Prevention and Nursing Management for Skin Cancer

Skin protects the body from injury and is a bulwark against bacterial infections, viruses, and fungi. Heat loss and heat storage arranged through vasodilation of skin blood vessels or sweat glands secretion. If skin surface is damaged then, an important body fluid will evaporate and electrolytes will be lost within a few hours.

There are several types of skin cancer. Skin cancer that forms in melanocytes (skin cells that make pigment) is called melanoma. Skin cancer that forms in squamous cells (flat cells that form the surface of the skin) is called squamous cell carcinoma. Skin cancer that forms in the lower part of the epidermis (the outer layer of the skin) is called basal cell carcinoma. Skin cancer that forms in neuroendocrine cells (cells that release hormones in response to signals from the nervous system) is called neuroendocrine carcinoma of the skin.

Sunlight is a major cause of skin cancer. Changes in the ozone layer caused by pollutants such as chlorofluorocarbon pollution, for those who got the ith therapy uses x-rays also cause skin cancer.

Increase in skin cancers are caused by changes in lifestyle, habits of people to sunbathe and do activities in the sun.

Another cause could be found, from skin cancer include:
  • Due to genetic factors.
  • Deficiency in the production of melanin pigment in the skin.
  • Coming into contact with certain chemicals, such as arsenic compounds, nitrate, coal, asphalt and paraffin.
  • Exposure X-ray and medical industries.
Skin tumors can be formed from different types of cells in the skin like epidermal cells and melanocytes. These tumors can be benign or malignant and can be localized in the epidermis or penetrate into the dermis and subcutaneous tissue.

Wet cell carcinoma incidence, based on the amount of melanin pigment in the epidermis and the old total direct exposure to the sun, the sailors and farmers for example, and are often exposed to the sun such as the face, head and neck.

Spectrum of sunlight, which are carcinogenic, are light wavelength range between 280-320 nm and other causes irradiation with light - x, facto genetic but such rare albino and xeroderma pigmentosum.
Spectrum of the sun is what makes skin burn and become damaged (skin color changes to brown).

Clinical Manifestations
  1. The form of skin disorders like moles, the shape is not symmetrical or the shape has no edges that are not equal to each other.
  2. Moles, who has more than one color color. Moles usually have a dark brown color. When seen have a dark brown color and looks to have some red, white, black or dice should be more vigilant.
  3. Moles uneven or faded.
  4. The mole with a diameter more than 6 mm should be checked.
  5. When the changes as painful inflamed bleed easily should consult a physician.

Skin Cancer Prevention
  1. Do not try to make the sun quickly yellowish brown skin, if your skin burn easily.
  2. Avoid unnecessary sun, especially when UV radiation occurs.
  3. Do not let sunburn because UV rays.
  4. Apply sunscreen skin protection preparations if you have to bask under the hot sun. This preparation will prevent the sun's harmful rays.
  5. Apply sunscreen preparations exposed to the sun again after a long time.
  6. Use a lip moisturizer containing ata ligloss reparat sunscreen with a high SPF number.
  7. Wear appropriate protective clothing (eg, hat, long-sleeved shirt).
  8. Do not use a heating lamp to make the skin a yellowish brown.

Skin Cancer Nursing Management

Because many skin cancers removed with excision of action, ran nurses are:
  1. Relieves pain and discomfort.
  2. Provision of appropriate analgesics.
  3. Relieves anxiety.
  4. Patient education and home care considerations.

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Nursing Diagnosis related to Endocarditis

Endocarditis is an infection of the heart valves or the inner membrane of the heart (endocardium). Most people who develop this condition already have heart problems and are over 50 years old, but it can occur at any age, including in children. Symptoms can include fever and chills, lethargy, loss of appetite, slow or rapid heart rate, increased breathing and a persistent cough. There are two types of endocarditis: infective and non-infective.

Some of the general symptoms of endocarditis can include:
  • Fever and chills
  •  Loss of appetite
  • Lethargy
  • Generalised aching throughout the body
  • Abnormal heart rhythms such as a slow heart rate or tachycardia (rapid heart rate)
  • Heart murmur
  • Increased breathing
  • Persistent cough.

The following conditions increase the risk:
  • a history of rheumatic fever or rheumatic heart disease
  •  prosthetic (artificial) heart valves
  • a congenital (present at birth) heart defect
  • a history of intravenous drug use
  • mitral valve prolapse (MVP)
  • diabetes
  • pregnancy

Nursing Diagnosis related to Endocarditis

1. Acute Pain related to
  • Inflammation of the myocardium or pericardium
  • Systemic effects of infection
  • Ischemic tissue (myocardium)

Possibility is evidenced by:
  • Chest pain, spreading to neck / back
  • Joint pain
  • Increased pain with deep inspiration, movement activities, position.
  • Fever, chills.

2. Activity Intolerance related to:
  • Inflammation and degeneration of myocardial muscle cells.
  • Restriction of cardiac filling / ventricular contraction, reduced cardiac output.
  • Toxin from the organism.
Possibility evidenced by:
  • Complaints weakness / fatigue / dyspnea with activity.
  • Changes in signs for activity.
  • Signs of chronic heart failure.

3. Risk for Decreased cardiac output related to:
  • Accumulation of fluid, in Pericardial sac (pericarditis)
  • Stenosis / valve insufficiency
  • Decrease in ventricular function or constricting
  • Degeneration of the heart muscle

Possibility evidenced by:
  • Not applicable for signs and symptoms make the actual diagnosis

4. Risk for Ineffective Tissue Perfusion related to:
  • Thrombus embolism / vegetation valve endocarditis secondary to

Possibility evidenced by:
  • Not applicable for signs and symptoms to make the diagnosis of actual

5. Knowledge Deficit: about condition / treatment can be related to:
  • Lack of information about the disease, how to prevent recurrence or complications

Possibility evidenced by:
  • Request for information
  • Failure to improve
  • Recurrence / complications that can be prevented

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Physical Examination and Examination Support for Rabies

Rabies is an acute infectious disease of the central nervous system in humans and mammals which have been fatal.

In humans theoretically, clinical symptoms consisted of 4 stages in a real situation is difficult to separate one from the other, namely:
  1. Nonspecific prodromal symptoms
  2. Acute encephalitis
  3. Brainstem dysfunction
  4. Coma and death

A variety of complications can occur in patients with rabies and usually occur in comatose. Neurologic complications can include increased intra-cranial pressure: abnormalities in the hypothalamus in the form of diabetes insipidus, syndrome of anti diuretic hormone abnormalities; autonomic dysfunction that causes hypertension, hypotension, hyperthermia, hypothermia, arrhythmias and cardiac arrest. Can be local or generalized seizures, and often in conjunction with arrhythmias and respiratory disorders. In the prodromal stage, common complications of hyperventilation and respiratory depression occurred in the neurological phase. Hypotension occurs due to congestive heart failure, dehydration and autonomic nervous breakdown.

Physical Examination of Rabies :

1. Respiratory Status
  • Increased respiratory rate
  • Tachycardia
  • Temperatures generally increased (37.9 ยบ C)
  • shiver

2. Nutritional Status
  • Difficulty in swallowing food
  • What is the patient's weight
  • Nausea and vomiting
  • Servings the meal was spent
  • Ntritional status

3. Status Neuro-sensory
  • Signs of inflammation

4. security
  • Convulsions
  • Weakness

5. Ego integrity
  • Clients feel anxious
  • Clients do not understand about the disease

Neurologic Physical Assessment:

1. Vital signs:
  • Temperature
  • Breathing
  • Heartbeat
  • Blood pressure
  • Pulse pressure

2. Fontanel head examination results:
  • Prominent, flat, concave
  • Common form of head

3. Pupillary Reaction
  • Size
  • Reaction to light
  • The similarity of response
4. Level of vigilance awareness:
  • The response to the call
  • Irritability
  • Lethargy and drowsiness
  • Orientation to self and others

5. Affect
  • Natural feeling
  • Lability

6. Seizure Activity
  • Type
  • Length

7. Sensory Function
  • Reaction to pain
  • Reaction to temperature
8. Reflex
  • Superficial tendon reflexes
  • Pathological reflexes

Examination Support of Rabies

There are few checks on rabies are:

1. Electroencephalogram (EEG): fatherly used to help define the type and focus of the seizures.

2. CT scan: using X-ray studies are more sensitive than normal to detect differences in tissue density.

3. Magnetic resonance imaging (MRI): generating shadows using a magnetic field and radio waves, useful to show areas of the brain that are not clearly visible when using a CT scan.

4. Positron emission tomography (PET): to evaluate persistent seizures and helped establish the location of the lesion, metabolic changes in the brain or blood alirann.

