Advantages / Benefits of Home Care

Health is the thing that is needed by every human being, it is reflected in the large number of patients who come to health services for treatment and care, they come from many different groups, ranging from high-class economic group, to the down economy.

Home health care is one type of long-term care that can be provided by professionals and non-professionals who have been trained. Home health care, which is one form of health care is a component of a continuous range of health services and comprehensive given to individuals and families in their homes which aims to improve, maintain or restore health and maximizing the level of independence and minimize the consequences of diseases including terminal. Services that meet the needs of individual patients and families, planned, coordinated and provided by the service providers organized to provide home care through staff or contractual arrangements or a combination of both.

Sherwen (1991) defines health care as an integral part of home nursing services performed by nurses to help individuals, families and communities achieve self-reliance in solving health problems that they face. While Stuart (1998) describe the home health care as part of the process of nursing at the hospital, which is a continuation of the repatriation plan (discharge planning), for clients it was time to go home from the hospital. Home care is usually performed by a nurse from the hospital initially, carried out by community nurses where the client is located, or carried out by a special team that handles home care.

Advantages / Benefits of Home Care

The benefits that can be obtained in general from the activities of home care include:

• Improve promotive, preventive, curative and rehabilitative.
• Reducing the frequency of hospitalization.
• Efficiency of time, cost, effort and thought.

The benefits of home care, hospital-based:

• Direct access to doctors who refer and treat patients and potential patients easier.
• The carrying capacity of a large organization financially available to help solve temporary cash - flow in the initial phase.
• Ease / advantage in securing managed care through a process of collaboration and service integration.
• The need for comprehensive care of patients will be met.
• Continuity of care and the internal controls of the cost, quality and access to services.
• Length of Stay will ter-manage more effectively.
• There are opportunities to increase hospital revenue.

Nursing Care Plan for Atherosclerosis

Atherosclerosis (ath-er-o-skler-O-sis) also known as arteriosclerotic vascular disease or ASVD. comes from the Greek words athero - meaning gruel or paste and sclerosis meaning hardness - and is a hardening of the arteries - it is the most common cause of heart disease. Atherosclerosis is a condition in which an artery wall thickens as a result of the accumulation of fatty materials such as cholesterol.

Atherosclerosis usually doesn't cause signs and symptoms until it severely narrows or totally blocks an artery. Many people don't know they have the disease until they have a medical emergency, such as a heart attack or stroke. Some people may have signs and symptoms of the disease. Signs and symptoms will depend on which arteries are affected.

These symptoms take some time to develop, as the disease must progress to the point where an artery is severely narrowed or completely blocked.

Common locations for narrowing and hardening of the arteries to occur include the:

•     Heart
•     Brain
•     Legs, pelvis, or arms
•     Kidneys.

Symptoms of Atherosclerosis in the Heart
If the arteries that supply the heart with blood (called the coronary arteries) are affected, you may have symptoms that include:

•     Chest pain or chest discomfort (angina)
•     Pain in one or both arms, the left shoulder, neck, jaw, or back
•     Shortness of breath
•     Dizziness
•     Faster heartbeats
•     Nausea (feeling sick to your stomach)
•     Abnormal heartbeats
•     Feeling very tired.

In some people, the first symptom is a heart attack. A heart attack occurs when a coronary artery becomes blocked, most commonly by a blood clot.

Causes and Risk Factors of Atherosclerosis

Why does atherosclerosis occur in the coronary arteries of some people but not others? An interplay of many factors including hypertension (high blood pressure), smoking, diabetes, obesity, high cholesterol, family history of heart disease, and a sedentary lifestyle are involved.

Treatment of Atherosclerosis

• Medication is unsatisfactory for treating atherosclerosis, since the damage has already been done.
• Anticoagulant drugs have been used to try to minimize secondary clotting and embolus formation.
• Vasodilator drugs are helpful in providing symptom relief, but are of no curative value.
• Surgical treatment is available for those unresponsive to medical treatment or in certain high-risk situations.
• Balloon angioplasty can open up narrowed vessels and promote an improved blood supply.
• The blood supply to the heart can also be restored by coronary artery bypass surgery.
• Large atheromatous and calcified arterial obstruction can be removed by endartectomy, and entire segments of diseased peripheral vessels can be replaced by woven plastic tube grafts.

