Priority Nursing Diagnosis for Hepatitis

Nursing Care Plan for Hepatitis

Hepatitis is swelling and inflammation of the liver. It is not a condition, but is often used to refer to a viral infection of the liver. Characterized by the presence of inflammatory cells in the tissue of the organ.

Hepatitis may start and get better quickly (acute hepatitis), or cause long-term disease (chronic hepatitis). In some instances, it may lead to liver damage, liver failure, or even liver cancer.

How severe hepatitis is depends on many factors, including the cause of the liver damage and any illnesses you have. Hepatitis A, for example, is usually short-term and does not lead to chronic liver problems.

The symptoms of hepatitis include:

•     Abdominal pain or distention
•     Breast development in males
•     Dark urine and pale or clay-colored stools
•     Fatigue
•     Fever, usually low-grade
•     General itching
•     Jaundice (yellowing of the skin or eyes)
•     Loss of appetite
•     Nausea and vomiting
•     Weight loss

Many people with hepatitis B or C do not have symptoms when they are first infected. They can still develop liver failure later. If you have any risk factors for either type of hepatitis, you should be tested regularly.


Priority Nursing Diagnosis for Hepatitis

1. Imbalanced Nutrition, Less Than Body Requirements
relate to:
discomfort in the right upper quadrant
impaired absorption and digestion of food metabolism
input failure to meet the metabolic needs due to anorexia, nausea and vomiting.

2. Acute pain
related to:
swelling of the liver, the inflamed liver and portal vein dam.

3. Hyperthermia
related to:
invasion agent in blood circulation secondary to liver inflammation

4. Fatigue
related to:
chronic inflammatory process secondary to hepatitis

5. Risk for skin integrity and tissue damage
related to:
pruritus secondary to the accumulation of the pigment bilirubin in the bile salts

6. Risk for the transmission of infection
related to:
infectious nature of the virus agent

Impaired Physical Mobility NCP Rheumatoid Arthritis

Nursing Care Plan for Rheumatoid Arthritis

Rheumatoid arthritis is an inflammatory arthritis and an autoimmune disease. This is where the body’s immune system attacks healthy tissues in the body, particularly the synovium the membrane joining the joints. The joints fill with fluid, due to this process and cause pain and systematic inflammation.

Rheumatoid arthritis is not only a condition linked with joints. It causes innumerable problems in other organs also such as eyes, lungs, skin and heart. Almost all of these problems are uncommon nevertheless they are crucial too, when they make their presence. Basically rheumatoid arthritis comes under the group of autoimmune diseases and hence it can make its presence in any part of the body once it catches hold of joints.

Rheumatoid arthritis is a chronic disease that may have periods of intense activity followed by a period of inactivity. Some patients may go through continuous activity that becomes worse with time. Organ damage and disability can occur with continuous rheumatoid arthritis.

The symptoms of rheumatoid arthritis come and go, depending on the degree of tissue inflammation. When body tissues are inflamed, the disease is active. When tissue inflammation subsides, the disease is inactive (in remission).

When the disease is active, symptoms can include fatigue, loss of energy, lack of appetite, low-grade fever, muscle and joint aches, and stiffness. Muscle and joint stiffness are usually most notable in the morning and after periods of inactivity.

Nursing Diagnosis: Impaired Physical Mobility

Related to:

• Skeletal deformity
• Painful
• Discomfort
• Activity intolerance
• Decreased muscle strength.

Can be evidenced by:

• Reluctance to try moving / inability to move in with their own physical environment.
• Limiting the range of motion, coordination imbalances, decreased muscle strength / control and mass (advanced stage).

The expected outcomes / evaluation criteria, patients will:

• Maintaining a function of position in the absence / restrictions contractures.
• Maintain or improve strength and function of and / or compensation of the body.
• Demonstrate techniques / behaviors enabling activities

Nursing Intervention Impaired Physical Mobility - Nursing Care Plan for Rheumatoid Arthritis

1. Evaluation / continue monitoring the level of inflammation / pain in the joints
Rationale: The level of activity / exercise depends on the development / resolution of the inflammatory process.

2. Keep the rest - bed rest / activity schedule sit down if necessary to provide a continuous period and nighttime sleep uninterrupted.
Rationale: Systemic Rest is recommended during acute exacerbations, and all phases of the disease is important to prevent exhaustion maintain strength

3. Assist with range of motion active / passive, and resistive exercise also demikiqan isometris if possible
Rationale: Maintain / improve joint function, muscle strength and general stamina.

