NCP for Psoriasis - 4 Nursing Diagnosis

Nursing Care Plan for Psoriasis

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

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

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

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

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

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

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

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

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

6) Metabolic
Hypocalcemia may cause psoriasis.


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


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


Nursing Diagnosis for Psoriasis

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

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

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

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

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

Nursing Care Plan for Chronic Kidney Disease / Chronic Renal Failure

Definition

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

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

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

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


Causes 

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

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

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

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

Goal :
Maintaining an ideal body weight without excess fluid

Outcomes:
no edema,
balance between input and output


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

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

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

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


Nursing Care Plan for Chronic Renal Failure - CRF

Nursing Diagnosis and Nursing Intervention for CRF - Chronic Renal Failure

Decreased Cardiac Output - Ventricular Septal Defect Care Plan

Ventricular Septal Defect

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

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

Decreased Cardiac output Definition

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



Nursing Diagnosis : Decreased cardiac Output related to cardiac malformations.

Goal:

• Decreased cardiac output does not occur

Interventions:

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

Rationale:

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

NANDA Decreased Cardiac Output

Acute Pain - Nursing Care Plan for Hypertensive Heart Disease

Hypertensive Heart Disease

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

Symptoms of heart failure include:

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

Symptoms of ischemic heart disease may include:

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

Acute Pain Definition

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



Nursing Care Plan for Hypertensive Heart Disease

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


Goal :

• Client reported pain / discomfort disappeared / controlled .

Interventions and Rationale :

1. Maintain bed rest during the acute phase.

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

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

4. Assist patients in ambulation as needed.

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

Rationale:

1. Minimize stimulation / promote relaxation.

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

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

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

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

Physical Examination for Congestive Heart Failure (CHF)

Nursing Care Plan for Congestive Heart Failure - CHF

Impaired Physical Mobility - NCP for Guillain-Barre Syndrome

Nursing Care Plan for Guillain-Barre Syndrome

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

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

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

Nursing Diagnosis: Impaired Physical Mobility related to neuromuscular damage

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

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

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

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

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

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

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

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

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

Collaboration

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

Disturbed Body Image - Nursing Care Plan for Brain Tumor

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

The most common primary brain tumors are:

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

The most frequent symptoms of brain tumors include:

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

Nursing Care Plan for Brain Tumor

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

Goal:

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

Interventions:

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

Rational:

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

Risk for Injury - Multiple Sclerosis Care Plan

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

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

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

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

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

Goal :
Risk for Injury did not occur

Outcomes:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Fluid Volume Deficit related to Diabetic Ketoacidosis Care Plan

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

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

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


Nursing Care Plan for Diabetic Ketoacidosis

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

Outcomes:

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

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

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

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

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

Nursing Care Plan for Migraine

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

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

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

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

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

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

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


Nursing Diagnosis for Migraine

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

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

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

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

Nursing Care Plan for Laryngeal Cancer

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

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

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

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

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

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

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

NCP - Nursing Diagnosis of Acute Pain related to BPH

Nursing Care Plan for Benign Prostatic Hyperplasia

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

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

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

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

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

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

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


Symptoms of Benign Prostatic Hyperplasia

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

1st Grade : Congestic

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

2nd Grade : Residual

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

3rd Grade : Urinary retention

• Ischuria paradosal.
• Incontinensia paradosal.

4th Grade

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

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

Goal: Pain is lost / controlled.

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

Nursing Interventions :

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

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

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

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

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

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

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 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

Pleural Effusion Care Plan - Nursing Diagnosis and Interventions

What is a Pleural Effusion?

Pleural effusion is a condition in which there is fluid in the chest cavity that should not exist (there is normally very little fluid as a lubricant), where the fluid will suppress lung and heart that will cause shortness.

Symptoms

• Shortness of breath that is increasingly severe, usually felt on one side.
• cough
• Sometimes accompanied by chest pain
• Stomach feel full / bloated
• Some patients hear the sound of moving water when the whisk.

How does this happen?

Pleural effusion occurs because: An imbalance between the production and disposal of the lubricating fluid, so fluid accumulates.

Some diseases that often cause complications pleural effusion is:

• Pulmonary TB
• Lung tumors
• Hypo-albumin, a state in which the albumin / protein in blood is very low such as in cirrhosis of the liver disease, kidney failure, etc..
• Heart failure
• Breast tumor
• Ovarian cysts
• etc..

What danger??

• Although not including gravity, in most cases, the fluid should be removed because:
• Polynomial, so that pressing the lungs, disrupting breathing and encourage the heart (cardiac pump is compromised, it can be fatal).
• The fluid can harden / solidify (organization) that reduced lung volume, (tightness) and cause permanent disability which continues to appear on x-rays.
• If infected, the liquid turns into pus. This became another disease that is empyema, different handling.
• If the liquid is in the form of blood, for example due to an accident, his name: haemothorax, need immediate attention.

Nursing Diagnosis for Pleural Effusion

Analysis can be expressions of the nursing diagnoses that include:

1. Ineffective airway clearance related to decreased lung expansion.
2. Fluid volume deficit related to diaphoresis.
3. Activity Intolerance related to dyspenia and fatigue

Nursing Interventions for Pleural Effusion

1). Ineffective airway clearance related to decreased lung expansion.

