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Showing posts with label Physical Examination. Show all posts
Showing posts with label Physical Examination. Show all posts

Assessment, Physical Examination and Nursing Care Plan for Hemophilia

Hemophilia

Hemophilia is a bleeding disorder caused by deficiency and hereditary factors essential for blood coagulation (Wong, 2003).

Hemophilia is a congenital blood clotting disease caused by deficiency of blood clotting factors, ie factor VIII and factor IX. Factor VIII and factor IX is a plasma protein that is a component needed for blood clotting, these factors are required for fibrin clot formation in the area of ​​trauma. (Hidayat, 2006).

Hemophilia is a congenital coagulation disorders the most frequent and serious. The disorder is associated with a deficiency of factor VIII, IX or XI is determined genetically (Nelson, 1999).

Hemophilia is a hereditary or acquired coagulation disorders are most common, manifest as intermittent episodes of bleeding (Price & Wilson, 2005)

Hemophilia there are 3 kinds:
  1. Hemophilia A: Disorders of the factor VIII (Anti - hemophilic factor)
  2. Hemophilia B: Disorders of the factor IX (Christmas factor)
  3. Van Willebrand disease
Clinical symptoms:
1. Infant (for diagnosis)
  • Prolonged bleeding after circumcision
  • Subcutaneous ecchymoses over the bumps of bone (at the age of 3-4 months)
  • Large hematoma after infection
  • Bleeding from the oral mucosa
  • Soft tissue bleeding
2. Bleeding episodes (during the life span)
  1. Early symptoms, including pain
  2. After the pain, the swelling, warmth, and decreased mobility
3. Long-term sequelae
  • Prolonged bleeding in the muscle can cause nerve compression and muscle fibrosis.

Pathophysiology of Hemophilia
Bleeding due to clotting disorder usually occurs in such a network that is located in muscles, joints, and other disorders because they can occur in the first, second and third, here the only disturbance will be discussed at the first stage, wherein the first stage is exactly what is the mechanism of interference freezing found in hemophilia A and B. Easy bleeding occurs in hemophilia, due to clotting disorder, at the start when a person is ± 3 months old or moments will begin to crawl the initial bleeding will occur due to minor injuries, followed by subsequent complaints.

Hemophilia can also cause cerebral hemorrhage, and fatal. Rationale is that when bleeding, there is a vascular injury (ie a channel where blood flows through the body) → blood out of the vessel. Blood vessels to shrink / shrank → Platelet (platelets) will close the wound on the vessel → Lack of a specific amount of blood clotting factors, resulting in wound closure webbing is not fully formed blood → did not stop flowing out → bleeding vessels (normal: blood clotting factors work to make webbing (fibrin strands) which will close the wound so that the blood stops flowing vessels).

Assessment and Physical Examination for Hemophilia

1. Assessment
  • Family history of bleeding disorder
  • Ask an unusual bleeding (bleeding that is difficult to stop a long time)
  • Spontaneous bleeding (hemorrhage without trauma)
2. Physical examination
a. Activity
Symptoms: Muscle weakness
Symptoms: fatigue, malaise, inability to perform activities.
b. Circulation
Symptoms: skin, mucous membranes pale, cerebral nerve deficit / signs of cerebral hemorrhage
Symptoms: Palpitations
c. Elimination
Symptoms: Hematuria
d. Ego integrity
Symptoms: Depression, withdrawal, anxiety, anger.
Symptoms: Feelings of hopelessness and helplessness.
e. Nutrition
Symptoms: Anorexia, weight loss.
f. Painful
Mark:. Cautious behavior, anxiety, irritability.
Symptoms: Pain in the bones, joints, central tenderness, muscle cramps
g. Security
Signs: hematoma
Symptoms: mild trauma history.
- There was spontaneous bleeding in joints and muscles over and over accompanied by pain and swelling occurs.
- Recurrent joint bleeding caused by hemophilia Atropati give rise to joint space, bone crest and limited joint movement.
- Usually found in the Gastrointestinal bleeding also, excessive hematuria, and brain hemorrhage.
- There was hematoma at the extremities.
- Limitations and joint pain continued to hemorrhage

3. Psychology
- Assess the patient's self-concept à body image, roles, etc.
- Assess the patient and family understanding about the condition and action
- Assess the impact on lifestyle lung condition

Nursing Care Plan for Hemophilia

Nursing Management for Hemophilia

People with hemophilia should be aware of circumstances that can cause bleeding. They should really pay attention to teeth care to not have to undergo a tooth extraction. Rest of the body where there are injuries. When the leg is bleeding, use a tool such as a cane. Compressed injured body part and the surrounding area with ice or other soft material and frozen / cold. Press and tie, so the bleeding body part can not be moving (immobilization). Use an elastic bandage but keep in mind, do not press too hard and tie. Put these body parts in a higher position than the position of the chest and place it on a soft object like a pillow.

