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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7 Nursing Diagnosis for Acromegaly

Acromegaly is a hormonal disorder that most commonly occurs in middle-aged men and women. This causes various symptoms which slowly develop over several years. In most cases it is the result of a tumor developing within the gland. In over 99 in 100 cases, the excess hormone comes from a small tumour (growth) in the pituitary gland. This is a benign (non-cancerous) growth called a pituitary adenoma. The adenoma may grow up to 1-2 cm across. The changes caused by this growth hormone excess are not noticeable straight away, but will vastly change the person's appearance after a number of years. Treatment options include surgery to remove the tumour and medicines to block the release or effects of growth hormone.

Acromegaly is rare. About 3 or 4 people in a million develop acromegaly each year in the UK. It mainly first develops in adults between the ages of 25-40. Men and women are equally affected.

According to Medilexicon's medical dictionary acromegaly is:

"A disorder marked by progressive enlargement of peripheral parts of the body, especially the head, face, hands, and feet, resulting from excessive secretion of somatotropin; organomegaly and metabolic disorders occur; diabetes mellitus may develop."

A person suffering acromegaly will experience a change in their physical appearance and other characteristics. These may include:
  • a large jaw
  • gaps between the teeth
  • a more prominent brow
  • the soft spot of their skull appears expanded
  • hands shaped like spades
  • a lack of sensation and tingling in hands and feet
  • rough and oily skin
  • skin tags
  • heavy sweating
  • headaches
  • large tongue
  • deeper voice
  • impaired vision
  • large feet
  • swelling of internal organs (particularly the heart)

Nursing Diagnosis for Acromegaly

1. Disturbed body image

related to : enlargement of body parts as manifested by enlarged hands, feet and jaw.

2. Ineffective coping

related to : change in appearance as manifested by verbalization of negative feeling about the change in appearance.

3. Disturbed sensory perception

related to : enlarged pituitary gland as manifested by protrusion of eye balls.

4. Disturbed sleeping pattern

related to : soft tissue swelling as manifested by verbalization of the patient about insomnia.

5. Fluid volume deficit

related to : polyuria as manifested by excessive thirst of the patient.

6. Anxiety

related to : change in appearance and treatment as manifested by verbalization of the patient about body appearance.

7. Knowledge deficit : regarding development of disease and treatment as manifested by repeated questions by the patient regarding disease and treatment.

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Preoperative and Postoperative Otosclerosis - Nursing Diagnosis

Surgical treatment has been available for about 45 years. The first operation for this disease was the fenestration procedure, which required mastoid surgery and an artificial opening in another part of the inner ear. The attention of the ear surgeons then became focused on the diseased stapes itself and the stapes mobilization procedure was developed. With the improvement in surgical technique, the treatment of choice then became the stapedectomy. This operation was first performed in 1956.

The stapedectomy operation involves the removal of the diseased bone and its replacement with an artificial substitute. Local or general anesthesia is used. The surgery usually takes place entirely through the ear canal so that no outer incisions are made.

Nursing Care Plan for Otosclerosis

Otosclerosis Preoperative Nursing Diagnosis

1. Disturbed Sensory Perception: Auditory
related to decreased sensory reception.

2. Impaired Verbal Communication
related to loss of facial muscle control.

3. Acute Pain
related to the suppression of bone mass in the ear.

4. Self-esteem disturbance
related to changes in body function.

5. Risk for Injury
related to the vertigo.

6. Activity intolerance
related to the vertigo.

7. Anxiety
related to the crisis situation.

8. Knowledge Deficit
related to not know the information.

Otosclerosis Postoperative Nursing Diagnosis

1. Impaired Skin Integrity
related to an incision in the skin of the ear tissue.

2. Acute Pain
related to extensive ear surgery.

3. Self-esteem disturbance
related to changes in the skin barrier in the presence of scar tissue.

4. Risk for Infection
related to tissue damage secondary to ear surgery.

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Nursing Care Plan for Otosclerosis (Postoperative)

Otosclerosis is a condition of the middle ear and mainly affects the tiny stapes bone. It causes gradual hearing loss. Treatments include hearing aids and surgery. The ossicles (bones) become knit together into an immovable mass, and do not transmit sound as well as when they are more flexible. Otosclerosis can also affect the other ossicles (malleus and incus) and the otic capsule.

