation smooth infusion.
3. Monitor vital signs and level of consciousness every 15 minutes, if stable continue for every hour.
4. Observation of skin turgor, mucous membranes, acral, capillary refill.
5. Monitor results of laboratory tests:

• Hematocrit
• BUN / Creatinine
• Blood osmolarity
• Sodium
• Potassium

6. EKG Monitor
7. CVP monitoring (when used)
8. Collaboration with other health team:

• Provision of parenteral fluids
• Provision of insulin therapy
• Installation of a urine catheter
• Installation of CVP if possible

Effect of Influenza During Pregnancy

INFLUENZA is a disease caused by a viral infection. Group of viruses that cause influenza are the types of RNA viruses of the family Orthomyxoviridae that often affects poultry and humans. Chills, fever, sore throat, muscle aches, headache, cough, fatigue / weakness are common symptoms of influenza. Influenza is often considered a mild illness that resolves itself, so handling is often times overlooked. What if this happens influenza in pregnant women? whether the effects on pregnancy and the fetus?

Influenza vaccination during pregnancy has been shown to reduce the risk of influenza and its complications during pregnancy until the baby is 6 months old. To assess the potential benefits and risks associated with the use of influenza vaccine this it is necessary to inspect / test the risk of influenza and its complications that occur during pregnancy and the baby will be born. Pregnant women have an increased risk of morbidity and mortality were higher during epidemics and pandemic influenza. Newborns of mothers who suffer from influenza during pregnancy, especially in severe influenza potentially adverse experience things such as premature births and low birth weights. 6 month old baby infected with influenza virus have hospital level of care and higher mortality than other babies who are not infected with influenza virus.

Decision influenza vaccine use during pregnancy should be strictly based on the ratio of benefits and disadvantages. To fully understand the benefits of this vaccine then we should know the complications associated with influenza virus infection is both the mother and the fetus. Also based on the results of randomized trials showed that influenza vaccination also protects infants from influenza attack up to the age of 6 months.

Based on the data of pandemic and seasonal influenza epidemics, pregnant women who catch influenza will be more likely to experience severe complications related to influenza are compared with the community at large. During pregnancy, physiological and immunological changes affect the respiratory system, the cardiovascular system and other organs so that a pregnant woman is at risk for complications of infection is greater. Pregnant woman's immune system will adapt to tolerate the presence of foreign genes fetus. How the adaptation mechanism is unknown, but it seems humoral immunity plays an important role in this regard. The immunologic adaptation increases the risk of complications associated with certain infections, including infections caused by influenza virus.

Latest facts about pandemic influenza A (H1N1)-pdm09 (2009 H1N1) provide evidence that pregnant women are at high risk for severe influenza complications. Data pregnant women compared with women of childbearing age who are not pregnant or the general population, showed that pregnant women are at risk of requiring inpatient care are higher even with intensive care and can result in mortality associated with the 2009 H1N1. The first month of data since the emergence of the 2009 H1N1 in the United States showed that pregnant women are at risk 4 times greater require hospital treatment.

Source : http://ruangdiskusiapoteker.blogspot.com/2012/08/pengaruh-influenza-pada-wanita-hamil.html

How to Naturally Eliminate Nausea During Pregnancy

Nausea during pregnancy is common especially your early pregnancy. Nausea or morning sickness known often found in pregnant women. Although this nausea is common but can be extraordinary / extreme if the intensity is high and very disturbing you. Especially for those who are still actively working, of course, is very disturbing activities. Nausea or morning sickness does not only happen in the morning but throughout the day, usually in the first 3 months. Even so, not all pregnant women experience nausea excessive, there is also the usual and did not experience nausea in the first 3 months. Fortunately, if you do not experience nausea during pregnancy because of pregnancy onwards also do not experience nausea.

Although there are some women do not experience nausea, but most women will experience nausea during pregnancy. What are the causes of nausea during pregnancy ? The nausea could be caused by the following factors :

1. Increased progesterone
Increased progesterone can cause digestive problems pregnant women. So that your metabolism is not so good. Good digestion metabolism can cause nausea and vomiting.

2. Food
Food can also be a cause of nausea and vomiting during pregnancy. Oily and spicy foods can cause nausea and vomiting.

3. Sensitivity of smell and taste
In the times of the first 3 months of pregnancy pregnant women usually have a higher level of sensitivity to smell and taste. Usually a very sharp odor can cause nausea to vomiting.

Nausea or morning sickness is normal and can actually be reduced, provided that the pregnant woman who has had to try to relieve the nausea. The nausea that comes often lead us lazy eating and can damage the health of the baby. Therefore, pregnant women need to know how to naturally eliminate nausea during pregnancy that can still maintain the health of mothers and infants, among others:

1 . Pregnant milk consumption
Today many pregnant dairy products on offer . It helps pregnant women , pregnant dairy consumption , to reduce nausea . The content of vitamin B 16 may reduce nausea .

2 . Balanced nutrition
During pregnancy , try to always adequate maternal nutrition and the baby . Eat vegetables and fruits are very good for the days of pregnancy .

3 . Aromatherapy
Aromatherapy can help pregnant women relieve nausea and vomiting . Choose aromatherapy as desired . Smell the aromatherapy can help relax and forget about the nausea .

4 . Adjust your diet
Pregnant women who experience nausea would be difficult to eat . This could be detrimental to the mother and baby in the womb . Pregnant women should adjust your diet . Consume a little bit is better than nothing at all .

5 . Rest
Adequate rest is highly recommended for pregnant women who experience nausea . In addition to rest, avoid stress which can also lead to nausea.

Those are some natural ways eliminate nausea during pregnancy that I can write in a health article this time . Hope it can help you through pregnancy , especially in a first pregnancy .

Nursing Diagnosis for Vomiting - Risk for Fluid Volume Deficit

Vomiting is defined as the discharge of the contents of the stomach up into the mouth by force. Vomiting can be an attempt removing toxins from the gastrointestinal tract such as diarrhea, lower gastrointestinal tract.

