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Fluid and Electrolyte Imbalances - Acute Diarrhea Care Plan

Acute diarrhea is a bowel movement with a frequency of more than 3 times per day, with liquid stool consistency, is suddenly and lasts less than 7 days in infants and in previously healthy children.

Etiology
  • Acute diarrhea in distinguishing 2 are:
  • Acute watery diarrhea without blood.
  • Acute diarrhea with blood (in the form of acute diarrhea dysentery).
Cause
  • Infections factors: viruses (rotavirus, adenovirus, enterovirus), bacteria (shigella, salmonella, E. coli), parasites (worms), candida (candida albicons).
  • Parental factors: infection in other body parts.
  • Immunodeficiency factors .
  • Malabsorption factors: carbohydrates, proteins, fats.
  • Dietary factors: stale food, toxic, too much fat, cooked vegetables undercooked.
  • Psychological factors: fear, anxiety.
Examination

Feces examination
Macroscopic and microscopic germs to search for and test resistance to various antibiotics (on persistent diarrhea).

Blood examination
Complete peripheral blood, blood gases and electrolytes.
Examination of blood urea and creatinine levels to determine kidney function.
Daudinal Intibatian
To find out the germs that cause quantitatively and qualitatively, especially in chronic diarrhea.


Nursing Diagnosis for Diarrhea : Fluid and Electrolyte Imbalances related to excessive loss through feces and vomit and limited intake.

Goal: fluid and electrolyte balance.

Outcomes:
  • Normal bowel movements (1-2 times daily).
  • Mucosa of the mouth and lips moist.
  • Client's condition improved.
  • Not sunken eyes and fontanel.
  • Good skin turgor (back in 2 seconds).
Intervention:
1. Give oral and parenteral fluids in accordance with rehydration program.
Rationale: In an effort rehydration to replace the fluid that comes out with the stool.

2. Monitor intake and output.
Rationale: Provide status information to establish the fluid balance fluid needs replacement.

3. Suggest to much to drink.
Rationale: Replacing body fluids.

4. Assess vital signs, signs / symptoms of dehydration and laboratory test results.
Rationale: Assessing hydration status, electrolyte and acid-base balance.

5. Collaborative execution of definitive therapy
Rationale: The provision of medicines known to causally important after diarrhea.
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Nursing Diagnosis and Interventions for Glomerulonephritis

Acute glomerulonephritis is also called acute post streptococcal glomerulonephritis is a non-suppurative inflammatory process involving the glomeruli, as a result of beta-haemolytic streptococcus bacterial infection of group A, type nephritogenic elsewhere. This disease often affects children.

Chronic glomerulonephritis is one of the important causes of end-stage renal disease that manifests as chronic renal failure.

Assessment

Activity / Rest
  • Symptoms: fatigue, weakness (malaise).
  • Symptoms: muscle weakness, loss of tone
Circulation
  • Symptoms: hypotension / hypertension
Elimination
  • Symptoms: changes in the pattern of urination, abdominal bloating, diarrhea / constipation
  • Signs: change the color of urine
Food /fluid
  • Symptoms: weight gain, weight loss, nausea, vomiting
  • Signs: Changes in skin turgor
Neuro-sensory
  • Symptoms: headache, blurred vision.
  • Signs: impaired mental status and seizures
Pain / comfort
  • Symptoms: body aches, headache
  • Signs: cautious behavior, restless.
Breathing
  • Symptoms: shortness of breath
  • Signs: tachypnea, increased frequency, depth.
Security
  • Symptoms: transfungsi reaction
  • Signs: fever, pruritus

Nursing Diagnosis and Interventions for Glomerulonephritis

1. Risk for fluid volume deficit r / t excessive fluid loss.

Goal : Increased homeostasis

Outcomes: Shows the input and output approaching a balanced, good skin turgor, moist mucous membranes, peripheral pulse, weight and vital signs stable, electrolytes within normal limits

Intervention:
  • Measure the input and output accurately.
  • Give fluid permitted during the period of 24 hours.
  • Monitor blood pressure.
  • Note the signs / symptoms of dehydration.
  • Collaboration (laboratory tests, eg, barium).