The human ear is divided into three parts: the external, middle, and inner ear. The external ear gathers surrounding sounds and directs them toward the ear drum. This results in vibration of the ear drum and the three small bones of hearing called the malleus ("hammer"), incus ("anvil") and the stapes ("stirrup"). This mechanical energy is then converted to electrical energy by the inner ear and is subsequently transmitted to the brain and results in what we call “hearing”.

In most cases, it is just the stapes which is affected. However, sometimes, over time, otosclerosis can also affect the bony shell of the cochlea and the nerve cells within it. If this is the case, the damage to the nerve cells means that the transmission of nerve impulses to the brain can be affected. A different type of hearing loss, called sensorineural hearing loss, can then occur.

Symptoms of Otosclerosis

The hearing loss associated with otosclerosis usually starts around age 20 but it may begin anytime between the age of 15 and 45. Both ears may be affected in 80% of patients. Balance problems (including unsteadiness, vertigo, or other sensations of motion) may occur in 25-30% of patients. Approximately 75% of patients with otosclerosis will develop a ringing or “rushing” sound in the affected ear (called tinnitus).

Treatment for Otoscerlosis

For a mild case, no treatment may be needed, or just hearing aids. For more severe cases, a surgery called stapedectomy may resolve the situation. In a stapedectomy, the "bad" stapes middle ear bone is taken out and replaced with a prosthesis.

Postoperative Care of Otosclerosis
  1. Do not blow your nose for three weeks following surgery. If you sneeze or cough keep your mouth open.
  2. Avoid any heavy lifting (over 4 kg), straining or bending for three weeks following surgery
  3. Keep your head elevated as much as possible. Sleep and rest on 2-3 pillows if possible.
  4. Do not get water in your ear. If showering/washing your hair, place a cotton wool ball coated in Vaseline in the car canal to seal it. If there is a separate incision keep this dry until your first post-operative visits.
  5. If you wear glasses either remove the arm on the operated side, or make certain that it does not rest on the incision behind your ear for one week.
  6. Replace the cotton wool ball daily until your first post-operative visit.
  7. Take your oral antibiotic as prescribed.
  8. You may use Panadol, Panadeine or Panadeine Forte for pain. Do NOT use Aspirin or other analgesics.
  9. If there is a separate incision a small amount of drainage may occur from this area also. If the drainage is profuse or develops a foul odour contact us.
  10. Popping sounds, a plugged sensation, ringing or fluctuating hearing may be occur during healing.
  11. Avoid travel by air for three weeks following surgery.
  12. If you should notice any swelling, redness or excessive pain, contact us.
  13. Some dizziness may occur after surgery. If severe or is associated with nausea or vomiting, contact us.
  14. Please contact our office to make an appointment to be seen 7-10 days after the time of your surgery unless stated otherwise by your physician.
Reference :

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Tips for Caring for Stroke Patients at Home

Only one key is needed in caring for stroke patients in the home, with extraordinary patience. Why is it amazing? Because, with patience levels are normal, not be able to provide good care.

It should be understood that the stroke patient, emotionally experiencing deterioration of the situation themselves. Previously, they could go even run, can speak to sing, can feed themselves as they pleased, and now all the circumstances that changed, becoming dependent on others so that the patient feels generally useless maybe even to depression.

Tips for Caring for Stroke Patients at Home

1. Care of stroke patients should be more than one, so that the work can be divided.

2. Select rooms are close to the bathroom, dining room, or kitchen.

3. Arrange furniture or equipment that is easy to use by the patient.

4. Ensure high bed of the patient, in accordance with the activities of daily care and use leak-proof layer between the mattress and sheets.

5. Create an atmosphere of calm and pleasant. Avoid talking about the inability of the patient. Do not force the patient to do something. We recommend using the advice or persuasion.

6. Help patients to take care of themselves, the extent to which that can be done, encourage the patient to take responsibility for training activities undertaken.

7. Praise all efforts.

8. Do not assume that the patient can not use his mind. Keep the same relationship as before he suffered a stroke.

9. Help the patient to maintain a relationship with the outside world and other people just like before the patient suffered a stroke.

