The Role of Public Health Nurses

Many roles can be performed by Public Health Nurses are:

1. As a service provider (Care provider)

Provide nursing care through reviewing the existing nursing problems, nursing action plan, implement and evaluate nursing care actions, which have been given to individuals, families, groups and communities.


2. As an educator and consultant (Nurse Educator and Counselor)

Provide health education to individuals, families, groups and communities both in the home, community health centers, and in society as organized in order to instill healthy behavior, resulting in a change of behavior as expected in achieving optimal health status.

Counseling is the process of helping the client to recognize and cope with psychological distress or social issues to establish good interpersonal relationships and to increase one's progress. In it are given emotional support and intellectual.

The teaching process has four components: assessment, planning, implementation and evaluation. This is consistent with the nursing process in the assessment phase of a nurse assess patient's learning needs and readiness to learn. During the planning nurses make specific goals and teaching strategies. During the implementation of the nurse implement teaching strategies and for evaluation of the nurse assess the results that have been obtained


3. As a role model (Role Models)

Public health nurses should be able to give a good example in the field of health to individuals, families, groups and the public about how healthy the way of life that can be imitated and emulated by the public.


4. As defenders (Client Advocate)

Defense can be given to an individual, group or community level. At the family level, nurses can perform its functions through social services in the community. A client advocate is an advocate of the rights of clients. Defense including an increase in what is best for clients, ensuring client needs are met and to protect the rights of clients (Mubarak, 2005).

The task of the nurse as a client advocate is responsible for assisting clients and families in interpreting information from a variety of service providers to provide information and other things necessary to take approval (Informed Concent) on nursing actions given to him. Another task is to preserve and protect the rights of the client, because the client must be sick and hospitalized will interact with many health workers.


5. As a case manager (Case Manager)

Public health nurses are expected to manage a variety of health services and community health centers in accordance with the burden of the duties and responsibilities imposed upon him.


6. As collaborators

The role of the nurse as a collaborator can be implemented by means of cooperation with other healthcare teams, both with doctors, nutritionists, radiologists, and others in relation to help speed up the healing process of collaboration or cooperation measures client is a decision-making process with others on the stage of the nursing process . This action plays a very important to plan the actions that will be implemented (Mubarak, 2005).


7. As planners further action (Discharge Planner)

Discharge planning can be provided to a client who has been undergoing treatment at a medical institution or hospital. This plan can be provided to clients who have experienced improved health conditions.


8. As identifiers health problems (Case Finder)

Implement monitoring of the changes that occur in individuals, families, groups and communities on issues of health and nursing as well as the resulting impact on health status through home visits, meetings, observation and data collection.


9. As a health services coordinator (Coordinator of Services)

The role of the nurse as a coordinator among others, direct, plan and organize health services provided to clients. Service of all members of the health team, because the client receives the services of many professionals.


10. As the carrier changes or reformer and leader (Change Agent and Leader)

Agents for Change is a person or group who initiate change or help others to make a change in him or in the system. Torney Marriner describes that the carrier change is that identifying the problem, assessing client's motivation and ability to change, suggesting alternatives, explore the possibility of alternative outcomes, reviewing resources, demonstrate the role of help, build and maintain relationship help, help during the phase of the change process and guiding clients through these phases.

Improvement and change is an essential component of treatment. By using the nursing process, the nurse helps clients to plan, implement and maintain such a change: knowledge, skills, feelings and behaviors that can improve health.


11. As an identifier and community service providers (Community Care Provider And Researcher)

This role is included in the process of nursing care services to the community which includes assessment, planning, implementation and evaluation of health problems and solving the given problem. Search action or identifying other health problems are also part of the role of community nurses.


Source : (Mubarak, 2005)

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Nursing Care Plan for Spinal Cord Tumor

NCP for Spinal Cord Tumor - Assessment, Nursing Diagnosis and Interventions

Spinal cord arranged in the spinal canal and are covered by a layer of connective tissue, dura meter. Spinal cord tumor is an uncommon disorder, and only a few are found in the population. However, if the tumor lesion grows and pressing on the spinal cord, this tumor can cause dysfunction of the limbs, paralysis and loss of sensation.

