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.

How to Naturally Eliminate Nausea During Pregnancy

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

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

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

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

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

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

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

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

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

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

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

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

Elderly Nursing Care Plan with Impaired Physical Mobility and Activity Intolerance

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

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

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


Impaired Physical Mobility

Definitions:

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

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

Defining characteristics

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

Related factors

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

Activity Intolerance

Definitions:

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

Defining characteristics

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

Related factors

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

 Internal Factors

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

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

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

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

5 . Reduced cognitive abilities : Disruption

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

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

8 . Psychological aspects : helplessness in learning , depression .


External Factors

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


Management

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

2. Secondary prevention

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

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

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

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

There are two types of gastritis are:

Acute Gastritis

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

Chronic Gastritis

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


Etiology

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

Clinical Manifestations

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

Acute Gastritis

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

Chronic Gastritis

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

Treatment

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

Acute Gastritis

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

Chronic Gastritis

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

Nursing Diagnosis for Premature Rupture of Membranes

Nursing Care Plan for PROM
 
Premature rupture of membranes (PROM) is the rupture of the membranes prior to the onset of labour.

Premature rupture of membranes (PROM) refers to a patient who is beyond 37 weeks' gestation and has presented with rupture of membranes (ROM) prior to the onset of labor. Preterm premature rupture of membranes (PPROM) is ROM prior to 37 weeks' gestation. Spontaneous premature rupture of the membranes (SPROM) is ROM after or with the onset of labor. Prolonged ROM is any ROM that persists for more than 24 hours and prior to the onset of labor.

Risk factors for PPROM are:

• Smoking. Heavy cigarette smoking increases the risk of PPROM more at early gestational age than at term.]
• Previous preterm delivery.
• Vaginal bleeding (at any time during the pregnancy).
• There is an association between lower genital tract infection and PPROM.
• Around a third of women with PPROM have positive amniotic fluid cultures.

The following are the most common symptoms of PROM. However, each woman may experience symptoms differently.

Symptoms of PROM:

• leaking or a gush of watery fluid from the vagina
• constant wetness in panties

If you notice any symptoms of PROM, be sure to call your physician as soon as possible. The symptoms of PROM may resemble other medical conditions. Consult your physician for a diagnosis.

Prevention of premature rupture of membranes:

Unfortunately, there is no way to actively prevent PROM. However, this condition does have a strong link with cigarette smoking and mothers should stop smoking as soon as possible.


Nursing Diagnosis for Premature Rupture of Membranes

1. Risk for Infection: maternal
related to:

• invasive procedures,
• recurrent vaginal examination,
• amniotic membrane rupture.

2. Impaired gas exchange: fetus
related to: the presence of disease.

3. Acute pain
related to: the rhythmic contraction of uterine smooth muscle.

4. Anxiety
related to:

• crisis situation,
• threat to the mother / fetus.

6. Activity intolerance
related to: muscle hypersensitivity.

Geriatric Nursing - Alzheimer's Disease Assessment

Assessment in Alzheimer's disease

1 . Activity / rest
Symptoms : Feeling tired
Signs : Day / night restless , helpless , disruption of sleep patterns
lethargy : decreased interest or concern in usual activities , hobbies , inability restates what is read / follow event television programs .
Motor skills disorder , inability to do normal things that have been done , the movement is very useful .

2 . Circulation
Symptoms: History of cerebral vascular disease / systemic . hypertension , embolic episodes ( a predisposing factor ) .

3 . Ego integrity
Symptoms : Suspicious or fear of the situation / person fantasies , misperceptions about the environment , identification of objects and faults of people , hoarding objects : objects that one believes that placement has been stolen , lost multiple , changes in body image and self-esteem perceived .
Signs : Hiding disability ( many reasons are unable to perform an obligation , it may also open the hand without reading the book yet ) , sit and watch the others , the first activity may accumulate objects are not moving and emotionally stable , repetitive movements ( folded unfolded folded cloth ) , hide stuff , or take a walk .

4 . Elimination
Symptoms : Encouragement urination
Signs : Incontinence of urine / feaces , tend to constipation .

5 . Food / fluid
Symptoms : History of hypoglycemia episodes ( a predisposing factor ) changes in taste , appetite , weight loss , denying the hunger / need to eat .
Symptoms: Loss of ability to chew , avoiding / refusing to eat ( probably trying to hide skill ) . and looking increasingly thin ( advanced stage ) .