4. Change positions frequently with sufficient amount of personnel. Demonstrate / removal of technical aids and mobility aid use, eg, trapeze
Rationale: Eliminates stress on the network and improves circulation. Facilitate patient self-care and independence. Proper removal techniques to prevent tearing skin abrasion.

5. Position with pillows, sandbags, rolls trokanter, splint, brace
Rationale: Increase stability (reducing the risk of injury) and maintain the necessary joint position and body alignment, reducing contractor.

6. Use a small pillow / thin below the neck.
Rationale: Preventing neck flexion.

7. Encourage the patient to maintain an upright posture and sitting height, standing, and walking.
Rationale: To maximize joint function and maintain mobility

8. Provide a safe environment, such as raising the chair, using the toilet railings, wheelchair use.
Rationale: Avoiding injury due to accidents / falls

9. Collaboration: consul with physiotherapy.
Rationale: Useful in formulating training programs / activities based on individual needs and identifying tools.

10. Collaboration: Provide foam mat / converter pressure.
Rationale: Reducing the pressure on the fragile tissue to reduce the risk of immobility.

Nursing Diagnosis for Hydatidiform Mole

Definition of Hydatidiform Mole

A hydatidiform mole is a relatively rare condition in which tissue around a fertilized egg that normally would have developed into the placenta instead develops as an abnormal cluster of cells. A molar pregnancy is a gestational trophoblastic disease that grows into a mass in the uterus that has swollen chorionic villi. These villi grow in clusters that resemble grapes.

Causes of Hydatidiform Mole

The specific cause behind the occurrence of Hydatidiform mole still remains to be found out. Nevertheless, the doctors point at some reasons like abnormalities in the egg, nutritional deficiencies during pregnancy. If a woman follows a diet which is low in protein, carotene and folic acid she can also contract this malady.

Symptoms of Hydatidiform Mole

• Abnormal growth of the womb (uterus) ; Excessive growth in about half of cases, Smaller-than-expected growth in about a third of cases
• Nausea and vomiting that may be severe enough to require a hospital stay
• Vaginal bleeding in pregnancy during the first 3 months of pregnancy
• Symptoms of hyperthyroidism ; Heat intolerance, Loose stools, Rapid heart rate, Restlessness, nervousness, Skin warmer and more moist than usual, Trembling hands, Unexplained weight loss
• Symptoms similar to preeclampsia that occur in the 1st trimester or early 2nd trimester -- this is almost always a sign of a hydatidiform mole, because preeclampsia is extremely rare this early in a normal pregnancy ; High blood pressure, Swelling in feet, ankles, legs

Diagnosis of Hydatidiform Mole

The physician may not suspect a molar pregnancy until after the third month or later, when the absence of a fetal heartbeat together with bleeding and severe nausea and vomiting indicates something is amiss.
First, the physician will examine the woman's abdomen, feeling for any strange lumps or abnormalities in the uterus. A tubal pregnancy, which can be life threatening if not treated, will be ruled out. Then the physician will check the levels of human chorionic gonadotropin (hCG), a hormone that is normally produced by a placenta or a mole. Abnormally high levels of hCG together with the symptoms of vaginal bleeding, lack of fetal heartbeat, and an unusually large uterus all indicate a molar pregnancy. An ultrasound of the uterus to make sure there is no living fetus will confirm the diagnosis.

Treatment of Hydatidiform Mole

Hydatidiform moles should be treated by evacuating the uterus by uterine suction or by surgical curettage as soon as possible after diagnosis, in order to avoid the risks of choriocarcinoma.[19] Patients are followed up until their serum human chorionic gonadotrophin (hCG) level has fallen to an undetectable level. Invasive or metastatic moles (cancer) may require chemotherapy and often respond well to methotrexate. The response to treatment is nearly 100%. Patients are advised not to conceive for one year after a molar pregnancy. The chances of having another molar pregnancy are approximately 1%.

Management is more complicated when the mole occurs together with one or more normal fetuses.

Carboprost (PGF2α) medication may be used to contract the uterus.