Vomiting can be caused by many things such as the following:

• Congenital abnormalities
• Infection of the digestive tract
• Feeding the wrong way
• Poisoned

Complications of vomiting are as follows :

• Dehydration or alkalosis, due to loss of body fluid / electrolyte
• Ketosis from not eating and drinking
• Acidosis caused a sustained ketosis can be a shock even to seizures
• Abdominal muscle tension, conjunctival hemorrhage, esophageal rupture, aspirations, caused by severe vomiting.

Persistent vomiting can lead to complications of dehydration, electrolyte disturbances, rips Mallory Wiess, aspiration of gastric fluid.


Nursing Diagnosis for Vomiting

Risk for Fluid Volume Deficit related to the feeling of nausea and vomiting

Goal: Maintain the balance of fluid volume.

Outcomes: The client does not nausea and vomiting.

Intervention:
1. Monitor vital signs.
Rationale: An early indicator of hypovolemia.

2. Monitor intake and output and urine concentration.
Rationale: Decreased urine output and concentration will improve the sensitivity / sediment as one impression of dehydration and require increased fluids.

3. Give fluid little by little but often.
Rationale: To minimize the loss of fluids.

4. The risk of infection associated with an inadequate immune, characterized by: body temperature above normal. Increased respiratory rate.

10 Way to Maintain a Healthy Body

Maintain a healthy body is very important, because it will determine whether or not our bodies healthy.

If we do not maintain the health of our bodies, the body will automatically become unhealthy, and will allow disease to enter the body, and ultimately your home becomes ill purposes.

Each person must have longed for a healthy body both physical and spiritual.

But here we are going to talk because his physical.
So here I will share tips on maintaining a healthy body in order to stay in shape, so that the body will be more resistant to any disease.

Here are 10 Way to Maintain a Healthy Body :

1. Maintain a healthy body is the first with positive thinking, In a healthy body there is a calm mind and healthy too. So try to always think positive to all the problems that hit us.

2. Tired after a long day is one of the causes of your immune deficiencies. So the rest of your body is a very appropriate step to eliminate the tiredness.

3. Adequate rest every day, is one of the factors to keep your immune system. In this case sufficient and quality sleep.

4. Every morning, try to always do regular exercise. It aims to maintain the condition of the body to keep it fit and healthy.

5. Fill fibrous foods every day. Fibrous foods are apples, carrots and nuts. This is the function of fiber foods keep the body from bacteria.

6. Always make sure that the food you eat is already in hygienic or clean or wash with thoroughly cooked perfect.

7. Eat reasonable portions do not overdo it. In fear of your body will be obese and at risk of disease associated with overweight or obesity.

8. Meet the needs of vitamin D. vitamin D because it serves to stimulate immune cells to ward off viruses and bacteria. Vitamin D can be found in sunlight, eggs, liver and fish.

9. Meet the needs of fluid required in the body. In this case the water is healthy. Eight glasses of water per day is the amount that must be fulfilled to meet the needs of the fluid in our body.

10. Smiling is a way of maintaining a healthy body most easily. This is because, with a smile so we can improve your immune system.

Nursing Care Plan for Migraine

Migraine is a complex of symptoms that have characteristics at the time of a severe headache attacks repeatedly.

Obvious cause of migraines is unknown, but it may lead to a primary vascular disorder that usually occurs in women, and many have a strong tendency in the family. Migraines are also caused by the occurrence of a combination of vasodilation (widening of blood vessels) and the release of a chemical substance from nerve fibers that surrounds the blood vessels. When a migraine attack, the temporal artery (the artery that runs around the temple) will be widened. The widening will cause stretching of the nerve fibers around arteries thus stimulating these nerve fibers to release chemicals. This substance will cause inflammation, headaches and feeling incredible.

Signs and symptoms of migraine on the result of cerebral cortical ischemia varying degrees. Typical attack starts with a scalp artery vasoconstriction and retinal blood vessels and cerebral. Extracranial and intracranial blood vessels dilated, which causes pain and discomfort. Studies suggest that arterial dilatation, causing hyperpermeable, and that sterilize local inflammation, which causes pain in surrounding areas and arterial dilatation. The state aims to enable existing substances in the blood vessels that participated in cleaning the inflammatory reaction.

Migraine attacks in general will activate the sympathetic nerves. The meaning of the sympathetic nerve is the nerve that is part of the human nervous system is responsible for controlling the body's response to stress and pain. Increased sympathetic nervous activity in the intestine causes nausea, vomiting and diarrhea. Sympathetic activity will also lead to slow gastric emptying resulting in drug delivery to the small intestine to be absorbed will also be hampered. Barriers to drug absorption that is the problem for people with migraine when administered orally administered drug. Increased sympathetic activity also decreases the flow of blood so that the skin will appear pale and cold. Increased neural activity will also lead to increased sensitivity to light and sound.

Migraine is a chronic condition. Most of the migraine attacks are also accompanied with another headache. Migraine headache is often described as a severe headache, throbbing and attacking head on one side. Some pain is felt in the forehead, around the eyes and behind the head so obscure symptoms with another headache. Although most of the migraine attack on one side of the head, but often also found symptoms of migraine headaches on both sides of the head. Side of the head migraines too often turns on every time attack. Be careful when the affected side of the head is always the same, another possibility is the occurrence of a brain tumor. Patients with migraine often tormented in performing daily activities, especially when the attack occurred. Other accompanying symptoms of migraine include, nausea, vomiting, diarrhea, facial pallor, cold hands feet, and the patient will be sensitive to light and sound. Due to an increased sensitivity to light and sound then migraine sufferers had to lie in a quiet and dark room. Migraine attacks usually subside within 4 to 72 hours.

Nearly 70% had a family history of migraine. Most of the women. The first attack in the migraine usually starts during adolescence and young adulthood, and then tended to decrease at the age of 5 and 6 decades. Usually there is a triggering factor. Patients generally have a perfectionist personality, rigid, and impulsive.

The clinical features of migraine is usually a throbbing headache but unilateral and bilateral or switched sides. Migraine attacks typically 2-8 times per month, once the attack duration between 4-24 hours or may take longer, moderate-severe pain intensity, accompanying symptoms, among others,: nausea, vomiting, photophobia and / or phonophobia, pale face, vertigo , tinnitus, irritable.