Nursing Care Plan for Atherosclerosis

Physical Examination - Nursing Care Plan for Atherosclerosis

1. Angina Pectoris (chest pain) followed by:

• The urge to urinate
• Diaphoresis
• Nausea
• Dyspnoea
• Cold extremities

2. Assess Pain to identify Angina

• Stable angina is chest pain or discomfort that Usually Occurs with activity or stress. Angina is chest discomfort due to poor blood flow through the blood vessels in the heart.
• Unstable angina is a condition in roomates your heart does not get enough blood flow and oxygen. It may lead to a heart attack.
• Nocturnal angina wakes a patient from sleep and may be provoked by vivid dreams. Symptoms are commonest in the early hours of the morning when coronary artery tone is maximal. Often the patient has critical coronary artery disease and hence Usually suffers from exertional angina. Nocturnal angina may be associated with coronary artery spasm - Prinzmetal's angina.
• Decubitus angina Occurs when the patient lies down. Usually it is a complication of cardiac failure due to the strain on the heart resulting from the Increased intravascular volume. Usually Patients have severe coronary artery disease.
• Prinzmetal's angina is a form of chest pain, pressure, or tightness (angina) Caused by spasms in the arteries that supply blood to the heart. It is a form of unstable angina, meaning that it Occurs at rest, Often without a predictable pattern. This is in contrast to stable angina, chest pain in roomates Occurs in a predictable pattern during exertion or exercise.

3. Assess the Chest Pain in relation to:

• Trigger factors in patients, what triggers the onset of pain is to be done before the pain began to occur (eg; smoking, excessive activity, excessive weight diet, emotional stress, sexual activity and drink too cold)
• Quality pain how (are like a burning sensation, feeling depressed or choke)
• Location of pain: occurs in substernal or mid anterior chest and around the neck, jaw, or left arm shoulder blades down.
• Remarkably attacks: mild, moderate or severe.
• Time; illness duration, frequency.
• Typical in the attack: a fist over his chest or left arm rub. Pain attacks occur gradually or abruptly for 15 minutes or more.
• Assess the client's feelings about the conditions and the perceived influence of lifestyle.

Nursing Assessment - Nursing Care Plan for Atherosclerosis

The data should be assessed in patients with atherosclerosis or arteriosclerosis depends on the location affected. When the coronary arteries are exposed to the clinical signs and symptoms according to clinical signs and symptoms of angina pectoris or acute myocardial infarction. When the brain is affected by the clinical signs and symptoms were assessed according to the case of stroke. Angina pectoris, myocardial infarction and stroke will be discussed separately. Nursing assessment will be our focus here is impaired peripheral perfusion of the organs other than those mentioned above.

Subjective data which may occur: sudden pain or felt melancholy, cramps, fatigue or weakness. Pain persists rest, pain, and discomfort, and usually occurs in the distal extremities. Cold feeling or numbness in the extremities due to decreased arterial flow. Assess the level of knowledge of the patient about the treatment of the disease.

Objective data that may be obtained: the affected extremity will look pale when elevated and cyanosis while hanging. The color and temperature of the extremities were recorded. Changes in skin and nails, ulcers, gangrene and muscle atrophy may seem obvious. The nails may thicken and cloudy, shiny skin, atrophy and dry with sparse hair growth. Peripheral pulses can be weakened or lost altogether.

Risk for Impaired Skin Integrity - NCP Guillain-Barre syndrome

Nursing Diagnosis Risk for Impaired Skin Integrity - Nursing Care Plan for Guillain-Barre Syndrome

Guillain-Barre syndrome is a serious disorder that occurs when the body's defense (immune) system mistakenly attacks part of the nervous system. This leads to nerve inflammation that causes muscle weakness and other symptoms.

Symptoms of Guillain-Barre syndrome include:

•     Numbness or tingling in your hands and feet and sometimes around the mouth and lips.
•     Muscle weakness in your legs and arms and the sides of your face.
•     Trouble speaking, chewing, and swallowing.
•     Not being able to move your eyes.
•     Back pain.

Symptoms usually start with numbness or tingling in the fingers and toes. Over several days, muscle weakness in the legs and arms develops. After about 4 weeks, most people begin to get better.