The incidence of all primary tumors of the spinal cord approximately 10% to 19% of all primary central nervous system tumors. (CNS), and like all tumors in the nervous axis, the incidence increases with age. Gender specific prevalence of almost all the same, except for the meningioma which is generally found in women, and ependymoma are more frequent in males. Approximately 70% of intradural tumors, an extramedullary and 30% is intramedular.

In this case the nurse has an important role in organizing efforts such as improved health (promotion) by way of providing information about the disease, disease prevention (preventive), cure (curative) and rehabilitative.

Complications that can result in spinal cord tumors are very noteworthy because of the impact would worsen the patient's condition, such as; damage the fibers of neurons, loss of sensation of pain (severe circumstances), bleeding metastases, rigidity, weakness, impaired coordination, difficulty urinating or causing loss of control of bladder or constipation.


Definition

Spinal cord tumors are the growth of new tissue in the spinal cord, can be benign or malignant.


Etiology

The pathogenesis of spinal cord neoplasms is unknown, but most arise from abnormal cell growth in the area. Genetic history looks very instrumental in the increased incidence in certain families or syndromic group (neurofibromatosis).


Assessment

• GCS assessment.
• Assessment of the level of consciousness.
• Pathological and physiological reflexes.

Nursing Diagnosis

Diagnosis of tumors of the spinal cord taken based on the results of history and physical examination and investigations. Extradural tumors had a clinical course of spinal cord function will disappear altogether accompanied by spastic weakness and loss of sensation of vibration.

Joint position below the level of the lesion is rapid. On examination of the spine radiogram, most of the patients the tumor will show symptoms of osteoporosis or significant damage to the pedicles and vertebral bodies. Myelogram can confirm the location of the tumor.

In extramedullary tumors, which dominates the symptoms is compression of the spinal nerve fibers, so that the initial look is pain, first in the back and then along the spinal nerve roots. As in the extradural tumors, pain aggravated by traction by movement, coughing, sneezing or straining, and the most severe occurred at night. Pain is intensified at night caused by traction on the nerve root pain, the spine when lengthening after the loss of shortening effect of gravity. Sensory deficits gradually rises to below the level of the spinal cord segments. In extramedullary tumors, CSF protein levels almost always increased. Spinal radiography may show an enlarged foramen and thinning adjacent pedicles. As in the extradural tumors, myelogram, CT scan, and MRI is essential to determine the exact location.

1 Impaired sense of comfort: pain related to increased ICP.

2 Impaired physical mobility related to compression of the blood supply to the corno anterior.

3 Impaired sense of comfort: pain related to intra-thoracic and intradominal.



Nursing Plan

Nursing plan is an action plan that nurses do before nurses perform actions to the patient, who is listed in the nursing plan is:
1. Independent and collaborative interventions, independent intervention is the action to be done independently of nurses to patients, while collaboration is an act of intervention that nurses do in collaboration with other health care team.
2 Criteria of expected results, and
3 Rational, which is the rational benefits of the actions taken by nurses to patients.

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Brain Tumor Assessment, Pre and Post Operative Nursing Diagnosis

Nursing Assessment for Brain Tumor

1. Health Perception and Health Management

• A family history of tumors.
• Exposed to excess radiation.
• A history of visual problems; lost visual acuity and diplopia.
• Alcohol Addiction, heavy smokers.
• There was a feeling abnormal.
• Personality disorder / hallucinations.

2. Nutritional Metabolic Pattern

• History of epilepsy.
• Loss of appetite
• The presence of nausea, vomiting during the acute phase.
• The loss of sensation on the tongue, cheeks and throat.
• Difficulty swallowing (interference on the palate and pharyngeal reflex).

3. Elimination Pattern

• Changes in the pattern of urination and bowel movements (incontinence).
• Bowel sounds; negative.

4. Activity and Exercise Pattern

• Disorders of muscle tone, the muscle weakness, impaired level of consciousness.
• Risk of trauma due to epilepsy.
• Hamiparese, ataxia.
• vision disorders.
• Feel tiredness, loss of sensation.

