Nursing homes near me: November 2014

Nursing Interventions for Gastric Cancer

Nursing Care Plan for for Gastric Cancer

Nursing Diagnosis : 1. Pain ( acute / chronic ) elated to the presence of abnormal epithelial cells, nerve impulse disorders of the stomach.

Goal : Pain is reduced, controlled.
Expected outcomes :

The patient was not seen grimacing.
Pain scale of 0 (no pain).
The patient seemed more relaxed.

Intervention :

1. Assess characteristics of pain and discomfort ; location, quality, frequency, duration, etc.
Rational : provide a basis for assessing changes in the level of pain and evaluate interventions.

2. Reassure the patient that you know, the pain is real and that you will assist the patient in reducing the pain.
Rational :
Fear can increase anxiety and reduce pain tolerance.

3. Collaboration in analgesic administration to improve circulation within the optimal pain prescription.
rational :
Tend to be more effective when given early in the cycle of pain.

4. Teach the patient new strategies to relieve pain and discomfort with distraction, imagination, relaxation.
rational :
Improving alternative pain relief strategies appropriately.

Nursing Diagnosis : 2. Imbalanced Nutrition : less than body requirements related to anorexia.

Goal : Nutritional needs of clients are met.
Expected outcomes :

The client will maintain nutrient inputs to the metabolic needs.
Increased appetite.
No weight loss.

Intervention :

1. Teach the patient the following things : avoid the sight, smell, sounds unpleasant in the environment during meal times.
Rational :
Anorexia can be stimulated or enhanced by noxious stimuli.

2. Suggest eating preferred and well tolerated by the patients, better food with high content of calories / protein. Respect the patient's food preferences based on ethnicity.
Rational :
A food that is well tolerated and high in calories and protein will maintain nutritional status during periods of increased metabolic needs.

3. Encourage adequate fluid intake, but limit fluids at mealtime.
Rational :
Fluid level is necessary to eliminate waste products and prevent dehydration.

4. Increase fluid levels with food can lead to a state of satiety. Consider the cold food, if desired.
Rational :
Cold foods high in protein can often be well tolerated and does not smell than hot food.

5. Collaborative provision of commercial liquid diet by way of enteral feeding through a tube, elemental diet.
Rational :
Feeding through a tube may be necessary in the patient with very weak gastrointestinal system is still functioning.

Nursing Diagnosis : 3. Anxiety related to malignancy advanced disease.

Goal : Anxiety clients decreased.
Expected outcomes :

Clients are more relaxed.
The normal pulse.
No increase in respiration.

Intervention :

1. Provide a relaxed environment and non-threatening.
Rational :
The patient can express fear, problems, and the possibility of anger due to the diagnosis and prognosis.

2. Encourage active participation of the patient and family in care and treatment decisions.
Rational :
To maintain independence and control of the patient.

3. Instruct the patient to discuss personal feelings with the supporters of such clergy if desired.
Rational :
Facilitating the process of grieving and spiritual care.

Gastric Cancer - Assessment and 5 Nursing Diagnosis

Assessment for Gastric Cancer

Nurses get a history of the patient's diet that focuses on issues such as high food intake and input smoked or marinated fruits and vegetables are low. Is the patient experiencing weight loss, if so how much.

Does the patient smoke ? If yes how much a day and how long ? Is the patient complained of stomach discomfort during or after smoking ? Does the patient drink alcohol ? If so how much ? The nurse asks the patient if there is a family history of cancer. If such a close family member or immediate or distant relatives affected ? Is the patient's marital status ? Is there someone who can provide emotional support ?
During the physical examination is possible to palpate a mass. Nurses must observe the presence of anxiety. Organs examined for tenderness or masses. Pain is usually the symptoms are slow. (Brunner & Suddart, 2001).

