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Urinary Incontinence in the Elderly : Stress, Urgency, Overflow, Functional

 
There are several clinical categories on the urinary incontinence. Let us consider one by one.


Stress urinary incontinence

Maybe you've come across people who when laughing or coughing followed by discharge of urine, either a little or a lot. Generally, the incident caused by the weakening of the muscles in the pelvic floor.

Although not the sole cause, but the frequency of occurrence of urinary incontinence due to a weakening of the pelvic muscles. This category incontinence usually occurs in the elderly who are aged in their 70s and often suffered by women.


Urgency urinary incontinence

Some of the neurological problems associated with urinary urgency incontinence, such as dementia, Parkinson's disease, stroke, or spinal cord injury. That occurs in this type of urinary incontinence is the patient complained of insufficient time to get to the toilet, but the urine was out first.

The process is very fast between the desire to urinate and the urine before patients are in the bathroom. This type usually occurs in old age people, over 70s.


Overflow urinary incontinence

Perhaps this type of incontinence rather rare. Uncontrolled urine that comes out in this type of incontinence is associated with the occurrence of prostate enlargement or multiple sclerosis, which can cause the patient to contract the bladder.

Factor drugs can also cause this overflow incontinence. How it happened? Patients who suffer from overflow incontinence is usually only a few passing urine without feeling the sensation when her bladder is full.


Functional urinary incontinence

For this type, mostly occurs due to severe dementia, environmental factors, and psychological factors. In patients who suffer from this type of incontinence is usually accompanied by the emergence of a variety of symptoms and urodynamic picture of the occurrence of more than one type of urinary incontinence.

Urinary Retention in Pregnancy

 
Uterine incarceration is a fairly rare occurrence with an incidence of only about 1 : 3000 pregnancies. Caused by uterine retroversion him, trapped behind the sacral promontory and fixed for the remainder of the pregnancy. Between 12-20 weeks gestation, the patient will complain of lower abdominal pain, constipation, urinary incontinence, urinary retention, or even urinate constantly.

Fernandes et al (2012) noted in 10 years at a hospital in Boston occurred eight cases of uterine incarceration. The risk is spontaneous abortion. In some severe cases, the uterus may interfere with the attitude of the bladder and rectum, so as causing rupture of the bladder and rectum gangrene.

Incarceration of the uterus can lead to misdiagnosis as ectopic pregnancy, the uterus is experiencing retroflexi part, presumed gestational sac cul - de -sac while the inferior part of the uterine endometrium unexpectedly empty. Ultrasound will show that the length of the cervix appears anterosuperior position. Fundus will be in the posterior, located next to the pelvic cavity.

In a journal written on J Ultrasound Med 2012; 31:645-50, Fernandes et al revealed that the repositioning of the uterus during pregnancy should be done between 14-20 weeks old. The patient was placed with the dorsal lithotomy position, then paired urinary catheter, and hand pressed bimanually the uterus. One finger went into the rectum, and then increase the pressure on the uterus. If difficult to do with regional anesthesia, this procedure can be performed laparoscopically or even laparotomy. Having returned to the position anteflexi uterus, uterine pessarium fitted for a week in order not to go back into retroversion.

Gastritis - Definition, Classification, Pathophysiology and Prevention

 
Definition of Gastritis

Gastritis is an inflammation localized or diffuse, in the gastric mucosa that develops when the mucosal protective mechanisms are filled with bacteria or irritants. (J. Reves, 1999).


Classification of Gastritis

Gastritis by type divided into 2 (two), namely :

1. Acute gastritis
Gastritis (inflammation of the gastric mucosa) is most often caused by carelessness diet, such as eating too much, too fast, eating food too much seasoning or infected food. Other causes include alcohol, aspirin, bile fefluks and radiation therapy. Gastritis can also be the first sign of acute systemic infection. Form a more severe acute gastritis caused by strong acid or alkali, which can lead to gangrene or perforation of the mucosa.

2. Chronic gastritis
Prolonged inflammation caused by both benign and malignant gastric ulcers, by the bacteria H. Pylori. Chronic gastritis may be classified as Type A or Type B. Type A occurs in gastric fundus or corpus. Type B (H. Pylori) the antrum and pylorus. May be related to the bacteria H. Pylori. Dietary factors such as hot drinks, seasonings, use of drugs, alcohol, smoking or reflux of intestinal contents into the stomach.


Pathophysiology of Gastritis

Foodstuffs, drinks, drugs and chemicals that go into the stomach causing irritation or erosion of the gastric mucosa to lose barrier (protective). Furthermore an increase in diffusion of hydrogen ions. Diffusion in mucosal disruption and increased gastric acid secretion is increased / lot. Stomach acid and digestive enzymes. Then invades the gastric mucosa and inflammatory reaction occurs. This is called gastritis. Response of the gastric mucosa against irritants are mostly with mucosal regeneration, therefore such disturbances often disappears by itself.

With the constant irritation, tissue become inflamed and can bleed.
The introduction of substances such as strong acids and bases are corrosive resulting in inflammation and necrosis of the stomach wall (gastritis corrosive). Necrosis can result in perforation of the stomach wall to the next due to bleeding and peritonitis.
Chronic gastritis can lead to a state of atrophy of the gastric glands and the state of mucosal thickening patches are gray or greenish gray (gastitis atrophic). The loss of the gastric mucosa will ultimately result in reduced gastric secretion and the onset of pernicious anemia. Atrophic gastritis may be a precursor to gastric carcinoma. Chronic Gastritis may also occur in conjunction with peptic ulcer or may occur after the action gastroyeyunostomía.