6. Hiygene
Symptoms: Need help / dependent people
Signs: not able to maintain the appearance, personal habits are lacking, poor cleaning habits, forgetting to go to the bathroom, forget the steps for waste water, unable to find a bathroom, and less interested in or have forgotten at meal time: dependent on others for over the kitchen to cook and prepare food, eat, use cutlery.

7. Neuro-sensory
Symptoms: The denial of the presenting symptoms, especially cognitive changes, and blurred or picture, hypochondria complaints about fatigue, dizziness or headache sometimes. Complaints in cognitive abilities, decision-making, given the pass, drop behavior (observed by nearby). Loss of sensation of proprioception (body position or a certain part of the body in space), and a history of cerebral vascular disease / systemic embolism or hypoxia that lasted periodically (as a predisposing factor) as well as seizure activity (secondary to the brain damage).
Symptoms: Damage communication: aphasia and dysphasia; difficulty in finding the right words (especially nouns); asked repeatedly or conversations with the substance of the word that has no meaning; fragmented, or speech not audible. Lose the ability to read and write stages (loss of fine motor skills).

8. Comfort
Symptoms: A history of serious head trauma (may be a predisposing factor or acceleration factor), traumatic accidents (falls, burns, and so on).
Sign: ecchymoses, lacerations and hostile / attack others.

9. Social interaction
Symptoms: Feeling lost power. psychosocial factors previously; influence of personal and individual that appears to change patterns of behavior that emerge.
Symptoms: Loss of social control, the behavior was not appropriate.

Nursing Assessment for Malignant Lymphoma (Signs and Symptoms)

Nursing Assessment for malignant lymphoma by Doenges, (1999) obtained the following data:

1. Activity / rest

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

2. Circulation

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

3. Ego integrity

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

4. Elimination

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

5. Food / fluid

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

6. Neuro-sensory

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

7. Pain / comfort

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

8. Breathing

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

9. Security

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

10. Sexuality

• Symptoms: problem about fertility / pregnancy (while the disease does not affect, but affect treatment), decreased libido.

Nursing Management for Malignant Lymphoma

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

The two main types of lymphoma are Hodgkin and non-Hodgkin lymphoma (NHL).

The diagnosis of malignant lymphoma requires the presence of malignant lymphocytes in a biopsy of lymph node or extra-lymphatic tissue. An excisional lymph node biopsy is essential for complete diagnostic assessment. If a whole lymph node is not obtainable, sufficient incised tissue from an extra-lymphatic site can be diagnostic but is less desirable. Fine needle aspiration biopsy is not sufficient for the initial diagnosis of malignant lymphoma.

Malignant lymphoma is derived from lymphocytes. These tumors usually stems from lymph nodes, but can involve the lymphoid tissue in the spleen, gastrointestinal tract (eg, stomach wall), liver, or bone marrow. Lymphocytes in lymph nodes is also derived from multipotential stem cells in the bone marrow. Multipotential stem cells in the early stages of transformation into a lymphocyte progenitor cells that subsequently differentiate along two parallel paths.

Partial maturation in the thymus gland to become T lymphocytes, and partly to the lymph nodes or remain in the bone marrow and differentiate into B lymphocytes cells
If there is an appropriate antigen stimulation by the T and B lymphocytes will be transformed into an active form and proliferating. Activated T lymphocytes functioning cellular immune response. Whereas B lymphocytes are then activated to imunoblas into plasma cells that form the immunoglobulins. Changes in normal lymphocytes into cell lymphoma is caused by a gene mutation on one of the cells of a group of old cell lymphocytes are in the process of transformation into imunoblas (the result of the stimulation of immunogen). This occurs in the lymph nodes, where lymphocytes are outside centrum old germinativum while imunoblast be the most central part germinativum centrum. If the tumor enlarges, it can cause and if not treated early it causes malignant lymphoma.

Cause of these tumors is unknown, but there are some risk factors include: immunodeficiency, infectious agents, environmental and occupational exposures (such as forest workers, farmers and agriculture), ultraviolet exposure, smoking, and eating foods high in animal fat. Signs and symptoms include fatigue, malaise weight loss, increased temperature, infection susceptibility, dysphagia, anorexia, nausea, vomiting, constipation, anemia, edema arising anasarka, drop in blood pressure, shortness of breath when grown in the chest area and disorders / enlargement organ. If this condition is ongoing, it can cause complications of pleural effusion, bone fracture, paralysis and kematin certainly occur within 1 to 3 years if no treatment.