5. Sleep Rest Pattern

• Hard or easy to relax and fall asleep.

6. Cognitive-Perceptual Pattern

• Dizziness.
• Headache.
• weakness.
• Tinnitus.
• Motor aphasia.
• Loss of sensory stimuli contra-lateral.
• Impaired sense of taste, smell and sight.
• Decline in memory, problem solving.
• Lost the ability influx of visual stimuli.
• Impairment of consciousness up to coma.
• Not able to record images.
• Not able to distinguish right / left.

7. Self-Perception-Self-Concept Pattern

• The feeling of helplessness and despair.
• Emotions unstable and difficult to express.

8. Role-Relationship Pattern

• Speech problems.

9. Reproduction

• The existence of disturbances and irregularities.
• Influence / relationship to disease.

10. Coping-Stress Tolerance Pattern

• Existence of feelings of anxiety, fear, impatient or angry.
• Coping mechanism commonly used.
• Feelings of helplessness, hopelessness.
• Emotional response to the client's current status.
• People who help in solving the problem.
• Irritability.

11. Value-Belief Pattern

• The religion, whether religious activities interrupted.

Nursing Diagnosis for Brain Tumor Pre-Surgery

1. Imbalanced Nutrition Less than Body Requirements related to nausea, vomiting and loss of appetite / growth of cancer cells.
2. Acute Pain / Chronic Pain ; head related to the growth of cancer cells in the brain.
3. Impaired physical mobility related to movement disorders and weakness.
4. Impaired Verbal Communication related to damage to the cerebral circulation.
5. Low self-esteem related to dependency, role changes, changes in self-image.
6. Knowledge Deficit; about the condition and treatment of diseases related to lack of information.
7. Anxiety related to surgical plan.

Nursing Diagnosis for Brain Tumor Post-Surgery

1. Acute Pain related to the effects of surgery.
2. Low self-esteem related to dependency, role changes, changes in self-image.
3. Knowledge Deficit; about brain tumors related to ignorance about resources
4. Anxiety related to chronic disease and an uncertain future.

Brain Tumor - 4 Nursing Diagnosis and Interventions

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Brain Tumor - 4 Nursing Diagnosis and Interventions

Nursing Care Plan for Brain Tumor

Tumor is a general term covering any benign growth in every part of the body. This growth was not intended, is growing at the expense of the parasite and the human host.

Brain tumor is a benign tumor on the lining of the brain or one of the brain.

Brain carcinoma (malignant) is a neoplasm that grows in the lining of the brain.

Neoplasm is a collection of abnormal cells formed by cells that grow continuously in a limited, uncoordinated with the surrounding tissue and not useful to the body.


Nursing Diagnosis and Nursing Interventions for Brain Tumor

I. Acute Pain / Chronic Pain related to the effects of surgery.

Goal: Pain is reduced until it disappears after the act of nursing.

Outcomes:

• Clients can perform activities without feeling pain.
• Relaxed facial expression.
• Clients demonstrate discomfort disappear.

Interventions:
1. Assess the level of pain (location, duration, intensity, quality) every 4-6 hours.
R /: As an early indicator in determining the next intervention.

2. Assess the patient's general condition and vital signs.
R /: As an early indicator in determining the next intervention.

3. Give a pleasant position for the patient.
R /: To assist patients in controlling pain.

4. Give a lot of time resting and less visitors as desired patient.
R /: Can reduce physical and emotional discomfort.

5. Collaboration with physicians in drug delivery.
R /: To assist in the healing of patients.



II. Low self-esteem related to dependency, role changes, changes in self-image.

Goal: Impaired self-resolved after the act of nursing.

Outcomes: Clients can be confident with the disease state.

Interventions:
1. Assess the response, and the patient's family's reaction to disease and treatment.
R /: To simplify the process approach.

2. Assess the relationship between patient and close family members.
R /: Support families helps in the healing process.

3. Involve everyone nearby in education and home care planning.
R /: Can ease the burden on the handling and adaptation at home.