1. Anamnesis (Hamsafir, 2010) :

Pain.
Weight loss.
Vomiting.
Anorexia.
Dysphagia.
Nausea.
Weakness.
Hematemesis.
Regurgitation.
Easily satisfied.
Ascites (abdominal bloating).
Abdominal cramps.
Real or faint blood in the stool.
The patient complained of discomfort in the stomach, especially after eating.

2. Physical Examination (Hamsafir, 2010) :

Hemodynamic Status : blood pressure, pulse, acral and breathing.
Less weight, cachexia, conjunctiva sometimes anemic.
Abdominal examination may be palpable mass epigastric region, epigastric pain. In malignancy can be found hepatomegaly, ascites.
If there are complaints of melena, do a digital rectal examination.
Malignancy = search enlargement supraclavicular (Virchow's node), axillary nodes left (Irish 's node), to the umbilicus (Sister Mary Joseph's nodes), palpable tumors pelvic cul - de - sac on the digital rectal examination (Blumer's shelf), enlarged ovaries (Krukenberg's tumor).

Nursing Care Plan for Gastric Cancer

Nursing Diagnosis for Gastric Cancer

1. Pain ( acute / chronic ) related to the presence of abnormal epithelial cells , nerve impulse disorders of the stomach .

2. Imbalanced Nutrition : less than body requirements related to anorexia .

3. Anxiety related to malignancy advanced disease .

4. Risk for Infection related to the surgical incision .

5. Risk for ineffective airway clearance related to the buildup secret .

Nursing Care Plan for Gastric Cancer

Definition of Gastric Cancer

Gastric cancer is a malignant form of gastrointestinal neoplasms. Gastric carcinoma is a form of gastric neoplasms are the most common and causes about 2.6 % of all deaths from cancer (Cancer Facts and Figures, 1991).

Gastric cancer occurs in the small curvature or gastric antrum and adenocarcinoma. Other factors, in addition to high- acid foods that cause the incidence of gastric cancer include inflammation of the stomach, pernicious anemia, aclorhidria (no hydrochloride). Gastric ulcer, bacteria H. plylori, and offspring. (Suzanne C. Smeltzer).

Cancer of the stomach or abdominal malignant tumor is an adenocarcinoma. This cancer spreads to the lungs, lymph nodes and liver. Risk factors include chronic atrophic gastritis with intestinal metaplasia pernicious anemia, high alcohol consumption and smoking. (Nettina sandra, nursing practice guidelines).

Gastric cancer is a malignancy that occurs in the stomach, most are of the type adenocarcinoma. Other types of gastric cancer are leiomyosarcoma (smooth muscle cancer) and lymphoma. Gastric cancer is more common in the elderly. Less than 25 % of certain cancers occur in people under the age of 50 years (Osteen, 2003).

Etiology of Gastric Cancer

The exact cause of stomach cancer is unknown, but there are several factors that can increase the development of gastric cancer, include the following matters :

1. Predisposing Factors

a. Genetic factors
Approximately 10 % of patients with gastric cancer have a genetic link. Although still not fully understood, but the mutation of the E - cadherin gene was detected in 50 % of gastric cancer types. The presence of a family history of pernicious anemia and adenomatous polyps was also associated with a genetic condition in gastric cancer. (Bresciani, 2003).

b. Age factor
In this case found to be more common in the age of 50-70 years, but about 5 % of gastric cancer patients aged less than 35 years and 1 % less than 30 years. (Neugut, 1996)

2. Precipitation Factors

a. Consumption of pickled food, smoked or preserved.
Several studies explain the dietary intake of pickled food becomes a major factor increase in gastric cancer. The content of salt that goes into the stomach slows gastric emptying, thereby facilitating the conversion of nitrates into carcinogenic nitrosamines group in the stomach. Combined condition of delayed emptying of stomach acid and an increase in the composition of nitrosamines in the stomach contributed to the formation of gastric cancer (Yarbro, 2005).