Nursing Management for Malignant Lymphoma

According to Brunner and Suddarth (2000), in providing care and client education. Clients often feel afraid to drugs that are radioactive and requires maintenance action and follow-up monitoring is special because it is the nurse should convey information about the therapeutic and soothing feelings of clients and families. For clients with postoperative laparotomy, clients are encouraged to rest and to avoid strain on the stitches. Gauze covering the wound should be reviewed periodically to determine the presence or not and do peradahan wound care according to the program every day, to observe signs of infection.

Preoperative Nursing Interventions for Apendicitis

Appendicitis is an inflammation of the appendix, a sac that no such additional functions located in the inferior and cecum. The most common cause of appendicitis is obstruction of the lumen by fecal eventually damage erode supply and mucosal blood flow, causing inflammation (Wilson & gold man, 1989).

Appendicitis is caused by blockage of the lumen of the appendix by fecalit, foreign objects, because there are previous inflammation. The obstruction causes mucus-producing mucosa, having the dam. However, the elasticity of the walls of the appendix has limitations that cause intra-luminal pressure. The increased pressure will inhibit the flow of lymph which will cause edema and ulceration of the mucosa, this occurs when the local acute appendicitis is characterized by the presence of pain.

Appendix unknown function, is part of the cecum. Inflammation of the appendix may occur by the presence of mucosal ulceration or obstruction of the lumen wall (usually by fecalit / hardened feces). Penymbatan spending mucus resulting in adhesions, and inhibition of bloodstream infections. Of hypoxia, resulting gangreng or rupture within 24-36 hours. If this process continues around the walls of organs appendix adhesions will occur that will cause an abscess (chronic). If the infection process is very fast will cause peritonitis.

Perforation signs include increased pain, muscle spasm right lower quadrant abdominal wall with a sign that generalized peritonitis or abscess localized, ileus, fever, malaise, leukocytosis increasingly clear. When perforation with generalized peritonitis or abscess formation has occurred since the increment clients outsmart come, the diagnosis can be established with certainty.

If peritonitis occurs, specific therapy is surgery performed to close the perforation origin. While the other acts as a support: Fowler position bed rest in the medium, the installation of NGT, fasting, correction fluids and electrolytes, giving tranquilizers, antibiotics with broad-spectrum antibiotics are continued in accordance with the culture, transfusion to treat anemia, and treatment of septic shock in the intensive , if any.


Preoperative Nursing Interventions for Apendicitis

1. Risk for Infection related to an inadequate immune.

Characterized by:

• body temperature above normal,
• increased respiratory frequency,
• abdominal distension,
• leukocytes> 10.000/mm3

Goal: Not an infection

Outcomes: There are no signs of postoperative infection.

Intervention:

1. Clean the field operations of several organisms that may be present through the principles of shearing.
2. Give laxatives 1 day before surgery.
3. Encourage clients with the perfect bath.
4. Do a good hand washing and aseptic wound care.

2. Acute Pain related to intestinal distension

Characterized by: respiratory tachypnea, tachycardia circulation, epigastric pain radiating to the local area Mc Burney, the client complained of feeling pain lower right area.

Goal: pain is resolved

Outcomes:

• normal breathing,
• normal circulation

Intervention:

1. Assess the level of pain, location and characteristics.
2. Encourage deep breathing.
3. Give analgesics.

Nursing Care Plan for Glaucoma - 5 Nursing Diagnosis

Glaucoma is a disease of the optic nerve can cause visual field abnormalities and can end up with permanent total blindness.

Cause

Mainly due to high eye pressure (normal value: 10-22 mmHg)

Risk Factors

• Age over 40 years.
• Families who have suffered from glaucoma.
• History of trauma to the eye.
• Myopia (nearsightedness)
• Hypermetropia (farsightedness)
• Have systemic disease (diabetes, heart disease)
• The use of drugs (steroids)
• Cataracts.

Symptom

Chronic glaucoma :

• Nerve damage occurs slowly.
• Painless.
• Narrowing the field of vision is not realized.
• Permanent blindness.
• Commonly called thief of sight.

Acute glaucoma

• Due to the sudden eye pressure high.
• Severe headache.
• Nausea vomiting
• Red eye
• Blurred vision
• Rainbow appear when viewing the lights.
• If not promptly treated, it will cause blindness.