Prevention of Gastritis

Although infection of H. pylori can not always be prevented, here are some suggestions to reduce the risk of gastritis:

1. Eating correctly. Avoid foods that can irritate especially spicy foods, acidic, fried or fatty. Which is just as important as the selection of the right foods for health is how to eat it. Eat a sufficient amount, on time and done with ease.

2. Avoid alcohol. The use of alcohol can irritate and erode the mucous lining of the stomach and can cause inflammation and bleeding.

3. Do not smoke. Smoking affect the protective stomach lining, making the stomach more susceptible to gastritis and ulcers. Smoking also increases stomach acid, thereby delaying the healing of the stomach and is a major cause of gastric cancer. However, to be able to quit smoking is not easy, especially for heavy smokers. Consult with your doctor about methods that can help to stop smoking.

4. Do exercise regularly. Aerobic exercise can increase heart rate and breathing, also can stimulate bowel muscle activity that helps remove food waste from the intestines more quickly.

5. Control stress. Stress increases the risk of heart attack and stroke, lowers the immune system and can lead to skin problems. Stress also increases the production of stomach acid and slow down the speed of digestion. Because stress for some people can not be avoided, then the key is to control it effectively by way of a nutritious diet, adequate rest, regular exercise and adequate relaxation.

6. Replace pain medication. If possible, avoid the use of NSAIDs, this class of drugs will cause inflammation and will make existing inflammation worse. Replace with pain relievers containing acetaminophen.

7. Follow the doctor's recommendations.

Nursing Care Plan for Gastritis

Urinary Tract Infection : Definition, Classification, Etiology, Signs and Symptoms

 
Definition

Urinary Tract Infection (UTI) is a state of the invasion of microorganisms in the urinary tract. (Agus Tessy, 2001)

Urinary Tract Infection (UTI) is a bacterial infection of the state of the urinary tract. (Enggram, Barbara, 1998)


Classification

Classification of urinary tract infections as follows:
  1. Bladder (cystitis)
  2. Urethra (urethritis)
  3. Prostate (prostatitis)
  4. Kidneys (pyelonephritis)

Urinary Tract Infection (UTI) in the elderly, can be divided into :

1 . Uncomplicated (simple)
Simple UTI that occurs in patients with urinary tract is not good, normal anatomic and functional. This UTI in elderly patients, especially regarding women and the infection just about superficial bladder mucosa.

2 . Complicated
Often cause a lot of problems because they are often difficult to eradicate germs, germs are often resistant to multiple kinds of antibiotics, frequent bacteremia, sepsis and shock. The UTI occurs when the circumstances are as follows :
  • Abnormal urinary tract abnormalities, such as stone, reflex vesico urethral obstruction, bladder atony, paraplegia, permanent bladder catheter and prostatitis.
  • Abnormalities of renal physiology : renal failure acute and chronic renal failure.
  • Immune disorders
  • Infections caused by virulent organisms such as prosteus spp, which produce urease.

Etiology

1. The types of microorganisms that cause UTI, among others:
  • Pseudomonas, Proteus, Klebsiella: the cause of complicated UTI.
  • Escherichia Coli : 90% cause of uncomplicated UTI (simple).
  • Enterobacter, epidemidis staphylococci, enterococci, and-others.

2. The prevalence of UTI in the elderly, among others:
  • Residual urine in the bladder is increased due to the bladder emptying less effective.
  • Decreased mobility.
  • Nutrition is often poor.
  • Decreased immune system, either cellular or humoral.
  • Barriers to the flow of urine.
  • Loss of bactericidal effect of prostate secretions.

Signs and Symptoms

1. Signs and symptoms of lower UTI are:
  • Frequent pain and a burning sensation when urinating.
  • Spasame the bladder and suprapubic area.
  • Hematuria.
  • Back pain can occur.

2. Signs and symptoms of upper UTI are:
  • Fever.
  • Chills.
  • Pelvic pain and waist.
  • Pain when urinating.
  • Malaise.
  • Dizziness.
  • Nausea and vomiting.
Urinary Retention related to Benign Prostatic Hyperplasia (BPH)

Nursing Care Plan for Urinary Tract Infection

Nanda for Urinary Tract Infection

Altered Urinary Elimination - NCP Urinary Tract Infections

 
Nursing Care Plan for Urinary Tract Infections

A urinary tract infection (UTI) is an infection that affects part of the urinary tract.
Symptoms from a lower urinary tract include painful urination and either frequent urination or urge to urinate (or both), while those of pyelonephritis include fever and flank pain in addition to the symptoms of a lower UTI.

Nursing Diagnosis : Altered Urinary Elimination related to mechanical obstruction of the bladder or other urinary tract structures.

Outcomes:
Improved elimination pattern , not the signs urinary disorders : urgency , oliguric , dysuria

Intervention:

1. Monitor input and output and urine characteristics.
Rational: provides information about kidney function and presence of complications.

2. Encourage increased fluid intake.
Rationale: increased hydration washes the bacteria.

3. Assess complaints of the urinary bladder.
Rational: urinary retention may occur causing tissue distension (bladder / kidney).

4. Observation of changes in the level of consciousness.
Rational: accumulation of uremic and electrolyte imbalances can be toxic to the central nervous system.

