Ineffective Tissue Perfusion related to Encephalitis

Nursing Diagnosis: Ineffective Tissue Perfusion related to increased intracranial pressure.

Goals:

• Patient's neurological status returned to the state before the illness.
• Increased patient awareness and sensory function.

Outcomes:

• Vital signs within normal limits.
• Reduced headache pain.
• Increased awareness.
• No signs or loss of increased intracranial pressure.

Intervention:

1. Total bedrest patients, with supine sleeping position without a pillow.
Rationale: Changes in inta-cranial pressure will be able to mislead the risk for brain herniation.

2. Monitor signs of neurological status with GCS.
Rational: It can reduce further brain damage.

3. Monitor vital signs such as blood pressure, pulse, temperature, respiration and caution in systolic hypertension.
Rational: In normal circumstances autoregulation maintains a state of altered systemic blood pressure fluctuation. Autoregulation failure will cause a cerebral vascular damage can be manifested by an increase followed by a decrease in systolic and diastolic pressure. While the increase in temperature can describe the course of infection.

4. Monitor intake and output
Rational: Hyperthermia can lead to increased IWL and increase the risk of dehydration, especially in patients who are not aware, and nausea were lower intake by mouth

5. Help the patient to limit vomiting, coughing. Instruct the patient to exhale when moving or turning in bed.
Rationale: Activity vomiting or coughing can increase intracranial and intra-abdominal pressure. Exhale when moving or changing position can protect themselves from the effects of Valsalva.

6. Give fluids per infusion with strict attention.
Rationale: Minimize the burden of vascular and fluctuations in intracranial pressure, fluid and fluid vetriksi can reduce cerebral edema.

7. Monitor blood gas analysis of oxygen delivery when needed.
Rational: The possibility of acidosis is accompanied by the release of oxygen at the cellular level may lead to the occurrence of cerebral ischemic.

8. Provide appropriate therapy such as physician advice: Steroids, Aminofel, Antibiotics
Rational Therapy given to decrease capillary permeability.
Lowering of cerebral edema
Lowered metabolic cells / consumption and seizures.

Nursing Care Plan for Meniere's Disease

Definition of Meniere's Disease

Meniere's Disease is a chronic disorder of the semicircular canal and the labyrinth of the inner ear, appear to be associated with over-production of endolymph in the inner ear (Elizabeth Corwin J: 2009).

Ménière's disease is a disease that affects the inner ear endolymphatic fluid pressure in the deeper parts of the ear that is responsible for balance and hearing function. Symptoms usually affect these functions and may differ from person to person. (Ananya Mandal: 2013)

Type of Meniere's Disease

1. Vestibular Meniere's disease
Vestibular Meniere's disease is characterized by episodic vertigo with respect to the pressure in the ears without cochlear symptoms.
Signs and symptoms:

• Merely episodic vertigo.
• Decrease in vestibular response or no response total pain in the ear.
• There was no cochlear symptoms.
• There was no hearing loss objective.
• Later may develop symptoms and signs of cochlear.

2. Classic Meniere's disease,
Signs and symptoms:

• Complained of vertigo
• Fluctuating sensorineural hearing loss
• Tinnitus
• Cochlear Meniere's disease

3. Cochlear Meniere's disease
Cochlear Meniere's disease identified with progressive sensorineural hearing loss with respect to tnitus and pressure in the ear without any findings or vestibular symptoms.
Signs and symptoms:

• Fluctuating hearing loss
• Aural pressure or full feeling
• Tinnitus
• Hearing loss seen in test results
• There was no vertigo
• Normal vestibular labyrinth test
• Later will suffer symptoms and signs of vestibular (Nn: 2011)

The degree of severity of Meniere's disease;

1. Grade I:
Early symptoms include vertigo accompanied by nausea and vomiting. Vagal disorders such as pale and sweating may occur. Before the attack of vertigo symptoms, the patient may feel a sensation in the ear, which lasted for 20 minutes to several hours. Among, the patient is normal.