5. Laboratory Test
  • Lumbar puncture: fluid analyzed cerebrovascular
  • Complete blood count: evaluate platelet and hematocrit
  • electrolyte panel
  • Toxic screening of serum and urine
  • GDA
  • Blood Glucose: Hypoglycemia is a predisposition seizure less than 200 mq / dl
  • BUN: Increased BUN, has the potential for seizures and an indication of the nephrotoxic effect of drug administration.
  • Electrolytes: K, Na
  • Electrolyte imbalance predisposes to seizure

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Malignant Lymphoma - Pathophysiology and Nursing Management

Understanding of malignant lymphoma among others by:

Danielle, (1999) that lymphoma is a malignancy that arises from the lymphatic system.

Susan Martin Tucker, (1998) is a group of neoplasms derived from lymphoid tissue.

Suzanne C. Smeltzer, (2001), suggested that malignant lymphoma is a malignancy of cells derived from lymphoid cells.

Doenges, (1999) is a cancer of the lymphoid glands.

Pathophysiology of Malignant Lymphoma

Malignant lymphoma is derived from lymphocytes. These tumors usually stems from lymph nodes, but can involve the lymphoid tissue in the spleen, gastrointestinal tract (eg, stomach wall), liver, or bone marrow. Lymphocytes in lymph nodes is also derived from multipotential stem cells, in the bone marrow. Multipotential stem cells in the early stages of transformation into a lymphocyte progenitor cells that subsequently differentiate along two parallel paths. Partial maturation in the thymus gland to become T lymphocytes, and partly to the lymph nodes or remain in the bone marrow and differentiate into B lymphocytes cells If there is an appropriate antigen stimulation by the T and B lymphocytes will be transformed into an active form and proliferating. Activated T lymphocytes functioning cellular immune response. Whereas B lymphocytes are then activated to imunoblas into plasma cells that form the immunoglobulins. Changes in normal lymphocytes into cell lymphoma is caused by a gene mutation on one of the cells of a group of old lymphocytes are in the process of transformation into imunoblas (the result of the stimulation of immunogen). This occurs in the lymph nodes, where lymphocytes are outside centrum old germinativum while imunoblast be the most central part germinativum centrum. If the tumor enlarges, it can cause and if not treated early it causes malignant lymphoma.

Cause of these tumors is unknown, but there are some risk factors include: immunodeficiency, infectious agents, environmental and occupational exposures (such as forest workers, farmers and agriculture), ultraviolet exposure, smoking, and eating foods high in animal fat. Signs and symptoms include fatigue, malaise weight loss, increased temperature, infection susceptibility, dysphagia, anorexia, nausea, vomiting, constipation, anemia, edema arising anasarka, drop in blood pressure, shortness of breath when grown in the chest area and disorders / enlargement organ. If this condition is ongoing, it can cause complications of pleural effusion, bone fracture, paralysis and death must happen within 1 to 3 years if no treatment.

Nursing Management of Malignant Lymphoma

Nursing management, according to Brunner and Suddarth (2000), in providing care and client education. Clients often feel afraid to drugs that are radioactive and requires maintenance action and follow-up monitoring is special because it is the nurse should convey information about the therapeutic and soothing feelings of clients and families. Laparotomy for postoperative clients, clients are encouraged to rest and to avoid strain on the stitches. Gauze covering the wound should be reviewed periodically to determine the presence of bleeding or not and do wound care on a daily basis according to the program, to observe signs of infection.

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Nursing Care - Personal Hygiene in the Elderly

Maintenance of personal hygiene will determine the health status, in which individuals consciously and personal initiative to maintain health and prevent disease. This effort is more profitable for the individual because it is more cost-effective, time and energy in creating prosperity and health.

Efforts maintenance of personal hygiene, covering about: cleanliness hair, eyes, ears, teeth, mouth, skin, nails, and cleaning the dress. In this attempt to maintain personal hygiene, family knowledge of the importance of personal hygiene is very necessary. Because knowledge or cognitive, is a very important domain in shaping one's actions.

Elderly need to get attention by seeking that they are not too dependent on other people and be able to take care of themselves (self-contained), maintaining personal hygiene, which of course is the duty of the family and the environment.

Along with physical setbacks, elderly in need of families to meet personal hygiene.

There are several factors that affect the personal hygiene of the elderly are:

1. Level of knowledge
2. Physical and psychological condition of the elderly Elderly
3. Economic factors
4. Cultural factors
5. Environmental factors
6. Body image factors
7. Family roles factors

Nurses have a role in providing health education about personal hygiene, ie as family advocacy. Nurses act as a companion for families, for the elderly and their families when faced with a problem, including in terms of personal hygiene, nurses as nurse conselor where nurses can give an ideas or opinions to the elderly and to families as implementing nursing care. Nurses provide care to the educational needs of nurses as health education appropriate to the needs of the elderly.

Type of Personal Hygiene

1. Hair Hygiene
2. Oral hygiene
3. Eye hygiene
4. Ear hygiene
5. Nail hygiene
6. Skin hygiene

Factors that can affect Personal Hygiene

There are several factors that affect the personal hygiene of the elderly are:

1. Knowledge factors

According Purwanto (1999) in Friedman (1998), cognitive domains related to intellectual knowledge (ways of thinking, abstract, analyze, solve problems and others). Which includes knowledge, comprehension, application, analysis, synthesis and evaluation. Individuals with knowledge of the importance of personal hygiene will always maintain personal hygiene to prevent the condition / sickness (Notoatmodjo, 1998).

2. Physical and Psychic in the Elderly

The more elderly person, it will decline, especially in the field of physical ability, which can result in decreased social roles. This has resulted in the disruption ends meet. So as to improve the help of others. (Nugroho, 2000).

According to Zainudin (2002) mental deterioration in the elderly could be due to dementia, in which the elderly decline in memory and this can affect the ADL (Activity of Daily Living is a person's ability to look after himself), starting from waking, bathing dressing, and so on.

3. Economic factors

According Geismer and La Sorte (1964) in Friedman (1998), a large family income will affect the ability of families to provide the facilities and the needs required to support life and family survival.

4. Cultural factors

Cultural and personal values ​​affect the ability of hygiene care. One of different cultural backgrounds have different self-care practices. Confidence based culture often determines the definition of health and self-care (Potter and Ferry, 2005).

5. Environmental factors

The environment includes all the physical and psychosocial factors that influence or effect on the lives and survival of the environment influence the ability to improve and maintain functional status, and improve well-being. (Potter and Ferry, 2005)

6. Body Image factor

Body image is a subjective concept of one's physical appearance. Good personal hygiene will affect the individual's body image enhancement. (Stuart & Sundeen, 1999 in Setiadi 2005).

7. Role of Family factors

Families strongly influence health behavior as well as any members of the health status of each individual affect how the function of the family unit and the ability to achieve goals. At the time of family satisfaction goals are met through adequate function, family members are likely to feel positive about themselves and their families (Potter and Ferry, 2005).

Signs of someone lacking Personal Hygiene
  1. Looks dirty / scruffy and untidy.
  2. Body odor.
  3. Hair disheveled, dirty and lots of ticks.
  4. Long and dirty nails.
  5. Sometimes body with skin diseases (fungal, sores, ulcers, etc.).

Personal Hygiene Problems In Elderly

According Siburian (2002) reduced physiological function and health in the elderly, there are several things to note about the cleanliness of the elderly, namely:

  • Bath: the elderly when entering the bathroom should be a strong body by guardians.
  • Oral hygiene: the elderly are not independent, have assisted in cleaning teeth.
  • Wash hair and skin: the skin and hair of the elderly began to dry up. Therefore after bathing necessary smeared with cream skin and hair need to get a hair conditioner. After bathing, hair dried quickly.
  • Nails: when cutting the nails should be careful to avoid injuries in the elderly, especially people with diabetes mellitus more difficult to recover.
  • Clothing: clothing elderly, should be made ​​of soft material, must be kept neat because a lot of elderly people who do not care about the clothes. Colors should be bright but soft clothing, do not wear flashy colors because this is only suitable for young children, do not also selected black, because it gives the impression of sadness.

How to Care Personal Hygiene in the Elderly

a) How to care - hair and head
  • Wash hair with shampoo, regular (min. 2 x / week)
  • Cut and comb hair to make it look neat.

b) How to keep the face and eyes
  • Wash the face at least 3 times daily
  • Clean the eye area from the outside to the inside (clean dirt attached to the corner of the eye lid)
  • When the object possessed eyes, immediately remove using a soft cloth or tissue, do it carefully.
  • When exposed to the eyes of soapy water, wash immediately using clean water, and to avoid rubbing eyes with hands.
  • When riding a motorcycle, use eye glass / glass protector.

c) How to maintain the cleanliness of the ear and nose
  • Clean nose and ears on a regular basis (1-2 weeks / 1 time) do it carefully using a clean and safe tool.

d) How to maintain oral hygiene
  • Brush the teeth after every meal and before bed the right way and regularly
  • Avoid eating / drinking too hot / cold
  • Avoid consumption of acidic foods
  • Many nutritious foods
  • Control to the dentist / health workers routinely.
e) How to maintain the cleanliness of the body
  • Shower using soap regularly at least 2 times a day (more often if necessary to do the work in place when dirty / sweat a lot.
  • Use a clean and tidy clothes (clothes replaced 1 x / hr or when clothes are dirty / wet)
  • When exposed skin fungus, do bathe as usual. Avoid the use of clothing, towels, blankets, soap, and glove together. Avoid using the clothes damp / wet (with sweat / other reasons). Use anti fungal skin medications (if necessary).
f) How to keep hands and feet
  • Clean hands and feet every day at least 2x/hr or dirty.
  • Cut nail 1 x / week or as long visible (use nail cutters and cut the nails after grinded / filed)
  • Use footwear soft, safe, and comfortable.