5. Monitor laboratory tests; electrolytes, BUN, creatinine.
Rational: monitoring of renal dysfunction.

6. Take action to maintain acidic urine: input increase berry juice and give medications to increase uric acid.
Rational: uric acid deter the growth of bacteria. Increased input preformance juice can affect the treatment of urinary tract infections.

Pleural Effusion Definition, Etiology, Signs and Symptoms

 
Pleural Effusion Definition

Pleural effusion is buildup of fluid in the pleural space, a primary disease process are rare but usually occurs secondary to other diseases. Effusion may be a clear liquid, which may be a transudate, exudate, or may be blood or pus (Baughman C Diane, 2000)

Pleural effusion is a collection of fluid in the pleural space which lies between the visceral and parietal surfaces, primary disease process is rare but is usually a secondary disease to other diseases. Normally, the pleural space contains a small amount of fluid (5 to 15 ml) serves as a lubricant that allows the pleural surface to move without friction. (Smeltzer C Suzanne, 2002).

Pleural effusion is a term used for the accumulation of fluid in the pleural cavity. (Price C Sylvia, 1995)


Pleural Effusion Etiology

Barriers resorption of fluid from the pleural cavity, because of the dam as in cardiac decompensation, renal disease, mediastinal tumor, Meig syndrome (ovarian tumor) and superior vena cava syndrome.

Formation of excess fluid, due to inflammation (tuberculosis, pneumonia, viral), bronchiectasis, sub-Phrenic amoebic abscess penetrating into the pleural cavity, because the tumor where the incoming fluid and bleeding due to trauma.

Excess fluid can accumulate in the pleural cavity neoplastic disease process, thromboembolic, cardiovascular, and infection. This is caused by at least one of the four basic mechanisms:
  • Increase in capillary pressure or subpleural lymphatics.
  • Decrease in colloid osmotic pressure of blood.
  • Increase in negative intrapleural pressure.
  • Inflammatory or neoplastic pleura.


Pleural Effusion Signs and Symptoms
  • The existence of liquid deposits resulting in pain due to friction, after fluid lost quite a lot of pain. When a lot of fluid, the patient will be short of breath.
  • The existence of the cause of disease symptoms such as fever, chills, and chest pain pleurisy (pneumonia), high heat (cocci), sub-febrile (tuberculosis), a lot of sweat, cough, lots of ripples.
  • Tracheal deviation away from sore spots may occur if there is a significant accumulation of pleural fluid.
  • Physical examination in the state of lying and sitting would be different, because the liquid will move. The sick will be less engaged in breathing, fremitus weakened (touch and vocals), the region was found percussion dullness, sits in a state of liquid surface forming a curved line (line "Ellis Damoiseu") .
  • Was found ; triangle Garland, the percussion area at the top of the line dim timpani "Ellis Domiseu". Triangle "Grocco - Rochfusz", ie volatile region as fluid pushed mediastinum to the other side, this area was found on auscultation with a weakened vesicular rales.
  • At the beginning and end of the disease, pleural audible crackles.

Nursing Care Plan for Pleural Effusion

Activity Intolerance - Hypertensive Heart Disease Care Plan

 
Hypertensive heart disease refers to heart conditions caused by high blood pressure.

These problems include:
  • Coronary artery disease and angina
  • Heart failure
  • Thickening of the heart muscle (called hypertrophy)
Hypertensive heart disease includes, among other conditions, heart failure, thickening of the heart muscle, and coronary artery disease. Coronary heart disease, for example, occurs when high blood pressure causes narrowing of the blood vessels that supply your heart with blood and oxygen.

Nursing Care Plan for Hypertensive Heart Disease

Nursing Diagnosis : Activity Intolerance related to general weakness, imbalance between supply and oxygen demand.

Goal:
  • Clients are able to do activities that are tolerated
Outcomes:
  • Clients participate in activities desired / required.
  • Reported an increase in tolerance activity can be measured.
  • Showed a decrease in physiological signs of intolerance.

Interventions and Rationale:

Interventions:
1. Assess the client's response to the activity, the attention of more than 20 pulse / min above the break frequency; significant increase in BP during / after activity, dyspnea, chest pain; excessive fatigue and weakness; diaphoresis; dizziness or fainting.

2. Instruct patients about energy saving techniques, eg, using a chair in the shower, sitting as combing hair or brushing teeth, doing activities slowly.

3. Encourage daily activity / self-care gradually if tolerated. Provide assistance as needed.

Rationale:

1. Mentioned parameters help in assessing physiological responses to stress and activity when there is an indicator of excess work-related activity levels.

2. Energy saving techniques reduce energy reduction also helps balance between supply and oxygen demand.

3. Progress activity increased gradually to prevent sudden cardiac work. Provide only limited assistance needs will encourage independence in their daily activities.

Nursing Care Plan for Congestive Heart Failure - CHF

Nursing Diagnosis for Ischemic Heart Disease

Nursing Interventions for Ischemic Heart Disease - Acute Pain

Nursing Care Plan for Nausea and Vomiting

 
Nausea

Nausea is the sensation (feeling) issued a strong food or want to vomit. Usually accompanied by autonomic signs such as hypersalivation, diaphoresis, tachycardia, pallor, and tachypnea, nausea closely related to anorexia. Nausea caused by distention or irritation in any part of the gastrointestinal tract, but can also be stimulated by higher brain centers.

Nausea is a common symptom of digestive disorders, but may also occur in fluid and electrolyte imbalance, infection, metabolic disorders, endocrine, and cardiac maze. Can also be as a result of drug therapy, surgery, and radiation.