b. H.pylori infection.
H. pylori is a bacterium that causes more than 90 % of duodenal ulcers and 80 % of gastric ulcers (Fuccio, 2007). These bacteria on the surface of the gastric ulcer, through the interaction between the bacterial membrane lectins, and specific oligosaccharides from glycoproteins membranes of gastric epithelial cells (Fuccio, 2009).

c. Socioeconomic.
Low socioeconomic conditions are reported to increase the risk of gastric cancer, but not specific.

d. Consume cigarettes and alcohol.
Patients with cigarette consumption of more than 30 cigarettes a day and combined with chronic alcohol consumption increases the risk of gastric cancer (Gonzalez, 2003).

e. NSAIDs.
Inflammatory gastric polyps can occur in patients taking NSAIDs in the long term and this (gastric polyps) may be a precursor of gastric cancer. Gastric polyps conditions will increase the risk of gastric cancer (Houghton, 2006).

f. Pernicious anemia.
This condition is a chronic disease with failure of absorption of cobalamin (vitamin B12), caused by a lack of intrinsic factor gastric secretion. The combination of pernicious anemia with H.pylori infection provides an important contribution to tumorigenesis in the stomach wall formation. (Santacrose, 2008).

Clinical Manifestations of Gastric Cancer

Early symptoms of gastric cancer is often uncertain because most of these tumors in the small curvature, which is only slightly causing interference function of the stomach. Several studies have shown that early symptoms such as pain that is relieved by antacids may resemble symptoms in patients with benign ulcer. Symptoms may include a progressive disease can not eat, anorexia, dyspepsia, weight loss, abdominal pain, constipation, anemia and nausea and vomiting (Harnawati).

Clinical symptoms were found among others (Davey, 2005) :

Anemia , vague gastrointestinal bleeding and resulted in an iron deficiency may be a presenting symptom of gastric carcinoma is the most common.
Weight loss, common and further illustrates metastatic disease.
Vomiting, an indication of the occurrence of gastric outflow obstruction.
Dysphagia.
Nausea.
Weakness.
Hematemesis.
Regurgitation.
Easily satisfied.
Enlarged abdominal ascites.
Abdominal cramps.
Real or faint blood in the stool.
The patient complained of discomfort in the stomach, especially after eating.

Complications of Gastric Cancer

1. Perforation

Perforation can occur acute and chronic perforation :

Acute Perforation. Perforation often occurs in : ulceration type of cancer that is located in the minor curvature, diantrum near the pylorus. Usually have symptoms similar to perforation of peptic ulcer. These perforations are often found in men (Hadi, 2002).
Chronic perforation. Perforations that occur frequently covered by the adjacent tissue, for example by omentum or is penetration. Usually more rare when compared with the complications of benign ulcer. Penetration may be found between layers or layer of omentum gastrohepatic bottom of the liver. What often happens is perforated and covered by the pancreas. With the penetration it will form a fistula, for example gastrohepatic, gastroenteric and gastrocolic fistula. (Hadi , 2002).

2. Haematemesis.
Massive hematemesis and melena occurred ± 5 % of carcinomas ventrikuli whose symptoms are similar as in massive bleeding so much blood is lost, causing hypochromic anemia. (Hadi, 2002).

3. Obstruction.
Can occur in the lower part of the stomach near the pylorus region are accompanied by complaints of vomiting (Hadi, 2002).

4. Adhesion.
If a tumor of the stomach wall can occur adhesion and infiltration of the surrounding organs and cause abdominal pain (Hadi , 2002)

Gastric Cancer - Assessment and 5 Nursing Diagnosis

Nursing Interventions for Gastric Cancer

Digestive System Neoplasm - Nursing Diagnosis and Interventions

Nursing Care Plan for Digestive System Neoplasm

Pre - Operation Nursing Diagnosis and Interventions

1. Pain (acute / chronic) related to the growth of cancer cells.

Goal : Pain is reduced until it disappears.

Interventions
1. Assess characteristics of pain, location, frequency.
R/ : Knowing the level of pain as the evaluation of interventions.