2. Fatigue r / t anemia

Goal: Accept the fact situation
Outcomes: Report a sense of energy improvements

Intervention:
  • Evaluation report fatigue, difficulty completing tasks.
  • Assess the ability to participate in desired activities.
  • Identification of stress factors / psychological aggravate.
  • Collaboration (electrolyte levels include: calcium, magnesium and potassium)

3. Imbalanced Nutrition: Less Than Body Requirements r / t anorexia

Goal: Indicates a stable weight

Outcomes: Maintaining / increasing weight, as indicated by an individual, free edema.

Intervention:
  • Assess / record dietary intake.
  • Give eat little and often.
  • Give the patient a list of foods / liquids are permitted and encouraged involvement in the selection menu.
  • Measure body weight each day.
  • Collaboration (laboratory tests, eg, BUN, albumin, serum transferrin, sodium and potassium and consult with a nutritionist)
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Nursing Care Plan for Patent Ductus Arteriosus

Assessment
  • Health history: a physiological response to the defect (cyanosis, limited activity).
  • Assess for signs of heart failure, rapid breathing, shortness of breath, retractions, extra heart sounds (machinery mur-mur), hepatomegaly.
  • Assess for chronic hypoxia: Clubbing finger
  • Assess for hyperemia at the fingertips
  • Assess diet, weight gain
  • Psychosocial Assessment include: age of the child, the task of child development, coping is used, the child's habits, family response to childhood diseases, family coping and family adaptation to stress.


Nursing Diagnosis for for Patent Ductus Arteriosus
  1. Decreased cardiac output r / t cardiac malformations.
  2. Impaired gas exchange r / t pulmonary congestion.
  3. Activity intolerance r / t imbalance between oxygen consumption by the body, and the supply of oxygen to the cells.
  4. Altered Growth and Development r / t inadequate supply of oxygen and nutrients to the tissues.
  5. Imbalanced Nutrition, Less Than Body Requirements r / t fatigue at mealtime and increased caloric needs.
  6. Risk for infection r / t decrease in health status.


Nursing Interventions for for Patent Ductus Arteriosus

1. Maintain adequate cardiac output:
  • Observation of the quality and strength of heart rate, peripheral pulses, skin color and warmth.
  • Enforce the degree of cyanosis (circumoral, mucous membranes, clubbing).
  • Monitor signs of CHF (restlessness, tachycardia, tachypnea, tightness, fatigue, periorbital edema, oliguria, and hepatomegaly).
  • Collaboration of digoxin appropriate order, using the toxicity hazard prevention techniques.
  • Give treatment to reduce afterload.
  • Give diuretics as indicated.
2. Reduce the increase in pulmonary vascular resistance:
  • Monitor the quality and respiratory rhythm.
  • Adjust the position of the child with Fowler position.
  • Avoid child of an infected person.
  • Give adequate rest.
  • Provide optimal nutrition.
  • Give oxygen if indicated.
3. Maintaining adequate levels of activity:
  • Allow the child to rest frequently, and avoid disturbances during sleep.
  • Encourage games and activities to do lightly.
  • Help the child to choose activities appropriate to the age, condition and ability of the child.
  • Avoid the ambient temperature is too hot or too cold.
  • Avoid the things that cause fear / anxiety in children.
4. Provide support for the growth and development
  • Assess the level of development of the child.
  • Give the stimulation of growth and development, play activities, gaming, watching TV, puzzles, drawing, and others according to the condition and age of the child.
  • Involve the family in order to keep providing stimulation for treatment.
5. Maintaining growth in weight and height appropriate
  • Provide a balanced diet, high nutrients to achieve adequate growth.
  • Monitor height and weight, documented in the form of graphs to identify trends in the growth of the child.
  • Measure body weight each day with the same weight and the same time.
  • Record intake and output correctly.
  • Give food with small portions but often to avoid fatigue at meals.
  • Children who receive diuretics are usually very thirsty, therefore not restricted fluid.
6. Children will not show signs of infection
  • Avoid contact with infected individuals.
  • Give adequate rest.
  • Give the optimal nutritional needs.
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Causes, Signs and Symptoms of Dissociative Disorders

Dissociative Disorders

In general, dissociative disorders can be defined as a loss of (some or all) of the normal integration (under conscious control) includes memories of the past, awareness of identity and immediate senses (awareness of identity and immediate sensations) as well as control of body movement.