Nausea is also common in the first trimester of pregnancy, nausea can arise from intense pain, anxiety, alcohol poisoning, excessive food or digest food or drinks that do not taste good.


Definition of "Vomit" is a discharge of most or all of the stomach contents food into the stomach occurs after a while, accompanied by contraction of the stomach and abdomen. (Vivian Nanny Lia Dewi, 2010)

In a simple sense of Vomiting is spending the stomach contents through the mouth. Another understanding of the vomiting is a discharge of most or all of the stomach contents food into the stomach occurs after a while, with stomach and abdominal contractions. In the first few hours after birth, the baby may experience vomiting mucus, sometimes with a little blood. Vomiting is not uncommon to settle after breast feeding or food, the situation is probably due to irritation of the gastric mucosa by a number of objects that are ingested during childbirth.

Many causes that can lead to vomiting, namely:
  • Virus infection
  • Stress
  • Gestation
  • Drug
  • Myocardial infarction
  • Uremia
  • Other conditions

Therapeutic Intervention

Nausea and vomiting are very few require intervention. However, if left unchecked will lead to dehydration and electrolyte imbalance. Loss of hydrochloric acid from the stomach can cause metabolic alkalosis. Vomiting black, like coffee, showed vomit mixed with blood. Protection of the airway during vomiting are the most important measures to prevent aspiration. Increased risk of aspiration in patients with loss of consciousness, the elderly, and the failure of reflexes. Place the patient in a comfortable position so that vomit out. Beating back while vomiting can lead to aspiration.


Nursing Process in Patients with Nausea and Vomiting

Assessment / data collection
  1. Episodes of nausea and vomiting
  2. Medical condition
  3. Drugs consumed
  4. Treatment is being done
Early signs of fluid loss:
  1. Weakness
  2. Headache
  3. Not be able to concentrate
  4. Postural hypotension
Further signs of fluid loss:
  1. Confused
  2. Oliguria
  3. Skin cool and moist
  4. Chest and abdominal pain


Nursing Diagnosis, Planning, and Implementation

1 . Nausea related to various causes

The desired result :
  • Patients expressed no nausea and vomiting .
  • Odor-free environment , clean so it does not cause nausea .

Interventions :
  1. Give anti- emetic .
  2. Oral care , to reduce emesis and increased comfort .
  3. Explained to the patient to avoid foods that cause or may cause vomiting .

2 . Risk for aspiration related to decreased reflexes or penuruanan awareness

The desired result :
  • Airway and lung sounds clean patient
Iintervention :
  1. Assess whether the patient is in the risk for aspiration .
  2. Place the patient in a position to prevent aspiration .

3 . Deficient Fluid Volume

The desired result :
  • Patient's vital signs within normal limits .

Interventions :
  1. Monitor for signs of hypovolemia to prevent any complications that may occur .
  2. Measure body weight each day .
  3. Monitor intake output , and vital signs , and vital signs , blood pressure ortohstatik .
  4. Give fluids by IV .
  5. Discharge monitoring during treatment to prevent deficit and excess fluid .

Evaluation

Patients showed no nausea, lung sounds clean and normal vital signs .

Imbalanced Nutrition : less than body requirements related to nausea and vomiting

Risk for Fluid Volume Deficit related to Vomiting

Definition and Causes of Congenital Talipes Equinovarus

 
Definition of CTEV (Congenital talipes Equinovarus)

Congenital talipes Equinovarus (CTEV) or so-called Clubfoot is a common term used to describe a common deformity in which the legs changed from its normal position which is common in children. CTEV is covering flexion deformity of the ankle, inversion of the legs, adduction of the forefoot, and media rotation of the tibia (Priciples of Surgery, Schwartz). Talipes derived from the talus (ankle) and pes (foot), suggesting an abnormality in the leg (foot) which causes the sufferer to walk on his ankle. Equinovarus being derived from the word equino and varus (bent towards the inside / medial).

Congenital talipes Equinovarus is a foot deformity in line twisted heel leg and foot plantar flexion experience. This situation is accompanied with a higher edge in the foot (supination) and the shift of the anterior part of the foot so that it rests on the medial axis of the vertical leg (adduction). With this type of foot arch higher (cavus) and foot in an equinus (plantar flexion). Equino congenital talipes varus is a condition in which the foot in plantar flexion position talocranialis, because musculus tibialis anterior is weak, Inversion ankle because musculus peroneus longus, brevis and Tertius weak, subtalar and midtarsal Adduction.


Causes of Congenital talipes Equinovarus
  1. Causes of Congenital talipes Equinovarus until now not known for sure but allegedly are associated with : Persistence of fetal positioning, Genetic, amniotic fluid in the amniotic too little during pregnancy (oligohydramnios), Neuromuscular disorder (sometimes found along with other abnormalities such as Spina bifida or dysplasia of the pelvis). There are several theories that may be linked to CTEV :
  2. Chromosomal theory , among others : germinativum defect of cells that are not fertilized and appear before fertilization .
  3. Embryonic theory , among others : primary defect that occurs in cells that fertilized germinativum (quoted from Irani and Sherman) which implies a defect occurs between conception and 12 weeks of pregnancy.
  4. Autogenic theory, the theory of development is hampered, among other temporary barriers of development that occurs on or around the week of the 7th to the 8th gestation. At this time there is a clear clubfoot deformity, but when these obstacles occur after 9 weeks, there was a clubfoot deformity is mild to moderate. The development of the theory of constraints associated with changes in genetic factors, known as the "Cronon". "Cronon" This is the right time to guide the progressive modification of any structure of the body during development. Therefore, clubfoot occurs due to disruptive elements (local and general) that cause changes in genetic factors (cronon).
  5. Fetus theory, namely the development of a mechanical block due to intrauterine crowding.
  6. Neurogenic theory, the primary defect in neurogenic tissue.
  7. Amiogenic theory, that the primary defect occurs in the muscle.
  8. Edward syndrome, which is a genetic disorder of chromosome number 18.
  9. Outside influences such as the emphasis on when the baby is still in the womb because at least the amniotic fluid (oligohydramnios)
  10. Can be found along with other congenital abnormalities such as spina bifida.
  11. Ecstasy use by the mother during pregnancy.