Nursing Diagnosis for Migraine

1. Acute pain related to stress and tension, increased intracranial
characterized by: said pain, pale around the face, restless.

2. Imbalance nutrition less than body requirements related to inability of the input, digest, absorb, food, due to biological factors and psychological
characterized by : nausea, vomiting, weight loss, anorexia.

3. Disturbed Sleep Pattern related to headache
Characterized by: insomnia, face pale, limp.

4. Deficient Knowledge related to lack of exposure to information
characterized by: the improper conduct and excessive.

7 Easy Ways to Sharpen Your Memory

Has a genius brain is the dream of all people. Despite the fact that, just a few who have a brain like a genius physicist Albert Einstein and several other scientists. One characteristic of having a genius brain that can solve complex problems quickly and remember things better that the present and recall memories of the past.

Has a sharp memory recall is needed by everyone. We may feel upset, when put stuff somewhere and when needed, we forgot to put where. So have a good memory is needed in all conditions and circumstances. This time, health tips will address an article that may be very valuable to the reader. Here's Tips to sharpen your brain memory:

1. On the sidelines of your activities, try to perform brain exercises. Brain exercises can be done by giving a few questions that you must answer for yourself. Such as, mentions that there are 10 items in the kitchen, 10 items in the office or school room, or other questions.

2. Like the body, the brain needs nutrients or foods for better memory. Kinds of good food for the brain food that is nutritional or green vegetables (spinach and other green vegetables) and fish (in this case a salmon).

3. All organs except the brain we do not need water to support in order to optimize its performance. In this case, drinking enough water is very useful to sharpen your brain memory. Ideally we should drink water 8 glasses of water each day.

4. Try to rest your brain when it was working all day. Sleep is the most effective way to rest your brain and your mind. So that when you wake up , the brain is more fresh and able to work optimally in helping us day-to- day activities are in desperate need of work in addition to our physical brains. By rest or sleep can sharpen our brain memory.

5. For those of you who do activities that desperately need your brain memory. It's good, no rest your brain for a few minutes. In order for your brain to be fresh again remember things in your employment.

6. Filling the hidden words in a crossword puzzle is a very powerful way to train your brain to sharpen your memory.

7. Trying to remember the beautiful memories of the past is one of the tips to sharpen your brain memory. Such memories with your friends while at school or in college or other fond memories.

8. Keep your Exercise your body every morning. Because exercise is good for health and accelerate blood circulation in the body, including your brain. So it will be able to sharpen your brain memory

4 Easy Tips to Keep Your Brain Healthy

The brain is an organ that is vital for humans. With the brain, we can remember so wonderful childhood, remembering all the happy things in our lives or remember anything in our lives. Maintain brain health should be the first thing we did. Then, how to keep the brain in order to stay healthy.

Many ways that we can do to maintain a healthy brain. From simple way to way a bit difficult for us to do. Here are 4 tips to keep your brain health:

1. You should avoid smoking and taking drugs are prohibited. This is because, the two materials will damage the function of your brain. For those of you who are heavy smokers is difficult to leave the habit, you should reduce it slowly until you eliminate the smoking habit.

2. You should have enough rest or sleep every day. With enough rest or sleep, then when you wake up, your brain will feel more fresh and working optimally. So do not use your brain to think that heavy or light hold, rest your brain with enough time.

3. You have to meet nutritional needs for your brain. This can be done by consuming foods that are beneficial for your brain.

4. Try to avoid impact on your brain. With frequent collisions in our brain, then the brain functions will also be disrupted.

Nursing Care Plan for Laryngeal Cancer

Laryngeal Cancer often found in the elderly over 40 years. Most of the men. This may be related to smoking, working with wood powder dust, toxic chemicals or powders, heavy metal. How is it not certain by experts. Head and neck cancer caused 5.5% of all malignant disease. Especially laryngeal neoplasm 95% are squamous cell carcinomas. If the cancer is confined to the vocal cords (intrinsic) spread slowly. Poor vocal cords lymph vessels so there is no lymph node metastases direction. If the cancer involves the epiglottis (extrinsic) metastasis is more common. Supraglottic and subglottic tumors should be large enough, before the vocal cords leading to hoarseness. True vocal cord tumors occur earlier when the vocal cords are usually still be moved.

Is the earliest form of hoarseness, or chronic hoarseness, does not heal even though the patient is undergoing treatment at the glottis and subglottic area. Unlike hoarse voice laryngitis, is not accompanied by systemic symptoms such as fever. Discomfort in the throat, like there's something stuck. In the advanced phase can be accompanied by pain on swallowing or speaking. Shortness of breath occurs when the rhyme glottidis closed or nearly closed 80 % of tumor. Shortness of breath does not arise suddenly but slowly. Therefore, patients can adapt, so just feel claustrophobic when the tumor was large ( late treatment ). Stridor caused by airway obstruction. When you have found significant enlargement of the tumor already in the advanced stage. Even sometimes the tumor can be felt, causing swelling of the larynx.

When the larynx tumor extension to the pharynx conduct will arise symptoms of dysphagia, pain when swallowing and pain spreading towards the ear. If the case is found clearly above, especially with the raucous noise complaints over the two weeks of treatment are not cured, affects adults or elderly, the patient should be referred immediately.

Examination of the larynx with laryngeal glass, or laryngoscopy, direct can show clearly the tumor. Place tumors often arise, can be seen in the picture. Chest X-ray, bone scan, to identify possible metastases. Complete blood count, anemia can be stated that a common problem. Laryngograph can be done with contrast for examination of blood vessels and lymph vessels. Then larynx examined under general anesthesia and performed a biopsy on the tumor. Untreated cavities, should be repealed at the same time.

In the case of laryngeal carcinoma can be done with radiation treatment and removal of the larynx (laryngectomy). Treatment chosen based on the stage. Radiation is given in stages 1 and 4. The reason to have the advantage to maintain a normal voice, but rarely can cure the tumor is advanced, the more so if it is contained enlarged neck glands. Therefore radiotherapy should be used for patients with small lesions without enlarged neck glands. The ideal case is the tumor limited to one vocal cord, and is easily moved. Nine out of ten patients with such a condition can be cured by radiotherapy and can perfectly sound normal maintenance. Fixation of the vocal cords showed the spread has reached the muscle layer. If the tumor has not spread stricken supraglotticatau subglottic, these lesions can still be treated with radiotherapy, but with a worse prognosis.