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Klinefelter's Syndrome - Symptoms and Treatment

Klinefelter's syndrome was first described in 1942 when Klinefelter et al studied 9 men with gynecomastia, small testes, azoospermia, and elevated levels of gonadotropins. They believe that hypogonadism is derived from Sertoli cell failure, of the testis, as a place of spermatogenesis. Pubic hair distribution and the corresponding axillar an indication of relatively normal function of Leydig cells that produce testosterone. They also say that these patients had a testicular hormone levels are low or sometimes nothing is regulated by pituitary gonadotropin levels through feedback inhibition. They named this hormone by hormone X, or inhibin.

Klinefelter syndrome is the most common chromosomal disorder associated with male hypogonadism and infertility. It is defined classically by a 47,XXY karyotype with variants that demonstrate additional X and Y chromosomes.

Klinefelter syndrome affects 1 in 500 to 1,000 newborn males. Most variants of Klinefelter syndrome are much rarer, occurring in 1 in 50,000 or fewer newborns.

Older children and adults with Klinefelter syndrome tend to be taller than their peers. Compared with unaffected men, adults with Klinefelter syndrome have an increased risk of developing breast cancer and a chronic inflammatory disease called systemic lupus erythematosus. Their chance of developing these disorders is similar to that of women in the general population.

Children with Klinefelter syndrome may have learning disabilities and delayed speech and language development. They tend to be quiet, sensitive, and unassertive, but personality characteristics vary among affected individuals.

Researchers suspect that Klinefelter syndrome is under-diagnosed because the condition may not be identified in people with mild signs and symptoms. Additionally, the features of the condition vary and overlap significantly with those of other conditions.

Symptoms of Klinefelter's Syndrome
  • Abnormal body proportions (long legs, short trunk, shoulder equal to hip size)
  • Abnormally large breasts (gynecomastia)
  • Infertility
  • Sexual problems
  • Less than normal amount of pubic, armpit, and facial hair
  • Small, firm testicles
  • Tall height

Treatment of Klinefelter's Syndrome

Testosterone therapy may be prescribed. This can help:
  • Grow body hair
  • Improve appearance of muscles
  • Improve concentration
  • Improve mood and self esteem
  • Increase energy and sex drive
  • Increase strength
Most men with this syndrome are not able to get a woman pregnant. However, an infertility specialist may be able to help. A special doctor called an endocrinologist may also be helpful.

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Ineffective Cerebral Tissue Perfusion related to Hydrocephalus

Hydrocephalus also known as "water on the brain," is a buildup of fluid inside the skull that leads to brain swelling. Hydrocephalus is a medical condition in which there is an abnormal accumulation of cerebrospinal fluid (CSF) in the ventricles, or cavities, of the brain.

This condition also could be termed a hydrodynamic disorder of CSF. Acute hydrocephalus occurs over days, subacute hydrocephalus occurs over weeks, and chronic hydrocephalus occurs over months or years.

CSF normally moves through the brain and the spinal cord, and is soaked into the bloodstream. CSF levels in the brain can rise if:
  • The flow of CSF is blocked
  • It does not get absorbed into the blood properly
  • The brain makes too much of it
When hydrocephalus is present at birth, it can be the result of conditions like spina bifida (where the primary cause is abnormal development of the spinal cord) or aqueductal stenosis (a narrowing of the small passageway, called the "aqueduct of Sylvius," that connects two major ventricles in the brain).

As a result, a baby with hydrocephalus will appear to have an abnormally shaped head — usually much larger than other babies the same age. Other signs to look for include:
  • bulging at the soft spots
  • "split" sutures — a gap can be felt between skull bones
  • rapid increase in head circumference
  • swollen veins that are recognizable to the naked eye
  • downward cast of the eyes (called "sunsetting")

Symptoms that may occur in older children can include:
  • Brief, shrill, high-pitched cry
  • Changes in personality, memory, or the ability to reason or think
  • Changes in facial appearance and eye spacing
  • Crossed eyes or uncontrolled eye movements
  • Difficulty feeding
  • Excessive sleepiness
  • Headache
  • Irritability, poor temper control
  • Loss of bladder control (urinary incontinence)
  • Loss of coordination and trouble walking
  • Muscle spasticity (spasm)
  • Slow growth (child 0 - 5 years)
  • Slow or restricted movement
  • Vomiting

Nursing Care Plan for Hydrocephalus

Nursng Diagnosis for Hydrocephalus : Ineffective Cerebral Tissue Perfusion related to increased intracranial pressure

characterized by impaired blood flow to the brain.

Goal: Adequate cerebral tissue perfusion,

Expected outcomes:
  • Improved level of consciousness (GCS: E4 M6 V5).
  • Not a stiff neck.
  • No seizures.
  • Blood pressure within normal limits.
  • Not vomiting progressive
  • No headaches

a) Maintain bed rest with the head flat and monitor vital signs as indicated after the lumbar puncture.
Rationale: Changes in cerebrospinal fluid pressure may be a potential risk of herniation of the brain stem, which requires immediate medical treatment.

b) Monitor / record neurological status, such as GCS.
Rationale: Assessment of trend changes and the potential of increasing the level of awareness of ICT is very useful in determining the location, distribution / extent and progression of cerebral damage.

c) Monitor the frequency / heart rhythm and heart rate.
Rationale: Changes in the frequency, dysrhythmias and heart rate may occur, which reflects brain stem trauma in the absence of underlying heart disease.

d) Monitor breathing, note the pattern, the respiratory rhythm and respiratory frequency.
Rationale: This type of pattern is a sign of heavy breathing from an increase in ICT / cerebral areas affected.

e) Elevate the head of the bed about 15-45 degrees as indicated. Keep the patient's head remains in neutral position.
Rationale: Increased venous outflow from the head to reduce ICT.

f) Monitor the GDA. Provide oxygen therapy as needed.
Rationale: The occurrence of acidosis may inhibit the entry of oxygen at the cellular level that aggravate cerebral ischemia.

g) Give the medication as indicated.

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5 Nursng Diagnosis Interventions for Malignant Lymphoma

Lymphomas are a group of cancers in which cells of the lymphatic system become abnormal and start to grow uncontrollably. Because there is lymph tissue in many parts of the body, lymphomas can start in almost any organ of the body.

The two main types of lymphomas:
  • Hodgkin's lymphoma (HL) — There are six types of HL, an uncommon form of lymphoma that involves the Reed–Sternberg cells.
  • Non-Hodgkin lymphoma (NHL) — There are more than 61 types of NHL, some of which are more common than others. Any lymphoma that does not involve Reed-Sternberg cells is classified as non-Hodgkin lymphoma.

The diagnosis of malignant lymphoma requires the presence of malignant lymphocytes in a biopsy of lymph node or extra-lymphatic tissue. An excisional lymph node biopsy is essential for complete diagnostic assessment. If a whole lymph node is not obtainable, sufficient incised tissue from an extra-lymphatic site can be diagnostic but is less desirable.

Treatment of malignant lymphoma is based on histologic subtype, extent of disease, and age of the patient as is shown in the following table. In the case of discordant (two separate sites of disease with differing types of lymphoma), composite (one site of disease with two discrete types of lymphoma at that site) or transformed (a second lymphoma developing out of a background of previously known lymphoma) lymphoma, treatment must be directed at the most aggressive phase of the disease.

Nursing Diagnosis for Malignant Lymphoma

1. Acute Pain related to the injury of biological agents.
2. Hyperthermia related to ineffective thermoregulation secondary to inflammation.
3. Imbalanced Nutrition Less than Body Requirements related to nausea, vomiting.
4. Knowledge Deficit related to lack of exposure to information
5. Risk for Ineffective Airway Clearance related to enlarged lymph medinal / airway edema.

Nursing Intervention for Malignant Lymphoma

1. Acute Pain related to the injury of biological agents.

Goal: Pain is reduced / lost

Expected outcomes:
  • Pain scale: 0-3
  • Clients do not face grimace
  • Clients not holding area pain

1. Assess pain scale with PQRST.
R /: to know the pain scale and to facilitate clients in determining interventions.

2. Teach the client relaxation and distraction techniques.
R /: relaxation and distraction techniques were taught to the client, can help in reducing the client's perception of the pain he suffered.