10. Frequently invite the patient to get out of bed, and if the patient is not able, take a seat while eating food. If at all possible, help with frequently turned to prevent pressure sores.

11. If possible, help patients move in his own abilities.

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Nursing Care Plan for Gout

Gout is a metabolic disorder that is due to abnormal metabolism of purines, a constituent of many foods. Gout occurs with the buildup of uric acid in the joints and kidneys. Essentially what happens is that the excretion of uric acid, which is the product of purine metabolism, does not keep pace with uric acid production. As a result there is abnormal accumulation of uric acid. As such it was also known as "The disease of the kings".

This situation is observed in cases where the kidneys become impaired and are incapable of excreting uric acid from the body in the normal way. The excess uric acid present in blood in such situations precipitates in the tissues.

Food and drinks that mostly contribute to gout attacks include seafood, red meat, organ meat, high-fructose corn syrup, sugar-sweetened items that are usually popular during the holidays and beer and liquor.

The typical early manifestations of gout are acute episodes of painful swollen joints. The usual sites of the first attacks are the big toe, the foot, and the ankle. If gout is not treated, uric acid accumulation worsens and other joints become inflamed and attacks become more frequent and debilitating. Besides being excruciatingly painful, the attacks also cause damage to joints and to internal organs such as the kidneys.

In the middle of the night, if you suddenly experience intolerable pain in any of your joints accompanied by inflammation, redness and stiffness of the joint, then you are experiencing a gout attack. Sometimes high fever may also be observed along with a gout attack. The skin surrounding the gout affected joint tends to peel off. Small pressure on the joint may aggravate the excruciating pain. As such walking or even standing up becomes an arduous task.

A number of studies have now identified the major contributing factors to gout. These include obesity, alcohol (especially beer), red meat, shellfish, and fructose containing beverages. The latter include both soft drinks as well as processed fruit juices.

Allopurinol is the pharmaceutical drug of choice used in long-term prevention of gout and decreases the body's production of uric acid. People experiencing gout attacks should, however, avoid medications containing aspirin as these can make gout worse. Pain relievers such as paracetamol or other more powerful analgesics, are often used to manage the pain. Anti-inflammatories, such as non-steroidal anti-inflammatory drugs (NSAIDs), are used to decrease joint inflammation and reduce the pain. If NSAIDs cannot be given because of an ulcer, your doctor may use colchicine may be used to settle an attack. I have found the homeopathic colchicines (30c) can be very useful for the gout patient instead of this drug. Do you take a "water tablet" or a diuretic? Pharmaceutical diuretics may cause gout in people who are genetically predisposed to gout by increasing the accumulation of uric acid within the body.

Nursing Diagnosis for Gout

1. Acute / Chronic Pain

2. Impaired Physical Mobility

3. Knowledge Deficit

Nursing Diagnosis and Interventions :

Acute / Chronic Pain

Goal : Comfortable feeling fulfilled or avoid pain

Nursing Interventions :

1. Provide a comfortable position, joint pain (leg) rested and given bearing. Rest can reduce local metabolism and reduce joint movement occurs.

2. Give warm or cold compresses can provide vasodilating effects, both have the effect of helping expenditure endorphins and cold can inhibit pain impulses.

3. Prevent to avoid irritation, such as avoiding the use of a narrow shoe, tripping over a hard object. If irritation persists it will be more painful, so take care if there is a sterile wound and drain care also attached to the wound.

4. Give the drugs according to the prescription and observe the side effects of these drugs.

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Osteoarthritis - 7 Nursing Diagnosis Nanda

Osteoarthritis is the most common form of arthritis. Osteoarthritis is a joint disease that most often affects middle-age to elderly people. It causes pain, swelling, and reduced motion in the joints. It can occur in any joint, but usually it affects the hands, knees, hips or spine.

Risk factors for osteoarthritis include
Being overweight
Getting older
Injuring a joint

Osteoarthritis is characterized by the following symptoms:
Joint pain
Joint stiffness
Joint tenderness
Limited range-of-motion
Crepitus (crackling, grinding noise with movement)
Joint effusion (swelling)
Local inflammation
Bony enlargements and osteophyte formation

Most often doctors detect OA based on the typical symptoms (described earlier) and on results of the physical exam. In some cases, X-rays or other imaging tests may be useful to tell the extent of disease or to help rule out other joint problems.