Dissociative disorders in diagnosis there must be a disorder that causes failure coordinate identity, memory or consciousness perception, and cause significant disruption in social functioning, work and take advantage of free time.

There are several penggolonga in dissociative disorders, among others Dissociative Amnesia, Dissociative Fugue, Dissociative Stupor, Trance and Trance disorders, motor skills disorders Dissociative, Dissociative Convulsions and Dissociative Anesthetics and Sensory Loss.


Causes of Dissociative Disorders

Dissociative Disorders exact cause is not yet known, but it usually occurs as a result of severe trauma of the past, but no organic disorder experienced. This disorder occurs when the first children but not distinctive and can not be identified, dissociative disorders in the course of the disease can occur at any time and trauma of the past never happen again, and again and again so that the symptoms of dissociative disorders.

In some references say that the trauma that occurs in the form of:
  • Unstable personality.
  • Sexual harassment
  • Physical abuse
  • Domestic violence (father and mother divorced)
  • Social environment that often show violence.
Personal identity is formed during childhood, and during even then, the children more easily step out of himself and observe trauma although it happens to someone else.


Signs and Symptoms of Dissociative Disorders

Dissociative disorders, under the control of consciousness and ability to selectively control the disturbed to the extent that can last from a day to day or even hour to hour.

Symptoms common to all types of dissociative disorders, including:
  • Loss of memory (amnesia) against certain period of time, events and people,
  • Problems of mental disorders, including depression and anxiety,
  • Perception of the people and objects around him are not real (derealization)
  • The identity of the opaque
  • Depersonalization
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Definition, Clinical Manifestations and Etiology Dementia

Definition of Dementia

Dementia is a decline in mental ability that usually progresses slowly, where there is a disturbance of memory, thought, judgment and ability to focus, and personality deterioration can occur. At a young age, dementia may occur suddenly if severe injury, disease or toxic substances (eg carbon monoxide) causing the destruction of brain cells. But dementia usually occurs slowly and attack aged over 60 years. But dementia is not part of the normal aging process.

Along with age, the changes in the brain can cause a loss of some memory (especially short-term memory) and a decrease in some learning abilities. These changes do not affect the normal function. Forgotten in the elderly bukn a sign of dementia or early-stage disease Alzameir. Dementia is a decline in mental abilities are more serious, that the longer
getting worse.

In normal aging , a person may forget the details of things but people with dementia may forget the whole event has just occurred .

Dementia is a condition of progressive collapse intellectual ability after reaching the highest growth and development (age 15 years) due to organic brain disorder, followed by the collapse of behavior and personality, manifested in the form of impaired cognitive functions such as memory, orientation, sense of heart and formation of the conceptual mind. Usually this condition is not reversible, otherwise progressive. Diagnosis is carried out by clinical examination, and imaging studies laboratorlum (imaging), is intended to look for treatable causes. Treatment is usually supportive only. Kolines feels inhibitor (cholinesterase inhibitors) may improve cognitive function for a while, and make some antipsychotics drugs are more effective than just with one drug alone. Dementia can occur at any age, but more on the elderly.

Most of them were treated in homes and occupy some 50% of the bed. Dementia can be defined as cognitive and memory disorders that can affect daily activities. People with dementia often show some disturbances and changes in daily behavior (behavioral symptoms) that interfere with (disruptive) or do not disturb (non-disruptive) (Voicer. L., Hurley, AC, Mahoney, E.1998). Grayson (2004) states that dementia is not just ordinary disease, but rather a collection of symptoms caused by multiple diseases or conditions resulting in changes in personality and behavior.

