Nursing Care Plan for Hyphema : Acute Pain

Hyphema or blood in the anterior chamber can occur due to blunt trauma (Sidarta, 1998). When the patient is sitting, hyphema will be seen to collect in the bottom of the anterior chamber and hyphema can occupy the entire space anterior chamber. Blood in the aqueous humor fluid can form a layer that is visible. This type of injury does not have to lead to perforation of the eyeball.

Acute pain related to exposure of pain receptors secondary to blunt trauma.

Goal: The pain is reduced

Expected outcomes:

The patient demonstrated knowledge of pain control.
The patient experience and demonstrate a period of sleep is not disturbed.
The patient expresses pain decreased with mild pain scale (1-3).

Interventions:

Assess the type, intensity and location of pain.
Use pain scale levels to determine the dose of analgesics.
Maintain bed rest in an upright position or the position of head of 60º.
Perform eye bandage on the affected part.
Give a cold compress to reduce pain and swelling.
Give sedation to minimize activity.
Collaboration: Giving therapy to reduce pain.
Give a back rub, a change of position for
increase comfort.
Help teach relaxation techniques.

Pain and Anxiety - NCP for Uterine Myoma (Fibroid)

Uterine Myoma (Fibroid)

Uterine fibroids are benign smooth muscle tumors of the uterus. The exact cause is unclear. However, fibroids run in families and appear to be partly determined by hormone levels. Symptoms depend on the location and size of the fibroid. Important symptoms include abnormal uterine bleeding, heavy or painful periods, abdominal discomfort or bloating, painful defecation, back ache, urinary frequency or retention, and in some cases, infertility.

Pain (acute / chronic) related to intrauterine tissue damage.

Goal: Pain is reduced.

Expected outcomes:

0-1 pain scale,
The client said the pain was reduced until it disappears,
Do not feel pain during mobilization,
Vital signs within normal limits.

Intervention:
1) Review the pain scale.
R /: Identify needs and appropriate interventions.

2) Encourage clients to use relaxation techniques and pain distraction.
R /: To divert the attention of the mother and the pain that is felt.

3) Motivation: for mobilization as indicated.
R /: Accelerating involution and reduce the pain gradually.

4) Encourage clients to rest.
R /: Reduce pain.

5) Collaboration: providing analgesic.
R /: Loosening the peripheral nervous system to decrease pain.

Anxiety related to lack of knowledge.

Goal: The client is not worried.

Expected outcomes:

No anxiety,
Knowledge of the client and family to disease increases.

Intervention:
1) Assess the level of knowledge / perceptions of the client and family to the disease.
R /: Ignorance can be the basis of the onset of anxiety.

2) Help clients to identify the causes of anxiety.
R /: Involving the client actively in nursing action is the support that may be useful for clients and increase client self-awareness.

3) Encourage the client to express feelings.
R /: Helps to increase the comfort of the client.

4) Give the physical comfort and security environment on the client.
R /: Giving comfort of the client.

5) Explain the things around curettage to be known by the client and family.
R / Counselling for clients is needed to increase knowledge and build support sisterm families to reduce the anxiety of clients and families.

Deficient Knowledge - Rheumatoid Arthritis Nursing Care Plan

Nursing Care Plan for Rheumatoid Arthritis

Deficient Knowledge (about the disease, prognosis, and treatment needs) related to the lack of exposure / recall, misinterpretation of information.

Evidenced by:

Questions / requests for information, statements misconceptions.
Not exactly follow the instruction / complications can be prevented.

Expected outcomes: The patient will be:

Demonstrate an understanding of the condition / prognosis, treatment.
Develop a plan for self-care, including lifestyle modifications consistent with mobility or activity restrictions.

Intervention and Rationale

1. Review the process of the disease, prognosis, and future expectations.
R /: Provide knowledge of where patients can make informed choices.