3. Collaboration in the delivery of analgesic drugs.
R /: analgesics may reduce or eliminate the pain suffered by the client.

2. Hyperthermia related to ineffective thermoregulation secondary to inflammation.

Goal: the client's body temperature down / within normal limits

Expected outcomes:
  • Body temperature within the normal range (35.9 to 37.5 0 Celsius)


1. Observation of the client's body temperature.
R /: to monitor the client's body temperature can know the state of the client and also can take the appropriate action.

2. Give a warm compress on the forehead, axilla, abdomen and groin.
R /: compress can reduce body temperature.

3. Encourage and provide drinking a lot (in accordance with the needs of the client's body fluids).
R /: by drinking lots are expected to help maintain the body's fluid balance in the client.

4. Collaboration in the provision of antipyretics.
R: antipyretics can reduce body temperature.

3. Imbalanced Nutrition Less than Body Requirements related to nausea, vomiting.

Goal: client's nutritional needs can be met

Expected outcome:
  • Showed an increase in body weight / body weight stable.
  • Clients increased appetite.
  • Clients exhibit behavioral changes in lifestyle to maintain an appropriate body weight.


1. Review the history of nutrition, including food preferences.
R /: to identify nutritional deficiencies and interventions.

2. Observation and record food intake.
R /: watching caloric intake.

3. Measure weight every day.
R /: oversee the effectiveness of weight loss and nutritional intervention.

4. Give eat little but often frequency.
R /: increase in total caloric intake and also to prevent gastric distention.

5. Collaboration in the provision of nutritional supplements.
R /: increase protein intake and calories.

4. Knowledge Deficit related to lack of exposure to information.

Goal: Clients and their families can learn about the disease suffered by the client

Expected outcomes:
  • Client and the client's family can understand the disease process.
  • Client and the client's family to get clear information about the disease suffered by the client.
  • Client and the client's family to comply with the therapeutic process to be carried out.


1. Provide therapeutic communication to clients and client families.
R/ : ease of doing terpiutuk procedures to clients.

2. Provide information about the disease process to the client and the client's family.
R/ : the client and the client's family can know the process of the disease suffered by the client.

5. Risk for Ineffective Airway Clearance related to enlarged lymph medinal / airway edema.

Goal: Effective client airway

Expected outcomes:
  • Clients can breathe normally / effective.
  • Clients are free of dyspnea, cyanosis.
  • There is no sign of respiratory distress.

1. Assess respiratory rate, depth, rhythm.
R /: changes may indicate the continued engagement / respiratory effects requiring intervention efforts.

2. Place the patient in a comfortable position, usually with a high headboard / or sit up straight to the feet of hanging.
R /: to maximize lung expansion, lower respiratory work, and reduce the risk of aspiration.

3. Assist with deep breathing techniques or breathing and lip / diaphragm. Abdomen when indicated.
R /: to help improve gas diffusion and expansion of small airway, give the client some control over breathing, helps reduce anxiety.

4. Assess the respiratory response to activity.
R /: decrease in cellular oxygenation lowering activity tolerance.

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Hypopituitary - 6 Nursng Diagnosis and Interventions

Hypopituitarism is a condition in which the pituitary gland does not produce one or more of its hormones or not enough of them. The pituitary gland is located at the base of the brain. This condition may occur because of disease in the pituitary or hypothalamu. When there is low or no production of all the pituitary hormones, the condition is called panhypopituitarism.

Hypopituitarism may be caused by:
  • Brain surgery
  • Brain tumor
  • Head trauma
  • Infections of the brain and the tissues that support the brain
  • Radiation
  • Stroke
  • Subarachnoid hemorrhage (from a burst aneurysm)
  • Tumors of the pituitary gland or hypothalamus

Nursng Diagnosis and Interventions for Hypopituitary

1. Disturbed Body Image related to changes in the structure and function of the body due to deficiency of gonadotropin and growth hormone deficiency.

Interventions and Rational:

1. Encourage clients to express feelings.
R /: Clients are able to express feelings.

2. Encourage clients to ask about the issues it faces.
R /: Clients are able to know their health problems.

3. Give the client a chance to care for themselves.
R /: Make the client can be independent, to meet their needs.

4. Collaboration: the synthetic growth hormones (exogenous).

2. Sexual Dysfunction

Interventions and Rational:

1. Identification of specific issues related to the client's experience sexual function.
R /: Clients understand the problem of the sexual function.

2. Encourage clients to discuss the issue with their partner.
R /: Clients can express their feelings on the issue of sexual function.

3. Generate client motivation to follow the treatment program on a regular basis.
R /: Clients can keep up with the regular treatment program.

4. Collaboration: the drug bromocriptine.

3. Ineffective individual coping related to the chronicity of the disease condition.

Interventions and Rational:

1. Help clients to be able to communicate.
R /: To be able to increase client communication.

2. Assist clients in solving their problems.
R /: In order for clients to solve their own problems.

3. Teach the client to be able to do relaxation techniques right.
R /: In order for the client to perform relaxation.

4. Low self-esteem are related to changes in body appearance.

Interventions and Rational:

1. Assist clients in building mutual trust relationship between the client and the nurse.
R /: To be able to build client relationships of mutual trust between the client and the nurse.

2. Assist the client in terms of social interaction.
R /: In order for the client to interact socially.

3. Help clients to increase self-esteem back by supporting all actions, hopes, and desires of the patient.
R /: To be able to discuss the client's feelings.

5. Anxiety related to threat or change in health status.

Interventions and Rational:

1. Provide comfort care to the client.
R /: To clients have confidence in the others.

2. Assist clients in activities that may reduce emotional tension.
R /: In order for the client to respond verbally and non-verbally.

3. Teach termination techniques anxiety.
R /: Agarklien can stimulate self-back.

6. Impaired skin integrity related to declining hormonal levels.

Interventions and Rational:

1. Teach clients how to perform regular skin care every day.
R /: regular skin care can repair skin damage.

2. Encourage clients to use a moisturizing lotion.
R /: moisturizing lotion helps keep the skin moist.

3. Encourage clients to not scratch the skin.
R /: Scratching the skin can cause skin irritation.

4. Maintain adequate fluid intake for adequate hydration.
R /: Fulfillment of adequate hydration.

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Nursing Diagnosis for Pyelonephritis : Impaired Urinary Elimination

Pyelonephritis is an ascending urinary tract infection that has reached the pyelum or pelvis of the kidney. It is a form of nephritis that is also referred to as pyelitis.

Pyelonephritis is a potentially serious kidney infection that can spread to the blood, causing severe illness. Fortunately, pyelonephritis is almost always curable with antibiotics.

Pyelonephritis presents with fever, accelerated heart rate, painful urination, abdominal pain radiating to the back, nausea, and tenderness at the costovertebral angle on the affected side.

Most cases of pyelonephritis are complications of common bladder infections. Bacteria enter the body from the skin around the urethra. They then travel up the urethra to the bladder.

Pyelonephritis may start with similar symptoms. However, once the infection has spread to the kidney, signs of more severe illness usually result:
  • Back pain or flank pain
  • Fever (usually present) and/or chills
  • Feeling sick (malaise)
  • Nausea and vomiting
  • Confusion (especially in the elderly)

Pyelonephritis may cause noticeable changes in the urine, such as:
  • Blood in the urine (hematuria)
  • Cloudy or foul-smelling urine
  • Pain when urinating
  • Increased frequency or urgency of urination

Nursing Diagnosis for Pyelonephritis : Impaired Urinary Elimination (dysuria, urge, frequency, and or nocturia) related to a kidney infection.

Goal : elimination pattern either

Expected Outcome : The pattern of elimination clients improved, there was no sign of urinary disorders (urgency, oliguric, dysuria)

Nursing Interventions and Rationale:

1. Measure and record the voiding of urine each time.
R /: To investigate the change of color, and to determine the input / output.

2. Advise to urinate every 2-3 hours.
R /: To prevent the buildup of urine in the urinary vesicles.

3. Palpation of the bladder every 4 hours.
R /: To determine the presence of bladder distension.

4. Help clients use bedpans / urinals.
R /: To facilitate clients in urination.

5. Help clients get a comfortable position to urinate.
R /: So that the client is not difficult to urinate.

6. Encourage increased fluid intake.
R /: Increased hydration rinse bacteria.

7. Observations of changes in mental status:, behavior or level of consciousness.
R /: Accumulated residual uremic and electrolyte imbalance can be toxic to the central nervous system.


1. Perform laboratory tests; electrolytes, BUN, creatinine.
R /: Monitoring of renal dysfunction.

2. Take action to maintain acidic urine.
R /: Acid urine hinder the growth of germs.

3. Increase input berry juice and give medications to increase uric acid.
R /: Increased input juice can affect the treatment of urinary tract infections.

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Ineffective Tissue Perfusion related to Meningitis

Meningitis is a disease caused by the inflammation of the protective membranes covering the brain and spinal cord known as the meninges. The inflammation is usually caused by an infection of the fluid surrounding the brain and spinal cord.