Impaired Verbal Communication related to Acute Tonsillitis

 
Acute Tonsillitis

Tonsillitis is defined simply as the swelling of the tonsils, which are located in the throat, towards the back of the mouth.

Acute tonsillitis comes on quickly and can be caused by a variety of organisms, including viruses, group A beta-hemolytic streptococci (Strep throat)and other types of bacteria.

Acute tonsillitis is caused by both bacteria and viruses and will be accompanied by symptoms of ear pain when swallowing, bad breath, and drooling along with sore throat and fever. In this case, the surface of the tonsil may be bright red or have a grayish-white coating, while the lymph nodes in the neck may be swollen.


Signs of Acute Tonsillitis :
  1. There is hyperaemia of pillars, soft palate and uvula.
  2. Often the breath is foetid and tongue is coasted.
  3. Tonsils are red and swollen with yellowish spots of purulent material presenting at the opening of crypts (acute follicular tonsillitis) or there may be a whitish membrane on the medial surface of tonsil which can be easily wiped away with a swab (acute membranous tonsillitis). The tonsils may be enlarged and congested so much so that they almost meet in
  4. the midline along with some oedema of the uvula and soft palate (acute parenchymatous tonsillitis).
  5. The jugulodigastric lymph nodes are enlarged and tender.


Symptoms of Acute Tonsillitis:
  1. Sore throat.
  2. Fever. It may vary from 38 to 40°C and may be associated with chills and rigors. Sometimes, a child presents with an unexplained fever and it is only on examination that an acute tonsillitis is discovered.
  3. Difficulty in swallowing. The child may refuse to eat anything due to local pain.
  4. Earache. It is either referred pain from the tonsil or the result of acute otitis media which may occur as a complication.
  5. Constitutional symptoms. They are usually more marked than seen in simple pharyngitis and may include headache, general body aches, malaise and constipation. There may be abdominal pain due to mesenteric lymphadenitis simulating a clinical picture of acute appendicitis.


Nursing Care Plan for Acute Tonsillitis

Nursing Diagnosis: Impaired verbal communication related to the effects of damage to the area to talk to the brain hemispheres.

Goal:
  • Patients are able to communicate to meet their basic needs and show improvement in their communication skills.

Interventions :
  1. Do a personal communication with the patient (often but short and easy to understand).
  2. Create an atmosphere of acceptance of the changes experienced by the patient.
  3. Teach the patient to improve communication techniques.
  4. Use non-verbal communication techniques.
  5. Collaboration in the implementation of speech therapy.
  6. Observation of the patient's ability to communicate in both verbal and non-verbal.

Nursing Care Plan for Tonsillitis

Nursing Care Plan Tonsillectomy

Nursing Interventions for Acute Tonsillitis

6 Trigger Factors of Migraine Attacks

 
Cause of migraine is not known clearly, but this can lead to a primary vascular disorder that usually occurs in women, and many have a strong tendency in the family. Migraines are also caused by the occurrence of a combination of vasodilation (widening of blood vessels) and the release of a chemical substance from nerve fibers that surrounds the blood vessels. When a migraine attack, the temporal artery (the artery that runs around the temple) will be widened. The widening will cause stretching of the nerve fibers around arteries thus stimulating these nerve fibers to release chemicals. This substance will cause inflammation, pain and migraine incredible.

Various factors that can trigger a migraine attack is determined by the presence of hereditary biological defects in the central nervous system. Among others:

1. Hormonal
Hormonal fluctuations are the trigger factor. the presence of glucose increased only 14% of women had an attack during menstruation. Reduced migraine attacks during pregnancy because estrogen levels are relatively high and constant, contrary porspartum first week, 14% of patients experienced severe attack due to lower levels of extradition. Use of the contraceptive pill also causes the frequency of migraine attacks.

 2. Menopause
Migraine generally will increase the frequency and severity at the time of menopause. However, some cases improved after menopause. Hormonal therapy with low-dose estrogen can be given to treat migraine attacks after menopause.

3. Food
Variety of foods / substances can trigger a migraine attack. Common migraine triggers are alcohol based vasodilatory effect, where wine and beer are strong triggers. Foods containing tyramine, an amino acid derived from thyroxine.

4. Monosodium Glutamate
Is the most common migraine triggers, namely: headache accompanied by anxiety, dizziness, parastesia and hands, as well as abdominal pain and chest pain.

5. Environment
Environmental changes in the body which include hormonal fluctuations in the menstrual cycle and hormonal changes can lead to getting out of bed acute migraine attacks. Changes in the external environment include the weather, season, air pressure, altitude, and late meals.

6. Sensory stimuli
Flashing light, glare, bright sunlight, or the smell of perfumes, cleaning chemicals, cigarettes, sura noise and extreme temperatures.