1. Chronic Pain
related to:
muscle spasm,
surgical procedures
chronic joint disease,

2. Anxiety
relate to:
operative procedures

3. Risk for Injury
related to:
mobility changes secondary to osteoarthritis

5. Risk for Infection
related to:
inadequate secondary defenses,
Long-term use of corticosteroids,
manipulation invasive surgical procedures,
decreased mobility.

6. Impaired Physical Mobility
related to:
pain and discomfort,
muskoleskeletal disorder,
surgical therapy

7. Knowledge Deficit: about condition, prognosis, and treatment needs
related to:
lack of information.

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Pathophysiology of Brain Tumors

Nursing Care Plan for Brain Tumors

Brain tumors cause progressive neurological disorder. Neurologic disorders in brain tumors typically considered to be caused by two factors: focal disruption caused by the tumor and increased intracranial pressure.

Focal disturbance occurs when there is an emphasis on brain tissue, and infiltration or direct invasion of the brain parenchyma with damage to neuronal tissue.

Changes in blood supply due to the pressure caused by the growing tumor causing brain tissue necrosis. Impaired arterial blood supply is generally manifest as an acute loss of function and may be confused with primary cerebrovascular disorders.

Seizures as symptoms change in sensitivity of neurons associated with compression of the invasion and changes in blood supply to the brain tissue. Some of the tumor, forming a cyst that also suppress the surrounding brain parenchyma so that aggravate focal neurological disruption.

Increased intracranial pressure can be caused by several factors: the increase of the mass in the skull, the formation of edema around the tumor, and changes in the circulation of cerebrospinal fluid.

Some tumors can cause bleeding. Venous obstruction and edema caused by damage to the blood brain barrier, all lead to an increase intracranial volume and increased intracranial pressure.

Obstruction of the circulation of cerebrospinal fluid from the lateral ventricle into the subarachnoid space causing hydrocephalus. Increased intracranial pressure would endanger lives. Compensation mechanism takes time to become effective and therefore useless if the intracranial pressure arise quickly.

This compensation mechanism among other works lowering intracranial blood volume, cerebrospinal fluid volume, intracellular fluid content and reduce parenchymal cells, the increase in pressure resulting in untreated unkus or cerebellar herniation, arising, bilagirus medial temporal lobe, sliding through a notch inferior territorial by the mass of the brain hemispheres. Herniation pressing mesensenfalon, causing loss of consciousness and hit the nerve of the third brain. Oblogata cord compression and stop breathing occur quickly.

Other physiological changes caused by increased intracranial fast is progressive bradycardia, systemic hypertension (widening pulse pressure), and respiratory disorders.

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Symptoms and Treatment of Brain Tumors and Brain Cancer

A tumor is an abnormal growth of body tissue. Tumors can be cancerous (malignant) or noncancerous (benign).

A brain tumor is an abnormal growth of cells within the brain, which can be cancerous or non-cancerous (benign).

Primary (true) brain tumors are commonly located in the posterior cranial fossa in children and in the anterior two-thirds of the cerebral hemispheres in adults, although they can affect any part of the brain.

Brain tumors can be grouped by the type of cell involved (such as meningioma, astrocytoma, lymphoma, etc.) or by the location in the brain. Metastasized cells may grow in one or several areas of the brain. Almost half of all brain tumors are non-cancerous (benign), slow growing and respond well to treatment.

A primary malignant brain tumour is a cancer which arises from a cell within the brain. The cells of the tumour grow into and damage normal brain tissue. Also, like benign brain tumours, they can increase the pressure inside the skull. However, unlike most other types of malignant tumours, primary brain tumours rarely spread (metastasise) to other parts of the body.

A secondary malignant brain tumour means that a cancer which started in another part of the body has spread to the brain. Many types of cancer can spread (metastasise) to the brain. The most common types that do this are cancers of the breast, lung, colon, kidney and skin (melanoma).

Brain Cancer Symptoms

Symptoms can be caused by:
  • A tumor pressing on or encroaching on other parts of your brain and keeping them from functioning normally.
  • Swelling in the brain caused by the tumor or surrounding inflammation.
  • The symptoms of primary and metastatic brain cancers are similar.