2. Assess the factors causing pain relief (fear, anger, anxiety).
R/ : By knowing the causes of pain, decisive action to reduce the pain.

3. Teach relaxation techniques take a deep breath.
R/ : Relaxation techniques can override the pain.

4. Collaboration with physicians for providing analgesic.
R/ : Analgesic effective for pain.

2. Anxiety related to planned surgery.

Goal : Anxiety can be minimized after the act of nursing.

Interventions :
1. Describe any actions to be performed on the patient .
R/ : The patient was cooperative in every action and reduce patient anxiety.

2. Allow the patient to express feelings of fear.
R/ : To reduce anxiety.

3. Evaluation of the level of understanding of the patient / significant others, on medical diagnosis.
R/ : Provide the information you need to select the appropriate interventions.

4. Acknowledge the fear / patient issues, and push express feelings.
R/ : Support enables the patient to start opening / accept the disease and treatment.

3. Imbalanced Nutrition : less than body requirements related to nausea, vomiting and no appetite.

Goal : The nutritional requirements can be met.

Expected Outcomes :
Nutrition met.
Nausea was reduced to disappear.

Interventions :
1. Serve food in small portions but often and warm.
R/ : warm food increases the appetite.

2. Assess the patient's eating habits.
R/ : Type of food that will help improve the patient's appetite.

3. Teach relaxation techniques that take a deep breath.
R/ : Helps to relax and reduce nausea.

4. Measure the weight whenever possible.
R/ : To determine the weight loss.

5. Collaboration with physicians for the provision of vitamins.
R/ : To prevent deficiency due to reduced absorption of fat-soluble vitamins.

4. Activity intolerance related to physical weakness .

Goal : Activity intolerance resolved.

Expected Outcomes :
Showed an increase in activity tolerance characterized by : do not complain of weakness, can move gradually.

Interventions :
1. Provide adequate rest periods.
R/ : Rest will provide enough energy and helps in the healing process.

2. Review of complaints during the move.
R/ : Identify abnormal activity.

3. Assess the ability to move.
R/ : Specifies the activities that can be done.

4. Help meet the needs.
R/ fulfillment needs.

Ineffective Thermoregulation related to Asphyxia Neonatorum

Nursing Care Plan for Asphyxia Neonatorum

Neonatal asphyxia is a condition in newborns who fail to breathe spontaneously and regularly soon after birth.

Signs and Symptoms

Hypoxia.
Respiration rate of more than 60 x / min or less than 30 x / min.
Gasping breath until respiratory arrest may occur.
Bradycardia.
The reduced muscle tone.
Cyanotic skin color / pale.

Diagnostic examination

Blood Gas Analysis.
Blood electrolytes.
Blood sugar.
Baby grams (chest X-ray).
Ultrasound (head).

Nursing Diagnosis :

Ineffective thermoregulation related to temperature regulation system is not inadequate.

Nursing Outcomes :

Thermoregulation: neonate

Indicators:
Normal body temperature

Assessment scale:
1. Extremely compromised.
2. Substantially compromised.
3. Moderately compromised.
4. Mildly compromised.
5. Not compromised.

Nursing Interventions

Temperature regulation

Place the baby in a warm temperature environments.
Monitor axillary temperature in infants unstable.
Monitor signs of hypothermia: fatigue, weakness, discoloration, skin.
Avoid situations that may cause the baby to lose heat, such as exposure to cold air, window or shower.

Rationale :

Maintaining the temperature of the baby's body.
Monitor the baby's body temperature.
Avoiding heat loss through conduction.

Ineffective Airway Clearance related to Asphyxia Neonatorum

Nursing Diagnosis :

Nursing Interventions : Ineffective airway clearance related to obstruction of mucus.

Nursing Outcomes:

Repiration status: Ventilation
Indicators:

Free of abnormal breath sounds.
No shortness of breath.
Respiration rate is within the normal range.
Regular respiratory rhythm.
No retraction of the chest.