Benefits of Early Mobilization for Postoperative Appendectomy

 
Appendicitis is an inflammation of the appendix are relatively common which can arise without apparent cause or arise after obstruction of the appendix by feces or due to twisting of the appendix or blood vessels. Appendix inflammation causes swelling and pain that can lead to gangrene due to impaired blood supply (Corwin, 2001).

Appendicitis is the most common cause of acute inflammation in the lower right quadrant of the abdominal cavity, as well as the most common causes of emergency abdominal surgery. Approximately 7% of the population will have appendicitis at the same time in their lives, men are more frequently affected than women, and adolescents are more frequent in adults. Although it can occur at any age, appendicitis occurs most often between the ages of 10 and 30 years (Smeltzer and Bare, 2002).

According to Smeltzer and Bare (2002), appendicitis treatment is indicated when the diagnosis of appendicitis has been upheld. Antibiotics and intravenous fluids are given until surgery is performed. Analgesics can be given after the diagnosis is established. Appendectomy (surgery to remove the appendix) as soon as possible to reduce the risk of perforation. Appendectomy can be performed with general or spinal anesthesia with a lower abdominal incision or with a laparoscope, which is the latest method is very effective.

Surgery is a treatment that uses all measures invasive way to unlock or show body parts to be handled. The opening part of the body is generally done by making an incision, after which the part to be handled displayed, performed remedial action that ended with the closure and suturing wounds. The next treatment will be included in the post- surgical care. Surgery or surgery can cause a variety of complaints and symptoms. Complaints and symptoms that often is painful (Sjamsuhidajat, 2002).

Surgery leads to changes in the continuity of body tissues. To maintain homeostasis, the body is a mechanism for immediate recovery of the tissue injury experience. In the recovery process is a chemical reaction occurs in the body so that the pain felt by the patient ( Fields, in Ani, 2010). In the operation process used anesthesia so that the patient does not feel pain during surgery. But after the operation is completed and the patient regained consciousness, he will feel the pain in the body that had surgery ( Wall & Jones, in Ani, 2010).

To prevent postoperative appendectomy complications in patients appendix, the patient must be done in accordance with the stages of early mobilization. Therefore, after having an appendectomy, patients are advised not to lazy to move after surgery, the patient should fast mobilization. The faster it moves, the better, but the mobilization must be performed carefully.

Early mobilization for Postoperative Appendectomy is an important aspect of the physiological function because it is essential to maintain independence (Carpenito, in Fitriyahsari, 2009). Patients feel healthier and stronger with early ambulation. With the move, the muscles of the abdomen and pelvis will be back to normal so that the stomach muscles become strong again and can relieve pain so the patient feel healthier and help gain strength and speed healing (Mochtar, in Fitriyahsari, 2009).

Pain by The International Association for the Study of Pain is a sensory and emotional experience that is not enjoyable, accompanied by tissue damage potential and actual. Pain is a condition that is more than just a single sensation caused by a particular stimulus (Potter & Perry, 2006). Pain is felt in the appendix postoperative patients can worsen the patient's condition and even cause many complications in the appendix.

The main complication of appendicitis is perforation of the appendix, which can develop into peritonitis or abscess. The incidence of perforation was 10 % to 32 %. Incidence is higher in young children and the elderly. Perforation generally occurs 24 hours after the onset of pain. Symptoms include a fever with a temperature of 37.7 ° C or higher, toxic appearance, and abdominal pain or tenderness of the continuous (Smeltzer and Bare, 2002).

Nursing Assessment - Physical Examination for Appendicitis

Risk for Deficient Fluid Volume - Nursing Interventions for Appendicitis

Appendicitis Pre- and Post-Operative Care Plan

 
Appendicitis Pre Operative Care:
  • Sonde installation to decompress the stomach.
  • Catheters to control urine production.
  • Rehydration.
  • Antibiotic with broad spectrum and is given intravenously.
  • Fever-reducing medicines.
  • If fever, should be reduced before anesthesia.

Appendicitis Operative Care :
  • Appendectomy
  • Appendix removed, if the appendix is perforated freely, then the abdomen was washed with physiological saline and antibiotics.
  • Appendix abscess treated with IV antibiotics, its mass may shrink, or abscess may require drainage within a few days.
  • Appendectomy done if the abscess performed elective surgery after 6 weeks to 3 months.

Appendicitis Post Operative Care:
  • Observation of vital signs.
  • Lift the stomach sonde when patients have realized that aspiration of gastric fluid can be prevented.
  • Put the patient in a semi-Fowler position.
  • Patients are said to be good when it is in 12 hours without any disturbance, during fasting.
  • When the action is bigger operation, for example the perforation, fasting continued until bowel function returned to normal.
  • Give drink from 15 ml / hour, for 4-5 hours, then raised it to 30 ml / hour. The next day give food strain, and the next day be given soft foods.
  • One day after surgery the patient is advised to sit upright in bed for 2 × 30 min.
  • On the second day the patient can stand and sit outside the room.
  • Day 7 stitches can be removed and the patient allowed to go home.

In the appendix to the state of the masses who are still active inflammatory process that is characterized by:
  • General state of the client it still looks sick, the body temperature is still high.
  • Local examination of the right lower quadrant of the abdomen are still clear signs of peritonitis.
  • Laboratory there are leukocytosis and the counts are shifting to the left.
Surgery should be performed as soon as the client is prepared, because it feared would happen appendix abscess and generalized peritonitis. Preparation and surgery should be done as well as possible given the complications of wound infection is higher than surgery in simple appendicitis without perforation.