2. Grade II:
Hearing loss deepened and fluctuate. Symptoms of the low-frequency sensorineural hearing loss.

3. Grade III:
Hearing loss is no longer fluctuating but progressive worsening. This time on both ears so deaf patients as having total. Vertigo began to decrease or disappear. (Nuzulul Zulkarnain Haq: 2009)


Etiology of Meniere's disease

The exact cause of Meniere's disease, until now not known with certainty, many experts have different opinions. Until now considered the cause of disease is caused by a disturbance in the physiology of the system, known as endolymph endolymph hydrops, a condition where the amount of endolymph fluid that resulted in an abrupt increase of the scale dilatation media. However, the cause of hydrops endolymph has yet to be ascertained.
There is some contention as to the cause of hydrops, among others:

• Increasing hydrostatic pressure at the arterial end.
• Reduced osmotic pressure in the capillaries.
• Increasing the osmotic pressure of the extra-capillary space.
• Way out sac endolimfatikus clogged, resulting in accumulation endolimfa.
• Middle ear infection.
• Upper respiratory tract infection.
• Head trauma.
• Consumption of foods that contain caffeine and high salt.
• Consumption of aspirin, alcohol, and cigarettes were prolonged.
• Herpesviridae virus infection group.
• Hereditary.

The following will explain the cause of Meniere's disease is considered to trigger:

1. Herpes virus (HSV)
Herpes viruses are found in patients with Meniere's. Once there was a report that 12 of the 16 patients there Meniere herpes simplex virus DNA in endolimfatikusnya sac. In addition it has been reported also in Meniere's patients who were given antiviral therapy are improved. But this assumption has not been proven entirely because they still need further research.

2. Hereditary
In the study found 1 in 3 patients had a parent who suffered from Meniere's disease as well. Hereditary predisposition is considered to have a relationship with anatomical abnormality or abnormalities in the channel endolimfatikus immune system.

3. Allergy
In patients with Meniere found that 30% of them have food allergies. Relationship between allergies with Meniere's disease are as follows: endolimfatikus sac may be the target organ of mediators that are released in the body when holding a reaction to certain foods. Antigen-antibody complexes may interfere with the ability of the sac endolimfatikus filtration. There is a relationship between allergy and viral infection that causes hydrops of endolimfatikus sac.

4. Head trauma
Scarring caused by trauma to the inner ear can be considered disturbing the hydrodynamic flow of endolimfatikus. This assumption is reinforced by the Meniere's patients who have a history of temporal bone fracture.

5. Autoimmune
There is also a presumption of experts stating that endolymph hydrops is not a cause of Meniere's disease. It is said by Honrubia in 1999 and Rauch in 2001 that the autopsy study found endolymph hydrops in 6% of people who do not suffer from Meniere's disease. Much research is now focused on immunologic function in endolimfatikus sac. Some experts argue Meniere's disease caused by an autoimmune disorder. Brenner conducted a study in 2004 said that in about 25% of patients with Meniere's disease is also found to thyroid autoimmune diseases. Additionally in 2002 Ruckenstein also getting in approximately 40% of patients with Meniere's disease obtained positive results in the examination of the blood such as autoimmune arthritis factor, antiphospholipid antibodies and Anti Sjoegren. (Nuzulul Zulkarnain Haq: 2009)

Nursing Concepts and Care Plan for Mental Retardation (MR)

Mental retardation (MR) is a condition in which a person has the mental capacity is insufficient. Mental retardation is a subnormal intellectual function abnormalities occur during development and is associated with one or more disorders of maturation, learning and social adjustment.

Mental retardation is defined as weakness / inability cognitive appeared in childhood (before the age of 18 years) is characterized by the function under normal intelligence (IQ 70-75 or less), and accompanied by at least two other limitations in the following areas: speech and language; self-care skills, ADL; social skills; using community facilities, health and safety; functional academic, work and relax, etc..

Clinical manifestations

Clinical manifestations of mental retardation, among others:
1. Cognitive impairment (pattern, thought process).
2. The slow reception skills and language expression.
3. Failed to get past the main stages of development.
4. Head circumference is above or below normal (sometimes larger or smaller than normal size).
5. Possibility of slow growth.
6. Possibility of abnormal muscle tone (more frequent weak muscle tone).
7. Possibility of dysmorphic features.
8. Delays in fine and gross motor development.

Pathophysiology

Mental retardation refers to the real limitations of daily living function. Mental retardation include weakness or cognitive disability that appears in childhood (before age 18 years) were characterized by below-normal intelligence function (IQ 70 to 75 or less) and with other limitations in adaptive functioning at least two areas: speaking and language, abilities / skills of self-care, homemaking, social skills, use of community facilities, self-direction, health and safety, functional academic, leisure and work. Cause of mental retardation can be classified into prenatal, perinatal and post-natal. Diagnosis of mental retardation established early in childhood.