Patients with tumors of the larynx which is accompanied by enlargement of the lymph nodes of the neck, the best treatment is a total laryngectomy and neck dissection radical gland. In this case enter stage 2 and 3. This is done on the type of supraglottic and subglottic tumors. In these patients the possibility of recovery is not so big, only one in three patients will recover completely. Laryngectomy classified into:

1. Partial laryngectomy. Removal of the tumor is confined to only one vocal cord and a temporary tracheotomy is done to maintain the airway. After recovering from the surgery the patient's voice will be hoarse.
2. Hemilaryngectomy or vertical. If there is a possibility of cancer including the right vocal cord, and one wrong. This section draws arytenoid cartilages and a half along the thyroid cartilage. Temporary tracheostomy performed and the patient's voice will be hoarse after surgery.
3. Supraglottic laryngectomy or horizontal. when the tumor
4. located on the epiglottis or vocal cords wrong, radical neck dissection and tracheotomies. Patient's voice remains intact or normal. Because the epiglottis raised the risk of aspiration due to increased food orally.
5. Total laryngectomy . Advanced cancer involving the majority of the larynx , requiring removal of the larynx, hihoid bone, cricoid cartilage tracheal rings from 0.2 to 3 , and liaison to the laryngeal muscles. Resulting in loss of voice and a hole ( stoma ) is a permanent tracheostomy. In this case there is no danger of aspiration of food orally, because the trachea is no longer associated with airway - digestion. An incision was made ​​dileher radical on this type of laryngectomy. This includes the removal of the lymphatic vessels, lymph nodes in the neck, the sternocleidomastoid muscle, internal jugular vein, spinal nerve asesorius, salifa submandibular gland and parotid gland fraction ( Sawyer , 1990) . Operations will make people unable to speak or speaking . But such cases can be overcome by teaching them to talk using the esophagus ( esophageal speech ), although the quality is not as good as when people speak the larynx organ . To practice speaking with oesophageal need the help of a speech community development .

Biography of Florence Nightingale "The Lady of the Lamp"

Florence Nightingale was born in Florence, Italy on May 12, 1820. During the Crimean War, she and a team of nurses improved the unsanitary conditions at a British base hospital, reducing the death count by two-thirds. Her writings sparked worldwide health care reform. In 1860 she established St. Thomas’ Hospital and the Nightingale Training School for Nurses. She died August 13, 1910, in London.

Florence’s father was William Shore Nightingale, a wealthy landowner who had inherited two estates—one at Lea Hurst, Derbyshire, and the other in Hampshire, Embley Park—when Florence was five years old. Florence was raised on the family estate at Lea Hurst, where her father provided her with a classical education, including studies in German, French and Italian.

While at Scutari, Nightingale had contracted "Crimean fever" and would never fully recover. By the time she was 38 years old, she was homebound and bedridden, and would be so for the remainder of her life. Fiercely determined, and dedicated as ever to improving health care and alleviating patients’ suffering, Nightingale continued her work from her bed.

Residing in Mayfair, she remained an authority and advocate of health care reform, interviewing politicians and welcoming distinguished visitors from her bed. In 1859, she published Notes on Hospitals, which focused on how to properly run civilian hospitals.

Throughout the U.S. Civil War, she was frequently consulted about how to best manage field hospitals. Nightingale also served as an authority on public sanitation issues in India for both the military and civilians, although she had never been to India herself.

In 1908, at the age of 88, she was conferred the merit of honor by King Edward. In May of 1910, she received a congratulatory message from King George on her 90th birthday.

In August 1910, Florence Nightingale fell ill, but seemed to recover and was reportedly in good spirits. A week later, on the evening of Friday, August 12, 1910, she developed an array of troubling symptoms. She died unexpectedly at 2 pm the following day, Saturday, August 13, at her home in London.

Characteristically, she had expressed the desire that her funeral be a quiet and modest affair, despite the public’s desire to honor Nightingale—who tirelessly devoted her life to preventing disease and ensuring safe and compassionate treatment for the poor and the suffering. Respecting her last wishes, her relatives turned down a national funeral. The "Lady with the Lamp" was laid to rest in a family plot at Westminster Abbey.

The Florence Nightingale Museum, which sits at the site of the original Nightingale Training School for Nurses, houses more than 2,000 artifacts commemorating the life and career of the "Angel of the Crimea." To this day, Florence Nightingale is broadly acknowledged and revered as the pioneer of modern nursing.

Biography courtesty of Bio.com

The Importance of Nursing Education

At the moment we are talking about the health care profession, we can not deny the importance of nurses. Medical science has made significant progress and there are significant advances in nursing education, so now things have changed because of necessity. Now there are doctors, medical assistants help doctors, then there is a registered nurse who examined each of the characteristics associated with patient care. Then we have licensed practical nurses who perform duties ordered by registered nurses and certified nursing assistants also supervise that helps patients in hygiene, eating and checking vital signs.

When talking about nursing education because of different responsibilities as well as education. The certified nursing assistants are trained to work in hospitals and can also visit patients to their homes. They will take care of people with long-term illness, physical disabilities, children with mental weakness, senior citizens and people recover. A certified nursing assistant job is to give them mental support and assist them with cleaning, bathing, changing clothes, and also cooking (while following the prescribed diet). A certified nursing assistant is responsible for taking prescriptions for patients with stroke, with a physical disability and when necessary.

The licensed Practical Nurses care for people who are injured , and healing any physical disabilities as ordered by a registered nurse from the doctor . They will check the patient's blood pressure , temperature , respiratory rate , dress wounds and give injections and help patients stand and walk by following all the necessary procedures . Then collected blood samples and also , bring them to the lab to do some simple tests , cleaning and monitoring of medical devices . While working at the doctor 's office they will also take care of the administrative work , they will make an appointment , perform administrative tasks and maintaining patient records .