Anyone can get meningitis, but it is more common in people whose bodies have trouble fighting infections. Meningitis can progress rapidly. You should seek medical care quickly if you have
  • A sudden fever
  • A severe headache
  • A stiff neck

Meningitis can produce mild symptoms — such as headache, low-grade fever and tiredness lasting two to three days — in some patients. In other patients, the symptoms can be severe and begin suddenly with fever, headache and stiff neck accompanied by some combination of other symptoms: decreased appetite, nausea, vomiting, sensitivity to bright light, confusion and sleepiness.

In newborns and infants, the classic findings of fever, headache and stiff neck may or may not be present. An infant may have no other symptoms than being listless, irritable and sleepy, having little interest in feeding and possibly vomiting. A purplish red rash may appear with meningococcal meningitis.

Nursing Diagnosis for Meningitis : Ineffective Tissue Perfusion related to Increased Intracranial Pressure

  • The patient returned to the state of the neurological status before the illness.
  • Increased patient awareness and sensory function.

Expected outcomes
  • Vital signs are within normal limits
  • Reduced head pain
  • The increased awareness
  • An increase in cognitive or loss and no signs of increased intracranial pressure.

Intervention and Rational:

1. Patients total bed rest with supine sleeping position without a pillow.
R /: Changes in intracranial pressure can cause the risk of going to the occurrence of brain herniation.

2. Monitor signs of neurological status with the GCS.
R /: to reduce further brain damage.

3. Monitor vital signs such as blood pressure, pulse, temperature, and caution in systolic hypertension.
R \ /: In normal autoregulation to maintain a state of altered systemic blood pressure fluctuations. Autoreguler failure will cause cerebral vascular damage that can be manifested by an increase in systolic and diastolic pressure followed by a decrease. While the increase in temperature can describe the course of infection.

4. Monitor intake and output.
R /: Hyperthermia can lead to increased IWL and increase the risk of dehydration, especially in patients who are not aware, a decrease nausea peroral intake.

5. Help patients to limit vomiting, coughing. Instruct the patient to exhale when moving or turning in bed.
R /: This activity can increase intracranial pressure and intra-abdominal. Exhale while moving or changing positions can protect themselves from the effects of Valsalva.


1. Give fluids per infusion with strict attention.
R /: Minimize the burden of vascular and fluctuations in intracranial pressure, fluid and fluid vetriksi can reduce cerebral edema.

2. Monitor AGD when needed oxygen delivery.
R /: The possibility of acidosis accompanied by the release of oxygen at the cellular level may lead to ischemic cerebral.

3. Provide appropriate therapy doctors advice.

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Acute Pain related to Menstrual Disorders (Dysmenorrhea)

A menstrual disorder is an irregular condition in a woman's menstrual cycle. There are a number of different menstrual disorders. Problems can range from heavy, painful periods to no period at all. There are many variations in menstrual patterns, but in general women should be concerned when periods come fewer than 21 days or more than 3 months apart, or if they last more than 10 days.

Dysmenorrhea is severe, frequent cramping during menstruation. Pain occurs in the lower abdomen but can spread to the lower back and thighs.

There are two types of dysmenorrhea: "primary" and "secondary".

Nursing Diagnosis and Interventions Menstrual Disorders (Dysmenorrhea) :

Acute Pain

Goal: reduced patient pain

Expected outcomes:
  • Pain is reduced / can be adapted,
  • Can identify activities that increase / decrease pain,
  • Low pain scale.

Interventions and Rationale:

1. Explain and help clients with pain relief measures, nonpharmacological and non-invasive.
R /: Approach using relaxation and other nonpharmacological has demonstrated effectiveness in reducing pain.

2. Teach the use of warm compresses.
R /: Relieves abdominal cramps. Heat works by the increasing vasodilation and muscle relaxation, while decreasing iskemic uterus.

3. Teach Relaxation: Techniques to reduce skeletal muscle tension, which can reduce pain intensity and improve relaxation massage.
R /: Will the blood circulation, so that the oxygen demand will be met by the tissue, which will reduce the pain.

4. Teach methods of distraction for acute pain.
R /: Divert attention pain to the things that make happy.

5. Do massage the lower back.
R /: Reduce pain with vertebral muscle relaxation and increased blood supply. Many women are adapting something positive with yoga, biofeedback, meditation, and relaxation therapy.

6. Give chance a break when it feels pain and provide a comfortable position; eg bedtime, mounted behind a small pillow.
R /: Rest will relax, thereby increasing comfort.

7. Encourage lowering sodium input during the week before menstruation.
R /: Reduce the risk of fluid retention.

8. Increase knowledge of: the causes of pain, and connect how long pain will last.
R /: Knowledge that will help reduce the pain felt. And can help develop client adherence to treatment plans.

9. Observations over the level of pain, and motor response client, 30 minutes after drug administration to assess the analgesic effectiveness. And every 1-2 hours after the maintenance action for 1-2 days.
R /: Assessment of optimal, will provide objective data to prevent possible complications and appropriate interventions.

10. Collaboration with physicians, providing analgesic.
R /: Analgesic block the path of pain, so the pain will be reduced.

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Nursing Intervention of Malaria

Malaria is caused by a type of parasite known as Plasmodium. This is a microscopic parasite that is transmitted by certain species of mosquitoes. Although there are numerous types of Plasmodia parasites, only four cause malaria in humans. These include:
  • Plasmodium falciparum
  • Plasmodium vivax
  • Plasmodium ovale
  • Plasmodium malariae

Features of malaria include high fever over 38C (100.4F) along with chills and sweating. There is intense muscle pain, headache, blurring of vision and dizziness. Some patients may develop diarrhea and vomiting as well. Symptoms develop within seven days after being bitten or may take between 10 to 15 days to appear.

Malaria can sometimes become complicated. Some of the complications include:
  • severe anaemia
  • cerebral malaria
  • malaria during pregnancy
  • spleen rupture
  • acidosis
  • kidney damage
  • multi-organ failure etc.

Nursing Care Plan for Malaria

Nursing Diagnosis 1.

Hyperthermia related to the development of malaria parasites in red blood cells.

Nursing Intervention:

1. · Assess any complaints or signs of increased body temperature changes.
R /: Increased body temperature will exhibit a variety of symptoms such as red eyes and the body feels warm.

2. Observation of vital signs, especially body temperature as indicated.
R /: To determine interventions.

3. Warm water compress on the forehead and both axilla.
R /: stimulates the hypothalamus to the center of the temperature setting.

4. Collaboration of antipyretic drugs.
R /: Controlling fever.

Nursing Diagnosis 2.

Risk for Fluid Volume Deficit related to hyperthermia

Nursing Interventions:

1. Supervise the input and output of fluids. Estimate loss of fluid through sweat.
R /: Provides information about the fluid balance, are guidelines for fluid replacement.

2. Observations of decreased skin turgor.
R /: Indicates excessive fluid loss / dehydration.

3. Give parenteral fluids if needed.
R /: Helping peroral fluid intake.

Nursing Diagnosis 3.

Imbalanced Nutrition, Less Than Body Requirements related to anorexia

Nursing Interventions:

1. Encourage bed rest / or activity restrictions.
R /: Maintaining sufficient energy savings.

2. Provide oral hygiene.
R /: a clean mouth can enhance the flavor of food.

3. Provide food in a well ventilated, pleasant environment, the situation is not in a hurry, accompany.
R /: Pleasant surroundings lower stress and more conducive to eating.

4. Collaboration of antiemetic drugs.
R /: Eliminate the symptoms of nausea and vomiting.

Nursing Diagnosis 4

Knowledge Deficit: about disease

Nursing Interventions:

1. Determine the patient's perception of the disease process.
R /: Creating a knowledge base and provide awareness of individual learning needs.

2. Review the disease process, the cause / effect relationship factors that cause symptoms and identify ways to lose factors. Encourage questions.
R /: Trigger factors / ballast individuals, so the patient needs to be aware of lifestyle factors may trigger symptoms. Accurate knowledge base gives patients the opportunity to make an informed decision / choice about the future and control of chronic diseases. Although many patients know about the disease itself, they can experience that has been left behind or wrong concept.

3. The review: medicine, destination, frequency, dosage, and possible side effects.
R /: Improving understanding and to increase cooperation in the program.

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Nursing Diagnosis for Pulmonary Edema

Pulmonary edema is fluid accumulation in the lungs, which collects in air sacs. Pulmonary edema is an abnormal buildup of fluid in the air sacs of the lungs, which leads to shortness of breath. It leads to impaired gas exchange and may cause respiratory failure. It is due to either failure of the left ventricle of the heart to adequately remove blood from the pulmonary circulation ("cardiogenic pulmonary edema"), or an injury to the lung parenchyma or vasculature of the lung ("noncardiogenic pulmonary edema").

