NCP for Psoriasis - 4 Nursing Diagnosis

Nursing Care Plan for Psoriasis

Psoriasis is a skin disease whose sufferers experience skin replacement process is too fast. The emergence of this disease sometimes for a longer period. In contrast to the normal human skin changes that usually lasts for three to four weeks, the skin changes in patients with psoriasis take place quickly is about 2-4 days, (it can even happen faster) that a lot of skin cell turnover and thickened.

Psoriasis can be found in all parts of the world with morbidity (incidence rate) is different. In terms of age, Psoriasis can be at any age, but usually more often found in adults.

Psoriasis is a skin disorder characterized by plaque, patches, scaly known papulosquamous disease. (Price, 1994).

The cause of psoriasis is unknown until now. Allegedly inherited polygenic. Although the majority of patients with psoriasis arises spontaneously, but in some patients found the existence of precipitating factors, among others:

1) Trauma
Psoriasis first arise in places that are exposed to trauma, scratching, incision, a former vaccination, and so on. The likelihood that this is a mechanism Koebner phenomenon. Typical in psoriasis arises 7-14 days after trauma.

2) Infection
In children, especially hemolytic streptococcal infections often cause guttate psoriasis. Psoriasis also arise after other bacterial infection and certain viral infections, but disappeared after infection healed.

3) Climate
Some cases tend to heal in the summer, while in the rainy season will recur.

4) Endocrine factors
The highest incidence at puberty and menopause. Psoriasis tends to improve during pregnancy and relapse and resistance to treatment after birth. Sometimes generalized pustular psoriasis arise during pregnancy and after high-dose progesterone treatment.

5) Sunlight
Although sunlight generally useful for patients with psoriasis, but in some patients the strong sunlight can stimulate the onset of psoriasis. Photochemical treatment has similar effects in some patients.

6) Metabolic
Hypocalcemia may cause psoriasis.


Patients usually complain of mild itching in places of predilection, namely the scalp, the border area with the face, extremities on the extensor, especially the elbows and knees, and the lumbosacral region. Skin disorders consisting of patches of elevated erythema (plaque) with scales on it. The scales are layered, rough, and white like mica, and transparent. In psoriasis there is the phenomenon of droplets of wax, Auspitz and Köbner.


Symptoms of psoriasis include:
Complained of mild itching.
Patches of erythema elevated, scaly thereon.
There is a phenomenon of the droplets of wax.
Cause nail abnormalities.


Nursing Diagnosis for Psoriasis

1. Impaired sense of comfort related to disease-related symptoms
characterized by: the itching, burning sensation on the skin, anxiety, clients seemed agitated, and disruption of sleep patterns.

2. Impaired skin integrity related to chemical irritation, mechanical factors, nutritional factors
characterized by: tissue damage of the skin (scaly skin, poor skin turgor, cracks, patches, itching).

3. Disturbed body image related to the biophysical, disease, and perceptual
characterized by: insecure, self-conscious, feelings of isolation, the interaction is reduced.

4. Anxiety related to changes in health status
characterized by: a client anxiety, fear, sleep disturbances, often sweating.

Altered Nutrition related to Nausea and Vomiting

Alteration Nutrition: Less Than Body Requirements related to Nausea and Vomiting

Nutrients are substances in food that are needed for the organism to grow and develop properly in accordance with its function.

Nutrients in adequate amounts and in accordance with the need for providing energy for the body to be able to grow and develop, and repair damaged tissue. Nutritional deficiencies will make the body of the organism does not grow and develop, it can even cause disease to end in death. Disruption of the body's metabolic processes are early symptoms of nutritional deficiencies.

Definition of nutrition, according to some experts is as follows:

• Nutrition is the process of taking important nutrients. (Nuwer, 2008).
• Nutrients are organic substances required by the organism for normal functioning of the body systems, growth and maintenance of health. (Wikipedia).

After knowing the definition of nutrients, there are several types of nutrients that it needs to be absorbed by us every day. Such as carbohydrates, this is a kind of nutritional composition consisting of the elements carbon, hydrogen and oxygen. This type of substance found in rice, corn, wheat, tubers. There are fat as the types of nutrients that are needed by our bodies, fat acts as an energy source that is compacted. There is a protein that is an important constituent of all cells in the body. Vitamin is also a means of nutrition is no less important to regulate the body's metabolism. Meneral and water is also a kind of important nutrients for the body.

Understanding of nutrition is not just limited to the nutritionists or health researchers only. However, this definition also extends in particular to the health of the world. Nutrition for health is a kind of critical intake found in foods often consumed by us. Contains vital substances such as vitamins, minerals, carbohydrates and others. Knowledge of the nutrients it needs to be recognized as a regulator of eating patterns. The nutritional requirements for the human body is certainly very important as supporting a variety of activities and health. The nutrients needed by the body also had higher levels of clear and useful to the body. There are several types of foods that actually do not really have a clear nutritional. It would be very concerned if we always vulnerable consumption in a long time. After all essential nutrients is a necessity that should not be missed. Nutrition serves to keep your metabolism in the body because there is a substance in nutrients and important things to be absorbed. The function of internal organs of the body will also be maintained if the fulfillment of these nutrients stable and clear presence.

Nausea and vomiting is a symptom that is frequently encountered. Nausea is an uncomfortable sensation in the upper abdomen that creates a feeling like vomiting. While vomiting is the release of stomach contents through the mouth.

Nausea and vomiting are symptoms. Therefore, nausea and vomiting caused by various medical conditions (diseases) of the underlying. Knowing the causes of nausea and vomiting are very important for the management of nausea or vomiting appropriately.

Medical condition or disease causes nausea and vomiting, among others:

• Motion sickness.
• Young pregnant (nausea occurring in approximately 50% -90% of all pregnancies, vomiting in 25% -55%).
• Originator drug vomiting.
• Taste very pain.
• Emotional stress (such as fear).
• Excessive eating (satiety).
• Gallbladder disease, for example gallstones.
• Food poisoning.
• Viral infection of the gastrointestinal tract (diarrhea).
• Reaction to the odor or a particular smell.
• Sore throat (kids).
• Heart attack.
• Concussion or brain injury.
• Brain tumor.
• Gastric ulcer.
• Some forms of cancer.
• Bulimia or other psychological illnesses.
• Gastroparesis or slow emptying of the stomach (a condition that is often seen in people with diabetes).
• Swallowing poison or drink alcohol excessively.

Causes of vomiting may differ according to age.
Vomiting in children is most often caused by a viral infection, food poisoning, milk allergy, motion sickness, overeating, coughing, or intestinal blockage, and a disease in which the child has a high fever.

Time of nausea or vomiting may indicate the cause. When it comes shortly after a meal, nausea or vomiting may be caused by food poisoning, gastritis (inflammation of the lining of the stomach), gastritis, or bulimia.

Nausea or vomiting 1-8 hours after a meal may also indicate food poisoning. However, foods containing certain bacteria, such as salmonella (the cause of typhoid fever), it could take longer, causing the symptoms of nausea and vomiting. Continuous vomiting can cause a dangerous condition that is dehydration, especially vomiting in infants and children. Moreover, they have not been able to say what they are feeling. Therefore, parents should know the signs of dehydration in children.

Here is how to overcome the nausea and vomiting in general regardless of age and cause:

• Drink plenty of water gradually (a little but often).
• Avoiding solid food until the vomiting episode has passed.
• Stop all medications (which can irritate the stomach and make vomiting worsened). But, do not discontinue any medication before consulting a doctor.
• If there is vomiting and diarrhea lasting more than 24 hours, oral rehydration solution such as ORS should be used to prevent and treat dehydration.
• Pregnant women who experience morning sickness can eat some crackers before getting out of bed or eating a high-protein snack before bed (meat or cheese).
• Vomiting associated with cancer treatment (chemotherapy) can often be treated with other types of drug therapy. There are also prescription and non-prescription medications that can be used to control vomiting associated with pregnancy and motion sickness. However, you should consult a physician before using these drugs.

You should seek emergency medical care, if vomiting is accompanied by:

• There was blood in the vomit (bright red or black "coffee grounds").
• Severe headache or stiff neck, fear the occurrence of meningitis.
• Weak lethargy, confusion, or decreased consciousness.
• Severe abdominal pain.
• Fever higher than 38.5 C.
• Diarrhea.
• Frequency of breath and very rapid and weak pulse.