You may need to be treated in the hospital for the first few weeks. This is because GBS can be deadly if weakness spreads to muscles that control breathing, heart rate, and blood pressure.

Signs and tests

A history of increasing muscle weakness and paralysis may be a sign of Guillain-Barre syndrome, especially if there was a recent illness.

A medical exam may show muscle weakness and problems with involuntary (autonomic) body functions, such as blood pressure and heart rate. The examination will also show that reflexes, such as the "ankle or knee jerk," are decreased or missing.

There may be signs of decreased breathing caused by paralysis of the breathing muscles.

The following tests may be ordered:

•     Cerebrospinal fluid sample ("spinal tap")
•     ECG
•     Electromyography (EMG) tests the electrical activity in muscles
•     Nerve conduction velocity test
•     Pulmonary function tests

Nursing Diagnosis : Risk for Impaired Skin Integrity : dekubitus related to kelemahan otot, paralisis, gangguan sensasi, perubahan nutrisi, inkontinensia.

Expected outcomes:

• Patients retain the skin remains dry and intact.
• Maintaining depressed area remains dry and intact, free of pressure sores.

Intervention:

1. Assess motor function and sensation every 4 hours.
R /: muscle paralysis can occur quickly with a pattern that has been rising.

2. Assess the patient's degree of dependence.
R /: To identify patients in need of ADL ability.

3 . Monitor depressed area.
R /: Identifying early signs of pressure sores.

4. Keep the bed, lake remains clean, tight and dry.
R /: Laken, wet, dirty, matted facilitate the occurrence of pressure sores.

5. Monitor intake and output of nutrients.
R /: inadequate nutrition reduce the risk of pressure sores.

6. Perform over the position every 2 hours.
R /: Smooth distressed parts of blood flow.

7. Perform ROM.
R /: Preventing atrophy.

Physical Examination for Meningitis

Meningitis 

Meningitis is a disease caused by the inflammation of the protective membranes covering the brain and spinal cord known as the meninges. It is most often caused by infection (bacterial, viral, or fungal), but can also be produced by chemical irritation, subarachnoid haemorrhage, cancer and other conditions. The severity of illness and the treatment for meningitis differ depending on the cause. Thus, it is important to know the specific cause of meningitis.

Viral Meningitis
Enteroviruses, the most common cause of viral meningitis, are most often spread from person to person through fecal contamination (which can occur when changing a diaper or using the toilet and not properly washing hands afterwards).

Bacterial Meningitis
Bacterial meningitis is contagious. The bacteria are spread through the exchange of respiratory and throat secretions (i.e., kissing).

The most common symptoms of either form of meningitis include:

• Fever.
• Severe and persistent headache.
• Stiff and painful neck, especially when trying to touch the chin to the chest.
• Vomiting.
• Confusion and decreased level of consciousness.
• Seizures.

Other symptoms of meningitis include:

• Sluggishness, muscle aches and weakness, and strange feelings (such as tingling) or weakness throughout the body.
• Eye sensitivity and eye pain from bright lights.
• Skin rash.
• Dizzy spells.

Physical Examination for Meningitis

1. Activity / Rest

• Symptoms: feeling unwell (malaise), limitations posed condition.
• Signs: Ataxia, problems walking, paralysis, involuntary movement, general weakness, limitations in range of motion.

2. Circulation

• Symptoms: the history of cardiology, such as endocarditis, some heart diseases Conginetal (brain abscess).
• Symptoms: increased blood pressure, decreased pulse rate, pulse pressure weight (associated with increased ICP and the influence of the vasomotor center). Tachycardia, distritmia (acute phase) as distrimia sinus (in meningitis)

3. Elimination

• Signs: The existence of urinary incontinence and retention.

4. Food and Fluids

• Symptoms: Loss of appetite, difficulty swallowing (acute period)
• Signs: Anorexia, vomiting, poor skin turgor, dry mucous membranes.