The following symptoms are most common:
  • Headache
  • Weakness
  • Clumsiness
  • Difficulty walking
  • Seizures

Other nonspecific symptoms and signs include the following:
  • Altered mental status -- changes in concentration, memory, attention, or alertness
  • Nausea, vomiting -- especially early in the morning
  • Abnormalities in vision
  • Difficulty with speech
  • Gradual changes in intellectual or emotional capacity

Treatment of Brain Tumors

When possible, brain tumors are removed through surgery. While many can be removed with little or no damage to the brain, others are located where surgical removal is difficult or impossible without destroying critical parts of the brain.

Brain damage caused by surgery can lead to partial paralysis, changes in sensation (feeling), weakness and poor thinking. Even so, removing a tumor is necessary when it threatens important brain structures. Even when it can't cure a malignancy, surgery can help reduce the size of the tumor, ease symptoms and help determine the type of tumor and best treatment.

Other treatments for brain tumors include: Radiation, Chemotherapy, Stem cell transplantation

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Nursing Intervention for Hospitalization - Play Therapy

The focus of nursing interventions:
  • Minimize stressors
  • Maximize the benefits of hospitalization provide psychological support to family members
  • Prepare the child before entering the hospital

1. Efforts to minimize stressors can be done by:
  • Prevent or reduce the impact of separation
  • Prevent feelings of loss of control
  • Reduce / minimize the fear of injury and body pain

2. Efforts to prevent / minimize the impact of separation
  • Involving parents take an active role in childcare
  • Modification of the treatment room
  • Maintain contact with school activities: correspondence, meeting classmates

3. Prevent feelings of loss of control:
  • Avoid physical restrictions if the child can be cooperative.
  • When children do modifications isolated environment
  • Create a schedule for the therapeutic procedure, exercise, play
  • Giving children the opportunity to make decisions and involve parents in planning activities.

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

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

6. Preparing children for treatment in hospital
  • Prepare the treatment room according to the stage of the child's age.
  • Orient the hospital situation.

On the first day you should take:
  • Introduce nurses and doctors
  • Introduce the patient to another.
  • Give the identity of the child.
  • Explain the rules of the hospital.
  • Implement assessment
  • Perform a physical examination

Play Therapy

Definition of play
  • Natural way for children to express the conflict within him unconscious.
  • Activities carried out in accordance with his own wishes to obtain pleasure.

Play is an activity
  • fun / enjoyable
  • physical
  • intellectual
  • emotion
  • social
  • to learn
  • mental development
  • play and work

Purpose of playing in the hospital
  • To be able to resume normal growth and development during hospitalization.
  • To express their thoughts and feelings and fantasies through the game.

Principles of play in hospital
  • does not require a lot of energy
  • time is short
  • easy to do
  • safe
  • age group
  • not opposed to therapy
  • involving the family

Function plays
  • sensory motor activity
  • cognitive development
  • socialization
  • creativity
  • therapeutically moral development
  • communication

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Nursing Care Plan for Pulmonary Atelectasis

Impaired Gas Exchange and Ineffective Airway Clearance

1. Impaired Gas Exchange related to
  • alveolar-capillary membrane dysfunction (inflammatory effect)
  • impaired oxygen-carrying capacity

Goal: patients showed improved ventilation and oxygenation of tissues

Expected outcomes:
  • gas exchange can be maintained


Independent :

1. Assess the depth of breathing frequency.
R / to evaluate the degree of respiratory distress or respiratory disease process.

2. Elevate head of bed, help patients choose a position that is easy to breathe, encourage the patient to deep breathing, or mouth breathing.
R / oxygen delivery can be improved with a high seating position and breathing exercises to reduce airway collapse.

3. Auscultation of breath sounds, defect area decreased airflow / noise addition, (crackles, wheezing, dim).
R / breath sounds may be dim due to reduced air flow, indicates the presence of wheezing bronchospasm.

4. Palpation fremitus (vibration vibration on palpation)
R / vibration reduction suspected fluid collection.

5. Evaluation of the level of activity tolerance.
R / for respiratory distress severe / acute, the patient is totally unable to perform daily activities

6. Monitor vital signs and cardiac rhythm.
R / tachycardia and changes in blood pressure that may indicate the existence of systemic hypoxemia on cardiac function.