Nausea and Vomiting related to Pregnancy

Although the cause is unknown, nausea and vomiting during pregnancy related to changes in the hormonal levels in the body of a pregnant woman. When a pregnant woman, there will be increased levels of human chorionic gonadotropin (HCG), which is derived from the placenta. This hormone serves to maintain adequate production of the hormones estrogen and progesterone from ovaries, resulting in pregnancy to be healthy.

In addition, the effect of this hormone is thought to cause nausea and vomiting in the first three months of pregnancy (first trimester) and will fall back after the fourth month. Therefore, nausea and vomiting usually goes away by itself after entering the fourth month. Besides HCG, the hormone estrogen is considered also cause nausea and vomiting in pregnant women.

Signs and symptoms

Level 1 (mild)

• Nausea and vomiting constantly affecting the general condition.
• Feeling weak.
• No appetite.
• Body weight decreased.
• Feel pain in the epigastric.
• Pulse increased by about 100 per minute.
• Decreased blood pressure.
• Reduced skin turgor.
• Tongue dries.
• Sunken eyes.

Level 2 (moderate)

• Looks weaker and apathetic.
• Skin turgor started ugly.
• Tongue dry and looked dirty.
• Pulse small and quick.
• Body temperature rises (dehydration).
• Eyes began to jaundice.
• Weight down and sunken eyes.
• Drop in blood pressure, hemoconcentration, oliguria and constipation.
• Acetone smell of respiration and occurs acetonuria.

Level III (severe)

• General condition is more severe (decreased consciousness from somnolence to coma).
• Severe dehydration.
• Pulse small, fast and smooth.
• Increased body temperature and blood pressure drop.
• Fatal complications occur in the nervous system known as Wernicke encephalopathy with symptoms of nystagmus, diplopia and mental decline.
• Jaundice which indicate heart trouble.

Prevention

Avoiding strong-smelling food, cigarette smoke or perfume smelling that can trigger nausea and vomiting.
Some dietary supplements may help reduce nausea and vomiting as a drink ginger or vitamin B6.
Eat a desired food when the body is able to receive it.
Do not lie down immediately after eating, should sit upright for a while to avoid bloating or nausea.
Avoid lots of drinking at meals, wait 30 minutes after eating a new drinking water. Outside of mealtime, are expected to drink more.
Eat small meals but frequently (every 2-3 hours) to prevent nausea without risk of malnutrition.
A diet that is complete and balanced.
Enough rest.
Consultation obstetrician if nausea and vomiting continues.

Activity Intolerance related to Anemia

Anemia is a term that indicates a low red blood cell and hemoglobin level, and hematocrit below the normal. Anemia is not a disease, but rather a reflection of the state of a disease or disorder of the body functions. Physiologically anemia occurs when there is a shortage of hemoglobin to carry oxygen to the tissues.
(Brunner & Suddarth, 2001)

This oxygen will be used to burn sugars and fats into energy. This may explain why anemia can cause symptoms of weakness and lethargy are not uncommon. Lungs and heart were also forced to work harder to get oxygen from the blood that causes shortness of breath.

Symptoms of anemia :

• Weakness, lethargy, dizziness, irritability, or trouble concentrating.
• Especially in the pale gums and eyelids or under the nails.
• Heart palpitations shortness of breath.
• Thrush of the mouth or tongue, welts or unusual bleeding.
• Numbness or tingling in the legs.
• Nausea and diarrhea.

Activity intolerance related to imbalance between the oxygen supply (delivery) and needs.

Goal: to maintain / improve ambulation / activity.

Expected outcomes:

• Reported increased exercise tolerance (including activities of daily living).
• Showed a decrease in the physiological signs of intolerance, such as pulse, respiration, and blood pressure is still within normal range.

Interventions:

• Assess the patient's ability to ADL.
• Assess lost or impaired balance, gait and muscle weakness.
• Observation of vital signs before and after the activity.
• Provide quiet environment, limit visitors, and reduce noise, keep bedrest when indicated.
• Use energy-saving techniques, advise patients to rest, in case of fatigue and weakness, advise patients to do his best activity (without imposing themselves).

Rationale:

• Affect the choice of intervention / assistance.
• Show neurological changes due to vitamin B12 deficiency affects patient safety / risk of injury.
• Cardiopulmonary manifestations of heart and lung efforts to bring an adequate amount of oxygen to the tissues.
• Increase rest to lower the oxygen needs of the body and lowers the strain the heart and lungs.
• Increase activity gradually, until normal and improve muscle tone / stamina without drawbacks. Boost self-esteem and sense of control.

Acute Pain and Hyperthermia related to Pharyngitis in Children

Acute pharyngitis is sore throat caused by a virus organism almost 70% and a group A streptococcal bacteria is a common organism with respect to acute pharyngitis were then referred to as "Strep Throat" (Brunner & Suddarth, 2001)

Chronic pharyngitis usually occurs in adult individuals who work / live in a dusty environment, use of excessive sound, suffer from chronic cough, habitual use of alcohol and tobacco.

There are 3 types of pharyngitis:

1. Hypertrophic (thickening of the common and congested mucous membrane of the pharynx).
2. Atrophic (the later stages of the first type: a thin membrane, whitish, smooth and wrinkled time).
3. Chronic granular (swelling of lymph follicles in the walls of the pharynx).

Acute Pain related to inflammation of the pharynx

Goal: expected, decrease pain

Expected outcomes: Children say:

• That pain is reduced.
• Adequate sleep and rest.
• Being able to use non-pharmacological methods to relieve pain.

Interventions:

• Perform a comprehensive pain assessment, including the location, characteristics, duration, frequency, quality factor and precipitation.
• Teach about non-pharmacological techniques (such as deep breath).
• Collaboration: Giving analgesics to reduce pain.
• Increase rest-sleep.

Rationale:

• Knowing the level of pain including the location, characteristics, duration, frequency, quality factor and precipitation.
• Deep breathing is one of relaxation to reduce tension and create a more comfortable feeling.
• Useful analgesic to relieve pain so that patients become more comfortable.
• Rest can relax so as to reduce the pain.

Hyperthermia related to inflammation of the pharynx.

Goal: expected normal body temperature.

Expected outcomes:

• Normal skin temperature.
• Body temperature.

Interventions:

• Assess body temperature every two hours.
• Encourage fluid intake and adequate nutrition.
• Give a warm compress for example in the armpit.
• Collaboration: Give antipyretic drugs.

Rationale:

• Knowing your child's temperature.
• Intake of fluids and nutrients can help speed the process of spending the body heat.
• Warm compresses can open the pores of the skin so as to accelerate the process of evaporation.
• Antipyretic drugs can help reduce the heat.

Risk Factors That May Affect the Occurrence of Malaria

Malaria is a disease caused by parasites. Malaria is spread by mosquitoes that have been infected by the parasite. Malaria can even be fatal if not treated properly.

Malaria infection can occur simply by a mosquito bite. Malaria is rarely spread directly from one person to another. Examples of conditions of transmission of this disease is in contact with the blood of the patient or fetus can be infected because of contracting out of the mother's blood.


Risk Factors That May Affect the Occurrence of Malaria :

1. Behavior
The behavior in question is the behavior of a person's life in an attempt to protect themselves from mosquito bites and keep clean sanitary environment in which he lived so that there is no possibility of the vector causing malaria to flourish.

2. Lighting
A healthy home requires sufficient light. Sunlight is very important because it can prevent the breeding of mosquitoes in the house. Therefore, the house must have enough driveway light such as windows and ventilation. Windows and vents have many functions such as to keep the flow of air inside the house to stay healthy, maintain the balance of oxygen and keep the humidity in the house.

3. Water temperature
Air temperature greatly affect the length - short of sporogonic cycle or extrinsic incubation period. The higher the temperature, the shorter the extrinsic incubation period and conversely the lower the temperature, the higher the extrinsic cycle.

4. Season
There is a direct relationship between the seasons and the development of the anopheles mosquito larvae into the adult form. Anopheles mosquito will grow faster during the rainy season especially in heavy rain with the number of rainy days are quite long, because it will affect where the anopheles mosquitoes or breeding.