4. Give time / listen to the things that become complaints.
R /: continuous support will facilitate the adaptation process.


III. Knowledge Deficit: about brain tumors related to ignorance about resources.

Goal: Information about self care and nutritional status is understood, after the act of nursing for 1 x 24 hours.

Outcomes:
The client expressed an understanding of the information provided.
Client states of consciousness and changes in patterns of self-care plan.

intervention:
1 Assess the patient's level of knowledge.
R /: To determine the level of knowledge in the receipt of information, so as to give correct information.

2 Discuss the relationship of the causative agent of the disease.
R /: To provide an understanding to the patient about the things that trigger the disease.

3 Explain the signs and symptoms of perforation.
R /: Symptoms of perforation is pain in the chest.

4 Explain the importance of the environment without stress.
R /: To prevent an increase in sympathetic stimulation.

5. Discuss implementation method of stress.
R /: How stress management: relaxation, exercise and medication.


IV. Anxiety related to chronic disease and an uncertain future.

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

Outcomes: Anxiety is reduced.

Intervention:
1. Listen patiently client complaints.
R /: Facing issues of patients and need to be explained and opened the way to resolve it.

2. Answering questions from clients and families, with friendly.
R /: Make sure the patient and believe.

3. Encourage client and family confide.
R /: Creating trust and decrease misperceptions.

4. Using therapeutic communication techniques.
R /: Establishing a trust relationship the patients.

5. Give the physical comfort of the patient.
R /: It is difficult to accept with the issue when it experiences extreme emotional / physical discomfort persist.

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NCP for Febrile Convulsions : Assessment and Nursing Diagnosis

Nursing Care Plan for Febrile Convulsions


Definition

Febrile Seizures is an occurrence in infants or children who usually occurs between the ages of 3 months to 5 years was associated with fever but never proven the existence of intra-cranial infection or a particular cause . ( Consesnsus Statement On Febrile Siezures , 1980).



Classification

1. Simple febrile seizures :

• Age 6 months to four years.
• Long seizures are not more than 15 minutes.
• Seizures are common.
• Seizures occurred 16 hours after the onset of fever.
• EEG normal one week after the seizure.
• Neurological examination before and after abnormal spasm.
• Seizure frequency generation in a single year is not more than four times.

2. Complex febrile seizures :

• Seizure time more than 15 minutes.
• Seizure frequency more than once in 24 hours.
• Children have a neurological disorder or a history of febrile seizures before.
• Seizure frequency generation in one year more than four times.

3. Epilepsy provoked by fever.

• Is that not all febrile seizures above criteria.

Originator or Risk Factors :

• High fever caused by upper respiratory tract infection, pneumonia, gastroenteritis and urinary tract infections.
• History of febrile seizures in parents or siblings.
• Developmental delay.
• Problems in the newborn period.
• Children in special care.
• Children with low levels of Na.
• Family history of epilepsy.

Pathophysiology

In a state of fever 1oC temperature rise will lead to increased basal metabolism 10-15 % and oxygen demand increased by 20%, resulting in a change in the balance of cell membranes of neurons and in a short time, diffusion of sodium and potassium ions through the membrane before, with the result of off an electric charge. Remove the charge is so large that it can spread throughout the cell and surrounding cell membrane with the aid of the so-called "neurotransmitters" and there was a seizure.


Differential diagnosis

• Another cause febrile seizures should be removed, especially meningitis and encephalitis.
• Children with high heat can arise delirium, chills and fever, cyanosis so as to resemble seizures.

Prognosis
Dependent factors :

• A history of seizures without fever disease in the family.
• Families with neurological disorders.
• Prolonged seizures or convulsions locally.

If there are two of these three factors will then later on febrile seizures is approximately 13%.



Nursing Care Plan for Febrile Convulsions

Nursing Assessment

1. Client identity

• Age is usually six months to four years, male gender women with a ratio of 2 : 1 , the highest incidence in children aged two years.

2. The main complaint

• Seizures because of the fever.

3. History of present illness

• Time of occurrence of seizures less than five minutes.
• Seizures are general.
• Seizures occurred within 16 hours after the onset of fever.
• No neurological abnormalities both clinical and laboratory.