Dementia is an illness that involves the brain cells that die abnormally. Only the terminology used to describe progressive degenerative brain disease. This disease may be experienced by all people of various educational and cultural backgrounds. Although there is not yet any treatment for dementia care to deal with the symptoms may be obtained through. Dementia is a decline in mental ability that usually progresses slowly, where there is a disturbance of memory, thought, judgment and ability to focus, and personality deterioration can occur.


Clinical Manifestations of Dementia
  1. Decline in memory that continues to happen. In patients with dementia, "forget" become a part of daily life that can not be separated.
  2. Impaired orientation of time and place, for example : forget the day, week, month, year, where people with dementia are.
  3. The decline and inability to arrange words into correct sentences, using words that are not appropriate for a condition, repeat the word or the same story many times.
  4. Excessive expression, for example, excessive crying when she saw a television drama, furious at small mistakes committed by others, fear and nervousness unwarranted. People with dementia often do not understand why these feelings arise.
  5. The change of behavior, such as : indifferent, withdrawn and anxious.
  6. The whole range of cognitive function is damaged.
  7. Originally impaired short-term memory.
  8. Personality and behavioral disorders, mood swings.
  9. Motors and focal neurologic deficits.
  10. Irritability, hostility , agitation and seizures.
  11. Psychotic Disorders : hallucinations, illusions, delusions and paranoia.
  12. Agnosia, apraxia, aphasia.
  13. ADL ( Activities of Daily Living ) difficult.
  14. Regulate the use of financial difficulties.
  15. Not be able to go home when traveling.
  16. Forgot to put the important stuff.
  17. Difficult bathing, eating, dressing, toileting.
  18. Patients can walk away from the house and can not go home.
  19. Easy to fall, bad balance.
  20. Finally paralysis, incontinence of urine and bowel movements.
  21. Unable to eat and swallow.
  22. Coma and death.


Etiology of Dementia

The most frequent cause of dementia is Alzheimer's disease. The cause of Alzheimer's disease is unknown, but is thought to involve genetic factors, because the disease seems to be found in some families and are caused or influenced by some specific gene abnormality. In Alzheimer's disease, some parts of the brain decline, resulting in cell damage and reduced response to a chemical signal channel in the brain. Found in the brain of abnormal tissue (called senile plaques and tangled nerve fibers) and abnormal proteins, which can be seen at autopsy. Dementia Lewy figure closely resembles Alzheimer's disease, but have differences in the microscopic changes that occur in the brain. The second most common cause of dementia is a stroke that row. Single stroke is small and causes mild weakness or weaknesses that arise slowly. This small strokes gradually cause damage to brain tissue, brain regions that were damaged due to blockage of blood flow is called infarction. Dementia is derived from several small strokes called multi - infarct dementia. The majority of sufferers have high blood pressure or diabetes, both of which cause damage to blood vessels in the brain.
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Physical Examination and Nursing Assessment for COPD


The assessment includes information about the symptoms and manifestations of the disease earlier. Here are some guidelines to get the data questions health history of the disease process:
  1. How long has the patient had difficulty breathing?
  2. Does activity increase dyspnea?
  3. How much limits the patient's activity tolerance?
  4. When patients complain most tired and short of breath?
  5. Is eating and sleeping habits affected?
  6. History of smoking?
  7. The drugs used every day?
  8. The drugs used in the acute attack?
  9. What is known about the patient's condition and disease?
Additional data were collected through observation and examination as follows:
  1. Patient's pulse rate and breathing?
  2. Do the same breathing, without effort?
  3. Is there a contraction of the abdominal muscles during inspiration?
  4. Is there any use of accessory respiratory muscles during breathing?
  5. Barrel chest?
  6. Does it seem cyanosis?
  7. Is there a cough?
  8. Are there peripheral edema?
  9. Is the neck veins appear enlarged?
  10. What color, amount and consistency of sputum of patients?
  11. What is the status of patients sensorium?
  12. Is there an increase in stupor? Anxiety?
  13. Results of diagnostic tests such as:
Chest X-Ray:
May indicate pulmonary hiperinflation, flattened diaphragm, increased retrosternal air space, decrease vascular signs / bullae (emphysema), an increase in the form of bronchovaskular (bronchitis), normally found during periods of remission (asthma)