Nursing Diagnosis for Hydatidiform Mole

1. Acute Pain

2. Activity Intolerance

3. Disturbed Sleep Pattern

4. Hyperthermia

5. Anxiety

Nursing Management for Hospitalization

Definition of Hospitalization

Hospitalization is a form of individual stressors that lasted for the individual to be hospitalized.

Hospitalization is a threatening experience for individuals as stressors encountered can lead to feelings of insecurity, such as:

1. Foreign environment.
2. Parting with the people who matter.
3. Lack of information.
4. Loss of freedom and independence.
5. Experiences related to health care, more often associated with hospitals, the smaller the form of anxiety or even vice versa.

Focus on Nursing Management for Hospitalization

1. Minimize the stressor.
2. Maximizing the benefits of hospitalization provide psychological support to family members.
3. Preparing the child before entering the hospital.

1. Efforts to minimize the stressor or stressors, can be done by:

• Prevent or reduce the impact of separation.
• Prevent feelings of loss of control.
• Reduce / minimize the fear of injury and body pain.

2. Efforts to prevent / minimize the impact of separation

• Involving parents take an active role in childcare.
• Modification of the treatment room.
• Maintain contact with school activities.
• Correspondence, meeting school friends.

3. Prevent feelings of loss of control

• Avoid physical restrictions if the child can be cooperative.
• If the child in isolation doing environmental modifications.
• Create a schedule for therapeutic procedures, practice, play.
• Giving children the opportunity to make decisions and involve parents in planning activities.

4. Minimizing the fear of bodily injury and pain

• Psychologically prepare children and parents for action procedures that cause pain.
• Make the game before the child's physical preparation.
• Bringing parents whenever possible.
• Show empathy. In elective action whenever possible actions performed by telling stories, pictures. Need to do a psychological assessment of the child's ability to receive this information openly.

5. Maximizing the benefits of child hospitalization

• Help the development of children by giving parents the opportunity to learn.
• Provide opportunities for parents to learn about the child's illness.
• Improving the ability of self-control.
• Provide opportunities for socialization.
• Giving support to family members.

6. Preparing children for treatment in hospital

• Prepare wards according to the stage of the child's age.
• Orient the hospital situation.

On the first day you should take:

1. Recommend nurses and doctors.
2. Recommend on another patient.
3. Give the identity of the child.
4. Explain the rules of the hospital.

Early History of the Roentgen Rays

Early History of the Roentgen Rays 

Wilhelm Conrad Röntgen was a German physicist, who, on 8 November 1895, produced and detected electromagnetic radiation in a wavelength range today known as X-rays or Röntgen rays, an achievement that earned him the first Nobel Prize in Physics in 1901.

Wilhelm Conrad Röntgen (27 March 1845 – 10 February 1923)

In 1865 : Roentgen tried to attend the University of Utrecht without having the necessary credentials required for a regular student. Upon hearing that he could enter the Federal Polytechnic Institute in Zurich (today known as the ETH Zurich), he passed its examinations, and began studies there as a student of mechanical engineering.

In 1869 : Roentgen graduated with a Ph.D. from the University of Zurich;

In 1873 : Roentgen became a favorite student of Professor August Kundt, whom he followed to the University of Strassburg.

In 1874 : Röntgen became a lecturer at the University of Strassburg.

In 1875 : He became a professor at the Academy of Agriculture at Hohenheim, Württemberg.

In 1876 : He returned to Strassburg as a professor of physics.

In 1879 : he was appointed to the chair of physics at the University of Giessen

In 1888 : He obtained the physics chair at the University of Würzburg.

In 1900 : At the University of Munich, by special request of the Bavarian government.

During 1895 : Röntgen was investigating the external effects from the various types of vacuum tube equipment — apparatuses from Heinrich Hertz, Johann Hittorf, William Crookes, Nikola Tesla and Philipp von Lenard — when an electrical discharge is passed through them.

Röntgen's original paper, "On A New Kind Of Rays" (Über eine neue Art von Strahlen), was published on 28 December 1895. On 5 January 1896, an Austrian newspaper reported Röntgen's discovery of a new type of radiation. Röntgen was awarded an honorary Doctor of Medicine degree from the University of Würzburg after his discovery. He published a total of three papers on X-rays between 1895 and 1897. Today, Röntgen is considered the father of diagnostic radiology, the medical specialty which uses imaging to diagnose disease.