4. Past medical history

• The presence of predisposing factors of febrile seizures among other head trauma, infection, and reactions to immunization.

5. Family history of disease

• 25-50 % of febrile seizures have a heredity factor families affected by the presence of febrile seizures, neurological diseases or other diseases.

6. Previous history

• History of pregnancy : maternal illness, bleeding, and medications used.
• Labor History : spontaneous birth or by action, antepartum hemorrhage, premature rupture of membranes, Aspixia.

Activity Daily Live

1). Food or liquids

• Patients will complain sensitive to foods that stimulate seizure activity, tooth decay, the presence of gingival hyperplasia , as a result of side effects of drugs.

2). Activity and Rest

• Patients complain of fatigue, general weakness, limitation of activities and changes in muscle tone.

3). Elimination

• Incontinensia
• Ictal face : an increase in pressure and tone springter blader.
• Post- ictal : muscle relaxation.

4). Psycho - social history

• Psycho : anamnesis of the child's temperament, cognitive abilities, and the response of pain conditions as well as hospitalization.
• Social : anamnesis the source of economic status and family, and the family response patterns of daily childcare.

Test and Diagnosis

1). Vital signs

• Decreased awareness
• Ictal phase : Increased pulse, respiration, blood pressure and temperature.
• Post ictal : normal V5 sometimes depression.

2. Physical Examination

• Head : head shape disproportion, generalized seizures, tonic clonic seizures and headaches.
• Eyes : Dilated pupils, eye movements and rapid eyelid, and conjunctival reflexes down red light.
• Mouth : Excessive production of saliva, vomiting and Cyanosis oral mucosa.
• Nose : The existence nostril breathing, Cyanosis.
• Neck : the tetanus occurs stiff neck.
• Chest : Ictal phase : Cyanosis, decreased respiratory movement and the pull intercostae. Post ictal : Apnoe or breath deep and slow.
• Abdomen : Ictal phase : Improved muscle tone blader and spingter. Post ictal : relaxation and hyper peristaltic muscles.
• Extremities : Ictal phase : spasms in upper and lower extremities and cyanosis of the fingers and toes. Post ictal : muscle relaxation and pain and weakness in the muscles.

3. General examination

• Electrolytes : Electrolyte imbalance predispose to seizures.
• Glucose : Hypoglycemia predispose to seizures.
• BUN : Increased BUN is a potential seizure.
• CBC : Aplastic Anemia can occur as a side effect of drug administration.
• LP : to detect the presence of abnormal pressure and signs of infection.
• Skull X - ray : the existence of space and lesions persisted.
• EEG : The focus of seizure activity.
• CT scan : Local cerebral abscess detect tumor lesions with or without contrast.

Nursing Diagnosis for Febrile Convulsions

1. Increased body temperature relation : the presence of pyrogens which disrupt the thermostat, the average increase in metabolism and disease dehydration.
2. Risk for Ineffective airway clearance related to neuromuscular damage and obstruction tracheo - broncial.
3. Knowledge Deficit : family related to misinterpretation and lack of information.
4. Self-concept Disturbance (low self esteem) related to epilepsy and wrong perceptions and uncontrolled.

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Nursing Care Plan for Impaired Swallowing

Impaired Swallowing. Swallowing is a unique process that requires good performance of the muscles in the throat , face, tongue, and palate. The presence of the disease, disorders or abnormalities in one of these organs will interfere with the process of swallowing.

Difficulty swallowing or dysphagia. It is usually a sign of a problem in the throat or esophagus (esophageal), tube-shaped muscle that moves food and liquid from the back of the mouth to the stomach. Although dysphagia can happen to anyone, but generally only occur in the elderly, infants, and those who have problems with the nervous system or brain.

There are many causes that can lead to throat or esophagus does not function normally. It could be because of some small things, but some other things that might cause it is a serious disorder. If only having one or two times only, not to worry, the possibility of not having a medical problem. But if trouble swallowing continuously, it is likely to suffer a serious problem that requires proper handling.