Treatment usually focuses on improving respiratory function and dealing with the source of the problem. It generally includes supplemental oxygen and medications. Acute pulmonary edema - the type that occurs suddenly - if a medical emergency. If treatment is prompt and adequate, pulmonary edema is rarely fatal.

Pulmonary edema may be caused either by direct damage to tissue, or a result of a heart or circulatory system malfunction. If pulmonary blood pressure is above 15 mmHg, pulmonary edema may occur.

Non-cardiogenic (not originating in the heart) causes of pulmonary edema:
  • Acute respiratory distress syndrome
  • Aspirin overdose
  • High altitude
  • Intracranial hemorrhage
  • Kidney failure
  • Methadone/heroin overdose
  • Pleural effusion - too much liquid around the lung is removed, causing it to expand too quickly
  • Pulmonary embolism
  • Severe seizures

Cardiogenic (originating in the heart) causes of pulmonary edema:
  • Congestive heart failure
  • Fluid overload, such as from kidney failure or intravenous therapy
  • Hypertensive crisis
  • Pericardial effusion with tamponade
  • Severe arrhythmias (tachycardia/fast heartbeat or bradycardia/slow heartbeat)
  • Severe heart attack with left ventricular failure

Symptoms of pulmonary edema may include:
  • Coughing up blood or bloody froth
  • Difficulty breathing when lying down (orthopnea) -- you may notice the need to sleep with your head propped up or use extra pillows
  • Feeling of "air hunger" or "drowning" (if this feeling wakes you from sleep and causes you to sit up and try to catch your breath, it's called "paroxysmal nocturnal dyspnea")
  • Grunting, gurgling, or wheezing sounds with breathing
  • Inability to speak in full sentences because of shortness of breath

Other symptoms may include:
  • Anxiety or restlessness
  • Decrease in level of alertness (consciousness)
  • Leg swelling
  • Pale skin
  • Sweating (excessive)

Nursing Diagnosis for Pulmonary Edema

1. Ineffective breathing pattern

related to: fatigue and breathing aids installation.

2. Impaired gas exchange

related to: distention of pulmonary capillaries.

3. Risk for infection

related to: the invasion of microorganisms area secondary to endotracheal tube installation.

4. Ineffective tissue perfusion

related to: decreased cardiac muscle contractility.

5. Risk for Injury / trauma

related to: anxiety secondary to the installation of breathing aids.

6. Anxiety

related to: the threat of biological integrity secondary to the actual installation of breathing aids.

7. Impaired verbal communication

related to: installation of endotracheal tube.

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The Symptoms of Most Common Types of Anemia

Anemia is a condition in which the body does not have enough healthy red blood cells. Red blood cells provide oxygen to body tissues.

1. Anemia due to B12 deficiency

Vitamin B12 deficiency anemia is a low red blood cell count due to a lack of vitamin B12.

Symptoms can include:
  • Diarrhea or constipation
  • Fatigue, lack of energy, or light-headedness when standing up or with exertion
  • Loss of appetite
  • Pale skin
  • Problems concentrating
  • Shortness of breath, mostly during exercise
  • Swollen, red tongue or bleeding gums

If you have low vitamin B12 levels for a long time, you can have nerve damage. Symptoms of nerve damage include:
  • Confusion or change in mental status (dementia) in severe cases
  • Depression
  • Loss of balance
  • Numbness and tingling of hands and feet

2. Anemia due to folate deficiency

Folate-deficiency anemia is a decrease in red blood cells (anemia) due to a lack of folate. Folate is a type of B vitamin. It is also called folic acid.

Causes of this type of anemia include:
  • Too little folic acid in your diet
  • Hemolytic anemia
  • Long-term alcoholism
  • Use of certain medications (such as phenytoin [Dilantin], methotrexate, sulfasalazine, triamterene, pyrimethamine, trimethoprim-sulfamethoxazole, and barbiturates)

Symptoms :
  • Fatigue
  • Headache
  • Pallor
  • Sore mouth and tongue

3. Anemia due to iron deficiency

Iron is an important building block for red blood cells. When your body does not have enough iron, it will make fewer red blood cells or red blood cells that are too small. This is called iron deficiency anemia.

You can get iron deficiency if:
  • You lose more blood cells and iron than your body can replace
  • Your body does not do a good job of absorbing iron
  • Your body is able to absorb iron, but you are not eating enough foods with iron in them
  • Your body needs more iron than normal (such as if you are pregnant or breastfeeding)

Symptoms may include:
  • Feeling grumpy
  • Feeling weak or tired more often than usual, or with exercise
  • Headaches
  • Problems concentrating or thinking

Symptoms of the conditions that cause iron deficiency anemia include:
  • Dark, tar-colored stools or blood
  • Heavy menstrual bleeding (women)
  • Pain in the upper belly (from ulcers)
  • Weight loss (in people with cancer)

4. Anemia of chronic disease

Anemia of chronic disease is anemia that is found in people with certain long-term (chronic) medical conditions.

Conditions that can lead to anemia of chronic disease include:
  • Autoimmune disorders, such as Crohn's disease, systemic lupus erythematosus, rheumatoid arthritis, and ulcerative colitis
  • Cancer, including lymphoma and Hodgkin's disease
  • Chronic kidney disease
  • Liver cirrhosis
  • Long-term infections, such as bacterial endocarditis, osteomyelitis (bone infection), HIV/AIDS, hepatitis B or hepatitis C.

Smptoms may include:
  • Feeling weak or tired
  • Headache
  • Paleness
  • Shortness of breath

5. Hemolytic anemia

Normally, red blood cells last for about 120 days before the body gets rid of them. In hemolytic anemia, red blood cells in the blood are destroyed earlier than normal.

The first symptoms may be:
  • Feeling grumpy
  • Feeling weak or tired more often than usual, or with exercise
  • Headaches
  • Problems concentrating or thinking

If the anemia gets worse, symptoms may include:
  • Blue color to the whites of the eyes
  • Brittle nails
  • Light-headedness when you stand up
  • Pale skin color
  • Shortness of breath
  • Sore tongue

6. Idiopathic aplastic anemia

Idiopathic aplastic anemia is a condition in which the bone marrow fails to properly make blood cells. Bone marrow is the soft, fatty tissue in the center of bones.

Symptoms are the result of bone marrow failure and the loss of blood cell production.

Low red cell count (anemia) can cause:
  • Fatigue
  • Pallor (paleness)
  • Rapid heart rate
  • Shortness of breath with exercise
  • Weakness

Low platelet count (thrombocytopenia) results in bleeding, especially of the mucous membranes and skin. Symptoms include:
  • Bleeding gums
  • Easy bruising
  • Frequent or severe infections
  • Nose bleeds
  • Rash--small pinpoint red marks on the skin (petechiae)

7. Pernicious anemia

Pernicious anemia is a decrease in red blood cells that occurs when your intestines cannot properly absorb vitamin B12.

Some people do not have symptoms. Symptoms may be mild. Include:
  • Diarrhea or constipation
  • Fatigue, lack of energy, or light-headedness when standing up or with exertion
  • Loss of appetite
  • Pale skin
  • Problems concentrating
  • Shortness of breath, mostly during exercise
  • Swollen, red tongue or bleeding gums

If you have low vitamin B12 levels for a long time, you can have nervous system damage. Symptoms can include:
  • Confusion
  • Depression
  • Loss of balance
  • Numbness and tingling in the hands and feet

8. Sickle cell anemia

Sickle cell anemia is a disease passed down through families in which red blood cells form an abnormal sickle or crescent shape. Red blood cells carry oxygen to the body and are normally shaped like a disc.

When the anemia becomes more severe, symptoms may include:
  • Fatigue
  • Paleness
  • Rapid heart rate
  • Shortness of breath
  • Yellowing of the eyes and skin (jaundice)

The following symptoms may occur because small blood vessels may become blocked by the abnormal cells:
  • Painful and prolonged erection (priapism)
  • Poor eyesight or blindness
  • Problems with thinking or confusion caused by small strokes
  • Ulcers on the lower legs (in adolescents and adults)

9. Thalassemia

Thalassemia is a blood disorder passed down through families (inherited) in which the body makes an abnormal form of hemoglobin, the protein in red blood cells that carries oxygen. The disorder results in excessive destruction of red blood cells, which leads to anemia.

Children born with thalessemia major (Cooley's anemia) are normal at birth, but develop severe anemia during the first year of life.

Other symptoms can include:
  • Bone deformities in the face
  • Fatigue
  • Growth failure
  • Shortness of breath
  • Yellow skin (jaundice)

Reference :

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Symptoms and Complications of Acromegaly

Acromegaly is a syndrome that results when the anterior pituitary gland produces excess growth hormone (GH) after epiphyseal plate closure at puberty. The term acromegaly comes from Greek words meaning “extremities” and “enlargement.” Acromegaly occurs in about 6 of every 100,000 adults.