Registered Nurse is one overseeing both Licensed Practical Nurses and Nursing Assistants. High nursing education for registered nurses because they must complete a four-year undergraduate program, called BSN Nursing Degree you could become a registered nurse with a diploma and a 2-year associate degree major responsibilities of a registered nurse is supervising and conducting research for nursing.

The Importance of Critical Thinking in Nursing Education

In nursing education and the nursing profession, critical thinking skills are very important. Responsibilities of a Registered Nurse have increased over the years . In correlation with this increase in responsibility comes an additional increase in educational prerequisites and core requirements necessary to achieve a degree in Nursing . ANA ( American Nursing Association ) Standards has established the necessary framework for critical thinking in the application of the " nursing process ".

Nursing process is the means by which all nurses can equally become proficient in critical thinking . The nursing process contains the following criteria :
1. Assessment
2. Diagnosis
3. Planning
4. Implementation
5. Evaluation

In this case, the application of each of these processes that nurses can become proficient in critical thinking. It is important to look at the components that describe critical thinking in nursing.


Components in Critical Thinking

Require objective, information, results focused thinking, which requires a careful identification of specific problems and other physiological and psychological factors that influence the position of the client in the continuum of health and well-being.

This process is driven by the client, the client's family and other health team members are also collaborating in ensuring essential client care.

Special education knowledge base and level of experience in applying that knowledge in client care. ( School of Nursing graduate nurses experienced nurse ) As the level of experience of the nurse increases so that basic scientific knowledge that nurses apply.

Proficiency in the application of agency standards, policies and procedures. Standard application of humanistic care in conjunction with the nursing process, to holistically treat the client's response to actual or perceived illness.

Constant evaluation and re-evaluation of the nursing process to determine the level of client health.

Tips to Speed up Hair Growth

Obviously you crave long and beautiful hair. Actually there is no shortcut to get beautiful and long hair. Necessary discipline to take care of your hair to suit your liking. Below are a few ways to quickly take care of long hair.

Eat Nutritious Food

In how to care for long hair so fast, the food should eat healthy foods, because the hair growth has a direct relationship with your nutritional intake. Therefore, make sure you eat foods rich in fiber and protein so that your hair follicles get all the nutrients they need. Examples of foods high in protein are fish, eggs, meat, and dairy. Moreover, how to care for long hair is so rapid consumption of vitamin-rich content such as vitamin B7 biotin each day. Biotin can prevent your hair from hair loss. Do not forget to drink plenty of water and avoid stress.


Use Conditioner

The most common problems faced by the long hair that often ends chapped or dry . In order to improve the already damaged hair like that , so every time we wear should wash hair conditioner even if we are the type of oily hair . Oily hair conditioner also still need to maintain the hair's natural moisture . Many underestimate the benefits of the conditioner . In fact , the conditioner will keep your hair needed moisture . So help your hair grow faster .

Apply conditioner from the middle to the ends of the hair only . Let's not on our scalp , because it can make the hair more limp and dirty too fast , so it can lead to dandruff .

If you want you can try a natural conditioner with olive oil and honey . Olive oil is a natural conditioner that is rich in vitamin E and is useful for dealing with dandruff . While honey has a mineral content such as calcium , magnesium , and B vitamins can also make hair more healthy .


Head Massage Routine

How to care for long hair so fast next is to massage the scalp us at least three times a week for 2 hours each time we wash. As good as any in the massage parlor, massage routine on your head is better. With this massage will improve blood circulation in the scalp and hair roots, but it removes dirt, dead skin cells and impurities that exist in our heads. You can add olive oil or walnut oil for massage. Impact, oil will seep earlier in the scalp and stimulate hair growth.


The things you should not do

Do not Heat Hair

Appliances such as hair straighteners , curling and hair dryer is widely used by women to beautify hair. Be careful with the use of these tools , if you get addicted to the device , it will make your hair dull and brittle . If forced to heat the hair try not too long . Avoid hair from heat stress will be very good for hair growth in the long term .

Do not wash it every day

Shampoo can reduce the natural oils produced by the hair , and useful to nourish the hair . Reduce this habit into a few times a week , eg, 3 times a week with one day lag time lapse . If you were forced to wash it every day because you work in the field , it can be helped with conditioner , hair so that moisture can be maintained .

Do not dye your hair too often

It does not matter what color your hair once or maybe twice a month . But if you often change color and give chemicals on your scalp , will inhibit hair growth

NCP - Nursing Diagnosis of Acute Pain related to BPH

Nursing Care Plan for Benign Prostatic Hyperplasia

BPH is a progressive enlargement of the prostate gland (in general in men older than 50 years) causes various degrees of urethral obstruction and urinary flow restriction (Marilynn, ED, 2000: 671).

The exact cause of the occurrence of BPH as yet unknown. But certainly the prostate gland depends on androgens. Another factor which is closely related to BPH are aging There are several possible causes of factors, among others:

1). Dihydrotestosterone (DHT)
Increased 5 alpha reductase and androgen receptor causes epithelial and stromal hyperplasia of the prostate gland experience.

2). Changes in the balance of estrogen - testosterone
The aging process in men increased estrogen and decreased testosterone resulting in stromal hyperplasia.

3). Interaction stromal - epithelial
Increased epidermal gorwth factor or fibroblast growth factor and transforming growth factor beta reduction causes stromal and epithelial hyperplasia.

4). Reduced cell death
Increased estrogen causes increased longevity stroma and epithelium of the prostate gland.

5). Back resurrection theory (reawakening) of urogenital sinus mesenchyme ability to proliferate and form the prostate tissue.


Symptoms of Benign Prostatic Hyperplasia

Based on the grade, divided into 4 grades as follows:

1st Grade : Congestic

• Patients early months or years of hard-urinary and began straining.
• If micturition was satisfied.
• Urine drips out and poor stream.
• nocturia
• Urine out at night more than normal.
• Longer than normal erection and more libido than normal.
• On hyperemia cytoscopy visible from the internal urethral orifice. Occurs slowly bleeding varices could eventually happen (blooding).