Goal: a patent airway / inadequate

Nursing Intervention:

• Give oxygenation in accordance with the program.
• Provide a comfortable sleeping position.
• Monitor vital signs.
• Teach effective cough.
• Teach resistant chest when coughing.

2). Fluid volume deficit related to diaphoresis

Goal: balance of body fluids

Nursing Intervention:

• Vital signs every 6 hours.
• Compress with warm water.
• Record intake and output.
• Collaboration with doctors for antibiotics.

3). Activity Intolerance related to dyspnea and fatigue

Goal: clients obtain energy

Nursing Intervention:

• Assess the activity patterns.
• Limit activity.
• Aids to overcome weaknesses.
• Schedule breaks.
• Physiotherapy consultation.

Nursing Care Plan for Dysentery

Dysentery is a inflammatory disorder of the intestine, especially the colon, which results in severe diarrhea containing mucus and / or blood in the stool. If left untreated, dysentery can be fatal.

Cause of Dysentery

Dysentery is usually caused by a bacterial or protozoan infection or infestation of parasitic worms, but can also be caused by chemical irritants or viral infection. The two most common causes are infection with a bacillus of the Shigella group, and infestation by an amoeba, Entamoeba histolytica. When it is caused by a bacillus called bacillary dysentery, and when it is caused by an amoeba called amoebic dysentery.

Symptoms of Dysentery

Dysentery symptoms can last for five days or even more. For some cases, the symptoms may be mild, while others suffer from severe diarrhea and vomiting or potentially cause dehydration. The following symptoms when exposed to dysentery:

• Flatulence
• Pain in the abdomen
• Bloody diarrhea
• Nausea, with or without vomiting

However, if the infection is severe, people may experience other symptoms caused by dehydration:

• Decreased urine production
• Dry skin and mucous membranes
• Excessive thirst
• Fever and chills
• Muscle spasms
• Limp
• Weight loss
• Yellowish white mucus

In cases of chronic dysentery, no effects after an acute attack. In severe cases, the body temperature will rise to 40 degrees Celsius to 40.6 degrees Celsius.


Prevention of Dysentery

Dysentery is spread as a result of poor hygiene. To minimize the risk of these conditions, then it should be done on the prevention of dysentery:

• Avoid swallowing water in swimming pools or recreational water sources
• Make sure you drink water that has been purified or boiled water
• Drink bottled water when traveling
• Wash your hands with anti-bacterial soap after using the bathroom, changing diapers, before preparing and eating food.
• Avoid sharing towels with others
• Wash clothing or eating utensils of an infected person.

Nursing Care Plan for Dysentery

Assessment

1. Identity

Noteworthy is the age. Episodes of diarrhea occurred in the first 2 years of life. Highest incidence is the age group 6-11 months. Most bacteria stimulate gut immunity against infection, it helps explain the decline insidence disease in older children. At the age of 2 years or more of active immunity begins to form. Most cases are due to an intestinal infection and asymptomatic enteric bacteria spread mainly clients are not aware of the infection. Economic status also influential, especially from the diet and treatment.

2. Main complaint
Defecation is more than 3 x

3. History of present illness
Defecation greenish yellow color, mixed with mucus and blood or mucus alone. Watery consistency, frequency is more than 3 times, spending time : 3-5 days (acute diarrhea), more than 7 days (prolonged diarrhea), more than 14 days (chronic diarrhea).

4. Past medical history
Never had diarrhea before, to those on long-term antibiotics or corticosteroids (candida albicans changes from saprophyte to parasite), food allergies, respiratory infections, UTI, OMA measles .

5. History of Nutrition
At toddler age children are given food as in adults, the portion given 3 times per day with additional fruit and milk. Malnutrition in toddler age children are particularly vulnerable. Way better food management, food hygiene and sanitation, hand-washing habits.

6. Family health history
There is one family that has diarrhea.

7. Environmental Health History
Food storage at room temperature, lacking hygiene, neighborhood .

8. Growth and development history
a. growth

• Weight gain since age 1 -3 years ranged between 1.5-2.5 kg (average of 2 kg), a body length of 6-10 cm (mean 8 cm) per year.
• The increase in head circumference: 12cm 2 cm in the first year and second year and so on.
• Teething 8 pieces: additional milk teeth; first molars and canines, totaling 14-16 pieces
• Eruption of teeth: molars perama menusul canines.

b. development

• Psychosexual stages of development according to Sigmund Freud.

Ineffective Tissue Perfusion related to Encephalitis

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

Goals:

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

Outcomes:

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

Intervention:

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

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

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

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

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

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

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

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

Nursing Care Plan for Meniere's Disease

Definition of Meniere's Disease

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

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

Type of Meniere's Disease

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

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

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

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

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

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

The degree of severity of Meniere's disease;

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

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

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


Etiology of Meniere's disease

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

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

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

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

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

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

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

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

Nursing Concepts and Care Plan for Mental Retardation (MR)

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

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

Clinical manifestations

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

Pathophysiology

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

Complication

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

Prevention

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


Nursing Care Plan for Mental Retardation (MR)

A. Assessment

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

B. Nursing Diagnosis

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

C. Intervention

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

D. Education on Parents

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

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