Assessment scale:

Extremely compromised.
Substantially compromised.
Moderately compromised.
Mildly compromised.
Not compromised.

Nursing Interventions

Airway management

Open the airway.
Position the patient to maximize ventilation.
Identification of patients need artificial airway appliance installation.
Remove secretions by suction.
Auscultation of breath sounds, note the presence of additional noise.
Set intake to optimize fluid balance.
Monitor respiration and O2 status every 6 hours.

Vital sign monitoring

Monitor blood pressure, pulse, temperature, and respiration.
Monitor quantities and heart rhythm.
Monitors heart sounds.
Monitor lung sounds.
Monitor abnormal breathing patterns.
Monitor temperature, color, and moisture.
Monitor peripheral cyanosis.
Identify the causes of changes in vital signs.

Oxygen therapy

Setting up the oxygen equipment and a humidifier.
Provide supplemental oxygen by order.
Monitor the liter flow of oxygen.
Monitoring canule position.
Monitor signs of oxygen toxicity.

Rationale:

Patency of the airway is the main requirement to obtain adequate ventilation.
Helping lungs to meet the body's need for oxygen.
Assessing changes in status, to determine actions to improve / maintain the status respiration.

Self-care deficit : Hygiene

Self-care deficit : hygiene is a condition in which individuals experience failure or ability to carry out personal hygiene activities completed (Carpenito, 1977).

Several factors influence the occurrence of Self-care deficit:
a. Developments
Family overprotective and indulgent clients that disrupts the development of the initiative and skills.
b. Biological
Chronic disease that causes the client is not able to perform self-care.
c. Social
Less support and training capabilities of the environment.

Data that needs to be studied
a. Self-care deficit.
b. Decreased motivation to self-care

Subjective Data:

say lazy bath,
do not want to comb the hairs,
do not want to rub the teeth,
do not want to cut the nails,
do not want to make up,
can not use a tool bathing / personal hygiene.

Objective Data:

Body odor, dirty clothes, dirty hair and skin, long nails, dirty teeth, mouth odor, appearance is not neat, can not use a tool shower.

Nursing Diagnosis
Self-care deficit: hygiene related to decline in self-care motivation.

Interventions:

1. General Goals: The client is able to perform self-care: hygiene.

2. Specific Goals:

a. The Client can mention the definition and signs of personal hygiene.
action:

Discuss with the client about the terms of hygiene and signs of hygiene.
Give positive reinforcement when the client is able to do something positive.

b. The Client can mention why the client does not want to maintain personal hygiene.
action:

Discuss with the client what the cause would not maintain personal hygiene.
Discuss the consequences of not willing to maintain personal hygiene.

c. The Client can call the hygiene.
action:

Discuss with the client about the benefits of hygiene.
Help the client identify the ability to maintain personal hygiene.

d. The client can mention how to maintain personal hygiene
action:

Discuss with the client how to maintain personal hygiene: shower 2 times a day (morning and afternoon) using soap, brush the teeth at least two times a day with toothpaste, wash the hair at least 2 times a week with a shampoo, cut the nails at least 1 time a week cutting the hair at least one time a month.
Give positive reinforcement when the client successfully.

e. The client can implement self-care hygiene with minimal assistance.
action:

Lead the client to do a demonstration on how to maintain personal hygiene.
Encourage the client to perform personal hygiene with minimal assistance.

f. The client can perform self-care hygiene independently.
action:

Give the client the opportunity to rid themselves gradually.
Encourage the client to express feelings after self-cleaning.
Together with the client to schedule self hygiene.
Guided the client to conduct regular hygiene activities.

g. The client has the support of the family.
action:

Give health education on caring for clients for personal hygiene through family gatherings.
Give positive reinforcement on the active participation of the family.

Risk for Decreased Cardiac Output - NCP for Heart Arrhythmias

Nursing Care Plan for Heart Arrhythmias

Heart rhythm disorder or arrhythmia is a frequent complication of myocardial infarction. Arrhythmia or dysrhythmia is the change in frequency and heart rhythm caused by abnormal electrolyte conduction or automatic (Doenges, 1999).