5. Wind
The wind speed at the time of sunrise and sunset which is when flying into or out of the house is one of the factors that will determine the amount of contact between humans and mosquitoes.

6. Sewerage
Sewerage can also affect the occurrence of malaria, where sewerage is not addressed by either the state of sanitation and the flow of the waste is stagnant or not because the anopheles mosquitoes like the place where the water is static or flowing slightly as we know that the waste water that is not treated with either will cause various health problems of society and the natural environment or the transmission of them become breeding grounds for mosquitoes.

Nutrition for Wound Healing

Nutrition is a food that contains enough nutrients and energy value for the development and maintenance of optimal health.

Reason nutrients needed for the wound healing process
In the state of the wound, then, interrupted wholeness of body tissues and require sufficient nutrients to be able to repair the body's tissues are damaged.

Type of food that should be considered for wound healing
Among the foods that contain carbohydrates, proteins, fats, vitamins, minerals and water, then the most important for wound healing is a protein and vitamin C.

The reason: Protein and vitamin C very important role in the wound healing process. In addition, vitamin C has an important role to prevent infection and bleeding wounds.

Examples of foods that need to be considered for wound healing:

• Protein is divided into, vegetable and animal. Examples of vegetable such as tempe, tofu, nuts etc. Examples of animal protein, liver, eggs, chicken, shrimp, etc.
• Vitamin C include: nuts, citrus, guava, papaya leaves, spinach, tomatoes.

Definition, Signs and symptoms of Hallucinations

Definition

Hallucinations are a response (perception) senses without stimulation from the outside (external)


Classification

Hallucinations can occur in any sensory modality:

• visual,
• auditory,
• olfactory,
• gustatory,
• tactile,
• proprioceptive,
• equilibrioception,
• nociceptive,
• thermoreceptive, and
• chronoception.

Signs and symptoms

• Pulling away, avoid others.
• Easily offended.
• Smile, speak for themselves.
• Anxiety, fear, face tense.
• Talks chaotic, sometimes unreasonable.
• Suspicion and hostility.
• Self-blame / others.
• Can be self-destructive, others and the environment.
• Unable to distinguish between the real and unreal.
• Unable to focus attention / concentration.
• Difficult to make a decision.
• Fear.
• Red face sometimes pale.
• Unwilling or unable to perform self care such as bathing, brushing teeth, dressing.

Gastritis - 5 Additional Tests to Determine a Clear Cause

When a patient is diagnosed with gastritis, usually followed by additional tests to determine a clear cause. The tests includes:

1. Blood tests.
This test is used to check for the presence of H. pylori antibodies in the blood. A positive test indicates that the patient has been in contact with the bacteria at some time in their lives, but it does not indicate that the patient is infected. Blood tests may also be done to check for anemia, which occurs due to gastric bleeding due to gastritis.

2. Breathing tests.
This test can determine whether a patient is infected by the bacteria H. pylori or not.

3. Feces Test.
This test checks whether there is H. pylori in the feces or not. A positive result could indicate infection. Test conducted for the presence of blood in the stool. It showed bleeding in the stomach.

4. The upper gastrointestinal endoscopy.
With this test can look for abnormalities in the upper gastrointestinal tract which may not be visible on X-rays. This test is done by inserting a small flexible hose (endoscope) through the mouth and into the esophagus, stomach and upper small intestine. Throat advance in anesthesia before the endoscope is inserted to ensure patients feel comfortable undergoing this test. If any tissue in the gastrointestinal tract looks suspicious, the doctor will remove a small sample (biopsy) of the tissue. The samples will then be taken to the laboratory for examination. This test takes approximately 20 to 30 minutes. Patients usually do not go home when the test is completed, but had to wait until the effects of anesthesia disappear, approximately one or two hours. Virtually no risk as a result of this test. Frequent complication is the discomfort of the throat from swallowing the endoscope.


5. X-rays of the upper gastrointestinal tract.
This test will look for signs of gastritis or other gastrointestinal diseases. Usually it will be asked to swallow a liquid barium X-ray done before. This liquid will coat the gastrointestinal tract and be seen more clearly when in the X-ray.

Classification and Pathophysiology of Gastritis

Gastritis is an inflammation localized or spread on the gastric mucosa that develops when the mucosal protective mechanism is filled with bacteria or irritants. (J. Reves, 1999)

Classification of Gastritis

Gastritis by type is divided into 2 (two), namely:

1. Acute Gastritis
Gastritis (inflammation of the gastric mucosa) is most often caused by recklessness diet, such as eating too much, too fast, eating food too much seasoning or infected food. Other causes include alcohol, aspirin, bile reflux and radiation therapy. Gastritis may also be the first signs of acute systemic infection. Form of more severe acute gastritis caused by strong acid or alkaline, which can cause the mucosa into gangrene or perforation.

2. Chronic Gastritis
Prolonged inflammation caused by both benign and malignant gastric ulcers, by the bacteria H. pylori. Chronic gastritis may be classified as a Type A or Type B. Type A this occurs in the gastric fundus or corpus. Type B (H. pylori) of the antrum and pylorus. May be related to H. pylori bacteria. Dietary factors such as hot beverages, seasonings, use of drugs, alcohol, smoking or reflux of intestinal contents into the stomach.


Pathophysiology of Gastritis

Foodstuffs, drinks, drugs and chemicals that go into the stomach, causing irritation or erosion of the mucosa, so that the hull loss of barrier (protective). Furthermore, an increase in back diffusion of hydrogen ions. Interference diffusion of the mucosa and increased secretion of gastric acid increase / lot. Stomach acid and digestive enzymes. Then invade the gastric mucosa and there was an inflammatory reaction. This is called gastritis. Gastric mucosal responses against most of these irritants is with mucosal regeneration, therefore, such disorders often disappears by itself.

With a constant irritation, tissue becomes inflamed and bleeding can occur.

With the introduction of substances such as acids and strong bases which are corrosive resulting in inflammation and necrosis of the wall of the stomach (corrosive gastritis). Necrosis may result in perforation of the stomach wall to the next due to bleeding and peritonitis.

Chronic gastritis may lead to a state of atrophy of the gastric glands and mucous circumstances there are patches of thickened gray or gray-green (atrophic gastritis). The loss of the gastric mucosa will ultimately result in reduced secretion of the stomach and the emergence of pernicious anemia. Atrophic gastritis may be the prelude to gastric carcinoma. Chronic gastritis may also occur simultaneously with peptic ulcer or may occur after gastroyeyunostomía action.

Nursing Diagnosis for Skin Infections related to Fungi, Bacteria and Viruses

Infection is the process of invasive organisms and proliferate in the body that cause disease (Potter & Perry, 2005). Meanwhile, the skin infection is a disease caused by a bacteria / germs, viruses, fungi.

Bacterial Infections (Pyoderma)

Bacterial infections of the skin can be primary or secondary. Primary skin infections originated from previous skin looks normal, and usually these infections are caused by one type of microorganisms. Secondary skin infections caused by skin disorders preexisting or due to disruption of the integrity of the skin due to injury or surgery. In both these circumstances, some types of microorganisms can be involved, such as Staphylococcus aureus or group streptokus A. Primary bacterial infection that most often the case, among others:

• Bullous impetigo. Is a superficial infection of the skin caused by Staphylococcus aureus, characterized by bullae formation of vesicles origin. The bullae rupture and leave red lesions as well as wet.
• Folliculitis. A staphylococcal infections arising in the hair follicle. Lesions can be either superficial or deep. Often seen on the chin area men who shave the beard and the limbs of women.
• Pseudofolliculitis barbae ("shaving bumps"). An inflammatory reaction in the face of curly haired man who happens because hair growth inward, piercing the skin and trigger irritating reactions.
• Furuncles (boils). Is an acute skin inflammation resulting in one or more hair follicles and spread to the surrounding dermis layer. More often occurs in areas of irritation, such as: posterior neck, axilla or gluteus.
• Carbuncles. An abscess on the skin and subcutaneous tissue depicting expansion of a furuncle that have invaded several pieces of hair follicles. Carbuncles most often found in areas where the skin is thick and inelastic.

Virus Infection

The most common infection is herpes zoster. Shingles is a viral inflammatory disorder, in which the virus causes vesicular eruptions that cause pain along the sensory nerve distribution of one or more posterior ganglion.