5. Hygiene

• Signs: Dependence on all the needs of self-care (acute period)

6. Neurosensory

• Symptoms: headache (may be the first symptom, and usually heavy), paresthesia, feels stiff in all the nerves are affected, loss of sensation (cranial nerve damage). Hyperalgesia / increased sensitivity (minimitis). Seizures arise (minimitis bacteria or brain abscess) disturbances in vision, such as monocular (early phase of multiple infections). Photophobia (on minimtis). Deafness (on minimitis / encephalitis) or maybe hypersensitivity to noise, the hulusinasi smell / touch.
• Signs:
  • Mental status / level of consciousness; lethargy to severe confusion to coma, delusions and hallucinations / psychosis organic (encephalitis).
  • Memory loss, difficulty in making decisions (can be a symptom of growing hidrosephalus communicant, following bacterial meningitis)
  • Aphasia / difficulty in communicating.
  • Eyes (size / pupil reaction): unisokor or do not respond to light (increased ICP), nystagmus (eyes move continuously).
  • Upper eyelid ptosis falling). Characteristic facial (face), changes to the motor and sensory functions (cranial nerves V and VII exposed)
  • Generalized seizures or locally (on the brain abscess). Temporal lobe seizures. Experiencing muscle hypotonia / flaccid paralysis (acute phase of meningitis). Spastic (encephalitis).
  • Hemiparese hemiplegic (meningitis / encephalitis)
  • Brudzinski's sign positive, positive Kernig sign, an indication of meningeal irritation (acute phase)
  • Regiditas face (meningeal irritation)
  • Deep tendon reflexes disturbed, positive Brudzinski
  • Abdominal reflexes decreased.

7. Pain / Leisure

• Symptoms: headache (throbbing madly, frontal) may be exacerbated by tension neck / back stiffness, pain on ocular movement, throat pain.
• Signs: Looks kept awake, behavioral distraction / agitated crying / complaining.

8. Breathing

• Symptoms: A history of sinus or lung infections.
• Signs: Increased work of breathing (early stage), mental changes (lethargy to coma) and restless.

9. Security

• Symptoms:
  • A history of upper respiratory tract infection or other infections, including sinus middle ear mastoiditis, dental abscess, abdominal or skin, lumbar function, surgery, fracture of the skull / head injury.
  • Immunizations are just getting under way; exposed to meningitis, exposed to measles, herpes simplex, animal bites, foreign bodies carried away.
  • Impaired vision or hearing
• Signs:
  • Increased body temperature, diaphoresis, shivering
  • General weakness; flaccid muscle tone or plastic
  • Sensory disturbances.

Ineffective Breathing Pattern - Ineffective Airway Clearance - Impaired Gas Exchange

Nursing Care Plan for Guillain-Barre Syndrome

Guillain-Barre syndrome is a severe inflammatory disorder of the peripheral nerves. It is an autoimmune disease, i.e. the immune system that is supposed to attack foreign substances like bacteria; starts attacking cells of own body, in this case the nerves. The immune system produces special molecules, called the antibodies that are mainly responsible for damage to nerve cells in Guillain-Barre Syndrome. A previously healthy person suddenly develops tingling and numbness primarily in the feet which within a couple of weeks spreads through the body to cause loss of muscle control and feeling throughout the body.

Symptoms of Guillain-Barre syndrome :

• Lack of feeling
• Weakness or itchiness in arms or legs
• 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.

Diagnosis

Gullain Barre syndrome is considered to be the most harmful disorder because it attacks the patient suddenly and surprisingly. The patient within weeks reaches the highest level of weakness. In 3rd or 4th weeks of the illness the patients are at their weakest. The recovery period can be varying according to the condition of the patient. It can be few weeks or in some cases a few years.


Nursin g Interventions for Guillain-Barre Syndrome

Ineffective Breathing Pattern, Ineffective Airway Clearance, Impaired Gas Exchange related to respiratory muscle weakness or paralysis, decreased cough reflex, immobilization.

Ineffective Breathing Pattern Definition : The exchange of air inspiration and / or expiration inadequate.

Ineffective Airway Clearance Definition: Inability to clear secretions or obstructions from the respiratory tract to maintain airway patency.

Impaired Gas Exchange Definition : Circumstances where an individual has decreased course of gas (O2 and CO2) that an actual or risk of lung alveoli and the vascular system.

Expected outcomes:

• Optimal breathing.
• Normal breath sounds.
• Patent airway.
• Blood gas analysis values within normal limits.