Acromegaly is a rare disease.
In the United States, the condition is newly diagnosed in about 3-4 people per million per year. About 1 person per 20,000 is estimated to have acromegaly.
The most common age at diagnosis is 40-45 years, although it can affect any age.
The condition affects all ethnic groups and strikes men and women equally.
Acromegaly can occur in children. When it does, it is called gigantism (from the word for giant), because abnormal growth of the long bones of the arms and legs makes the child unusually tall.

Acromegaly is caused by the pituitary gland overproducing growth hormone (GH) over time. The pituitary, a small gland situated at the base of your brain behind the bridge of your nose, produces a number of hormones. GH plays an important role in managing your physical growth.

Symptoms of Acromegaly
  • Body odor
  • Carpal tunnel syndrome
  • Decreased muscle strength (weakness)
  • Easy fatigue
  • Excessive height (when excess growth hormone production begins in childhood)
  • Excessive sweating
  • Headache
  • Hoarseness
  • Joint pain
  • Large bones of the face
  • Large feet
  • Large hands
  • Large glands in the skin (sebaceous glands)
  • Large jaw (prognathism) and tongue
  • Limited joint movement
  • Sleep apnea
  • Swelling of the bony areas around a joint
  • Thickening of the skin, skin tags
  • Widely spaced teeth
  • Widened fingers or toes due to too much skin growth, with swelling, redness, and pain

Complications of Acromegaly
  • Severe headache
  • Arthritis and carpal tunnel syndrome
  • Enlarged heart
  • Hypertension
  • Diabetes mellitus
  • Heart failure
  • Kidney failure
  • Colorectal cancer
  • Compression of the optic chiasm leading to loss of vision in the outer visual fields (typically bitemporal hemianopia)
  • Increased palmar sweating and sebum production over the face (seborrhea) are clinical indicators of active growth hormone (GH) producing pituitary tumors. These symptoms can also be used to monitor the activity of the tumor after surgery although biochemical monitoring is confirmatory.

Reference :

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Urinary Tract Infection (UTI) - 4 Nursing Diagnosis Interventions

NCP Urinary Tract Infection (UTI) : Nursing Diagnosis and Interventions

1. Acute Pain related to inflammation and infection of the urethra, bladder and other urinary tract structures.

Goal: Pain is reduced / lost, the spasms can be controlled.

Expected outcomes: client reported no pain on urination, no pain in the suprapubic region.

1. Monitor urine color changes, monitor the voiding pattern, input and output every 8 hours and monitor the results of urinalysis repeated.
Rationale: To identify the indications of progress or deviations from expected results

2. Note the location, time intensity scale (1-10) pain.
Rationale: To help evaluate the place of obstruction and cause pain.

3. Provide convenient measures, such as massage.
Rationale: Increase relaxation, reduce muscle tension.

4. Give perineal care.
Rational: To prevent contamination of the urethra.

5. If using a catheter, catheter treatment 2 times per day.
Rationale: The catheter provides a way for bacteria to enter the bladder and urinary tract up to.

6. Divert attention to the fun.
Rationale: Relaxation, avoid too feel the pain.

7. Collaboration of analgesics.
Rational: to control the pain.

2. Impaired Urinary Elimination related to frequent urination, urgency, and hesitancy.

Goal: improve urinary elimination pattern.

Expected outcomes: clients reported a reduction in frequency (frequent urination), urgency, and hesistensi.

1. Assess the patient's pattern of elimination.
Rationale: as a basis for determining interventions.

2. Encourage the patient to drink as much as possible and reduce drinking in the afternoon.
Rationale: To support the renal blood flow and to flush bacteria from the urinary tract. The liquid that can irritate the bladder (eg, coffee, tea, alcohol) is avoided. In order not to wake up frequently at night to urinate.

3. Encourage the patient to urinate every 2-3 hours and when it suddenly felt.
Rationale: Because it significantly lowers the number of bacteria in the urine, reduced urine status and prevent recurrence of infection.

4. Prepare / encouragement do perineal care every day.
Rationale: Reduce the risk of contamination / infection increased.

3. Disturbed Sleep Pattern related to pain and nocturia.

Goal: to improve sleep patterns.

Expected outcomes: clients reported being able to sleep, clients seem fresh.

1. Determine the usual sleeping habits and changes.
Rationale: Assess and identify appropriate interventions.

2. Provide a comfortable bed.
Rationale: Improve sleeping comfort and support of physiological / psychological.

3. Increase comfort bedtime regimen, for example, a warm bath and a massage, a glass of warm milk.
Rationale: Increases the effect of relaxation. Note: The milk has sopofik quality, boost the synthesis of serotonin, a neurotransmitter that helps patients and sleep longer.

4. Reduce noise and light.
Rationale: Provide a situation conducive to sleep.

5. Instruct relaxation measures.
Rationale: Helps induce sleep.

4. Hyperthermia related to the reaction to iflamation.

Goal: body temperature back to normal.

Expected outcomes: client reported no fever, no palpable heat, vital signs within normal limits.

1. Assess any complaints or signs of increased body temperature changes.
Rationale: Increased body temperature will shows a variety of symptoms such as red eyes and the body feels warm.

2. Observation of vital signs, especially temperature, as indicated.
Rationale: To determine interventions.

3. Warm water compress on the forehead and both axilla.
Rationale: To stimulate the hypothalamus to the temperature control center.

4. Collaboration of antipyretic drugs.
Rationale: Controlling fever.

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Decreased Cardiac Output - NCP Heart Failure

Heart failure or congestive heart failure occurs when the heart is unable to provide sufficient pump action to distribute blood flow to meet the needs of the body.

Heart failure can be caused by coronary artery disease, heart attack, cardiomyopathy, and high blood pressure.

Heart failure treatment includes exercise, dietary changes, medicines, and rarely surgery.

There are three main types of heart failure. They are:
  • heart failure due to left ventricular systolic dysfunction (LVSD) - due to the part of the heart that pumps blood around your body (the left ventricle) becoming weak
  • heart failure with preserved ejection fraction (HFPEF) - usually due to the left ventricle become stiff, causing difficulty in filling with blood
  • heart failure due to valve disease

Nursing Diagnosis: Decreased Cardiac Output related to:
  • Changes in myocardial contractility / inotropic changes,
  • Changes in frequency, rhythm and electrical conduction, changes
  • structural,

characterized by;
  • Increased heart rate (tachycardia): dysrhythmias, changes in ECG pattern picture.
  • Changes in blood pressure (hypotension / hypertension).
  • Extra sound (S3 and S4).
  • Decrease in urine output.
  • Peripheral pulse was not palpable.
  • Dull winter skin.
  • Orthopnea, krakles, liver enlargement, edema and chest pain.

The client will:
  • Showed vital signs within acceptable limits (dysrhythmias can be in control or lost) and free of heart failure symptoms.
  • Reported a reduction in episodes of dyspnea, angina.
  • Participate in activities that reduce the heart's workload.

Nursing Intervention:

1. Auscultation apical pulse; examine the frequency, heart rhythm.
Rational: Usually tachycardia (although at rest) to compensate for decreased ventricular contractility.

2. Record heart sounds
Rational: S1 and S2 may be weak due to reduced pumping work. Common Gallop rhythm (S3 and S4). Murmurs can indicate incompetence / stenosis.

3. Peripheral pulse palpation
Rationale: Decreased cardiac output may indicate decreased radial artery, popliteal, dorsalis, pedis and posttibial. Pulse may disappear fast or irregular to palpation and pulse alternan.

4. Monitor blood pressure.
Rationale: In chronic heart failure early, moderate or chronic, blood pressure may rise. In advanced CHF, the body can no longer compensate and hypotension can not be normal again.

5. Assess the pale skin and cyanosis.
Rational: Pale indicating reduced peripheral perfusion secondary to inadequate cardiac output; vasoconstriction and anemia. Areas affected often blue or striped because of increased venous congestion.

6. Give supplemental oxygen by nasal cannula / mask and drugs as indicated (collaboration)
Rationale: Increase dosage myocardial oxygen to the need to counter the effects of hypoxia / ischemia. Many drugs can be used to improve contractility and reduce congestion.

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11 Nursing Diagnosis related to Typhoid Fever

Typhoid fever is a bacterial disease, caused by Salmonella typhi. It is transmitted through the ingestion of food or drink contaminated by the faeces or urine of infected people.

Salmonella Typhi lives only in humans. Persons with typhoid fever carry the bacteria in their bloodstream and intestinal tract. In addition, a small number of persons, called carriers, recover from typhoid fever but continue to carry the bacteria. Both ill persons and carriers shed Salmonella Typhi in their feces (stool).

Typhoid fever can also be caused by Salmonella paratyphi, a related bacterium that usually leads to a less severe illness. The bacteria are deposited in water or food by a human carrier and are then spread to other people in the area. Typhoid fever is rare in industrial countries but continues to be a significant public-health issue in developing countries.