2nd Grade : Residual

• When micturition is hot.
• Nocturia Dysuria gain weight.
• Can not urinate (urinary dissatisfied).
• Infection can occur because of residual urine.
• High heat can occur and chills.
• Pain in the lumbar region (spreading to the kidneys).

3rd Grade : Urinary retention

• Ischuria paradosal.
• Incontinensia paradosal.

4th Grade

• Full bladder.
• Patients feel pain.
• Urine dripped periodically called over flow incontinensia.
• On physical examination, palpation of the lower abdomen to feel there is a tumor, because of a great dam.
• Patients with an infection and high fever can shiver around 40-41 ° C.
• Then the patient could commas.

Nursing Diagnosis for Benign Prostatic Hyperplasia : Acute Pain related to irritation of the bladder mucosa, bladder distension, renal colic, urinary infection.

Goal: Pain is lost / controlled.

Outcomes:
Clients reported pain relief / control, relaxation skills and demonstrate therapeutic activity as indicated for individual situation. Seemed to relax, sleep / rest appropriately.

Nursing Interventions :

1 . Assess pain , note the location , intensity ( scale of 0-10 ) .
R / : sharp pain , intermittent with the urge to urinate / massage urine around the catheter showed spasm of the bladder , which tend to be heavier on the approach TURP ( usually decreases within 48 hours ) .

2 . Maintain patency of the catheter and drainage system . Keep the hose free of grooves and clot .
R / : Maintaining the function of the catheter and drainage system , reduce the risk of distension / bladder spasm .

3 . Maintain bed rest when indicated
R / : Required during the initial phase during the acute phase .

4 . Provide comfort measures ( therapeutic touch , changing position , back massage ) and therapeutic activity .
R / : Reduce muscle tension , back memfokusksn attention and can improve coping skills .

5 . Give soak sit or heating lamps when indicated .
R / : Improving tissue perfusion and improvement of edema and promote healing ( perineal approach ) .

6 . Collaboration in the provision antispasmodic
R / : Eliminates spasm .

Leg Cramps During Pregnancy - Prevention and Pain Management

Complaint that is often experienced by pregnant women are leg cramps, sometimes your fingers cramp as well. Especially when changing position from sitting to standing. Leg cramps during pregnancy usually occurs in the second trimester of pregnancy until the end. This situation may be due to a calf must withstand loads with increasing gestational age. The most frequent calf muscle cramps is below and behind the knees. Cramping pain may last a few seconds to minutes. Leg cramps can occur when we are resting, perhaps even sleeping.

Causes

Cramps can occur when the muscle is stimulated to contract in a position to contraction. This happens when we sleep on his knees half bent, and feet slightly downward. At this position the calf muscles flexed and somewhat prone to cramps. That is why the movement stretching before bed can prevent it.

It could also be because of leg fatigue of having to sustain the increased load during pregnancy. Other causes could be due to lack of blood flow to the lower body due to increased weight and pressure in the uterus.

Onset of leg cramps caused by an imbalance of some kind of mineral levels in the blood, ie, calcium, potassium and magnesium are too low, while phosphorus levels are too high. All it causes interference to the nervous system the body's muscles.

In some cases, cramps may occur due to problems or other conditions, for example:

• Several types of medications can give side effects such as cramping.
• Dehydration
• Imbalance of salts in the blood (eg, calcium or potassium levels are too low)
• Pregnancy, especially in the final trimester
• An underactive thyroid gland
• Narrowing of the leg arteries that impede circulation
• Disorders of the nervous
• Cirrhosis of the liver

Prevention

• Tell your doctor if cramps may be caused by the consumption of one of the above drugs . Doctors can provide alternative medicine .
• Drink at least six glasses filled every day , including one glass before bed . Also drink before , during and after exercise .
• Consumption of foods rich in calcium , potassium and magnesium . Eat one or two bananas a day is enough to meet the needs of potassium .
• Avoid standing for too long .
• Avoid impaired blood flow to the foot by not folding legs when sitting .
• Diligent walking as exercise is safe for pregnant women .
• pregnancy exercise
• If you often have cramps during sleep , do movement on the relaxation of the calf muscles before bed . The trick is to stand about 60-90 cm from the wall , then lean toward the wall with your foot stays in place . Do it several times . You may need a few days to do it until the effect is felt.
• Sleep with your calf muscles that prevent depressed without realizing it : o Use a pillow to support your feet while you sleep on your back . o When you sleep on his stomach , put your feet dangling on the end of the mattress . o Try to keep loose blankets in the foot so that the fingers and soles of feet are not facing down while sleeping .
• If the cramps subside , provide heating on calf and lower leg .

Pain Management

• Eliminate the pain immediately following action (if necessary ask for help from others).
• Align the heel and toe, then slowly bend your heel and toes.
• Massage leg muscles were cramping gently and slowly.
• When exposed leg cramps when sitting or sleeping, try to move your toes upward. Get out of bed and stood for a moment a few minutes, until the pain goes away.

Elderly Nursing Care Plan with Impaired Physical Mobility and Activity Intolerance

Mobility is the movement that gave freedom and independence for someone. Although the type of activity changed throughout human life, mobility is central to participate in and enjoy life. Maintaining mobility is critical for optimal mental and physical health of all elderly.

Immobility is broadly defined as the level of activity that is less than optimal mobility. Immobility, activity intolerance, and sindromdissue often occurs in the elderly. Barriers to physical mobility nursing diagnosis, potential disuse syndrome, and activity intolerance gives a broader definition of immobility.

Onset of immobility or intolerance activity for most people does not occur suddenly, moving from full mobility to physical dependence or total inactivity, but rather develop slowly and unnoticed. Interventions directed toward the prevention of the consequences of immobility and inactivity may decrease the speed of the decline.