Mycotic Infection (Fungus)

Fungus (mushroom) which is a member of the plant world are small and eating of organic matter, is the cause of various types of skin infections which are often found, among other things:

• Tinea pedis (foot fungus / athlete's foot). Is a fungal infection that most often found. These infections often affects adolescents and young adults although can occur in any age group as well as male and female.
• Tinea corporis (body fungal disease). Affects the face, neck, trunk and extremities. At the infected part will look ring-shaped lesions, or circle typical.
• Tinea capitis (scalp fungal disease). Is a contagious fungal infection that attacks the hair shaft and causes of hair loss are often found among children.
• Tinea cruris (groin fungal disease). Is a fungal infection of the groin that extends to the inner thighs and buttocks. Most often occurs in younger runners, people who are obese and who wear underwear too tight.
• Tinea unguium (onychomycosis). Is a chronic fungal infection of the toenails or fingernails. Usually accompanied by a fungal infection that is long in the legs.

Nursing Diagnosis for Skin Infections related to Fungi, Bacteria and Viruses

1. Acute Pain related to peripheral nerve damage.
2. Hyperthermia related to the inflammatory process.
3. Impaired skin integrity related to damage to the structure of the dermis layer.
4. Disturbed body image related to the lesions and skin structure changes.
5. Anxiety related to the disease process.

Erythrasma - Definition, Causes, Symptoms and Prevention

Erythrasma

DEFINITION

Erythrasma is an infection of the top layers of the skin caused by the bacterium Corynebacterium minutissimum.


CAUSE

Bacterium Corynebacterium minutissimum. Erythrasma common in adults and diabetics; The most commonly found in the tropics.


SYMPTOMS

Often found in areas where skin contact with the skin, such as under the breasts and armpits, between the toes and the genital area (especially in men, where the thighs touch the scrotum). Infection causes the formation of patches of pink with irregular shapes, which will then be transformed into smooth scales brown.

In some patients, the infection spreads to the torso and anal area. Could itching that are mild.


PREVENTION

Some actions can be done to reduce the risk of Erythrasma:

• Maintain cleanliness of the body.
• Keep skin dry.
• Using clean clothes with materials that absorb sweat.
• Avoiding excessive heat or moisture.

Nursing Diagnosis for Acute and Chronic Pancreatitis

Acute and Chronic Pancreatitis

Pancreatitis is inflammation in the pancreas.
There are two types of pancreatitis, acute and chronic.

Acute pancreatitis
Acute pancreatitis is a serious condition where the pancreas becomes inflamed over a short period of time.

Symptoms most commonly begins with abdominal pain in the middle or upper left part of the abdomen and may increase after eating or lying flat the back.
Other symptoms :

• nausea,
• fever,
• rapid heartbeat, and
• dehydration.
• severe acute pancreatitis symptoms and signs may show skin discoloration around the belly button or the side of the body between the ribs and hip (flank), or small erythematous skin nodules.

Chronic pancreatitis
Chronic pancreatitis is a condition where the pancreas becomes permanently damaged due to inflammation.

Symptoms may or may not include abdominal pain that may include :

• bleeding due to anemia,
• liver problems (jaundice),
• weight loss,
• nutritional deficiencies, and
• inability to produce insulin resulting in diabetes.

Causes of acute and chronic pancreatitis are similar; about 80%-90% are caused by alcohol abuse and gallstones (about 35%-45% for each); while the remaining 10%-20% are caused by

• medications,
• chemical exposures,
• trauma,
• hereditary diseases,
• infections,
• surgical procedures, and
• high fat levels in the blood and genetic abnormalities with pancreas or intestine

Nursing Diagnosis for Acute and Chronic Pancreatitis

1. Ineffective breathing pattern related to a decrease in oxygen entering the lungs.
2. Impaired tissue perfusion related to a decrease in blood supply to the tissues.
3. Fluid volume deficit related to a decrease in the amount of fluid in the intravascular.
4. Acute pain related to abdominal distention capsule.
5. Fluid volume related to the buildup of excess fluid in the peritoneal cavity.
6. Hyperthermia related to an infection of the peritoneum and gallbladder.

Altered urinary elimination related to a decrease in urine output.
Risk for imbalanced nutrition: less than body requirements related to nausea and vomiting.
Activity intolerance related to a decrease in the formation of energy.

Definition, Causes and Symptoms of Non-typhoidal Salmonella Infections

Non-typhoidal Salmonella Infections

DEFINITION

Non-typhoidal salmonella infections are infections caused by salmonella bacteria that do not cause typhoid fever.


CAUSES

Salmonella bacterium. There are 2200 species of Salmonella, including the type that causes typhoid fever. Every type can cause disturbances in digestion, enteric fever, and specific localized infections.

Salmonella is found in infected meat, poultry, raw milk, eggs and processed eggs. Salmonella can also be found in reptiles that are kept, deep red dye.


SYMPTOMS

Salmonella infections can cause gastrointestinal or enteric fever; sometimes the infection is only about a specific part. Some people who are infected may have no symptoms, but they act as carriers of these bacteria.

Gastrointestinal disorders usually begin to occur within 12-48 hours after infection with Salmonella bacteria. Initial symptoms are nausea and cramping abdominal pain soon followed by diarrhea, fever, and sometimes vomiting. Usually diarrhea is very watery, but sometimes can be a semi-solid stool. This disorder is usually mild and lasts 1-4 days, but can last much longer. Diagnosis is reinforced by breeding bacteria in stool samples or rectal swabs of patients.

Enteric fever occurs when Salmonella into the blood. Fever causes tremendous fatigue. Bacteria can live and multiply in the digestive tract, blood vessels, heart valves, membranes of the brain and spinal cord, lungs, joints, bones, urinary tract, muscle or other organs. Sometimes the bacteria infect the tumor, thus forming an abscess which in turn can cause blood infections.

A carrier does not show symptoms but will continue to release the bacteria in the stool. Less than 1% of patients who went on to become carriers of the bacteria for a year or more.

Definition, Causes and Symptoms of Septic Shock

Septic Shock

DEFINITIONS

Septic shock is a condition in which blood pressure drops to levels that endanger lives as a result of sepsis.

Septic shock often occur in:

• newborn baby,
• age above 50 years, and
• people with immune system disorders.

CAUSES

Septic shock caused by toxins produced by certain bacteria and due to cytokines (substances made by the immune system to fight an infection). Toxins released by the bacteria can cause tissue damage and circulatory disorders.

Risk factors for septic shock:

• Chronic diseases (diabetes, blood cancer, genital-urinary tract, liver, gall bladder, intestine).
• Infection.
• Long-term use of antibiotics.
• Medical procedures or surgery.

SYMPTOMS

Early signs of septic shock is often a decrease in mental alertness and confusion that arise within 24 hours or more before the blood pressure falls. This phenomenon is caused by reduced blood flow to the brain. Outpouring of blood from the heart is indeed increased, but the blood vessels widen so blood pressure goes down. Breathing becomes fast so that the lungs secrete excessive levels of carbon dioxide in the blood decreases.

Early symptoms include shivering, body temperature rises very fast, warm and reddish skin, weak pulse and blood pressure fluctuated. Decreased urine production despite increased flow of blood from the heart. In later stages, the body temperature often drops to below normal.

When the shock worsens, several organs fail:

• Kidneys: urine production is reduced.
• Lungs: respiratory distress and decreased oxygen levels in the blood.
• Heart: fluid retention and swelling.

May develop blood clots in the blood vessels.

COPD - Definition, Causes, Clinical Manifestation, Classification and Pathophysiology

Chronic Obstructive Pulmonary Disease

DEFINITIONS

Chronic Obstructive Pulmonary Disease (COPD) is a chronic lung disease characterized by the air flow resistance in the airway that is progressive nonreversibel or partially reversible. COPD consists of chronic bronchitis and emphysema or both. Chronic bronchitis is a respiratory disorder characterized by chronic cough with phlegm at least 3 months of the year, at least two consecutive years, is not caused by other diseases. while emphysema is an anatomical abnormality characterized by a widening lung airspaces distal to the terminal bronchioles, accompanied by destruction of the alveoli walls.