Congenital glaucoma

• In infants or children
• Very rare
• Congenital abnormality
• Eyeball bigger than normal
• Cornea is not clear
• Watery eyes
• Afraid to see the light

Complication

Blindness occurs that can not be cured but can be prevented.

Prevention

• Regular eye examinations, especially over the age of 40 years.
• Regular control for patients with glaucoma.

Treatment

• Lowering drugs eye pressure, is used regularly and continuously to prevent further damage to the optic nerve.
• Surgery or laser to create a new channel in order to decrease eye pressure.

5 Nursing Diagnosis for Glaucoma

1. Disturbed Sensory Perception
2. Anxiety
3. Acute pain
4. Disturbed Body Image
5. Self-care Deficit

Pediatric Nursing

Pediatric Nursing Demystified (Demystified Nursing)

The quick and easy way to learn the concepts and major theories of pediatric nursing – and how to apply them to real-world situations

If you’re looking for a fun, fast review that boils pediatric nursing down to its most essential, must-know points your search ends here! Pediatric Nursing Demystified is a complete yet concise overview of all the important pediatric nursing concepts and the disorders that most often afflict infants to adolescents. You’ll also learn how to apply those principles to real-life clinical situations.

In order to make the learning process as easy and effective as possible, you’ll find learning aids such as chapter objectives, key terms, a brief overview of each topic, content summaries, chapter-ending questions, numerous tables and diagrams, and a comprehensive final exam that includes NCLEX-style questions covering all the content found in the book.

Great for course exams and as an NCLEX review!

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Wong's Essentials of Pediatric Nursing, 9e

When it comes to caring for children, no other resource better prepares you for practice than Wong's Essentials of Pediatric Nursing. Authored by Marilyn Hockenberry and David Wilson, two of the most well-known and respected names in the field, Wong's features the most readable, up-to-date, and accurate content available. An abundance of full-color illustrations helps you visualize key concepts, and highlighted boxes and tables offer quick access to vital facts and information. Plus, when you buy this book, you get unlimited access to hands-on study tools that help you learn pediatric nursing essentials with ease!

• Developmental approach clearly identifies key issues at each stage of a child's growth to help you provide appropriate, individualized care for each child.
• UNIQUE! Family focus includes a separate chapter on the role of the family in child health, family content throughout the text, and Family-Centered Care boxes that highlight information on patient teaching, home care, and incorporating the family in the child's care.
• An emphasis on wellness offers health promotion and injury prevention strategies for each age group.
• UNIQUE! Evidence-Based Practice boxes demonstrate how research is applied to nursing care in the clinical setting.
• UNIQUE! Atraumatic Care boxes provide guidance for administering nursing care with minimal pain or stress to the child, family, and nurse.
• NEW! Safety Alerts call your attention to important patient safety considerations and support the QSEN initiative for better outcomes of nursing care..

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Pediatric Success: A Course Review Applying Critical Thinking Skills to Test Taking (Davis Success Series)

Over 900 NCLEX-style questions on pediatrics and growth and development into body system chapters. Add a 100- question comprehensive exam at the end of the book, plus two 75-question final exams on the bonus CD-ROM, and learning and studying become easier...and measurable. Students use the RACE model to apply critical thinking to the question types they’ll encounter in class and on the NCLEX.

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Pediatric Nursing: An Introductory Text, 11e

Covering evidence-based pediatric nursing care from infancy through adolescence, Pediatric Nursing: An Introductory Text, 11th Edition provides a clear, easy-to-read guide to pediatric nursing for LPN/LVN students. Content in this edition is reorganized for a "best of both worlds" approach to pediatric nursing, with early chapters devoted to normal growth and development by age group followed by chapters covering the most common childhood disorders grouped by body system. Updated coverage reflects the latest issues in pediatric nursing care, including childhood obesity and teenage pregnancy. Clinical Snapshots and Nursing Care Plans with critical thinking questions show how to apply the nursing process in real patient care scenarios. Written by noted pediatric nursing educators Debra L. Price and Julie F. Gwin, this market-leading textbook provides the essential knowledge you need to succeed in LPN/LVN practice.