2. Discuss the habits of the patients in the management of the hospital, through; diet, medication, and a balanced diet, exercise and rest.
R /: The purpose of disease control is to suppress the inflammatory own / other tissue to maintain joint function and prevent deformity.

3. Assist in planning integrated realistic schedule of activities, rest, personal care, administering medications, physical therapy, and stress management.
R /: Provide structure and reduce anxiety during the handling of complex chronic disease processes.

4. Emphasize the importance of continuing management pharmacotherapeutics.
R /: Advantages of drug therapy depends on the accuracy of the dose.

5. Encourage digest medication with food, milk, or an antacid at bedtime.
R /: Limiting irrigation gastric, pain reduction will improve sleep and reduce stiffness in the morning.

6. Identification of the side effects of drugs that harm, eg tinnitus, gastrointestinal bleeding, and purpuric rash.

7. Emphasize the importance of reading product labels and reduce drug use-the-counter medicines without a doctor's approval.
R /: Many products contain salicylic hidden that can increase the risk of servings worth of drugs / dangerous side effects.

8. Review the importance of a balanced diet with foods rich in vitamins, protein and iron.
R /: Increase the general healthy feeling and tissue repair.

9. Encourage obese patients to lose weight and provide information about weight loss as needed.
R /: Weight reduction will reduce the pressure on the joints, especially the hips, knees, ankles, feet.

10. Provide information about the tools.
R /: Reduce compulsion to use the joints and allows individuals to participate more comfortably in activities that are necessary.

Nursing Diagnosis and Interventions for Pediatric GERD

Gastroesophageal reflux disease (GERD) is a chronic digestive disease. GERD (gastroesophageal reflux disease) is a condition in which the acidified liquid content of the stomach backs up into the esophagus.

The cause of GERD is complex and may involve multiple causes.

Like in adults with the condition, gastroesophageal reflux is the upward movement of stomach contents into the esophagus and sometimes into or out of the mouth.

According to the National Digestive Disease Information Clearinghouse, a child's immature digestive system is usually to blame. They add that most infants grow out of GERD by the time they are 1 year old.

Symptoms of Acid Reflux in Infants and Children

Frequent or persistent cough
Crying with feeding or after feeding
Heartburn, gas, or abdominal pain
Frequent or recurrent vomiting
Refusing to eat or difficulty eating (choking or gagging with feeding)

Nursing Diagnosis for Gastroesophageal Reflux Disease (GERD)

Deficient Fluid Volume related to input, nausea and vomiting / excessive spending.
Acute pain related to inflammation of the esophagus lining.
Imbalanced Nutrition: less than body requirements related to anorexia, nausea, vomiting.
Risk for Impaired Gas Exchange
Risk for Impaired Home Maintenance
Risk for Aspiration related to barriers to swallow, decreased reflux larynx and glottis to liquid reflux.
Ineffective airway clearance related to fluid reflux into the larynx and throat.
Impaired swallowing related to narrowing / stricture of the esophagus due to gastroesophageal reflux disease.
Anxiety related to the disease process.

Nursing Interventions for Gastroesophageal Reflux Disease (GERD)

1. Increase fluid intake and adequate nutrition.

Keep head of bed at a position 60 degrees for 30 minutes to 40 minutes.
Give food a little but often 2 to 3 hours.
Thicken the milk with cereal.
Give dinner.
Measure weight each morning.
Monitor intake and output.

2. Observe and report any signs of respiratory distress, assess for changes in respiratory status.

3. Before the surgery is done to prepare the client and family for surgery.

4. Monitor the operating side to wholeness.

5. Prevent abdominal distension.

Maintain patency of a nasogastric tube (NG) or gastrostomy, if installed.
Check hose NG position.
Auscultation bowel sounds.

6. Monitor for signs and symptoms of postoperative hemorrhage.

Decreased blood pressure and increased pulse apex.
Blood in NG drainage.
Drainage like coffee grounds would exist in the first 24 hours.