Impaired Physical Mobility

Definitions:

A state of the limited ability of independent physical movement experienced by a person. (Carroll-johnson. 1988)

Immobilization is the inability of a person to move his own body. Immobilization said to be the main risk factor in the emergence of decubitus wound either in the hospital or in the community. This condition can increase the time an emphasis on skin tissue, and subsequently lead to lower circulation decubitus sores. Immobilization in addition to directly affecting the skin, also affects several organs. For example, the cardiovascular system, peripheral blood circulation disorders, respiratory system, reduce lung movement to take oxygen from the air (lung expansion) and result in decreased oxygen intake to the body. (Lindgren et al. 2004)

Defining characteristics

1. Inability to move with purpose in the environment, including mobility in bed, move and ambulate
2. Reluctance to move
3. Limitation of range of motion
4. Decrease the power, control, or muscle mass
5. Experienced restrictions on movement, including protocols and medical mechanical
6. Impaired coordination

Related factors

1. Activity intolerance
2. Decreased strength and endurance
3. Pain and discomfort
4. Perceptual or cognitive disorders
5. Neuromuscular disorders
6. Depression
7. Severe anxiety

Activity Intolerance

Definitions:

A state of energy insufficiency in physiological or psychological on a person to survive or complete daily activities necessary or desirable. (Carroll-johnson. 1988)

Defining characteristics

1. Verbal report of fatigue or weakness
2. Heart rate or blood pressure is not normal to the activity
3. Discomfort: Dyspnea after activity
4. Electrocardiographic changes indicating the presence of dysrhythmias or ischemia

Related factors

1. Bed rest and immobility
2. General weakness
3. Sedentary lifestyle
4. Imbalance between oxygen supply and requirement

 Internal Factors

Internal factors that cause or contribute to immobility .
1 . Decrease in musculoskeletal function :
Muscles ( atrophy , dystrophy , or injury ) , bone ( infection , fracture , tumors , osteoporosis , or osteomastia ) , joints ( arthritis and tumors ) , or a combination of the structure ( and cancer drugs ) .

2 . Changes in neurologic function :
Infection (eg, encephalitis ) , tumor , trauma , drugs , vascular disease ( eg, stroke ) , degenerative diseases ( eg, Parkinson's disease ) , demyelinating disease ( eg, multiple sclerosis ) , exposure to toxic products ( eg, carbon monoxide ) , metabolic disorders ( eg, hypoglycemia ) , or nutritional deficiencies .

3 . Pain :
Multiple and varied as the causes of chronic diseases and trauma .

4 . Perceptual deficits :
Excess or shortage of input sensory perception

5 . Reduced cognitive abilities : Disruption

6 . Fall :
Physical effects : injury or invoice
Psychological effects : syndrome after fall

7 . Changes in social relations
Actual factors ; ( eg, loss of a spouse , moving away from family or friends )
Perceptual factors ( eg, change of mindset as depression )

8 . Psychological aspects : helplessness in learning , depression .


External Factors

External factors that contribute to immobility:
1. Therapeutic program
2. Characteristics institutional residents
3. Characteristics of staff
4. Nursing care delivery systems
5. Barriers
6. Institutional policies


Management

1. Primary Prevention
Primary prevention is a process that lasts throughout life and episodic. As an ongoing process throughout life, moblilitas and activity depends on the function of the musculoskeletal system, cardiovascular, pulmonary. As an episodic process of primary prevention aimed at preventing the problems that can arise due to imoblitas or inactivity.

2. Secondary prevention

Downward spiral, which occurs due to an acute exacerbation of immobility can be reduced or prevented by nursing interventions. The success of the intervention comes from an understanding of the various factors that cause or contribute to immobility and aging. Secondary prevention focuses on maintenance of function and prevention of complications. Nursing diagnosis related to secondary prevention is impaired physical mobility.

Benefits of Classical Music for Mother and Baby's Brain

How the influence of music for babies in the womb? Many experts give conflicting opinion or controversy about the influence of music for babies in the womb. There are studies showing that the fetus can react to the sound or the voice to move.

But other experts argue that no one knows for sure what is the meaning of the movement of the baby while listening to music; whether the baby should feel pleased or annoyed, because experts can not examine unborn babies, as easy as the baby is born. And other experts state that there is no direct research evidence that music can make your baby more resourceful and creative. And there are many opinions about the controversy mutual influence of music for babies in the womb.

There is a study that found that music helps better growth in premature infants, in which the quiet songs played in premature infants for 40 minutes every day, and the day-to-4 examination premature infants, who played music gaining weight, heartbeats become more powerful than those not listening to music. After assessing the many conflicts of opinion of several experts on the influence of music and the baby in the womb, whether music gives pleasure or disturb the fetus in the womb, then there remains the decision on your own whether making music for your baby or not.

And in fact we all know that music can provide a sense of calm and relaxed on someone so well, music can help pregnant women to be more relaxed, calm and will indirectly have a positive impact for the baby in the womb.

One type of music is recommended for listening to classical music such as "Mozart", because the music can give you peace and express no opinion classical music increases brain wave activity that can help build networks with better brain synapses. Listen to music on a regular basis so as not to over-stimulate your baby, as well as a voice that was not too hard because it will be painful and shocking your baby. Do not worry because your amniotic fluid is a conductor or a good conductor of sound. You need to know when you decide to play music on your unborn baby, is because you enjoy it and give peace, relaxed for you, not because you are trying to make a baby in your womb is more clever and creative.


Benefits of Classical Music for Mother and Baby's Brain

Classic song turned out to have a positive influence on the growth of the fetus in the womb of a mother. Classical music can stimulate the fetus in the womb. Regular and continuous stimulation will stimulate children's intelligence. Music can stimulate the right brain intelligence, brain right brain is associated with creativity, art, style, socialization and personality. A scientist from Europe and the United States found that classical music can give auditory stimuli that are good for the fetus, the fetus is helpful to education.

The study found that during the baby listening to the music of Mozart and Bach, could expand the volume of the brain, increase the main activities of the nerves, helping the abstract imagination of normal growth in children.

Research shows, conduct periodic sound stimuli to the fetus, eg soft light classical music and gently whisper parents and others, can promote the growth of the fetus and sensory nerve skin layer of the brain stem central flavorings, laid the foundation for the development of wisdom. Otherwise under modern music and sound stimuli bustle, the fetus can feel uneasy and worried, accelerated heart rate, shaking the content stronger.

