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