Complication

1. Cerebral palsy
2. Seizure disorders
3. Psychiatric disorders
4. Impaired concentration / hyperactivity
5. communication deficits
6. constipation

Prevention

1. Increase healthy brain development and the provision of care and an environment that stimulates growth.
2. Should focus on the biological health and early life experiences of children living in poverty in terms of prenatal care, regular health monitoring and family support services.


Nursing Care Plan for Mental Retardation (MR)

A. Assessment

The assessment consists of a comprehensive evaluation of the shortcomings and strengths associated with the adaptive skills; communication, self-care, social interaction, use of facilities in the community self-direction, health care and safety, functional academic, recreational skill formation, and tranquility.

B. Nursing Diagnosis

1. Impaired growth and development related to cognitive dysfunction.
2. Impaired verbal communication related to cognitive dysfunction.
3. Risk for injury related to aggressive behavior imbalance of physical mobility.
4. Impaired Social Interaction related to difficulty speaking / social adaptation difficulties.
5. Interrupted family processes related to having a child with mental retardation.
6. Self care deficit related to changes in physical mobility / lack of developmental maturity.

C. Intervention

1. Assess the factors causing impaired child development.
2. Identification and use of educational resources to facilitate optimal child development.
3. Provide consistent care.
4. Increase communication verbal and tactile stimulation.
5. Give simple instructions and repeat.
6. Give positive reinforcement on child outcomes.
7. Encourage children to do their own maintenance.
8. Difficult child behavior management.
9. Encourage children to socialize with the group.
10. Create a safe environment.

D. Education on Parents

1. Each stage of child development for ages.
2. Support parental involvement in child care.
3. Anticipatory guidance and management face a difficult child behavior.
4. Inform existing educational facilities and groups.

E. Expected results
1. Children to function optimally the relevant level.
2. Families and children are able to use coping with challenges due to disability.
3. Families are able to obtain the resources community facilities.

Natural Treatment for Urticaria

Urticaria is a raised, itchy rash that appears on the skin. The rash can be limited to one part of the body or spread across large areas of the body.

Urticaria can develop gradually or suddenly, and can be widespread throughout the body, or be centralized in a particular area.

The appearance of urticaria is usually due to an allergic reaction and can be caused by direct contact with an irritant. Urticaria can also develop among those with autoimmune disorders such as lupus. Urticaria is not contagious, and it cannot be passed along from skin to skin contact.

There are many food allergens which trigger urticaria, which is why it’s especially critical to pinpoint whether one may be allergic to a specific food. Some of the most common food allergies include nuts, peanut butter, fish, eggs, milk, dairy, citrus and wheat products.

Other common causes of urticaria can include pet dander, pollen, dust, outdoor allergens, mites, insect bites, chemicals and latex products. Additionally, an individual may develop urticaria when exposed to stressful situations. Usually, in these instances, the rash will disappear once the stressful event is over.

These substances cause the blood vessels in the affected area of skin to open up (often causing redness or pinkness) and become leaky. This extra fluid in the tissues causes swelling and sometimes itchiness.

In most cases of long-term urticaria, there is no obvious cause. However, most experts think it's often caused by the immune system mistakenly attacking healthy tissue. Certain triggers make the symptoms worse, such as:

• drinking alcohol or caffeine
• emotional stress
• warm temperature

Natural Treatment for Urticaria

Baking Soda
Make a paste out of water and baking soda and apply to the affected area. This recipe helps relieve itching and inflammation caused by urticaria.

Fish Oil
Use the liquid from a 1,000mg fish oil capsule to apply to the hives. The oil contains fatty acids, which promote healthy skin and decrease inflammation.

Ice
If you aren't sensitive to cold temperatures, ice compressions may be the best choice for getting rid of hives. The ice reduces inflammation, itching, and relieves itchy.

Vinegar
Mix vinegar and warm water on a 1:1 ration; use a cotton ball to gently apply the solution to your skin.

Oatmeal
Take a bath in pre-soaked oatmeal water; the oatmeal contains anti-inflammatory properties that will help soothe your skin.