Intervention:

1. Monitor the number of respiratory rhythm and depth every 1-4 hours.
R /: Paralysis of breathing can occur 48 hours.

2. Auscultation of breath sounds every every 4 hours.
R /: breath sounds indicate inadequate ventilation.

3. Maintain effective airway, suction and clean the mouth.
R /: a patent airway.

4. Help the patient to cough effectively.
R /: Increase effective airway.

5. Perform chest physiotherapy.
R /: Preventing pneumonia and atelectasis.

6. Collaboration in the provision of oxygenation.
R /: Fulfilling the need of oxygen.

7. Monitor blood gas analysis.
R /: Knowing the changes in oxygen in the blood.

8. Assess the level of consciousness and skin tone.
R /: Changes in blood gas analysis will affect the level of consciousness and skin tone.

Priority Nursing Diagnosis for Hypertension

Hypertension is among the world's famous disease. Hypertension is a condition of increased blood pressure on blood vessels. There are a lot of things that we need to know about the disease hypertension. This is mostly the complaints of every individual visiting clinics and hospitals all over the world and is among the complications too of other forms of diseases.

Normal blood pressure with respect to cardiovascular risk is less than 120/80 mm Hg, (however, unusually low readings should be evaluated for clinical significance as well).

Normal
Systolic, (top number) lower than 120, diastolic, (bottom number) lower than 80.

Prehypertension
Systolic 120-139, diastolic 80-99.

Stage 1 hypertension
Systolic 140-159, diastolic 90-99.

Stage 2 hypertension
Systolic equal to or more than 160, diastolic equal to or more than 100

Hypertension, also called high blood pressure, is categorized into two types - essential hypertension and secondary hypertension - on the basis of the underlying causes for its occurrence.

Taking your vital signs daily very often will let you determine if you have a high pressure in the blood or a low blood pressure. Having a blood pressure chart at home will let you see the average level that is recommended for your age and your weight. Also, the chart will let you compare the previous readings and thus make you alert once you notice that it is increasing or decreasing.

Examination Support

1. History and thorough physical examination.
2. Examination of the retina.
3. Laboratory tests to determine damage to organs such as the kidneys and heart.
4. ECG to determine left ventricular hypertrophy.
5. Urinalisa to determine protein in the urine, blood, glucose.
6. Examination; renogram, intravenous pielogram renal arteriogram, renal function tests and determination of urine separately.
7. Chest x-ray and CT scan.

Treatment of Hypertension

Treatment of hypertension all begins with doing lifestyle modifications. When you have seen in your blood pressure chart that your blood pressure reading is increasing, you should perform several lifestyle changes that way you can save yourself from having hypertension.

Natural treatment requires hypertension patients to implement certain lifestyle modifications. Exercise and relaxation therapies are an inevitable part of natural treatment. The excess calories have to be burnt off through regular exercises and it helps to induce oxygenation of blood. Relaxation therapies and meditation techniques such as yoga, breathing exercises, tai chi, biofeedback, and hypnotherapy help to avoid stress and other related psychiatric problems. Avoid alkaloid rich drinks such as coffee and fatty foods. Smoking has to be essentially quitted and dependency on alcohol has to be avoided.

Priority Nursing Diagnosis for Hypertension

1. Risk for Decreased Cardiac Output

2. Activity Intolerance

3. Acute Pain

4. Imbalanced Nutrition: More than Body Requirements

5. Knowledge Deficit

Pathophysiology of Neonatal Sepsis

Neonatal sepsis is a major health problem globally. Neonatal sepsis is a blood infection that occurs in an infant younger than 90 days old. Early-onset sepsis is seen in the first week of life. Late-onset sepsis occurs between days 8 and 89. Of newborns with early-onset sepsis, 85% present within 24 hours, 5% present at 24-48 hours, and a smaller percentage present within 48-72 hours. Onset is most rapid in premature neonates.