7. Help the parents to express feelings or frustration because they feel responsible or not enough help.

8. Give the stimulation activity.

Discharge planning and home care.
Encourage parents about drug administration.
Encourage parents about feeding.
Encourage parents to report any vomiting or presence of fresh blood.

Difficulty Swallowing (Dysphagia) related to Throat Disorders

Dysphagia is difficulty swallowing.

A person may have difficulty moving the food from the upper part of the throat into the esophagus because of abnormalities in the throat.

This problem most often occurs in people who have abnormalities in voluntary muscle (skeletal muscle) or nerves, that sufferers:

Dermatomyositis: Dermatomyositis (DM) is a connective-tissue disease related to polymyositis (PM) that is Characterized by inflammation of the muscles and the skin.
Myasthenia gravis is a chronic autoimmune neuromuscular disease characterized by varying degrees of weakness of the skeletal (voluntary) muscles of the body.
Muscular dystrophy is a group of diseases that cause progressive weakness and loss of muscle mass.
Poliomyelitis (polio) is a highly infectious viral disease, which mainly affects young children.
Pseudobulbar palsy is a medical condition characterised by the inability to control facial movements (such as chewing and speaking) and caused by a variety of neurological disorders.
Disorders of the brain and spinal cord such as Parkinson's disease and amyotrophic lateral sclerosis (Lou Gehrig's disease).
People who drank phenothiazines (antipsychotic drugs) could also have trouble swallowing because the drug affects the throat muscles.

When one of these abnormalities cause difficulty swallowing, patients often regurgitating food through the nose, or breathe it into the trachea (windpipe) and will coughed.

At cricopharyngeal incoordination, valve upper esophagus (cricopharyngeal muscle) remain closed or opened by means uncoordinated.

Abnormal functioning valve that allows food repeatedly into the trachea and lungs, which causes chronic lung disease.

When untreated, this condition can lead to the formation of diverticula, a sac formed when layers of the esophagus pushed out and backwards through cricopharyngeal muscle.

Dysphagia is generally a symptom of a disorder or disease in the oropharynx and esophagus.

Clinical manifestations are often found is the sensation of food stuck in the throat or chest when swallowing. Locations sense of heaviness in the chest area, it can show abnormalities in the thoracic esophagus. But if the blockage is in the neck, disorder located in the pharynx or cervical esophagus.

Symptoms can be of two types, namely; oropharyngeal dysphagia and esophageal dysphagia. Oropharyngeal dysphagia symptom is difficulty trying to swallow, choking or inhaling saliva into the lungs during swallowing, coughing during swallowing, vomiting fluids through the nose, breathe while swallowing food, weak voice, and weight decreased. While the symptoms of esophageal dysphagia is the sensation of pressure in the middle of the chest, sensation of food stuck in the throat or chest, chest pain, painful swallowing, heartburn include chronic, belching, and sore throat.

Dysphagia can also be accompanied by other complaints, such as nausea, vomiting, regurgitation, hematemesis, melena, anorexia, hypersalivation, cough, and rapid weight loss is reduced.

Difficulty swallowing can occur in all age groups, resulting from congenital abnormalities, structural damage, and / or certain medical conditions. Problems in swallowing is a common complaint obtained among the elderly. Therefore, the incidence of dysphagia is higher in the elderly and in patients with stroke. Approximately 51-73% of stroke patients suffering from dysphagia.

Nursing Care Plan for Dysphagia

8 Benefits of Distance Learning

Distance Learning is a solution-based learning model of teaching and learning activities are constrained by time, space, and human resources. Need to be agreed beforehand that the model of distance learning can be divided into several parts. The first part is a distance learning within the scope of e-learning, which is an online media that have the resources to support the process of teaching and learning activities based on information technology over the internet. This system may contain material of books, teaching modules, practice questions, and discussion forums.