7. Supervise / picture series blood gas analysis and pulse
R / PaCO2 usually increases (bronchitis, emphysema) and PaCO2 generally decreased, resulting in hypoxia.

8. Give supplemental oxygen in accordance degan indicative of the results of blood gas analysis and patient tolerance.
R / improve or prevent worsening hypoxia

9. Assist patients in intubation, provide / maintain mechanical ventilation.
R / occurrence of respiratory failure that requires rescue efforts will come alive.

2. Ineffective Airway Clearance related to increased production of sputum

Goal: patients exhibit achieve airway clearance.

Expected outcomes:
Clients can maintain effective airway


1. Auscultation of breath sounds, record the presence of breath sounds, eg wheezing, crackles.
R / some degree of bronchial spasms occur with airway obstruction and there adventisius breath.

2. Assess the frequency and depth of breathing chest movement
R / breathing shallow and asymmetrical chest movements often occur because of discomfort chest wall movement / lung fluid.

3. Give fluids at least 2500 ml / day, unless contraindicated, offer warm water.
R / liquid (especially hot water) to mobilize

4. Observation color skin, mucous membranes and nails
R / cyanosis nails shows the vasoconstriction, cyanosis of mucous membranes and the skin around the mouth indicates systemic hypoxemia.


1. Give medication as indicated
R / relaxes smooth muscle and reduce local congestion

2. Provide additional humidifier, eg ultranik nebulizer, aerosol humidifier room
R / humidity decrease the viscosity of secretions and facilitate secret spending.

3. Provide respiratory treatment, eg, chest physiotherapy
R / postural drainage and percussion parts esse

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Nursing Management of Nephrotic Syndrome

Nephrotic Syndrome


Nephrotic syndrome is a condition where there is a change in renal function, which is characterized by:
  • hypoproteinemia
  • edema
  • hyperlipidemia
  • proteinuri
  • ascites
  • decrease in urine output

The existence of the glomerular injury is usually followed by a:
  • proteinuria
  • hypoalbuminemia
  • hyperlipemia
  • edema
  • proteinuria increased
  • increased glomerular permeability to protein loss
  • plasma.

  • Primary renal parenchymal disease
  • Acute post-streptococcal glomerulonephritis
  • Idiopathic Glomerular
  • Systemic Diseases
  • DM, renal abnormalities that are characteristic of diabetes is diabetic nephropathy
  • Amyloidosis / associated with chronic diseases such as tuberculosis, chronic osteomiliti, lung abscess, ulcerative colitis and neoplasms.
  • SLE is known as lupus nephritis. SN is a clinical manifestation of SLE
  • Mechanical circulatory disorders
  • Renal vein thrombosis
  • The increase in renal venous pressure can lead to increasing the basal membrane permeability resulting in leakage of plasma
  • Right heart syndrome
  • Proteinurin to congestive heart disease.

  • In nephrotic syndrome, type III hypersensitivity reaction occurs in which the immune complex precipitated in the tissue.
  • Activation of the complement system also stimulates vaksoaktive amines (including histamine) and this substance causes retraction of endothelial cells thus increasing vascular permeability.
  • Changes in membrane glomerolus, causing increased permeability, allowing the proteins (especially albumin) out through the urine (proteinurine).
  • Decreased oncotic pressure causing albumin moves from intra vascular space into interstitiel.
  • Transfer of proteins to the interstitial cavity causing lipoproteinemia.
  • It stimulates the liver to compensate by increasing the production of lipoproteins and increased concentrations of blood fats (hyperlipidemia).
  • When the liver is not able to compensate for damage in fat and protein metabolism.
  • Transfer of protein exit the vascular system, causing fluid to move into the space plasma interstitisel resulting edema and hypovolemia.
  • Decrease in vascular volume stimulates renin angiotensin system, which allows the secretion of aldosterone and antidiuretic hormone (ADH).
  • Aldosterone stimulates increased reabsorsi distal tubules of the sodium and water, leading to increased edema.