The baby gets the infection from the mother before or during delivery. The microorganisms most commonly associated with early-onset infection include the following :

• Group B Streptococcus (GBS)
• Escherichia coli
• Coagulase-negative Staphylococcus
• Haemophilus influenzae
• Listeria monocytogenes

Symptoms of Infants with neonatal sepsis may have the following :

• Body temperature changes
• Breathing problems
• Diarrhea
• Low blood sugar
• Reduced movements
• Reduced sucking
• Seizures
• Slow heart rate
• Swollen belly area
• Vomiting
• Yellow skin and whites of the eyes (jaundice)

Pathophysiology of Neonatal Sepsis
Neonates are particularly vulnerable to infection as a result of lower non-specific immunity (inflammation) and specific (humoral), such as low phagocytosis, chemotaxis response delay, minimal or absence of immunoglobulin A and immunoglobulin M (IgA and IgM), and low levels of complement.

Sepsis in the neonatal period can be obtained before birth through the placenta from the maternal blood stream or during labor for ingestion or aspiration of infected amniotic fluid.

Sepsis early (less than 3 days) obtained in the perinatal period, infection can occur from direct contact with the organism from the gastrointestinal or genitourinary tract maternal. The most frequent infecting organism is group B streptococcus (GBS) and Escherichia coli, which is present in the vagina. GBS emerged as a highly virulent microorganisms in the neonate, with a high mortality rate (50%) in infants exposed to Haemophilus influenzae and Staphylococcus negative coagulation are also often seen in early-onset sepsis in infants with very low birth weight.

Advanced Sepsis (1 to 3 weeks after birth) primarily nosocomial, and organisms that attack is usually staphylococci, Klebsiella, enterococcus and pseudomonas. Coagulation negative staphylococci, commonly found as the cause of septicemia in infants of low birth weight and very low birth weight. Bacterial invasion can occur through such Gated umbilical stump, skin, mucous membranes of eyes, nose, pharynx, and ear, and internal systems such as the respiratory system, nervous, urinary, and gastrointestinal.

Postnatal infection, derived from cross-contamination with other babies, personnel, or objects in the environment. Bacteria commonly found in water sources, a humidifier, sink pipes, suction machines, most equipment respiration, and arterial and venous catheters inserted used for infusion, blood sampling, monitoring of vital signs. (Donna L. Wong, 2009).

The process begins with the invasion of the pathophysiology of bacterial sepsis and systemic contamination.
The release of endotoxin by bacteria cause changes in the function of the myocardium, changes in uptake and utilization of oxygen inhibition of mitochondrial function, and progressive metabolic chaos. In sepsis sudden and severe, complemen cascade caused much death and damage cells. The result is a decrease in tissue perfusion, metabolic acidosis, and shock, disseminated intravascular coagulation resulting (DIC) and death. (Bobak, 2004).

Patients with immune disorders have an increased risk for serious nosocomial sepsis. Cardiopulmonary manifestations of gram-negative sepsis can be replicated by injection of endotoxin or Tumor Necrosis Factor (TNF). Barriers to employment TNF by anti-TNF monoclonal antibody greatly weakens manifestation of septic shock. When the bacterial cell wall components are released in the bloodstream, cytokine-activated, and can further lead to more physiological mess. Either alone or in combination, bacterial products and pro-inflammatory cytokines trigger a physiological response to stop the invaders (invader) microbes. TNF and other inflammatory mediators increase vascular permeability and vascular tone imbalance, and the imbalance between perfusion and increased metabolic needs of the network.

Shock is defined as a systolic pressure below the 5th percentile for age or defined with cold extremities. Capillary refilling the late (more than 2 seconds) is seen as a reliable indicator of a decrease in peripheral perfusion. Peripheral vascular pressure in septic shock (heat) but be very up on a further shock (cold). In septic shock tissue oxygen consumption exceeds oxygen supply. This imbalance is caused by peripheral vasodilatation in the beginning, during further vasoconstriction, myocardial depression, hypotension, ventilator insufficiency, anemia. (Nelson, 1999).

Septicaemia shows the emergence of a systemic infection of the blood caused by the rapid multiplication of microorganisms or toxic substances, which can cause huge psychological change. These substances can be pathogenic bacteria, fungi, viruses, and rickets. The most common cause of septicemia is a gram-negative organisms. If the protection of the body is not effective in controlling the invasion of microorganisms, septic shock may occur, which is characterized by hemodynamic changes, imbalance of cellular functions, and multiple system failures. (Marilynn E. Doenges, 1999).