CAUSES

There are three factors that affect the incidence of COPD is cigarette, infection and pollution, but it is also associated with heredity, allergies, age and genetic predisposition, but it is not yet clear whether these factors play a role or not.

• Smoking: According to the report of the WHO expert committee on smoking control, smoking is the main cause of COPD. Physiologically cigarettes directly related to hiperflasia bronchial mucous glands and squamous metaplasia of the respiratory tract. Can also cause acute bronchoconstriction. According Crofton and Doouglas smoke cause too inhibition activity vibrating hair cells, alveolar macrophages and surfactants.
• Infections: upper respiratory tract infection in a patient with chronic bronchitis is almost always causes lower respiratory tract infection, and cause lung damage increases. Estimated exacerbation of chronic bronchitis is most often preceded by a viral infection, which then lead to secondary infection by bacteria.
• Pollution: pollution chemical substances that can also cause bronchitis is a reducing agent such as CO2, oxidising agents such as N2O, hydrocarbons, aldehydes and ozone.

CLINICAL MANIFESTATION

Common signs and symptoms appear in patients with COPD are as follows:

• Productive cough, initially intermittent and occurs almost every day over time.
• White or mucoid sputum, if there is an infection becomes purulent or mukopurulent, shortness of breath to use additional respiratory muscles to breathe, cough and expectoration, which tends to increase and the maximum in the morning.
• Shortness of breath after strenuous activity occurred along with the development of disease in the case of weight, shortness of breath occurs even with minimal exertion and even at rest due to the deterioration of gas exchange abnormalities.
• In the moderate-to-severe disease, physical examination may show a decrease in breath sounds, expiratory elongated, Ronchi, and hyperresonance on percussion.
• Anorexia.
• Weight loss and weakness.
• Tachycardia, sweating.
• Hypoxia.

All respiratory disease characterized by chronic obstruction of the airflow. The main cause of the obstruction assortment, for example:

• Airway inflammation.
• Mucosal adhesions.
• Narrowing of the airway lumen.
• Damage to the airway.
• Tachypnea.
• Orthopnea. (Doenges, 1999: 152)

CLASSIFICATION

Classification of COPD can be divided into three, namely:

• Bronchial asthma: a disease characterized by increased reaction response of the trachea and bronchi to various kinds of stimulation with manifestations such as difficulty in breathing caused by narrowing of the airways thorough.
• Chronic bronchitis: a clinical disorder characterized by the formation of excessive mucus in the bronchi and manifested in the form of chronic cough and sputum formed during 3 months of the year, a minimum of 2 years continuously.
• Emphysema: changes in the anatomy of the lung parenchyma characterized by widening the walls of the alveoli, alveolar ducts and alveolar wall destruction (Muttaqin, 2008).

PATHOPHYSIOLOGY

Inhalation of cigarette smoke or other harmful gases activates macrophages and epithelial cells to release chemotactic factors that recruit more macrophages and neutrophils. Then, macrophages and neutrophils release proteases that destroy these structural elements in the lungs. Proteases can actually be overcome by endogenous antiproteases, but the imbalance antiproteases against the dominance of protease activity that will eventually become a predisposition to the development of COPD. The formation of highly reactive oxygen species such as superoxide, hydrogen peroxide hydroxyl free radicals have been identified as factors that contribute to the pathogenesis because these substances can increase the destruction antiproteases.

Chronic inflammation result metaplasia on the walls of the bronchial epithelium, mucous hypersecretion, increased smooth muscle mass and fibrosis. There is also the epithelial ciliary dysfunction, causing disruption clearance excessive mucus production. Clinically, this process manifests as chronic bronchitis, characterized by a chronic productive cough. In the lung parenchyma, destruction of structural elements
mediated protease causes emphysema. Alveolar septum damage leads to reduced elasticity of the recoil of the lungs and airways dynamics failure due to damage to the small airways support non-cartilage. This whole process results in a patent airway obstruction and other symptoms characteristic pathophysiological for COPD.

Obstruction of the airways produce alveoli are not ventilated or less ventilated; Continuous perfusion of the alveoli will cause hypoksemia (low PaO 2) by a mismatch between ventilation and blood flow (V / Q is not appropriate). Ventilation of the alveoli are not perfused or less pefusi increase the space of the appendix (Vd), causing inefficient disposal of CO2. Hyperventilation would normally occur to compensate for this situation, which in turn will increase the work required to overcome airway resistance has increased, in the end this process fails, and there was retention of CO2 (hypercapnia) in some patients with severe COPD.

Knowledge Deficit - Definition, Defining Characteristics and Related Factors

Knowledge Deficit

DEFINITION: the absence or deficiency of cognitive information related to a particular topic

DEFINING CHARACTERISTICS :

• Behavior hyperbole.
• Inaccuracies follow orders.
• Inaccuracies test.
• Inappropriate behavior (ie., Hysteria, hostility, agitation, apathy).
• Disclosure issues.

RELATED FACTORS :

• Cognitive limitations.
• One interpretation of information.
• Less exposure.
• Lack of interest in learning.
• Less can remember.
• Not familiar with the resources.

NOC LINKED TO NANDA

Outcomes to measure resolution of diagnosis

• Knowledge: acute illness management
• Knowledge: body mechanics
• Knowledge: bottle feeding
• Knowledge: breastfeeding
• Knowledge: conception prevention
• Knowledge: depression management
• Knowledge: diabetes management
• Knowledge: health behavior
• Knowledge: health promotion
• Knowledge: healthy diet
• Knowledge: healthy lifestyle
• Knowledge: heart failure management
• Knowledge: hypertension management
• Knowledge: pain management
• Knowledge: parenting
• Knowledge: pregnancy
• Knowledge: stress management
• Knowledge: time management
• Knowledge: stroke prevention
• Knowledge: treatment procedure
• Knowledge: weight management
• Knowledge: infant care
• Knowledge: infection management
• Knowledge: kidney disease management
• Knowledge: labor and delivery
• Knowledge: medication

Additional outcomes to measure defining characteristic

• Adherence behavior
• Adherence behavior: healthy diet
• Agitation level
• Compliance behavior
• Compliance behavior: precribed activity
• Health seeking behavior
• Motivation

Outcomes associated with related factors or intermediate outcomes

• Abstract thinking
• Cognition
• Concentration
• Delirium level
• Dementia level
• Informstion processing
• Memory
• motivation

NIC LINKED TO NANDA

Suggested nursing intervention for problem resolution

• Anticipatory guideline
• Health education
• Learning faclitation
• Teaching: disease process
• Teaching: individual
• Teaching: foot care
• Teaching: preoperative
• Teaching: sexuality
• Teaching: toilet training
• Teaching: prescribed diet

Additional optional intervention

• Allergy management
• Anxiety reduction
• Asathma management
• Behavior modification
• Counseling
• Energy management
• Infection control
• Pain management
• Support group
• Therapeutic play

Reference :

• NANDA International. 2012. Diagnosis Keperawatan: Definisi, Dan Klasifikasi 2012-2014/Editor, T. Heather Herdman; Alih Bahasa, Made Sumarwati, Dan Nike Budhi Subekti ; Editor Edisi Bahasa Indonesia, Barrah Bariid, Monica Ester, Dan Wuri Praptiani. Jakarta; EGC.
• Moorhed, (et al). 2013. Nursing Outcomes Classifications (NOC) 5th Edition. Missouri: Mosby Elsevier
• Gloria M. Bulechek, (et al).2013. Nursing Interventions Classifications (NIC) 6th Edition. Missouri: Mosby Elsevier

Nausea - Definition, Defining Characteristics and Related Factors

Nausea

Definition: wavelike sensation in the back of the throat, epigastric, or abdomen that is subjective and unpleasant that may cause the urge or desire to vomit.

Defining Characteristics :

• Aversion to food
• Vomiting sensation
• Increased salivation
• Increased swallow
• Reported nausea
• Sour taste in the mouth

Related Factors :

Biophysical

• Biochemical disorders (eg., Uremia, diabetic ketoacidosis).
• Esophageal disease.
• Gastric distention.
• Stomach irritation.
• Increased intracranial pressure.
• Intra-abdominal tumor.
• Labyrinthitis.
• Stretching the liver capsule.
• The tumor is localized (ie., An acoustic neuroma, a primary or secondary brain tumors, metastatic bone at the base of the skull).
• Meniere's disease.
• Meningitis.
• Motion sickness.
• Pain.
• Pancreatic disease.
• Pregnancy.
• Stretching capsule spleen.
• Toxins (ie., A peptide produced by a tumor, abnormal metabolites due to cancer).