• Reading Level: 9.6
• Nursing Care Plans with critical thinking questions reinforce problem-solving skills as the nursing process is applied to pediatric nursing, with NEW critical thinking answer guidelines provided on the companion Evolve website Evolve to help you understand how a care plan is developed and how to evaluate care of a patient.
• UNIQUE! Free, built-in Study Guide includes scenario-based clinical activities and practice questions for each chapter.

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Pediatric Nurse's Survival Guide (Rebeschi, The Pediatric's Nurse's Survival Guide)

Practical and convenient, the thoroughly updated third edition of The Pediatric Nurse's Survival Guide is the perfect clinical reference! This handy resource offers quick answers to your pediatric nursing questions concerning assessment, clinical values and standards, and the most common conditions and diseases seen in the pediatric population.

2 Nursing Interventions for Shock

Shock is a life-threatening medical condition in which the body suffers from insufficient blood flow throughout the body. Shock often accompanies severe injury or illness. Medical shock is a medical emergency and can lead to other conditions such as lack of oxygen in body tissues (hypoxia), heart attack (cardiac arrest) or organ damage. It requires immediate treatment because the symptoms can worsen quickly.

Medical shock is a shock is different than emotional or psychological shock that can occur after a traumatic emotional event or scary.



Etiology

1. Hypovolemic shock

• Bleeding
• Loss of fluid volume
• Displacement of fluid from the vascular to the interstitial cells

2. Cardiogenic shock

• Impaired the ability of the heart pump (cardiac arrest, arrhythmia, valve disease, myocardial degeneration, systemic infection drugs.

3. Vasogenic shock

• Decrease simpatic tone, vasodilatation, increased capillary permeability

neurogenic, or chemicals (anaphylactic), severe pain, psychological stress, neurological damage, cholinergic drugs, alpha adrenergic blocker agent.

4. Septic shock

• Cause of gram-negative organisms (P. aerogenosa, Escherichia coli, Klebseilla pneomoni, Staphylococcus, Streptococcus).
• Predisiposisi: malnutrition, large open wounds, ischemia of the gastrointestinal tract (GI), immunosuppression.
• Host interactions - toxin stimulates systemic complement activity - changes in organ microcirculation, increased capillary permeability, cell injury, increased cell metabolism.

Signs of shock :

• General state: weak.
• Perfusion: pale skin, cold, wet.
• Tachycardia.
• Peripheral vein is not visible.
• Decreased blood pressure, systolic less than 90 mmHg or a fall of more than 50 mm Hg of pressure before.
• Hyperventilation.
• Peripheral cyanosis.
• Restlessness, decreased consciousness.
• Decreased urine production.

2 Nursing Interventions for Shock

1. Fluid Volume Deficit
a. Intravenous therapy (according to type of shock):
Crystalloid (to restore the liquid electrolyte).

b. Colloid (to restore plasma volume and restore the osmotic pressure): WB, PRC, plasma.

2. Decrease Cardiac Output
Goal:

• Increase the vascular fluid.
• Support the compensatory mechanisms.
• Prevent ischemic complications.

Drug therapy:

• Improve venous return.
• Improve myocardial contraction.
• Ensure adequate myocardial perfusion:
• Vasoconstrictor agents.
• Agents that increase myocardial contraction.
• Myocardial perfusion agent adds.

Dysentery - Nursing Diagnosis and Interventions

1. Nursing Diagnosis for Dysentery : Imbalanced Nutrition: less than body requirements
related to: inadequate intake and output

Goal: nutritional needs are met

Expected outcomes:

• Increased appetite.
• Increased or normal weight according to age.

Nursing Interventions for Dysentery:
1. Discuss and explain about the diet restrictions of patients (high fiber foods, fatty and water is too hot or cold)
R / high fiber, fat, water is too hot / cold can stimulate irritate the stomach and intestinal tract.

2. Create a clean environment, away from the smell of the odor or litter, serve food in a warm state.
R / situation comfortable, relaxed to stimulate appetite.

3. Provide hours of rest (sleep) and reduce excessive activity.
R / Reducing energy consumption is excessive

4. Monitor intake and output within 24 hours.
R / Knowing the amount of output can merencenakan amount of food.

5. Collaboration with other health care team:
a. Nutritional therapy: A diet high in calories and high in protein, low in fiber, milk.
b. medications or vitamins (A)
R / Containing substances necessary for the growth process.


2. Nursing Diagnosis for Dysentery: Imbalanced Body Temperature
related to: the impact of infection secondary to diarrhea.