Arrhythmias arising from myocardial cells electrophysiological changes. These electrophysiological changes manifest as changes in action potential shape ie graphic record of electrical activity of cells (Price, 1994).

Heart rhythm disturbances are not only limited to the irregularity in heart rate but also including rate and conduction disorders (Hanafi, 1996).

Nursing Diagnosis : Risk for Decreased Cardiac Output related to electrical conduction disturbances, decreased myocardial contractility.

Outcomes:

Maintain / increase cardiac output adequately evidenced by blood pressure / pulse in the normal range, adequate urine output, the same palpable pulse, normal mental status.
Showed a decrease in the frequency / no dysrhythmias.
Participate in activities that decrease myocardial work.

Interventions :

Feel the pulse (radial, femoral, dorsalis pedis) record the frequency, regularity, amplitude and symmetrical
Auscultation of heart sounds, note the frequency, rhythm. Note the extra heart rate, decreased pulse.
Monitor vital signs and assess adequacy of cardiac output / tissue perfusion.
Determine the type of dysrhythmia and rhythm note: tachycardia; bradycardia; atrial dysrhythmias; ventricular dysrhythmias; block.
Provide quiet environment. Assess the reasons for limiting the activity during the acute phase.
Demonstrate / encourage use of behavioral stress management eg deep breathing relaxation, guided imagery.
Assess pain report, note the location, duration, intensity and factor relievers / ballast. Note the presence of non-verbal pain, for example; frown face, crying, changes in blood pressure.
Prepare / do CPR as indicated.
Monitor laboratory tests, for example; electrolyte.
Provide supplemental oxygen as indicated.
Give medications as indicated: potassium, anti dysrhythmias.
Prepare for elective cardioversion aids.
Help installing / maintaining the function of the pacemaker.
Enter / maintain input IV - Prepare for invasive diagnostic procedures.
Prepare for the installation of automatic cardioverter or defibrillator.

Liver Abscess - 7 Nursing Diagnosis, Interventions and Evaluation

Nursing Diagnosis, Interventions and Evaluation for Liver Abscess

1. Breathing pattern, ineffective related to Neuromuscular, imbalance perceptual / cognitive.

Goal : normal breathing pattern / effective and free from signs of cyanosis or hypoxia .

Intervention :

Maintain the patient's airway by tilting the head.
Auscultation of breath sounds.
Observation of the frequency and depth of breathing, the muscles use the respirator.
Monitor vital signs continuously.
Do the motion as soon as possible.
Observation of the excess.
Do suction mucus when necessary.
Provide supplemental oxygen as needed.
Give treatment as instructed.

2. Disturbed Sensory Perception : the process of thought related to chemical changes : the use of pharmaceutical drugs.

Goal : increasing the level of awareness

Intervention :

Orient the patient back continuously after coming out of the influence of anesthesia.
Talk with the patient in a clear voice and normal.
Minimize negative discussion.
Use the pads on the edge, do binding if necessary.
Observations of the existence of hallucinations, depression and others.
Maintain a calm and comfortable environment.

3. Fluid Volume Deficit, Risk for oral fluid intake restriction (process / medical procedure / nausea).

Goal : there is adequate fluid balance .

Intervention :

Measure and record the input and output.
Assess urinary spending, especially for the type of surgical procedure performed.
Monitor vital signs.
Note the emergence of nausea / vomiting, history of motion sickness.
Check the pads, appliance drein at regular intervals , examine the wound for swelling.
Give parenteral fluids, blood products and / or plasma expanders as directed. Level IV speed if necessary.
Give back oral intake gradually as directed.
Give antiemetics as needed.

4. Pain (acute) related to disorders of the skin, tissue, and muscle integrity.

Goal : pain has been controlled / eliminated, the client can rest and activity according to ability.