Honours and awards

In 1901 Röntgen was awarded the very first Nobel Prize in Physics. The award was officially "in recognition of the extraordinary services he has rendered by the discovery of the remarkable rays subsequently named after him". Röntgen donated the monetary reward from his Nobel Prize to his university. Like Pierre Curie, Röntgen refused to take out patents related to his discovery, as he wanted mankind as a whole to benefit from practical applications of the same (personal statement). He did not even want the rays to be named after him.

•     Rumford Medal (1896)
•     Matteucci Medal (1896)
•     Elliott Cresson Medal (1897)
•     Nobel Prize for Physics (1901)

In November 2004 IUPAC named element number 111 Roentgenium (Rg) in his honour. IUPAP also adopted the name in November 2011.

Source : http://en.wikipedia.org

Nursing Management for Peritonitis

Definition of Peritonitis 

Peritonitis is an inflammation of the membrane which lines the inside of the abdomen and all of the internal organs. This membrane is called the peritoneum.

Causes of peritonitis

Most often, peritonitis is caused by the introduction of an infection from a perforation of the bowel such as a ruptured appendix or diverticulum. Other sources include perforations of the stomach, intestine, gallbladder, or appendix. Pelvic inflammatory disease in women is also a common cause of peritonitis. Peritonitis can also develop after surgery if bacteria enters into the abdomen during an operation.

Signs and Symptoms of Peritonitis
The signs and symptoms of peritonitis include:

• Swelling and tenderness in the abdomen with pain ranging from dull aches to severe, sharp pain
• Fever and chills
• Loss of appetite
• Thirst
• Nausea and vomiting
• Reduced urine output
• Not being able to pass gas or stool

Risk Factors of Peritonitis

The following factors may increase the risk for primary peritonitis:

• Liver disease (cirrhosis)
• Fluid in the abdomen
• Weakened immune system
• Pelvic inflammatory disease
• Risk factors for secondary peritonitis include:
• Appendicitis (inflammation of the appendix)
• Stomach ulcers
• Torn or twisted intestine
• Pancreatitis
• Inflammatory bowel disease, such as Crohn's disease or ulcerative colitis
• Injury caused by an operation
• Peritoneal dialysis
• Trauma

Prevention of Peritonitis
There is no way to prevent peritonitis, since the diseases it accompanies are usually not under the voluntary control of an individual. However, prompt treatment can prevent complications.

Treatment of Peritonitis
Treatment depends on the source of the peritonitis, but an emergency laparotomy is usually performed. Any perforated or damaged organ is usually repaired at this time. If a clear diagnosis of pelvic inflammatory disease or pancreatitis can be made, however, surgery is not usually performed. Peritonitis from any cause is treated with antibiotics given through a needle in the vein, along with fluids to prevent dehydration.


Nursing Management for Peritonitis

Replacement fluids, colloids and electrolytes is the main focus. Given analgesics to manage pain, antiemetics can be given as a treatment for nausea and vomiting. Oxygen therapy by nasal cannula or mask will improve oxygenation is adequate, but sometimes the incubation shape of the airway and ventilation is required. But medical nonoperatif using antibiotic therapy, hemodynamic therapy is used for lung and kidney, metabolic and nutritional therapies and therapeutic modulation of the inflammatory response.

Management of penetrating trauma patients with hemodynamically stable at the lower chest or abdomen vary, but all surgeons agree patients with signs of peritonitis or hypovolemia should undergo surgical exploration, but it is uncertain for patients with no signs of sepsis-with stable hemodynamics. All stab wounds to the chest and abdomen should be explored first. When a penetrating wound peritoneum, the action required laparotomy. Prolapsed viscera, signs of peritonitis, shock, loss of bowel sounds, there is blood in the stomach, bladder and rectum, the presence of intraperitoneal free air and a positive peritoneal lavase also an indication perform laparotomy. If not, patients should be observed for 24-48 hours. While the gunshot wound patients are encouraged to laparotomy.

Perioperative nursing is a term used to describe a variety of nursing functions related to the surgical patient experience that includes three phases:

1. Preoperative phase of perioperative nursing role begins when a decision for surgical intervention is made and ends when the patient is being led shirt surgery. The scope of nursing activities during this time may include establishing a basic assessment of the patient in the clinic or at home, underwent preoperative interview and prepare patients for surgery and anesthesia given. However, the nursing activities may be limited to assessing the patient's preoperative place operating room.