On the state of the appendix mass with inflammatory process has subsided characterized by:
  • General condition has improved with no visible pain, body temperature is not high anymore.
  • Local inspection abdomen there are no signs of peritonitis and only clear and palpable mass with mild tenderness.
  • Laboratory leukocyte count and differential count normal.

Actions taken should be conservative with antibiotics and bed rest. Surgery if the bleeding was more difficult and more, especially when mass appendix has formed more than a week since the attacks of abdominal pain. Surgery is carried out immediately if the treatment occurs abscess with or without generalized peritonitis.

Impaired Skin Integrity related to Cellulitis Care Plan

 
Cellulitis is a skin infection that is caused by bacteria. The bacteria called Staphylococcus aureus and Group A Streptococcus are usually responsible for this kind of infection. Streptococci and Staphylococci can enter the skin to cause cellulitis infection through scrapes, cuts, wounds, blisters, insect bites and ulcers and find their way into the dermal and subcutaneous layers of the skin. Different cellulitis infections are facial cellulitis, breast cellulitis, orbital (eye) cellulitis, periorbital (eyelid) cellulitis, hand or arm cellulitis, perianal cellulitis and lower leg or foot cellulitis.

The main symptoms are skin redness or inflammation that spreads in size as the infection spreads , tight, glossy, stretched occurrence of the skin , tenderness of the area , skin injury or rash, sudden onset ,warmth over the redskin,fever .there are some other signs of infection includes chills, shaking, fatigue, warm skin, sweating, muscle aches, myalgias. Some of the additional symptoms that may be related with this disease are nausea, vomiting and hair loss at the site of infection.


Nursing Diagnosis and Interventions for Cellulitis

Impaired Skin Integrity related to changes in turgor

Goal: Demonstrate tissue regeneration.

Outcomes:
  • Lesions began to recover and the free area of the infection,
  • Clean skin,
  • Dry and surrounding area free from edema,
  • Normal temperature.

Nursing Intervention:

1. Assess the damage, size, color depth of the liquid.
R /: proper assessment of the wound and the healing process will assist in determining further action.

2. Maintain bed rest with an increase in limb and mobilization.
R /: Circulation that can smoothly accelerate the wound healing process.

3. Maintain aseptic technique.
R /: to accelerate the wound healing process.

4. Use the compress and bandage.
R /: Compress and dressing could reduce contamination from outside.

5. Monitor the temperature of the report, report your doctor if there is improvement.
R /: Early indications for infectious complications.

Clinical Manifestation and Pathophysiology of Migraine

 
Clinical Manifestation of Migraine

Migraine is a chronic condition. Most of the migraine attacks are also accompanied with another headache. Migraine headache is often described as a severe headache, throbbing and attacking head on one side. Some pain is felt in the forehead, around the eyes and behind the head so obscure symptoms with another headache. Although most of the migraine attack on one side of the head, but often also found symptoms of migraine headaches on both sides of the head. Side of the head migraines too often turns on every time attack. Be careful when the affected side of the head is always the same, another possibility is the occurrence of a brain tumor. Patients with migraine often tormented in performing daily activities, especially when the attack occurred. Other accompanying symptoms of migraine include, nausea, vomiting, diarrhea, facial pallor, cold hands feet, and the patient will be sensitive to light and sound. Due to an increased sensitivity to light and sound then migraine sufferers had to lie in a quiet and dark room. Migraine attacks usually subside within 4 to 72 hours.

Nearly 70% had a family history of migraine. Most of the women. The first attack in the migraine usually starts during adolescence and young adulthood, and then tended to decrease at the age of 5 and 6 decades. Usually there is a triggering factor. Patients generally have a perfectionist personality, rigid, and impulsive.
The clinical features of migraine is usually a throbbing headache but unilateral and bilateral or switched sides. Migraine attacks typically 2-8 times per month, once the attack duration between 4-24 hours or longer isa, moderate-severe pain intensity, accompanying symptoms, among others,: nausea, vomiting, photophobia and / or phonophobia, pale face, vertigo , tinnitus, irritable. On migraine with aura, the symptoms prodromalnya is skotomata.teikopsia (fortification spectra), photophobia (light flashes) paresthesias and visual hallucinations exhausted, feeling tired, very hungry and feeling nervous / anxious.
Headaches often appear at the wake, but it can happen at any time.


Pathophysiology of Migraine

Signs and symptoms of migraine on the result of cerebral cortical ischemia varying degrees. Typical attack starts with a scalp artery vasoconstriction and retinal blood vessels and cerebral. Extracranial and intracranial blood vessels dilated, which causes pain and discomfort. Studies suggest that arterial dilatation hyperpermeable and cause local inflammation that sterilize, which causes pain in surrounding areas and arterial dilatation. The state aims to enable existing substances in the blood vessels (histamine, serotonin, plasmokinin) who participated in cleaning the inflammatory reaction.

Migraine attacks commonly activate the sympathetic nervous going. The meaning of the sympathetic nerve is the nerve that is part of the human nervous system is responsible for controlling the body's response to stress and pain. Increased sympathetic nervous activity in the intestine causes nausea , vomiting and diarrhea. Sympathetic activity will also lead to slow gastric emptying resulting in drug delivery to the small intestine to be absorbed will also be hampered. Barriers to drug absorption that is the problem for people with migraine when administered orally administered drug. Increased sympathetic activity also decreases the flow of blood so that the skin will appear pale and cold. Increased neural activity will also lead to increased sensitivity to light and sound.