In normal circumstances, the muscles in the throat and esophagus will squeeze or contract to move food and liquids from the mouth to the stomach without obstacles. There are two types of problems that can make it difficult for food and liquid move into the esophagus, namely :

1. The muscles and nerves that help move food through the throat and esophagus does not work properly. This can happen because :

• Suffered a stroke, brain or spinal injury.
• Problems with the nervous system, such as post - polio syndrome, multiple sclerosis, muscular dystrophy, or Parkinson's disease as well. It could also be caused after diphtheria, syphilis, poisoning, bibulous, and hysteria.
• Immune system problems that cause swelling or inflammation, and weakness, such as polymyositis or dermatomyositis.
• Esophageal spasms. This means that the muscles of the esophagus suddenly pressing. Sometimes this can prevent the food to reach the stomach.
• Scleroderma. In this condition, the tissues of the esophagus become hard and narrow. Scleroderma can also make the muscles become weak lower esophagus, which can cause food and stomach acid back up into the throat and mouth.

2. There is something blocking the throat or esophagus. This may occur because :

• Gastroesophageal reflux disease (GERD). When stomach acid up into your esophagus, it can cause ulcers in the esophagus, which then can cause scars or wounds. These scars can make a narrow esophagus.
• Esophagitis. It is an inflammation of the esophagus. It can be caused by many things, such as GERD or an infection or because the pill is stuck in the esophagus. In addition, difficulty swallowing can also be caused by allergic reactions to certain foods or things other airborne.
• Diverticula. It is a small sac that grows on the wall of the esophagus or throat.
• Esophageal tumors. Growth in the esophagus may be cancerous or noncancerous.
• Lymph nodes and tumors that suppress the esophagus.

In addition , dry mouth could make matters worse dysphagia . This is because you may not have enough saliva to help the food from the mouth to enter the esophagus . Dry mouth can be caused by the influence of the consumption of drugs or other health problems.


Dysphagia can come and go at any time, mild or severe, or worse than would occur continuously. If experiencing dysphagia, may be :

• Food or liquid could not swallow at swallowing the first experiment.
• Vomiting, choking, or coughing when swallowing.
• Food or liquid back up into the throat, mouth, or nose after swallowing.
• Feeling like food or fluid trapped in one or several parts of the throat or chest.
• Pain when swallowing.
• Pain or distress in the chest or stomach.
• Weight loss due to not getting enough food or fluid intake.

Nursing Care Plan for Dysphagia : Impaired Swallowing
will depend on what is causing dysphagia. Treatment for dysphagia includes :

• Exercise for the muscles to swallow. If there is a problem with the brain, nerves, or muscles, may need to do exercises to train the muscles to work together to help swallow. Also may need to learn how to good posture or how to put food in the mouth in order to swallow either.
• Change in eating food. The doctor may suggest to avoid or change certain types of foods and liquids to make the process easier to swallow.
• Dilation (widening). In this treatment, the device is placed into the esophagus, then carefully will expand the narrow areas of the esophagus. Perhaps this treatment should be done several times.
• Endoscopy. In some cases, a long, thin scope can be used to retrieve the object that is stuck in the esophagus.
• Food that is stuck mashed with similar chemicals such as papain, that blob can continue down the food into the stomach.
• Surgery. If there is something blocking the esophagus (such as a tumor or diverticula), may need surgery to remove it. Surgery is also sometimes used in people who have a problem that affects the muscles of the esophagus (achalasia).
• Drugs. If experiencing dysphagia associated with GERD, the heat in the stomach, or esophagitis, prescription drugs can help prevent stomach acids enter the esophagus. Infections of the esophagus are often treated with antibiotic drugs.

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Nursing Care Plan for Dysphagia : Impaired Swallowing

Nursing Diagnosis for Dysphagia -Impaired Swallowing


Swallowing is a complex process that allows the movement of food and liquids from the mouth to the stomach. This process involves structures in the mouth, pharynx, larynx and esophagus.