Situational

• Anxiety.
• Fear.
• Unpleasant odors.
• The taste of food / drink was not tasty on the tongue.
• Pain.
• Psychological factors.
• Stimulation unpleasant sight.

Therapy

• Gastric distention.
• Environmental irritants.
• Pharmaceutical (medicinal herb).

Reference :

• NANDA International. 2012. Diagnosis Keperawatan: Definisi, Dan Klasifikasi 2012-2014/Editor, T. Heather Herdman; Alih Bahasa, Made Sumarwati, Dan Nike Budhi Subekti ; Editor Edisi Bahasa Indonesia, Barrah Bariid, Monica Ester, Dan Wuri Praptiani. Jakarta; EGC.
• Moorhed, (et al). 2013. Nursing Outcomes Classifications (NOC) 5th Edition. Missouri: Mosby Elsevier
• Gloria M. Bulechek, (et al).2013. Nursing Interventions Classifications (NIC) 6th Edition. Missouri: Mosby Elsevier

How to Choose the Right Natural Treatment Mask

White facial skin has become a dream every person, whether it's women or men. Many people are willing to do anything to get a smooth white face. There were go to a doctor with a big cost, there is also wearing facial bleach, there is injected and much more. But nothing last long, that there is even damage the skin. Better try a natural material that you can create and process their own.

With traditional ingredients guaranteed to make more effective and economical. But before making the traditional ingredients, you first need to know your skin type. So you can make maximum skin care.

Types of Skin

1. Normal Skin

Normal skin generally has a degree of dryness and humidity standards. So that normal skin is usually very rarely got into trouble on the skin. So that when the process whiten the skin, normal skin tends to be easier. The skin looks a bit dry, but not too dry, but it is also the skin look smoother.

2. Oily Skin

Oily skin has the characteristics of a shiny face. The skin produces more oil. So sometimes it is very difficult for oily skin wearing makeup, because it will be easier to fade. However, the skin will tend to be more youthful because humidity is maintained. Although with difficulty a lot of dirt and may clog pores causing acne. Well then of the people who have oily skin are at high risk of acne. So wash your face frequently, especially after traveling and wearing makeup.

3. Dry Skin

For dry skin is recommended to always use a moisturizer to keep skin smooth and moist, so the skin is maintained and away from wrinkles. This skin tends to look dry even face sometimes looks flaky.


Which Must be Considered

• For dry skin should never or too frequently wash your face with warm water because it will make the skin more dry. But for oily skin it is recommended to use warm water.
• For dry skin are preferred to wear a mask least once a week use milk cleanser and toner as well, but for oily skin should not.

Choosing the Right Natural Treatment Mask

• Normal skin: For normal skin is not too problematic, you want to use any natural mask. Provided that thereafter washed and cleaned. But should wear cucumbers, carrots, potatoes etc.
• Oily Skin: For oily skin is highly recommended to make a natural mask of pineapple or lime. Other materials that can be used is egg white, egg yolk and honey.
• Dry skin: For dry skin you can make a mask of avucado, yam, bananas and other fruits. Moreover mask that contains flour is also very good.

Do You Know The Common Symptoms of Sinusitis ?

If you are having difficulty breathing, nasal congestion, pain in the eye or forehead, face like feel full, even on your teeth ache. You'd better be careful. You can be exposed to sinusitis. Those are some common symptoms of sinusitis. Do you know what exactly is sinusitis?

Sinusitis can be described as an inflammation of the sinus area. Sinus itself an air space that is located in the area of the face and connect directly with your nose.

Well, due to the inflammation of the sinus area are stockpiling the lenders in the sinus area. This resulted in the growth of bacteria. Well, but to diagnose sinusitis a person is infected with is not easy.

This is due to sinusitis symptoms similar to flu symptoms. A child whose flu for more than ten days is suspect that the child has been exposed to sinusitis.

Well, that's why on this occasion will discuss these concerns sinusitis symptoms. And expected you able to cope.

1. Nose colds
At first the disease begins with cold sinusitis. It is caused by inflammation triggered by colds, irritation or allergy attack that is common in sinusitis.

2. Pressure around the teeth and face
Basically sinusitis patients who are already infected will experience symptoms much. Usually a patient will experience nasal congestion even sick or feel excessive pressure in the area around the teeth and face. Excessive pressure on the teeth and facial area is a major sign that signifies that a person infected sinusitis. The pressure caused by the already inflamed tissue in the wall of nerve endings in your sinuses.

If you feel pain in the forehead area or even hurt your head then this is caused by frontal sinusitis which is located in the upper area of the forehead or eyes. If you feel pain in the cheek area and then spread to an area of the upper teeth, then this is caused by maxillary sinusitis located in both your cheekbones.

However, if you feel pain in your eye area, then this is caused by ethmoid sinusitis that lies between your eyes. Whereas if the pain in the crown of the head, behind the eyes or even along your neck, then this is a result of the sphenoid sinusitis which is located below the brain and behind your nose.

3. Nasal mucus
Symptoms of sinusitis worse still is the patient's nose will discharge that is green, yellow, or clear it. Other symptoms experienced by the patient is feeling excessive fatigue.

4. Decreased sense of smell and taste
In addition to the symptoms of sinusitis above, there are also symptoms of a reduction in your sense of smell. Due to the swelling of the lining of the nose will inhibit many kinds of smells that you can breathe.

So make your olfactory receptors will gradually experience a reduction. It turns out in addition to the reduction of sense of smell, your taste buds power will also decrease.

5. Cough and breath odor
Other common symptoms of sinusitis are experienced by patients is that bad breath and coughing. Bad breath caused by mucus that had been infected. This mucus containing bacteria so that if the exit going to stink.

If cough, this occurs because the mucus that can touch your vocal cords so will cause you to cough. Some symptoms of sinusitis should be considered because of the help that is ignored or overlooked (untreated), will make the germ of a sinusitis infection spread to the bone around the affected sinus cavity, eye, receptor (brain), and even the lungs.

Symptoms of Anemia That Can Facilitate You To Know

Anemia is a condition where the body is deficient in red blood cells or hemoglobin (the oxygen-carrying protein). Hemoglobin is an important element that should be normal so that oxygen is successfully distributed to all tissues of the body through the lungs.

Someone said anemia when the concentration of hemoglobin (Hb) less than 13.5 g / dL or hematocrit (HCT) is less than 41% in men, and hemoglobin concentration of less than 11.5 g / dL or Hct is less than 36% in women.

Anemia makes the process of circulating red blood cells to be disrupted, so that the body is deprived of oxygen which is then processed into energy. From here already clear that the initial symptoms of anemia can be often feel tired, tongue and eyelids pale.

Anemia is also associated with less blood condition. Here is a series of symptoms of anemia that can facilitate you to know anemic from sources Activebeat.

1. Fatigue and lack of energy
Fatigue is a common symptom of anemia that all patients must have experienced it. Some types of anemia, such as iron deficiency or vitamin B-12, may cause long-term excessive fatigue due to low hemoglobin levels.

2. Headaches and shortness of breath
Anemia makes patients feel tired often excessive, although it is not currently doing any strenuous activity. Moreover, it is not uncommon patient complained of headaches and shortness of breath. Such as when getting up suddenly from sitting, the head feels dizzy and the room seemed to move round. The condition indicates severe anemia caused by multiple organ finds no sufficient blood and oxygen. If there is a long term concern of the body ischemia, ie, the death of some tissues or cells.

3. Damage to some organs, such as brain and heart
Some parts of the body requires oxygen carried by hemoglobin so that its performance remains stable. Therefore, anemia interfere with the delivery process, the cardiovascular system disorders. Lack of oxygen-carrying blood not only result in extreme fatigue, but rather lead to damage some organs, such as brain and heart.

4. Leg cramps
Other common symptoms of anemia are leg cramps. In the mild anemia, leg cramps only occur once or moderate physical activity, such as walking, running, and long standing. Whereas in patients with severe anemia, leg cramps can occur even during rest. Will clearly called anemia when accompanied by muscle weakness, pale skin, and shortness of breath.