As for women who are pregnant, classic songs can be freed from the stress of pregnancy. Emotional condition of a pregnant woman greatly influenced the development of the fetus.

Nursing Care Plan for Elderly with (Acute / Chronic) Gastritis

Gastritis is a common disease in the community, but once the disease is often underestimated and overlooked by the sufferer. In fact, gastritis disease can not be underestimated. Gastritis is a digestive disease of the stomach are caused by excessive stomach acid production. This resulted imflamasi or inflammation of the gastric mucosa. Sufferers feel will feel sore stomach and heartburn in the area around the solar plexus. If this is allowed and ignored protracted it will lead to erosion of the gastric mucosa. In some cases, gastritis can lead to ulcers in the stomach and an increase in stomach cancer.

Gastritis (dyspepsia / heartburn) is a disease caused by excess stomach acid or stomach acid resulting in increased inflammation of the gastric mucosa such as cut, or pain in the gut. Symptoms occurred, ie, the stomach was sore and heartburn. Mechanisms of gastric damage caused by an imbalance of digestive factors such as gastric acid and pepsin to the production of mucus bicarbonate blood flow.

There are two types of gastritis are:

Acute Gastritis

Acute Gatritis (inflammation of the gastric mucosa) is most often caused by faulty diet, eg. eating too much, too fast, eating too much food seasoning, or infected food. Other causes include alcohol, aspirin, bile reflux or radiation therapy. Gastritis can also be the first sign of acute systemic infection. Form a more severe acute gastritis caused by strong acid or alkali which can lead to gangrene or perforation of the mucosa.

Chronic Gastritis

Prolonged gastric inflammation caused by benign and malignant gastric ulcers or bacteria Helicobacter pylori. These bacteria colonize the place with the concentrated gastric acid. Chronic gastritis is classified as type A or type B. Type A disease associated with autoimunmis, pernicious anemia. Type A occurs in gastric fundus or corpus. Type B (H. pylori) on the antrum and pylorus. Associated with H. pylori. dietary factors like-iminum heat, seasoning, use of drugs, alcohol, smoking, or refluksisi intestine into the stomach.


Etiology

• Gastritis is an inflammation of the gastric mucosa.
• Acute erosive gastritis: irritants that can heal itself caused by irritants (eg, NSAIDs, alcohol), severe physiological stress (eg, major surgery, burns, ventilator), or local trauma (eg NG tube).
• A type of chronic gastritis: inflammation of the proximal stomach as a result of pernicious anemia, atrophic gastritis, aclorhidria, autoimmune disorders, or radiation.
• Type B chronic gastritis: inflammation of the distal stomach or antrum as a result of Helicobacter pylori infection.
• Reflux gastritis: inflammation as a result of the bile and pancreatic lymph in the secondary hull as a result there is no pyloric or pyloric are nonfunctional (eg after partial gastrectomy).
• Hemorrhagic gastritis: gastritis with significant inflammation as a reaction to severe stress (eg ICU patients, hypoxia, ischemia, uremia).

Clinical Manifestations

• Epigastric pain or burning in bad taste that gain weight by eating.
• Dyspepsia
• Anorexia
• Nausea / vomiting
• Bleeding can occur resulting in hematemesis, melena.

Acute Gastritis

• Superficial ulceration may occur and lead to hemorrhage.
• Discomfort in the abdomen with headache, lethargy, nausea, and anorexia. Possible vomiting and hiccups.
• Some patients showed asymptomatic.
• Colic and diarrhea can occur if foods that irritate not vomited but instead reaches the intestine.
• Patients usually recover about a day, although the appetite may be lost for 2 to 3 days.

Chronic Gastritis

• Gastritis type A: essentially asymptomatic except for the symptoms of vitamin B12 deficiency.
• Gastritis type B: patients complain of anorexia, heartburn after eating, belching, a sour taste in the mouth or nausea and vomiting.

Treatment

Treatment of gastritis in general is to eliminate the main factor etiology, gastric diet with small portions and often, as well as drugs. However, the specifics can be distinguished as follows:

Acute Gastritis

1. Reduce drinking alcohol and eating regular and healthy until the symptoms disappear; transformed into a diet that does not irritate.
2. If symptoms persist, IV fluids may be required.
3. If gastritis caused by ingesting strong acidic or alkaline, dilute and neutralize the acid with common antacids, such as aluminum hydroxide, H2 receptor antagonists, proton pump inhibitors, anticholinergics and sucralfate.
4. If gastritis caused by ingesting a strong base, use citrus juice or vinegar diluted in dilute.
5. If severe corrosion, avoid emetic and rinse the stomach because of the danger of perforation.
6. Antacids: Antacids are drugs that can be liquid or tablet form and is a common drug used to treat mild gastritis. Antacids neutralize stomach acid and can relieve pain caused by stomach acid quickly.
7. Acid inhibitors: When antacids are no longer able to cope with the pain, the doctor may recommend medications.

Chronic Gastritis

1. Diet modification, stress reduction, and pharmacotherapy.
2. Cytoprotective agents: Drugs of this class helps to protect the tissues that line the stomach and small intestine.
3. Proton pump inhibitors: A more effective way to reduce stomach acid is to close the "pumps" within acid-producing cells of the stomach acid. Proton pump inhibitors reduce acid by covering the work of the "pumps" it.
4. H. pylori may be treated with antibiotics. There are several regimens in overcoming the infection of H. pylori. The most commonly used is a combination of antibiotics and proton pump inhibitors. Sometimes also added bismuth subsalycilate. Antibiotics used to kill bacteria, proton pump inhibitor works to relieve pain, nausea, heals inflammation and improve the effectiveness of antibiotics. Treatment of infection of H. pylori is not always successful, the speed to kill H. pylori is extremely diverse, depending on the regimen used. However, a combination of three drugs seem more effective than a combination of two drugs. Therapy in the long term (for 2 weeks of therapy compared with 10 days) also seem to increase effectiveness. To ensure H. pylori is gone, it can be re-examined after the treatment carried out. Respiratory examination and stool examination were two types of checks are often used to ensure the absence of H. pylori. Blood tests will show positive results for several months or even more despite the fact that the bacteria is gone.