Complaints of difficulty in swallowing (dysphagia) is one of the symptoms of the disorder or disease in the oropharynx and esophagus. These complaints will arise when there is interference with the movement of the muscles of swallowing and impaired transport of food from the mouth to the stomach. Types of foods that cause dysphagia can provide information regarding disorders that occur.


Purpose

1. General Purpose

• Knowing nursing care in patients with Dysphagia.

2. Special Purpose
To know the nursing care for patients who experience such as :

• Definition of Dysphagia.
• Etiology of Disphagya.
• Pathophysiology of Disphagya.
• Diagnosis and treatment Disphagya.
• Disphagya nursing care to patients.

Nursing Care Plan for Dysphagia


Definition

Disphagya is difficulty in swallowing and getting food from the esophagus into the stomach. Dysphagia can cause all sorts. Important to know the difference dysphagia, because orofaring and esophageal disorders. If not carefully observed, the symptoms are very similar.

On the problems of the esophagus, dysphagia sometimes there is, in the event of esophagitis or esophageal obstruction. Problems of the esophagus is usually also accompanied by regurgitation. Hypersalivation never or rarely occurs and when there is usually a result of a foreign object is actually a pseudo - hypersalivation.


Etiology

Disphagya can be found on some of the causes that can cause the condition include:

• Stroke.
• Progressive neurological disease.
• The tube on trachestomy.
• Paralise or absence of movement of the vocal cords.
• Tumors in the mouth.
• Surgery of the head.

Pathophysiology

Normally people swallow solid food or drinking liquids and swallow saliva or mucus produced by the body hundreds of times every day. The swallowing process has four stages : the first stage of preparation in the mouth, where food or solids mobilized / manipulated and chewed in preparation for swallowing. During the oral stage, the tongue pushing food or solids into the back of the mouth, and began to swallow response. Pharyngeal phase began immediately after food or liquid pass through the pharynx (the tube that connects the mouth to the esophagus) into the esophagus or gastrointestinal tract. The last stage is the stage of esophageal, food or liquid pass through the esophagus into the stomach. Although the first and second stages have some control voluntair, stages three and four occur by itself without realizing it. If the swallowing process stalled due to various reasons, will result in difficulty swallowing.





Nursing Assessment

Nursing assessment needs to be done in patients with swallowing disorders or disphagya include :

• History of the disease.
• History of stroke.
• History of the use of medical devices : tracheostomy, nasogastric tube, mayo tube, ETT, post endoscopy examination.
• History surgery laryx blood, pharynx, esophagus, thyroid.
• Postoperative mouth area.

Physical examination :

• Mouth shape is not symmetrical.
• Looks an inflammation of the pharynx.
• The presence of Candida in the oral / mouth.
• Edema of the pharynx.

Nursing Diagnosis and Nursing Interventions

1. Impaired swallowing related to muscle weakness due to swallowing paralise

Outcomes :
Patients can demonstrate the proper method of swallowing food without causing despair.


Intervention :
a. Review the patient's ability to swallow , note the extent of facial paralysis.
b. Increase efforts to be able to perform effective ingestion such as helping the patient hold his head.
c. Place the patient in a sitting position / upright during and after eating.
d. Stimulation lips to open and close the mouth manually by pressing lightly on the lips / under the chin.
e. Place the food in the mouth is not ill / disturbed.
f. Tap the deepest part of the cheek with a spatula to know the weakness of the tongue.
g. Give eat slowly in a quiet environment.
h. Start by giving a semi-liquid food orally , soft foods when patients can not swallow water.
i. Help the patient to choose foods that are small or do not need to chew and easy to swallow.
j. Instruct the patient to use a straw to drink liquids.
k. Suggest to participate in the exercise program.


2. Imbalanced Nutrition Less than Body Requirements related to lack of adequate food intake.

Outcomes :
Adequate nutritional intake.

Intervention :
a. Instruct the patient to eat slowly and chew food thoroughly.
b. Feeding little and often with foods that are not irritating.
c. Serve food in interesting ways.
d. Avoid eating or drinking foods that contain irritant substances.
e. Measure body weight each day and record the increase.
f. Observation of the patient's intake of nutrients and review the things that hinder / complicate the swallowing.

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