Intervention :

Assess pain scale, intensity, and frequency.
Evaluation of pain on a regular basis.
Assess vital signs.
Assess the cause of the discomfort that may be appropriate operating procedures.
Put repositioning as directed.
Encourage use of relaxation techniques.
Give medicines as directed.

5. Impaired Skin Integrity related to the interrupt mechanism of the skin / tissue.

Goal : to improve the metabolic action shows.

Intervention :

Review the functional capabilities and circumstances.
Place the client in a particular position.
Keep the body well-being functionally.
Help or actions to perform range of motion exercises.
Give skin care carefully.
Monitor urine output.

6. Risk for infection related to an operating wounds and invasive procedures.

Goal : There are no signs and symptoms of infection

Intervention :

Provide anti-septic and aseptic care, maintain good hand washing.
Observations damaged skin area (stitches) attached regions invasive tool.
Monitor the entire body on a regular basis, record the presence of fever, chills, and diaphoresis.
Keep an eye or the number of visitors.
Give antibiotics as indicated.

7. Disturbed Sleep Pattern related to the disease process, the effects of hospitalization, changes in the environment.

Goal : resting needs can be met

Intervention :

Assess the client's ability and sleeping habits.
Provide a comfortable bed with a few personal belongings. Example : pillows, bolsters.
Suggest to light activity.
Suggest to take action relaxation.
Encourage the family to always accompany.
Supervise and limit the number of visitors.

8. Knowledge deficit (learning need) regarding condition / situation, prognosis, treatment needs.

Goal : Declare, understanding of disease processes / pragnosis.

Intervention :

Revisit surgery / special procedures performed and on future expectations.
Discuss drug therapy , including the use of a prescription.
Identification of specific activity limitations.
Schedule an adequate period of rest.
Emphasize the importance of further visits.
Involve famous people in the teaching program. Provide written instructions / teaching materials.
Repeat the importance of diet and fluid intake adequate nutrition.

Nursing Care Plan for Liver Abscess

Anatomy and Physiology of the Liver

The liver is the largest gland in the body, the average weight of 1,500 grams. 2 % of normal weight adults. The liver has two lobes that left and right. Each lobe of the liver is divided into structures called lobules, which is a microscopy unit and functional organ. The human liver has a maximum of 100,000 lobules. Between plates of liver cells are capillaries called sinusoids. Sinusoid limited by phagocytic cells and Kupffer cells. Kupffer cell function is to engulf bacteria and other foreign substances in the blood. (Sylvia a. Price, 2006).

The liver has two sources of blood supply , of the gastrointestinal tract and spleen through the hepatic portal vein and from the aorta through hepatic artery. About one-third of the incoming blood is arterial blood and two-thirds is the portal venous blood. The total volume of blood passing through the liver every minute was 1,500 ml. (Sylvia a. Price, 2006).

The liver is the largest and most important metabolic organ in the body. These organs perform a variety of functions, include the following :

Processing metabolic major nutrients (carbohydrates, fats, proteins) after absorption is the digestive tract.
Detoxification or degradation of residual substances and hormones as well as drugs and other foreign compounds.
Synthesis of plasma proteins, including proteins that are essential for blood clotting, as well as to transport thyroid hormones, steroids and cholesterol in the blood.
Deviations of glycogen, fat, iron, copper, and many vitamins.
The activation of vitamin D.
Spending bacteria from the red blood cells are worn out due to the resident macrophages.
Excretion of cholesterol and bilirubin (Sherwood, 2001)

Definition of Liver Abscess

Liver abscess is a form of infection in the liver caused by a bacterial infection, parasites , fungi and sterile necrosis originating from the gastrointestinal tract characterized by the process of suppuration with the formation of pus in the liver parenchyma (Aru W Sudoyo, 2006).