According Soekartawi (2005), there are several benefits of distance learning, which are:

Learning can be done with the nature of open, flexible and not limited by time. Long learning time also depends on the ability of each learner. Learners can determine at any time to learn, according to the availability of time each. If the learner has achieved the learning objectives, he can stop it. Conversely, if the learner still needs time to repeat the subject of learning, he can immediately repeat it without depending on other learners or teachers. Remembering, learning materials stored in the computer, it means the material is easily updated in accordance with the development of science and technology. The learners can ask the things that are poorly understood directly to the teacher, so that the accuracy of the answers can be guaranteed.
Help the interaction between the students who are in remote areas and lecturer / instructor with the holding of regular meetings;
Reach learners in a wide scope for improving educational equity. Possible occurrence of education distribution to all corners of the country with a capacity of unlimited capacity, because it does not require a classroom. Teachers and students do not need to be face to face directly in the classroom, because that is used is a computer facility connected to the Internet or intranet. Thus, with this kind of learning will reduce the operational costs of education, such as the cost of construction and building maintenance, transportation, lodging, paper, stationery and so on.
Reducing the school dropout rate, or dropped out of college.
Improving learning achievement, especially for students who experience barriers geographically as far from the site of learning.
Increase confidence for learners.
Increase the depth of knowledge that no longer limited by distance, time, or age. Learners can choose a topic or instructional materials in accordance with the wishes and needs of each. This is very good because it can support the achievement of learning goals. Such is believed to be the educator, that learners will be very effective when in accordance with the wishes and needs of learners.
Overcome the shortage of education.

Levels of Health Education Services

Health education can be based on five levels of prevention, namely:

1) Health Promotion
At this level of health education is needed, for example in personal hygiene, environmental sanitation, regular health checks, nutrition and healthy living habits.

2) Specific Protection
At this level of health education is needed to increase public awareness. for example; about the importance of immunization as a means of protection against disease in both children and adults. The immunization program is a special protection service.

3) Early Diagnosis and Prompt Treatment
At this level of health education is needed because of the low level of knowledge and awareness about health and disease that occurs in people. This situation makes it difficult to detect a disease that occurs in the community, people do not want to check and treat the disease. Prevention level activities include finding case, cure and prevention of the disease process continues, preventing the spread of infectious diseases, and prevention of complications.

4) Disability Limititaton
At this level of education necessary because public health is often obtained not want to continue treatment to completion or unwilling to perform the examination and treatment of the disease completely or do not want to do the examination and treatment of the disease completely. This happens due to lack of understanding and awareness of health and illness. At this level of activities include treatments to stop the disease, prevention of further complications, overcome disability and prevent death.

5) Rehabilitation
At the level of health education is needed because after recovering from a particular disease, one might be defective. To remedy the flaws that needed training. To perform an exercise properly determined in accordance program, there needs to be an understanding and awareness of the people concerned. In addition, there is a sense of shame and fear are not acceptable for return to the community after recovering from an illness or perhaps people do not want to receive other community members who are recovering from an illness.

Clinical signs of Urinary Retention

Urinary retention is a buildup of urine in the bladder due to the inability of the bladder to empty the bladder.

The main symptoms of acute urinary retention is no urine output for several hours and there is a distended bladder. Clients who are under the influence of anesthetics or analgesics may only feel pressure, but clients are aware of the great pain due to bladder distension beyond its normal capacity. In severe urinary retention, bladder can hold 2000 to 3000 ml of urine. Retention caused by urethral obstruction, trauma surgery, changes sensory and motor nerve stimulation of the bladder, side effects of medication and anxiety.

Clinical Signs of Urinary Retention:

Inconvenience for the pubic area.
Distended bladder.
Inability to urinate.
Frequent urination when the bladder contains little urine (25-50ml).
The imbalance in the amount of urine output and intake.
Increasing concerns and the desire to urinate.
The presence of urine in the bladder 3000-4000ml.

Urinary retention can cause an infection that can result from excessive bladder distension, impaired blood supply to the bladder wall and the proliferation of bacteria. Impaired renal function may also occur, especially when there is obstruction of the urinary tract.