Goal: no increase in body temperature

Expected outcomes:

• Body temperature within normal limits (36-37,5 C)
• There are no signs of infection (rubur, dolor, calor, tumor, fungtio leasa)

Nursing Interventions for Dysentery:
1. Monitor body temperature every 2 hours.
R / Early detection of abnormal changes in body function (an infection)

2. Give warm compresses.
R / stimulate heat regulating center to reduce the production of body heat

3. Collaboration of antipyretic
R / Stimulate the heat regulating center in the brain.


3. Nursing Diagnosis for Dysentery: Risk for Impaired Skin Integrity: perianal
related to: increased frequency of bowel movements (diarrhea)

Goal: skin integrity is not compromised

Expected outcomes :

• No irritation: redness, blisters, hygiene maintained.
• Families are able to demonstrate perianal care properly.

Nursing Interventions for Dysentery:
1. Discuss and explain the importance of keeping the beds.
R / Hygiene prevent the proliferation of germs.

2. Demontrasikan and involve families in the treatment of perianal (if wet clothing and replace the bottom as well as the base).
R / Preventing skin iritassi unexpected because kelebaban and stool acidity.

3. Adjust the position of sleep or sit with an interval of 2-3 hours.
R / Smooth vascularization, reducing the emphasis that long so did not happen ischemia and irritation.


4. Nursing Diagnosis for Dysentery: Anxiety: children
related to: invasive measures

Goal: the client is able to adapt

Expected outcomes:

• Want to receive care measures, the client seems quiet and no fuss

Nursing Interventions for Dysentery:
1. Involve the family in performing maintenance actions.
R / initial approach to the child through the mother or family.

2. Avoid the wrong perception on nurses and hospitals.
R / reduce the fear of the child to the nurse and the hospital environment.

3. Give kudos if the client would be given care and treatment measures.
R / increase the child's confidence will courage and ability.

4. Make contact as often as possible and do communication both verbal and non-verbal (touching, fondling, etc.).
R / Love and the introduction of self saying nurses would menunbuhkan sense of security on the client.

5. Give children toys as sensory stimuli.

Nursing Care Plan for Meniere's Disease

Definition of Meniere's Disease

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

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

Type of Meniere's Disease

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

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

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

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

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

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

The degree of severity of Meniere's disease;

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

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

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


Etiology of Meniere's disease

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

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

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

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

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

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

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

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

The Role of Higher Education in Nursing

There are 4 critical role of higher education in nursing :

1. Fostering an outlook attitude and professional skills

Higher Education in Nursing was instrumental in fostering the attitude, outlook, and professional skills, graduates. Nurses are expected to be able to act, and have a professional outlook, nursing a broad-minded, and have sufficient scientific knowledge of nursing, and master the professional skills is good and right (Husin, 1966).

As a profesional nurse, obtained job satisfaction which in turn foster the achievement of performance capability through better working again. Critical thinking skills to make decisions and be able to account for the decisions and actions taken is one of the main factors to achieve job satisfaction (Jones and Beck, 1996). Nurse job satisfaction will result in satisfaction of the nursing service users, both societies and institutions of employment.

2. Improve the quality of care / nursing care and health

Nursing education to be able to produce professional nurses include intellectual skills, interpersonal, and technical, able to account legally, decisions and actions taken in accordance with the standards and code of ethics, and can be a role model for other nurses.

Nursing theories and models can be said to be useful, if it can be applied to services, as well as the management system of nursing is learned during training. Service facilities that can be used as an educational resource that is expected is conducive to the learning process of learners (Hamid, 1997).

3. Resolve nursing problems and develop science and technology of nursing through nursing

With the cooperation between the educational institutions and services, enabling the transformation of science and technology, including the identification of health problems, particularly on issues related to nursing for nursing research that aims to produce an answer to the question, resulting in a solution of the problem, either through product form technology or new methods or products and services based on the theory test conditions or new facts. (Leddy and Pepper, 1993; Mayer, Medden and Lawrence, 1990)

4. Improve the lives of professionalism through professional organizations

Higher education in nursing, will facilitate the development of nursing organizational life, for more professional. With profesional education, nurse as a member of a professional organization will better understand and appreciate the roles, responsibilities, and rights as a member of a professional organization that has a nature, views, and professional capability, it is possible nursing organizations act as quality control of nursing care services to the community through regulation of rights, responsibilities, and authority of each nurse based on their competence (Schmale, 1996).