Early symptoms include fever, general ill-feeling, and abdominal pain. A high (typically over 103 degrees Fahrenheit) fever and severe diarrhea occur as the disease gets worse.

Other symptoms that occur include : Abdominal tenderness, Agitation, Bloody stools, Chills, Confusion, Difficulty paying attention (attention deficit), Delirium, Fluctuating mood, Hallucinations, Nosebleeds, Severe fatigue, Slow, sluggish, lethargic feeling, weakness.

Two basic actions can protect you from typhoid fever:
  • Avoid risky foods and drinks.
  • Get vaccinated against typhoid fever.
It may surprise you, but watching what you eat and drink when you travel is as important as being vaccinated. This is because the vaccines are not completely effective. Avoiding risky foods will also help protect you from other illnesses, including travelers' diarrhea, cholera, dysentery, and hepatitis A.
Fluids and electrolytes may be given through a vein (intravenously), or you may be asked to drink uncontaminated water with electrolyte packets.

Appropriate antibiotics are given to kill the bacteria. There are increasing rates of antibiotic resistance throughout the world, so your health care provider will check current recommendations before choosing an antibiotic.

11 Nursing Diagnosis for Typhoid Fever

1. Ineffective Breathing Pattern
related to: the imbalance of oxygen supply to the needs, dyspnea.

2. Imbalanced Body Temperature: Hyperthermia
related to the inflammatory process typhi salmonella germs.

3. Acute Pain related to the inflammatory process.

4. Disturbed Sleep Pattern related to pain, fever.

5. Imbalanced Nutrition, Less Than Body Requirements related to inadequate intake.

6. Risk for Fluid Volume Deficit related to inadequate intake and increased body temperature.

7. Altered Bowel Elimination related to constipation.

8. Disturbed Sensory Perception : Visual. related to loss of consciousness.

9. Impaired Physical Mobility related to intake of weakness.

10. Self-Care Deficit : Bathing / Hygiene related to weakness.

11. Anxiety: parents related to lack of knowledge about the disease and the child's condition.

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Sample of NCP for Hepatitis - Acute Pain

Some of the symptoms associated with hepatitis C can cause pain. People with hepatitis C may experience episodes of abdominal pain. Pain or soreness on the right side just below the ribs could be from the liver. The pain may come and go, or, for a few patients, it may persist. This sort of pain may be caused by a stretching of the outer edge of the liver, but it does not mean the hepatitis C is worsening.

People with hepatitis C may experience muscle and joint pain. Common sites of joint pain are the hips, knees, fingers, and spine, although any joint can be a source of pain. Pain associated with hepatitis C can move around and come and go. Aches and pains in the muscles are usually experienced as a generalised feeling. However, some people report having pain in only one area of the body.

If there is abdominal pain due to hepatitis C, treating the hepatitis C with pegylated interferon and ribavirin will not necessarily change any abdominal pain which is experienced. The treatment of hepatitis C is not expected to better, worsen or have any effect on abdominal pain.

Some people find benefit in complementary and alternative therapies, such as herbal products or massage. It is best to be advised by a qualified complementary/alternative professional about any therapies or products that could be useful. If you pursue complementary and alternative therapies it is important that you tell your liver specialist and GP of any therapies that you have recently used, are using, or plan to use.

Nursing Diagnosis for Hepatitis: Acute Pain related to hypertrophy of the liver (Hepatomegaly)

characterized by:
Subjective data:
  • client complains of pain when pressed on the upper right quadrant.
  • client says prickling pain.

Objective data:
  • client wince when in press the upper quadrant of the abdomen.
  • there is enlargement of the right upper quadrant of the abdomen.
  • pain scale: 3

After nursing actions for 3x24 hours, the pain resolved.

Expected outcomes:
  • clients feel comfortable.
  • pain scale was reduced to 2.

Nursing Interventions :
  • Observation of vital signs every 6 hours.
  • Assess pain scale.
  • Train client relaxation techniques with a deep breath.
  • Adjust the position of the client as comfortable as possible and stick to bed rest when patients have impaired comfort to the abdomen.
  • Divert attention to the client's pain to talk, read newspapers.
  • Collaboration with physicians for providing analgesic.

  • To determine the patient's general condition.
  • To know the state of pain that feels.
  • Relaxation techniques with deep breathing relaxation can lessen pain.
  • Reduce muscle tension, reduce metabolic needs and protect the liver.
  • By diverting the attention of the client does not focus on the pain
  • Reduce gastrointestital instability and pain and comfort to the abdominal disorders.

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Nursing Care Plan for Tinnitus

Tinnitus is a ringing, swishing, or other type of noise that seems to originate in the ear or head. Sometimes the noise pulsates at the same rate as your pulse. Tinnitus can be either constant or come and go. It can vary in loudness and character from time to time.

According to the National Institute on Deafness and Other Communication Disorders (NIDCD), almost 12 percent of men who are 65 to 74 years of age are affected by tinnitus. In many cases it is not a serious problem, but rather a nuisance that eventually resolves. Rarely, however, tinnitus can represent a serious health condition.

Tinnitus can arise in any of the four sections of the hearing system: the outer ear, the middle ear, the inner ear, and the brain. Some tinnitus or "head noise" is normal.

One of the most common causes of tinnitus is damage to the microscopic endings of the hearing nerve in the inner ear. Advancing age is generally accompanied by a certain amount of hearing nerve impairment, and consequently chronic tinnitus.

There are a number of causes which may provide the initial trigger including:
  • middle ear infection
  • dental or jaw problems
  • some medications
  • exposure to loud noises
  • inner ear damage.
Nursing Diagnosis and Interventions :

1. Anxiety
related to the lack of information about hearing loss (tinnitus)

Goals / outcomes:
  • knowledge of the disease increases.

  • Assess the level of anxiety / fear.
  • Assess the client's level of knowledge about the disorder.
  • Educate about tinnitus.
  • Assure the client that the disease can be cured.
  • Encourage clients to relax and avoid stress.

2. Disturbed Sleep Pattern
related to hearing loss

Goals / outcomes:
  • Sleep disorders can be overcome or adapted

  • Assess the level of difficulty sleeping.
  • Collaboration in sedation / sleep medications.
  • Encourage clients to adapt to the disorder.

3. Risk for Social Isolation
related to communication barriers

Goals / outcomes:
  • Risk of damage can minimize social interaction.
  • Assess hearing difficulties.
  • Assess how severe the hearing loss in the client experience.
  • If possible, help clients understand nonverbal communication.
  • Encourage clients with hearing aids every in need if available.

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Impaired Skin Integrity related to Impetigo

Impetigo is a skin infection caused by bacteria. It causes red sores that can break open, ooze fluid, and develop a yellow-brown crust. Usually the cause is staphylococcal (staph) but sometimes streptococcus (strep) can cause it, too. It's very common and affects mainly children. These sores can occur anywhere on the body but most often appear around the mouth and nose.

There are two types of impetigo:

bullous impetigo, which causes large, painless, fluid-filled blisters
non-bullous impetigo, which is more contagious than bullous impetigo and causes sores that quickly rupture (burst) to leave a yellow-brown crust

Symptoms of impetigo :
  • On the skin, especially around the nose or mouth. The sores begin as small red spots, then change to blisters that eventually break open. The sores are generally not painful, but they may be itchy.
  • That ooze fluid and look crusty. Sores often look like they have been coated with honey or brown sugar.
  • That increase in size and number. Sores may be as small as a pimple or larger than a coin.

To minimise the risk of impetigo spreading, it's also advisable to:
  • avoid touching the sores
  • wash your hands regularly
  • not share flannels, sheets or towels
  • keep children off nursery, playgroup or school until their sores have dried up

Nursing Diagnosis and Interventions

Impaired Skin Integrity related to lesions and mechanical injury (scratching the itchy skin)

Expected outcomes :
  • No injuries or lesions on the skin.
  • Good tissue perfusion.
  • A good skin integrity can be maintained (sensation, elasticity, temperature)
  • Able to protect skin and keep skin moist and natural treatments.

Interventions and Rational :

1. Keep clean skin, to keep them clean and dry.
Rational: the skin clean and dry, will reduce the spread or proliferation of bacteria.

2. Instruct the patient to use, loose clothing.
Rational: a loose shirt, shirt will reduce friction on the skin lesions.

3. Monitor skin color, the existence of redness.
Rational: to know the progression of the disease and the effectiveness of actions taken.

4. Cut nails and keep the client's hand hygiene.
Rational: the nail that will reduce the short and avoid scratching the impetigo lesion severity.

5. Bathe the patient with warm water and soap (antiseptic).
R: warm water will kill bacteria and reduce the rash. Anti-septic soap can reduce or kill the bacteria on the skin.

6. Give the knowledge of the client not to scratch the wound.
Rational: the knowledge of patients on the treatment process can accelerate the success of the nursing process.

7. Collaboration for the administration of topical antibiotics on the client.
Rational: topical antibiotic may discontinue or inhibit the growth of bacteria.

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