Clinical Manifestas
  • weight increased
  • anorexia
  • edema anasarca
  • abdominal pain
  • swelling of the face, especially around the eyes
  • voleme urine decreased, sometimes colored thick and foamy
  • pale skin
  • the child becomes irritable, tiredness / lethargy
  • celulitis, pneumonia, peritonitis or sepsis
  • azotemia
  • blood pressure is usually normal / up slightly
Nursing Management of Nephrotic Syndrome
a. Focus Assessment
  • Urinary System (oliguric, urine retention, proteinurin and urine discoloration).
  • Fluid and electrolyte balance (excess fluid, edema, ascites, weight gain, dehydration)
  • Circulation (increased blood pressure)
  • Neurology (decreased level of consciousness due to dehydration)
  • Breathing (shortness of breath, tachypnea)
  • Mobility (redness, malaise)

b. Nursing Diagnosis
  1. Impaired Urinary Elimination related to Na and water retention.
  2. Excess Fluid Volume related to edema
  3. Imbalanced Nutrition Less Than Body Requirements related to damage protein metabolism
  4. Ineffective Breathing Pattern related to suppression of the diaphragm due to ascites

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9 Nursing Diagnosis for Bronchitis

Nursing Care Plan for Bronchitis

Bronchitis is a pulmonary disease caused by the onset of inflammation in the bronchial tubes, which are the air passages into the lungs. It causes a cough that often brings up mucus, as well as shortness of breath, wheezing, and chest tightness. There are two main types of bronchitis: acute and chronic.

There are two forms of bronchitis, acute and chronic, which are somewhat similar and with similar causes, but run their course in different ways.

Acute bronchitis often occurs after a cold or the flu, as the result of bacterial infection, or from constant irritation of the bronchi by polluted air or chemical fumes in the environment. It is characterized by a slight fever that may last for a few days to weeks, and is often accompanied by a cough that may persist for several weeks. Acute bronchitis, symptoms usually resolve within 7 to 10 days, however, a dry, hacking cough can linger for several weeks.

Chronic bronchitis, also known as chronic obstructive pulmonary disease or COPD. As the condition gets worse, the affected person becomes increasingly short of breath, has difficulty with physical exertion, and may require supplemental oxygen. It may include fever, nasal congestion, and a hacking cough that can linger for months at a time.

General bronchitis symptoms are: cough, wheezing, throat pain, difficulty breathing, chest discomfort and soreness when breathing, fatigue and headache. If these bronchitis symptoms are accompanied by sweating, high fever and nausea, it means that the illness is caused by infection with bacteria. Bronchitis symptoms that might indicate an aggravation of the illness are: severe cough that contains yellowish mucus, spitting blood.

9 Nursing Diagnosis For Bronchitis

1. Ineffective airway clearance
related to: increased production of secretions.

2. Acute pain
related to: the inflammation of the pleura.

3. Impaired gas exchange
related to: airway obstruction by secretions, spasm of the bronchus.

4. Ineffective breathing pattern
related to: bronchoconstriction, mucus.

5. Imbalanced Nutrition, Less Than Body Requirements
related to: dyspnoea, anorexia, nausea, vomiting.

6. Risk for infection
related to: the settlement of secretions, chronic disease processes.

7. Activity intolerance
related to: insufficiency of ventilation and oxygenation.

8. Anxiety
related to: changes in health status.

9. Knowledge Deficit
related to: the lack of information about the disease process and treatment at home.

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Complete Nursing Assessment of patients with Delirium


Delirium, or acute confusional state is sudden severe confusion and rapid changes in brain function that occur with physical or mental illness. Delirium represents an organically caused decline from a previously-attained level of cognitive functioning. Delirium typically appears suddenly with a readily-identifiable time of onset, such as a time space of a few hours, or overnight.

Complete Nursing Assessment of patients with Delirium

1. Identity

The identity of the patient includes name, age, gender, ethnicity / cultural background, civil status, education, occupation and address.

2. The main complaint

The main complaint or the main reasons that caused the client comes to treatment (according to the client and or family). The main symptoms are decreased consciousness.

3. Predisposing Factors

Finding a mental disorder that is the basis of making a diagnosis as well as determine the level of interference as well as describing the structure of personality that might explain the history and development of the existing mental disorders. Of psychiatric symptoms, the etiology of the disease is not known bodily, but necessary internal and neurological examinations were thorough. The symptoms are more determined by premorbid mental state, psychological defense mechanisms, psychosocial circumstances, the nature of help from family, friends and health care workers, social structure and the characteristics of the surrounding culture. Mental disorders are psychotic or nonpsychotic disorders caused by brain tissue function. Impaired function of brain tissue can be caused by physical illness which is mainly about the brain (meningoencephalitis, cerebrovascular disorders, brain tumur etc.) or are primarily outside the brain or skull (typhoid, endometriosis, heart failure, toxemia of pregnancy, intoxication, etc.) .