In addition, professional organizations will be instrumental in the process of developing and fostering professional skills and implement a code of professional conduct for each of its members through the provision of setting up and continuing education system and to control the use and development of nursing science and technology (Husin, 1999).

Purpose of Education In Nursing

The purpose of education is often very general nature, such as a good human being, responsible, devoted to God, to serve the community, the nation and the state, and so on.

In the world of education, recognized a number of attempts to decipher the very general purpose. One of them was Herbert Spencer (1860) who analyzed the educational purpose in five sections, namely to:

• Activities for survival.
• Attempt to make a living.
• Children's education.
• Maintaining relationships with the community and the state.
• Use of leisure time.

Educational goals set forth by Herbert Spencer, based on what is considered the most valuable and necessary for every person to life in society.

Bloom cs distinguish three categories of educational purpose, namely:

I. Cognitive (head)

Purpose of Cognitive regarding the ability of the individual to know about the world, which includes intellectual or mental development. Purpose of cognitive divided into 6 sections, namely;

a) Knowledge
Includes information and facts that can be mastered through memorization to remember.

b) Comprehension
Is the ability to express a definition, formula, interpreting a theory.

c) Application
An ability to apply or use a sense, concepts, principles, theories that require the acquisition of knowledge and deeper understanding.

d) Analysis
Namely the ability to decipher something in elements such as analysis of the relationship between people and nature, and the universe.

e) Synthesis
Namely the ability to see the relationship between the number of elements.

f) Evaluation
Judgment based on the evidence or specific criteria.


II. Affective (heart)

Purpose of Affective regarding the development of attitudes, feelings, and values ​​or emotional and moral development. Affective objectives is divided into 5 sections, namely;

a) Receiving
Receive, pay attention to a certain value.

b) Responding
Which showed a reaction to certain norms, shows willingness and readiness to respond, feel satisfied in response.

c) Valuing
Ie accept a norm, a norm of respect, and bind themselves to these norms.

d) Organization
Forming a concept of a value, develop a system of values.

e) Characterization by Value or Value Complex
Embodies personal values ​​in making a person's character, it becomes part of the norm personally.


III. Psychomotor (hand)

Purpose of Psychomotor development involves an element of motor skills.

The role of nurses not only caregivers but also as counselor, educator and consultant, so with the role of a nurse requires knowledge of education in order to provide appropriate education in a systematic manner, methods and media education are true and correct to the client, so that the results of education given to the client can be achieved on target and appropriate.

Nurses must master the field of education, for study of science education, a department of nursing students are expected to give and receive information that will be needed in the face of the patient (others) so as to lead to the achievement of professional competence.

Mental Health Nursing Care for the Elderly

Every year the definition of elderly changes, but maybe its fair to talk about the age of 65 as being the start of elderly. While this definition is somewhat arbitrary, it is many times associated with the age at which one can begin to receive pension benefits. At the moment, there is no United Nations standard numerical criterion, but the UN agreed cutoff is 60+ years to refer to the older population.

Elderly mental health care is an important issue that affects almost one in every five American adults who are in fact known to be affected by some form of mental illness or the other. These mental illnesses include suffering from dementia and psychosis, delirium as well as depression and schizophrenia.

Elderly mental health care today suffers from many lacunae and among these lacunae is the fact the majority of elders suffering from mental ailments shirk from getting them treated. It is commonly found that such elders will suffer their condition in silence and are ready to put up with many discomforts rather than face the stigma of being known as being mentally disturbed.

In today's day and age a worrying aspect to dealing with elderly health care needs is the fact that the cause of death in the twentieth century is radically different than what was common in the previous century. In the nineteenth century deaths were caused by acute as well as infectious ailments, though in these modern times the main killers are chronic as well as degenerative ailments of old age.

In most cases, mental health problems in elders that require treatment are quite conveniently ignored. Improper treatment of mental illnesses in elders seems to the most prominent reason contributing to high suicidal rate in these people. Many of these people require specialized mental health services.

There are several reasons that contribute to improper mental health services to the elderly :

1. In most cases, elders are reluctant to undergo treatment for their mental health disorder. They continue to harbor their minds with discomfort and stigmas, thereby showing resistance to leaving their homes and going to a rehabilitation center or a clinic.

2. Our society has never shown respect or dignity for individuals suffering from mental health problems. Even a mental health professional is apprehensive about an elderly person with such condition. Beliefs and attitudes of these professionals do have a significant influence on the quality of medical care provided to the patients.