5. Skin pale
Skin look pale, an indication of anemia. This is a direct effect of the decrease in the amount of hemoglobin against the skin. Too pale fingertips, you can find out by pressing the tip of a finger and see the change to white or pale. While the body is yellowish skin.

6. Difficulty concentrating
Hemoglobin inability to circulate oxygen also affects the brain's ability to concentrate. This is compounded by unmet needs essential nutrients for the brain such as vitamins and minerals (folic acid, iron, and vitamin B12).

7. Irregular heartbeat
In the medical world this condition is called palpitations, the heart rate is not stable. Palpitations can occur when the heart is deprived of oxygen.

8. Insomnia
Sleep disorders, such as anxiety are also considered as a symptom of anemia after research conducted in 2008 in Ireland involving children and adolescents. Iron deficiency in some people cause insomnia, legs often move because feel uneasy or restless leg syndrome called.


Immediately consult a doctor when the body starts showing some symptoms of anemia above, especially for pale skin that must be addressed by a doctor.

Risk for Aspiration related to GERD (Gastroesophageal Reflux Disease)

Nursing Care Plan for GERD (Gastroesophageal Reflux Disease)
 
Gastroesophageal reflux disease (GERD) is a chronic digestive disease. GERD occurs when stomach acid or, occasionally, stomach contents flowing back into the food pipe (esophagus). Backwash (reflux) irritate the lining of the esophagus and causes GERD.

Both disorders stomach acid and heartburn is a common digestive condition that many people experience from time to time.

Signs or symptoms of GERD:

• A burning sensation in the chest (heartburn), sometimes spreading to the throat, along with a sour taste in the mouth.
• Chest pain.
• Difficulty swallowing (dysphagia).
• Dry cough.
• Hoarseness or sore throat.
• Regurgitation of food or sour liquid (acid reflux).
• Sensation of a lump in the throat.

Nursing Diagnosis and Interventions for GERD (Gastroesophageal Reflux Disease)

Risk for aspiration related to barriers to swallow, decreased reflexes of the larynx and glottis to liquid reflux.

Goals: None of aspiration.

Expected outcomes:

• The client can breathe easy, normal breathing frequency.
• The client is able to swallow, chew without aspiration, and capable of performing oral hygiene.
• Patent airway, breathing easily, do not feel suffocated and no abnormal breath sounds.

Interventions:

• Monitor the level of consciousness, cough reflexes and the ability to swallow.
• Raise the head of 30-45 degrees after eating.
• Cut food into small pieces.
• Avoid eating when residue is still a lot.

Rationale:

• Increase the maximum lung expansion and airway clearance.
• Increase air filling the entire segment of the lung, mobilize and remove secretions.
• Avoid the risk of aspiration is too high.
• Gastroesophageal may limit expansion.

Relationship Between Anxiety with Migraine

More than 100 years the relationship between psychological factors and headache studied.
Emotional factors often trigger a headache, especially migraine. Three types of headache is most often associated with psychological factors are studied in migraine more intensive compared than other forms.

Typically, migraine sufferers have a specific personality (perfect, ambitious, rigid) as a group, patients with migraine usually intelligence and perfectionist and they are people who are capable of facing the day-to-day crises. But in adaptation to life changes such as puberty, menstruation, separation from family and home, change jobs, marriage, parenthood, or get a high position, it turns out the ability to tackle problems that are usually good, being less well and therefore attack headache then arise.


Migraine

Migraine is a painful headache, often accompanied by nausea, vomiting, and sensitivity to light.

The exact cause of migraines is unknown, although migraine related to changes in the brain and genetic causes. People with migraines may inherit the tendency to be affected certain migraine triggers, such as fatigue, bright lights, weather changes, and others.

For many years, scientists believed that migraines associated with the expansion and inhibition / constriction of blood vessels in the brain's surface. However, it is now believed that migraines are caused by inherited abnormalities in certain areas of the brain.

There are "central pain" migraine, or generator in the brain. Migraine begins when hyperactive nerve cells send impulses to the blood vessels, causing the blood vessels are prohibited or restricted, followed by dilation (expansion) and the release of prostaglandins, serotonin, and other inflammatory substances that cause painful pulse.

Most migraines seem to be triggered by external factors. Some triggers may include:

• Emotional stress. This is one of the most common triggers of headache / migraine. Migraine sufferers are generally highly affected by stressful events. During stressful events, certain chemicals in the brain are released to combat the situation (known as response "fight or retreat"). The release of these chemicals can provoke vascular changes that can cause migraines. Repressed emotions surrounding stress, such as anxiety, fear, excitement, and fatigue can increase muscle tension and dilation of blood vessels can increase the severity of migraine.
• Sensitivity to certain chemicals and preservatives in food. Food and beverages, such as aged cheese, alcoholic beverages, and food additives such as nitrates and monosodium glutamate may be responsible for triggering mingrain up to 30%.
• Caffeine. Excessive caffeine consumption or the effects of caffeine withdrawal can cause headaches when the caffeine level suddenly drops. The blood vessels seem to be sensitive to caffeine, and when caffeine is not ingested, a headache may occur. Caffeine itself is often helpful in treating acute migraine attacks.
• Changes in weather conditions. Storms, changes in air pressure, winds, or changes in altitude, all can trigger a migraine.
• Menstrual period.
• Overexertion.
• Skipping meals.
• Changes in normal sleep patterns.

The symptoms of migraine can occur in various combinations and include:

• Headache hitting or beating, which often begins as pain and develops into throbbing pain. The pain is usually aggravated by physical activity. The pain can shift from one side of the head to the other, or it can affect the front of the head or felt like illness affects the whole head.
• Sensitivity to light, noise and odors.
• Nausea and vomiting, abdominal unwell, abdominal pain.
• Loss of appetite.
• The taste sensation that is very warm or cold.
• Paleness.
• Fatigue.
• Dizzy.
• Blurred vision.
• Diarrhea.
• Fever (rare).

Most migraines last about four hours despite severe can last up to a week. The frequency of migraines varies greatly between individuals. Common for a migraine sufferer to get a headache from two to four times per month. However, some people may have headaches every few days, while others only get a migraine once or twice a year.


Anxiety

Anxiety is a feeling worried vague source, often non-specific or unknown to the individual.

Anxiety is a feeling / emotional response to the judgment, feelings of uncertainty and helplessness (Stuart and Sundeen, 1988). Emotional state experienced objectively and communicated in interpersonal relationships. Anxiety is the emotional response to the judgment in everyday life. Anxiety describe the state of worry, anxiety, fear, do not feel at ease with a variety of physical complaints.

Levels of Anxiety

Mild Anxiety

Mild anxiety associated with the tension of the events of everyday life. At this level of perception widen and individuals will be cautious and alert.

Physiological responses:

• Occasionally short of breath.
• Tone and blood pressure rises.
• Mild symptoms in the stomach.
• Wrinkled face and lips quivering.

Cognitive Response:

• Capable of receiving stimuli complex.
• Concentration on the issue.
• Solve problems effectively.

Behavioral and emotional responses:

• Unable to sit quietly.
• Fine tremor of the hands.
• Voice sometimes rising.

Moderate Anxiety

At this rate decreased perception of the environment, individuals are more important things to focus on the moment and the exclusion of anything else.

Physiologic response:

• Often short of breath.
• Pulse and blood pressure rises.
• Dry mouth.
• Anorexia.
• Diarrhea / constipation.
• Agitated.

Cognitive responses:

• Field narrowed perception.
• External stimuli are not able to be accepted.
• Focusing on what the attention.

Behavioral and emotional responses:

• Jerky movements / squeezing hands.
• Talk and more quickly.
• Insomnia.
• Feelings of insecurity.

Severe Anxiety

Physical response:
Muscle tension weight, hyperventilation, eye contact is bad, sweating increased, fast talking, high tone, action aimless and haphazard, jaw tensed, gritted his teeth, need for space increases, pacing, yelling, squeezing hands and shaking.

Cognitive response: field is limited perception, thought processes fragmented, difficulty thinking, problem solving poor, unable to take into consideration the information, only to notice the threat, preoccupation with his own thoughts, and self-centered.