4. Physical Examination

Decreased awareness and thereafter there is amnesia. Decreased blood pressure, tachycardia, febrile, weight loss due to decreased appetite and would not eat.

5. Psychosocial

a. Genogram
The results of the study found, monozygotic twins influence higher than dizygotic twins.

b. Self-concept

Self-image, stressors that cause changes in self-image because the pathological processes of disease.
Identity, varies according to the level of individual development.
Roles, role transition from healthy to be sick, discrepancy between the roles with other roles.
Ideal self, a desire that does not correspond to reality and existing capabilities.
Self-esteem, inability to achieve the goals that the client feels low self-esteem because of his failure.

c. Social relations

Various factors in the community that makes a person removed or loneliness, which can not be overcome, causing severe consequences such as delusions and hallucinations. Self-concept is formed by a pattern of social relations particularly with people who are important in the lives of individuals. If the relationship is not healthy, then individuals in internal emptiness. The development of social relations is not adequate cause failure of the individual to learn to maintain communication with others, as a result clients tend to separate themselves from others and is only involved in their own mind that does not require the control of others. This situation lead to loneliness, social isolation, shallow relationships and dependent.

d. Spiritual

Religion and belief is still strong but no or less capable in performing worship in accordance with their religion or belief.

6. Mental status

a. Clients look untidy and are unable to care for himself.

b. Talks loud, fast and incoherent.

c. Motor activity, motor changes can manifest an increase in motor activity, restlessness, impulsive, automatic.

d. Natural feeling
Clients look of fear and despair.

e. Affective and emotional.
Affective changes occur because the client is trying to make some sense of distance, as if directly experiencing these feelings can cause anxiety. This situation raises the changes affect a client is to protect themselves, because the affect that has changed, enabling clients to deny the painful emotional impact of the external environment. Client's emotional response may seem inappropriate because it comes from the frame of mind has changed. Affective changes are blunt, flat, inappropriate, excessive and ambivalent.

f. Interaction during the interview
Client's attitude toward the examiner less cooperative, less eye contact.

g. Perception
Perception involves thinking and emotional understanding of an object. Changes in perception may occur at one or more of the five senses, namely sight, hearing, touch, smell and taste. Changes in perception can be mild, moderate and severe or prolonged. Change in perception is the most common hallucination.

h. The process of thinking

Assessment reality privately by the client is subjective assessments associated with people, objects or events that are not logical. (Autistic thinking). The client does not re-examine the truth of reality. Thought autistic basis, changes in thought processes that can be manifested by the notion of primitive, loss of association, magical thinking, delusions, linguistic change (exhibit impaired abstract thinking that it seems the client regression and a narrow mindset.

i. level of consciousness
Decreased consciousness, confused. Disorientation to time, place and person.

j. Memory
Impaired memory that just happened (the events of a few hours or days ago), and that has long ago occurred (incident a few years ago).

k. The level of concentration
Clients are not able to concentrate

l. Capability assessment
Mild impairment in judgment or decision.

7. The daily needs of clients
a. Sleep: Client sleeplessness due to anxiety, restlessness, lying down or sitting and restless. Sometimes it is difficult to wake up in the night and go back to sleep. The sleep may be disturbed during the night, so do not feel refreshed in the morning.
b. Appetite: The client does not have the appetite or eating just a little, out of desperation, feeling unworthy, limited activity so that weight loss can occur.
c. Elimination: The client may be impaired urinate, sometimes more often than usual, because of sleeplessness and stress. Sometimes constipation can occur, due to disturbed eating patterns.

8. Coping mechanisms

If clients are not successful, failed, then he would neutralize, deny or destroy by developing various patterns of coping mechanisms. Inability to constructively address the primary causes of the formation of a pattern of pathological behavior. Coping mechanisms used by someone in a state of Delerium is to reduce eye contact, using the words fast and hard (grumble).

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