2. Intraoperative phase of the perioperative nursing begins when the patient entered or transferred or assigned to the recovery chamber. In this phase the scope of nursing activities may include: installing infusion (IV), providing intravenous medication, conduct a thorough physiological monitoring during surgical procedures and maintaining patient safety. In some instances, nursing activities limited to grasp the hands of patients during induction of general anesthesia, acting in its role as a nurse scub, or assist in positioning the patient on the operating table by using the basic principles of body alignment.

3. Postoperative phase, beginning with the inclusion of patient recovery chamber and ends with follow-up evaluation in the framework of the clinic or at home. The scope of nursing includes a wide range of activities during this period. In the immediate postoperative phase, the focus on assessing the effects of anesthetic agents and monitoring of vital functions and prevent complications. Nursing activity then focuses on healing patients and do counseling, follow-up care and referrals are essential for a successful recovery and rehabilitation followed by repatriation. Each phase are reviewed in detail in this unit. When relevant and possible, the nursing process of assessment, nursing diagnosis, intervention and evaluation are described.

Nursing Care Plan for Cerebral Vascular Accident / Stroke

Cerebral Vascular Accident (CVA) or Stroke is caused by the interruption of the blood supply to the brain, usually because a blood vessel bursts or is blocked by a clot. This cuts off the supply of oxygen and nutrients, causing damage to the brain tissue.

Many things can go wrong and cause the disruption of the blood supply to the brain.  However, the most common culprits are a ruptured artery, or a blood clot that blocks the flow of blood.  It is commonly called CVA which is a major cause of death. It also causes serious problems in the way that the body functions.

There are two types of CVA. They are:

• Hemorrhagic CVA – This occurs when the there is a ruptured artery that leaks blood to the brain.
• Ischemic CVA – This happens when there is a blood clot in the arteries that blocks the transfer of oxygenated blood to the brain tissue.

You may ask what the risk factors are. This depends on the age of the affected individual and the part of the brain whose blood supply has been interfered with. In the most severe cases of stroke, death has been known to occur within a short period of time. However, in most cases, the deterioration of one’s health is gradual with many tell-tale signs.

There is more to Cerebral Vascular Accident than meets the eye. For example, did you know that there are three main causes of CVA that are known to doctors? They are:

• Cerebral hemorrhage
• Cerebral embolism
• Cerebral thrombosis

Risk factors for narrowed blood vessels in the brain are the same as those that cause narrowing blood vessels in the heart and heart attack (myocardial infarction). These risk factors include:

•     high blood pressure (hypertension),
•     high cholesterol,
•     diabetes, and
•     smoking.

The most common symptom of a stroke is sudden weakness or numbness of the face, arm or leg, most often on one side of the body. Other symptoms include: confusion, difficulty speaking or understanding speech; difficulty seeing with one or both eyes; difficulty walking, dizziness, loss of balance or coordination; severe headache with no known cause; fainting or unconsciousness.

Management of Stroke
To treat acute conditions need to be considered critical factors as follows:
1. Trying to stabilize vital signs with:

• Maintaining a patent airway suctioning of mucus that is done frequently, oxygenation, if you need to do tracheostomy, help breathing.
• Controlling blood pressure is based on the patient's condition, including efforts to improve hypotension and hypertension.

3. Trying to find and correct cardiac arrhythmias.
4. Treating bladder, as far as possible do not wear a catheter.
5. Placing the patient in the proper position, it should be done as soon as possible the patient should be shifted position every 2 hours and performed passive motion exercises.

Nursing Care Plan for Cerebral Vascular Accident / Stroke

Nursing Priority for Cerebral Vascular  Accident (CVA) or Stroke

1. Increasing cerebral perfusion and oxygenation adequate.
2. Preventing and minimizing complications and permanent disability.
3. Helping patients to fulfill their daily needs.
4. Provide support to the process of coping mechanisms and integrating the changes in self-concept.
5. Provide information about disease process, prognosis, treatment and rehabilitation needs.

The Goal for Cerebral Vascular Accident nursing (CVA) or Stroke
1. Increased cerebral function and decrease neurological deficits.
2. Prevent / minimize complications.
3. Daily needs are met either by himself or others.
4. Positive coping mechanisms and to plan for the state after illness
5. Understand the process of disease and prognosis.