Nursing Assessment - Physical Examination for Appendicitis

Nursing Assessment - Physical Examination for Appendicitis


Physical Examination for Appendicitis

Interview
  • Get a thorough medical history, especially regarding:
  • The main complaint: the client will get a pain around the epigastrium radiating to the lower right abdomen. Complaints arising under the right abdominal pain may be a few hours later after the pain in the center or in the epigastrium felt in some time ago. Pain is felt continuously, may be lost or attributable to, pain in a long time. Complaints which usually accompanies a client complaining of nausea and vomiting, the body heat.
  • Past medical history of health problems usually associated with a client right now.
  • Diet, eating foods low in fiber.
  • Elimination habits.
Physical examination
  • Physical examination of the general state of ill clients seem mild / moderate / severe.
  • Circulation: tachycardia.
  • Respiratory: Tachypnea, shallow breathing.
  • Activity / rest: Malaise.
  • Elimination: Constipation in early onset, sometimes diarrhea.
  • Abdominal distension, tenderness / pain off, stiffness, decreased or absent bowel sounds.
  • Pain / comfort, epigastric and abdominal pain around the umbilicus, the increased severe and localized to the point Mc. Burney, an increase of walking, sneezing, coughing or breathing deeply. Pain in the lower right quadrant because the position of the right leg extension / seated upright position.
  • Fever over 38 ° c.
  • Psychological data, appear restless.
  • There are changes in pulse rate and breathing.
  • On rectal toucher palpable lump and the patient will feel pain in the pro-lithotomy.
  • Weight as an indicator to determine the drug.
Examination Support
  • Signs of peritonitis, lower right quadrant. Line drawings of air fluid level in the cecum or ileum.
  • Erythrocyte sedimentation rate (ESR) is increased in the state of appendicitis infiltrates.
  • Routine urinalysis is important to see what there is infection in the kidney.
  • The increase of leukocytes, Neutrophilia, without eosinophils.
  • Appendix on barium enema is not filled.
  • Ultrasound: fekalit non-calcified, non-perforated appendix, appendix abscess.

Physical Examination for Congestive Heart Failure (CHF)

Congestive heart failureor Heart failure is inability of the heart to pump an adequate amount of blood to the systemic circulation to meet the body's metabolic demands.

In most cases, heart failure is a process that occurs over time, when an underlying condition damages the heart or makes it work too hard, weakening the organ. Heart failure is characterized by shortness of breath (dyspnea) and abnormal fluid retention, which usually results in swelling (edema) in the feet and legs.

Common symptoms of congestive heart failure include:
  • Shortness of breath with exertion or when lying down
  • Cough
  • Swelling in legs, feet and ankles (pooling of blood)
  • Swelling of the abdomen
  • Weight gain
  • Loss of appetite, indigestion
  • Irregular or rapid pulse
  • Low blood pressure
  • Weakness and fatigue
  • Heart palpitations (feeling the heart beat)
  • Difficulty sleeping
  • Other symptoms may include:
  • Decreased in alertness or ability to concentrate
  • Decreased urine production
  • Nighttime urination (the need to get out of bed to go to the bathroom)
  • Nausea and vomiting
Physical Examination for Congestive Heart Failure (CHF)

GENERAL SITUATION
Obtained good or composmentis awareness and change according to the level of perfusion disorders involving the central nervous system

Breathing
  • Visible shortness
  • Frequency of breathing exceeds the normal
Bleeding
  • Inspection: the scar, complaints of physical weakness, edema of the extremities.
  • Palpation: weak peripheral pulses, thrill
  • Percussion: Shifting boundaries of heart
  • Auscultation: decreased blood pressure, extra heart sounds
BRAIN
  • Awareness is usually composmentis
  • Peripheral cyanosis
  • The face grimacing, crying, moaning, stretched and stretched.
Bladder
  • Oliguria
  • Extremity edema
Bowel
  • Nausea
  • Vomiting
  • Decrease in appetite
  • Weight loss
BONE
  • Weaknesses
  • Fatigue
  • Unable to sleep
  • Sedentary lifestyle
  • Schedule regular exercise could not
PSYCHOSOCIAL
  • The integrity of the ego: denial, fear of dying, anger, worry.
  • Social interaction: stress due to family, work, difficulties of economic cost, difficulty coping.
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