3. Medical negligence is another big hurdle. In many situations, symptoms of mental health diseases are just written off as indicators of ageing.

Pediatric Nursing Management for Dehydration

Definition of Dehydration :

1. Dehydration is a condition where a person who did not undergo fasting experiencing or at risk of dehydration vascular, interstitial or intra-vascular (Lynda Jual Carpenito, 2000 : 139).
2. Dehydration is a lack of body fluids due to the amount of fluid that comes out more than the amount of fluid intake (Sri Ayu Ambarwati, 2003).
3. Dehydration is a disturbance in fluid balance, along with the output exceeds intake, so the amount of water in the body is reduced (Drs. Syaifuddin, 1992: 3).

Based on the above notions, it can be concluded that dehydration is the lack of extra cellular fluid which resulted in the migration of fluids or lost from the body.


3 Types Classification of Dehydration :

a. Isotonic dehydration
Isotonic dehydration is an equal loss of water and sodium. Isotonic means that the number of particles contained on one side of a permeable membrane is the same as on the other side, thus there is no fluid shift in either direction. The amount of intracellular and extracellular water remains in balance. This can be caused by a complete fast, vomiting, and diarrhea.

b. Hypotonic dehydration
Hypotonic dehydration is the loss of water and sodium at the same time but lack of water than sodium, serum sodium lower than the normal range of extracellular fluid was hypotonic body status to reduce the secretion of antidiuretic hormone, so that the water in the renal tubular reabsorption decrease in urine output to increase from an increase in extracellular osmotic pressure.

c. Hypertonic dehydration
Hypertonic dehydration is the loss of water and sodium at the same time, but the lack of sodium than water, it is higher than the normal range of serum sodium, extracellular fluid status was hypertonic. When lack of water than sodium, the increase in extracellular osmotic pressure, increased secretion of antidiuretic hormone, renal tubular reabsorption of water increased, reduced urine output.


Etiology of Dehydration

Various types cause dehydration (According to Donna D. Ignatavicus, 1991: 253).

1. Dehydration

• bleeding
• vomitus
• diarrhea
• hypersalivation
• fistula
• Ileustomy (cuts colon)
• diaporesis (excessive sweating)
• burn
• fasting
• therapy hypotonic
• suction gastrointestinal (stomach wash)

2. Hypotonic dehydration

• DM disease
• excess fluid rehydration
• severe malnutrition and chronic

3. Hypertonic dehydration

• hyperventilation
• water diarrhea
• diabetes insipidus (ADH hormones decreased)
• excessive fluid rehydration
• dysphagia
• Impaired sense of thirst
• disorders of consciousness
• systemic infection: increased body temperature.

Clinical Manifestations of Dehydration

The following symptoms or signs of dehydration by level (Nelson, 2000):

1. Mild dehydration (loss of fluids 2-5%, of its original weight)

• thirsty, restless
• pulse: 90 -110 x / min, normal breath
• normal skin turgor
• urine output (1300 ml / day)
• good awareness
• heart rate increased

2. Moderate dehydration (fluid loss of 5%, of its original weight)

• increased thirst
• rapid and weak pulse
• dry skin turgor, dry mucous membranes
• reduced urine output
• increased body temperature

3. Severe dehydration (loss of fluids 8%, of its original weight)

• loss of consciousness
• weak, lethargic
• tachycardia
• sunken eyes
• no urine output
• hypotension
• pulse rapid and smooth
• cold extremities

Management of Dehydration

Management in patients with dehydration (Doenges & Sylvia Anderson):

1. Antiemetic drugs (To overcome vomiting)

2. Antidiarrheal drugs
Spending excessive feces may be given anti-diarrhea medications.

3. Provision of drinking water
Provision of drinking water containing sodium sufficient to address the imbalance that occurs.

4. Intravenous fluid administration
In the severe dehydration, intravenous fluid administration is needed. Isotonic saline solution (0.9%) were intravenous fluids chosen for cases with near-normal sodium levels, as it will increase the plasma volume. Soon after reaching normotensive patients, half of normal saline solution (0.45%) is given to provide water to the cells and helps the disposal of metabolic waste products.

5. IV fluid bolus administration
Initial IV bolus administration of fluid in a fluid load test, to determine whether to increase the flow of urine, which showed normal renal function.