Examination of Lung Function: Guide to determine the cause of dyspnea, determine whether the function abnormalities due to obstruction or restriction, to estimate the level of dysfunction and to evaluate the effects of therapy, eg bronchodilator.

TLC: Increase in severe bronchitis and usually on asthma, decreased in emphysema.

Capacity Inspiration: Decrease in emphysema

FEV1/FVC: Ratio of pressure expiratory volume (FEV) against the pressure of the vital capacity (FVC) decreased in bronchitis and asthma.

ABGs: Indicates a chronic disease process, often decreased PaO2 and PaCO2 normal or increased (chronic bronchitis and emphysema) but often decreased in asthma, the normal pH or acidosis, respiratory alkalosis secondary to hyperventilation light (moderate emphysema or asthma).

Bronchogram: Can show dilatation of the bronchi during inspiration, kollaps bronchial expiratory pressure (emphysema), enlargement of mucous glands (bronchitis)

Complete Blood: Increased hemoglobin (severe emphysema), an increase in eosinophils (asthma).

Blood Chemistry: Alpha 1-antitrypsin is made to the possibility of less on primary emphysema.

Sputum culture: To determine the presence of infection, identify the pathogen, cytologic examination to determine malignancy or allergic disease.

ECG: right axis deviation, tall P wave (severe asthma), atrial dysrhythmias (bronchitis), gel. P in Leads II, III, AVF length, height (bronchitis, emphysema), QRS axis vertical (emphysema)

Exercise ECG, Stress Test: Helping assess the level of respiratory dysfunction, evaluate the effectiveness of bronchodilator drugs, plan / program evaluation ..

Palpation:
  1. Reduction in the development of breast palpation?
  2. Is there decreased tactile fremitus?
Percussion:
  1. Is there hiperesonansi on percussion?
  2. The diaphragm moves just a little bit?
Auscultation:
  1. Is there a loud wheezing sound?
  2. Is there ronkhi sound?
  3. Nomal or decreased vocal fremitus?
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Theories of Aging Process

1. Biological Theory

a. Gene Mutation Theory
Aging occurs as a result of changes in biochemistry that is programmed by the molecule / DNA and every cell in turn will undergo mutation.

b. Usage and broken
Effort can lead to excess stress causes the body's cells exhausted (used up).

c. Auto Immune theory
There are certain body tissues that are not resistant to certain substances that the body tissues become weak and sick.

d. stress theory
Aging occurs due to loss of cells commonly used body . Regeneration of body tissue can not maintain a stable internal environment, excess effort and stress that causes fatigue unused cells.

e. Free radical theory
Unstable oxygen free radicals resulting in oxidation of organic matter which in turn causes the cells can not regenerate.

f. Cross-linking theory
Old cells that cause a chemical reaction of a strong bond, especially the collagen network which in turn lead to less elastic, chaos and loss of function.

g. Theory courses
Organism's ability to set the number of dividing cells after the cells are dead cells.


2. Social psychological theory

a. Activity (activity theory)
In the elderly who are successful and those who are actively involved in many social activities and maintain the relationship between the individual and the social system that is stable from middle age to old age.

b. Personality continues
It is a combination of the above theory in which the changes occur in the elderly seseroang greatly influenced by the type of personality he has.

c. Liberation theory
The breakdown in relationships or relationships with the community and setbacks individual to individual. With increasing age, a gradually began to break away from social life or withdrawn surroundings. This situation resulted in decreased social interaction elderly, both in quality and quantity so often happens double loss: loss of role, social contact barriers, reduced commitment.
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