Emotional response: very anxious, agitated, scared, confused, feel inadequate, withdrawal, denial and want to be free.


Relationship Between Anxiety with Migraine

1. Anxiety is common in migraine sufferers.
2. There is a relationship between the degree of pain intensity with anxiety due to the severity of migraine.
3. There is a relationship between duration of pain with the severity of anxiety in patients with migraine.

Causes, Prevention, Signs and Symptoms of Gout

Gout is a type of arthritis caused by a buildup of uric acid crystals in the joints. Uric acid is a breakdown product of purines that are part of the food we eat. Abnormality in handling uric acid and crystallization of these compounds in the joints can cause attacks of painful arthritis, kidney stones, and blockage of the filtering process of the renal tubules with uric acid crystals, leading to kidney failure.

Acute gout attack is characterized by rapid onset / sudden pain in the affected joint followed by a warm feeling on touching the joints, swelling, redness, and pain. Small joints at the base of the big toe is the most commonly attacked. Other joints that can be affected include the ankles, knees, wrists, fingers, and elbows. In some people, the pain suddenly / acute so strong that even the sheets at the foot of causing severe pain. Painful attacks usually subside within a few hours or days, with or without medication. In rare cases, attacks can last for weeks. Most people with gout will experience repeated attacks of gout arthritis for many years.

Gout is nine times more common in men than in women. It mainly affects males after puberty, with a peak age of 75 years of age. In women, gout attacks usually occur after menopause.

Obesity, excessive weight, especially in youth, drinking moderate to severe, high blood pressure, and abnormal kidney function is one of the risk factors for developing gout. Drugs and certain diseases can also cause an increase in uric acid levels. Interestingly, a recent study showed an increased prevalence of abnormally low thyroid hormone levels (hypothyroidism) in patients with gout.

The base of the big toe joint is the most common site of an acute Gout attacks. These attacks can occur, except gout treated. See your doctor, even if you are sick rheumatism / gout has been lost. Over time, they can harm the joints, tendons, and other tissues.

Uric acid crystals in the finger joints and stiffness which result in painful inflammation.

People may experience gout by deposition of uric acid crystals in the joints of their fingers. To reduce the pain of a gout attack, rest the painful joints.

Maintain adequate fluid intake helps prevent acute gout attacks and reduce the risk of kidney stone formation in people having gout. Alcohol is known to have diuretic effects that can cause water shortages and triggered an acute gout attack. Alcohol can also affect uric acid metabolism and cause hyperuricemia. This causes gout, therefore slowing spending uric acid from the kidneys as well as to cause shortage of liquid, which causes uric acid crystals to precipitate in the joints.

Dietary changes can help reduce uric acid levels in the blood. Because purine chemicals are converted by the body into uric acid, purine rich foods should be avoided. Foods rich in purines include shellfish and organ meats, such as liver, brain, and kidneys. Researchers have reported that meat or seafood consumption increases the risk of gout attacks, while dairy consumption seems to reduce this risk. Weight loss can help in lowering the risk of recurrent gout attacks.


Reference:

MedicineNet.com WebMD Medical Reference from Healthwise: "Gout - Topic Overview."

Acute Bronchitis - Definition, Etiology, Risk Factors, Signs and Symptoms

Definition of Acute Bronchitis

Acute bronchitis is an acute respiratory tract infection disease (inflammation of the bronchi) that usually occurs in infants and children are usually also accompanied by tracheitis (Ngastiyah; 1997; 36).

Etiology

• Acute bronchitis is usually often caused by viruses such as Rhinovirus, respiratory syncytial virus, influenza virus, parainfluenza virus, and coxsackie virus. Acute bronchitis can also be found in children who are suffering from measles (morbilli), pertussis and Mycoplasma pneumoniae infections.
• Another cause of acute bronchitis may also by bacteria (staphylococcus, streptococcus, pneumococcus, haemophilus influenzae). Bronchitis can also be caused by a parasite such as ascariasis and fungi.
• Causes of non-infectious is due to aspiration of the physical or chemical materials. Predisposing factors occurrence of acute bronchitis is a change in weather, allergies, air pollution and chronic upper respiratory tract infections predispose to bronchitis.

Risk Factors

Factors that increase the risk of bronchitis include:

• Cigarette smoke. People who smoke or who live with smokers are at higher risk for symptoms of acute bronchitis and chronic bronchitis.
• Low resistance. This is usually the result of other acute illness, such as a cold or a chronic condition that compromise the immune system. Adults, infants and children have a greater susceptibility to infection.
• Exposure to irritants on the job. Bronchitis disease risk is greater when working around the place that may be exposed to lung irritants, such as iron ore or textiles and exposed to chemical vapors.

Signs and Symptoms of Bronchitis

Both symptoms of acute bronchitis and chronic bronchitis, signs and symptoms may include:

• Cough.
• Production of mucus (sputum), which can be clear, white, gray or yellowish green.
• Fatigue.
• Slight fever and chills.
• Discomfort in the chest.

Reference :

• (Ngastiyah; 1997; P 36, 37).
• (Purnawan Junadi; 1982; 206).

Knowledge Deficit related to Urinary Tract Infection (UTI)

Urinary tract infection is an infection caused by pathogenic microorganisms in the urinary tract, with or without symptoms. (Brunner and Suddarth, of Medical Surgical Nursing 8th Edition Vol. 2, page 1428).

Etiology

1. Risk Factors

• Women are more at risk than men.
• Have a history of sexually transmitted disease.
• Catheterization.

2. Factors Predisposition

• Escherichia coli, Proteus, Klebsiella, Enterobacter, Pseudomonas, and Staphylococcus saprophyticus.
• Disruption of glycosaminoglycans.
• Ureterovesical reflux.
• Obstruction of urine flow.

3. Factors Precipitation

• Poor hygiene.
• How to wash genitals that are less clean / not true.
• Often hold urine.

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

Characterized by:

Subjective Data:

• Patients say do not know about his illness.
• Patients say do not know about the treatment of the disease.

Objective data:

• Patients looked confused when asked about his illness.

Goal:

• Expected lack of knowledge of the patient can be resolved,

with expected outcomes:

• Expressed and understood about the condition, diagnostic examination, treatment plan, self-care and preventive measures.

Interventions :

• Review the disease process and hope that will come.
• Provide information: the source of infection, measures to prevent the spread, explain antibiotics, diagnostic examinations: a goal, a brief description, preparation required prior to the examination, examination after treatment.
• Make sure the patient or significant others have written agreements for further treatments and written instructions for care after the examination.
• Instruct the patient to use the drug administered.
• Provide the opportunity for patients to express their feelings and concerns about the treatment plan.

Rationale:

• Provide basic knowledge in which patients can make informed choices.
• Knowledge of what is expected to reduce anxiety and help make the client adherence to the plan of therapeutic.
• Verbal instructions can easily be overlooked.
• Patients often discontinue their medications, if signs of abating disease. Fluids help flush the kidneys.
• To detect cues indicative of the possibility of non-compliance and help develop the acceptance of the therapeutic plan.

Causes and Common Symptoms of Gastritis in Children

Gastritis is an erosion in the lining of the stomach, where this process can occur suddenly, called acute gastritis or slow and takes a long time (chronic gastritis). In addition to erosion of the stomach lining, inflammation or irritation can also cause gastritis.

Gastritis can strike from children to adults, where if it is not in the intensive treatment, it can cause a variety of diseases of the stomach.

Many things can cause gastritis, one of the main factors is an infection of the microorganism Helicobacter pylori (H.pylori). Rising back bile into the digestive system can also cause gastritis. Or patients 'Pernicious anemia' in which a person can not digest vitamin B12 can also trigger gastritis.

Another cause could be a precipitating factor gastritis are undergoing treatment for a long time such as cancer patients undergoing chemotherapy or people with HIV-AIDS.


Here are the common symptoms of gastritis in children:

• Stomach feels uncomfortable.
• Pain in the abdomen either before or after meals.
• Flavor full or satiated.
• Nausea and vomiting.
• Indigestion after eating food.
• Loss of appetite.
• Insomnia.
• Uninterrupted night's sleep suddenly, due to abdominal pain.
• Diarrhea.
• Frequent hiccups.
• Feces when defecation is black.