An abscess is a collection of pus fluid thick, yellowish caused by bacterial, protozoal or fungal invasion into the tissues of the body. Abscesses may occur in the skin, gums, bones, and organs such as the liver, lungs, and even the brain, an area that occurred abscess red and puffy, there is usually a sensation of pain and local heat (Microsoft Encarta Reference Library, 2004).

Causes

Liver abscess is generally divided into two, namely ; amebic liver abscess and pyogenic liver abscess.

a. Amebic liver abscess
Obtained several species of amoeba that can live as a non-pathogenic parasite in the mouth and intestines, but only Entamoeba histolytica that can cause disease. Only some individuals infected with Entamoeba histolytica, which gives the symptoms of invasive, so it is thought there are two types of E. histolytica, namely ; pathogenic and non- pathogenic strain. Variations in the virulence of these strains differ based on its ability to cause lesions in the liver (Aru W Sudoyo , 2006).

E.histolytica in the stool can be found in two forms: vegetative or trophozoite and cyst forms that can survive outside the human body. Mature cyst size 10-20 microns, resistant to dry and acidic atmosphere. Forms tropozoit will die in dry atmosphere and acid. Large trophozoite very active, capable of consuming erythrocytes , which contains protease ; hyaluronidase and mucopolysaccharidase capable of resulting in tissue destruction.

b Pyogenic liver abscess
The infection is mainly caused by gram- negative bacteria and the most common cause is E. coli . Moreover, the cause is Streptococcus faecalis also, Proteus vulgaris, and Salmonellla Typhi. Can also anaerobic bacteria such as Bacteroides, aero bacteria, actinomicosis, and anaerobic streptococci . Necessary for the finding of blood culture, pus, bile, and swabs in anaerobic or aerobic (Aru W Sudoyo, 2006).

Signs and Symptoms

Initial complaint : fever / chills, abdominal pain, anorexia / malaise, nausea / vomiting, weight loss, night sweat, diarrhea, fever (temperature greater than 38°), hepatomegaly, right upper quadrant tenderness, jaundice, ascites, and sepsis the cause of death. (Cameron 1997)

An abscess is the last stage of a tissue infection that begins with a process called inflammation.
Initially, such as bacteria activate the immune system, several events occur :

Blood flow to the area increases.
The temperature of the area increases due to the increased blood supply.
The area swells due to the accumulation of water, blood, and other fluids.
It turns red.
It hurts, because of irritation from the swelling and the chemical activity.
The four signs ; heat, swelling, redness, and pain - the characteristics of inflammation.

Diagnostic Examination

According to Julius, the science of diseases in Volume I, (1998). Investigations among others ;
1. Laboratory
To determine the hematologic abnormalities include hemoglobin, leukocytes, and liver function examination.
2. chest x-ray
Can be found in the form of the right diaphragm, decreased movement of the diaphragm, pleural effusion, lung collapse and lung abscess.
3. Plain abdominal X-ray
Abnormalities may include hepatomegaly, ileus picture, picture of free air above the liver.
4. Ultrasonography
Detecting abnormalities of biliary tract and diaphragm.
5. Tomography
See abnormalities in the posterior and superior , but can not see the integrity of the diaphragm.
6. Serology
Shows a high sensitivity to germs.

Nursing Diagnosis for Liver Abscess

According Doenges, EM (2000), nursing diagnoses of patients with liver abscess include:

Breathing pattern, ineffective related to Neuromuscular, imbalance perceptual / cognitive.
Disturbed Sensory Perception : the process of thought related to chemical changes : the use of pharmaceutical drugs.
Fluid Volume Deficit, Risk for oral fluid intake restriction (process / medical procedure / nausea).
Pain (acute) related to disorders of the skin, tissue, and muscle integrity.
Impaired Skin Integrity related to the interrupt mechanism of the skin / tissue.
Risk for infection related to an operating wounds and invasive procedures.
Disturbed Sleep Pattern related to the disease process, the effects of hospitalization, changes in the environment.
Knowledge deficit (learning need) regarding condition / situation, prognosis, treatment needs.

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