There are various theories that explain the occurrence of migraine.

Vascular theory, disruptions vasospasm causing cerebral blood vessels constrict, causing brain hypoperfusion which began in the visual cortex and spread forward. Continued deployment of frontal headache and cause phase begins.

Theory of cortical spread depression, which in the migraine threshold value decreases neuronal excitation of neurons so easily happen, then apply shortlasting depolarization wave, by potassium - liberating depression ( decreased release of potassium ) that results in a prolonged period of depressed neurons. Furthermore, there will be deployment of depression that would suppress the activity of neurons as it passes through the cerebral cortex.

Theory of neovascular (trigeminovascular), the vasodilatory effect NOS activity and NO production would stimulate the trigeminal nerve endings in blood vessels, releasing CGRP (calcitonin gene related). CGRP binds to its receptor on mast cells and will stimulate spending meningens inflammatory mediators that lead to inflammation of neurons. CGRP is also working on the cerebral arteries and the smooth muscle that will lead to increased blood flow. In addition, CGRP will work on post junctional second order neurons site that acts as the transmission of pain impulses.

5 Types of Migraine

 
Migraine is a recurrent headache is idiopathic, with pain attacks lasting 4-27 hours, usually one-sided, throbbing nature, moderate-severe pain intensity, the more intense by regular physical activity, can be accompanied by nausea, photophobia and phonophobia. Migraines can occur in children with pain more often bifrontal location.

1. Classic Migraine
Preceded by a visual aura, a scotoma, flash of light, vision fireflies or black and white stripes, or blurred vision for 10-20 minutes. Then comes the headache, throbbing, unilateral, which is more severe, lasts between 1-6 hours. Will usually subside within 6-24 hours but sometimes longer. Accompanying symptoms are often encountered are nausea, vomiting, photophobia, phonophobia, irritable and malaise.
Classic migraine attack can be divided into three phases, namely:
1). Aura phase
When migraine with aura is connected, the aura can be more than 30 minutes and can give sufficient time for the patient to determine which drugs would be used to prevent attacks in the. This period is the manifestation of the characteristics of sensory, particularly visual disturbances (glare).
Other symptoms may occur in the presence of:
  1. Pins and needles
  2. Itchy feeling on the face and hands
  3. Confusion being
  4. A little weak on the extremities
  5. Dizziness
Period aura, is associated with vasoconstriction without pain that begins with early physiologic changes characteristic of classic migraine. Cerebral blood flow studies conducted during the headache phase of migraine attacks showed that all reduced cerebral blood flow throughout the brain, with a further loss of autoregulation and CO2 responsiveness damage.
2). Headache phase
At the time of initial symptoms began to diminish, these symptoms followed by unilateral headache (two-thirds of patients) and pulsed. Severe headache and was not able to make and is often associated with photophobia, nausea, and vomiting. Duration of this state varies, with the distance of a few hours in a day or all day.
3). Recovery phase
Is the period of muscle contraction neck and scalp are associated with local muscle pain and tension. Fatigue and exhaustion are common physical cause back pain headaches. During the post-headache phase, the patient may sleep for a long time.

2. Common Migraine
Headache arise without any prior prodromal visual aura as the classic migraine and usually lasts longer.

3. Association Migraine
At this migraine, headache accompanied by transient neurological deficits, for example in oftalmoplegik migraine, hemiplegic migraine, and migraine with aphasia. Deficit neurogis This usually occurs prior to or after the headache (migraine association) or in the absence of headache (migraine dissociation).

4. Complicated Migraine
At this migraine, neurological deficit arising will settle due to cerebral infarction. Therefore, the constrictor phase should not be given so as not to aggravate the infarction.


5. Status Migraine
Is a migraine attack that lasts more than 24 hours due to sterile inflammation around the blood vessels are dilated.

Non- Pharmacological Therapies for Constipation

 
Constipation is a condition in which a person's bowel movement difficulty with normal daily pattern. At each state of constipation, causes of constipation should be correctly identified in order to determine the therapeutic approach. Causes of constipation can be as diverse as a low fiber diet or due to the consumption of drugs hypothyroidism.

Constipation is generally regarded as the usual health problems, experienced by many people, and generally they do the treatment themselves. Problems many people experience constipation problems are usually associated with a low fiber diet. Constipation is also often wrongly understood by the general public. Society generally considers that a bowel movement every day is important for health. And assume that the bowel is not routine every day will contribute to the accumulation of toxins and lead to somatic complaints varied. This misunderstanding resulted in the use of laxatives are less rational society.

To assess the condition of constipation, required an assessment of the following variables:
  1. Frequency of bowel movements. Someone would otherwise be constipated if bowel frequency magnitude less than 3 times a week in women and 5 times per week in men.
  2. The size and consistency of stools. A person with constipation requires 25% more time than usual for the number of defecation and fecal or fewer.
  3. Symptoms as the sensation of defecation incomplete.
The following are some factors or conditions can cause constipation:
  1. Diseases of the gastrointestinal tract; irritable bowel syndrome, diverticulitis, gastrointestinal disease above the anal and rectal disease, hemorrhoids, tumors, hernia, intestinal volvulus, syphilis, tuberculosis, worm infections, limphogranuloma, hirscprung's Disease
  2. Metabolic and endocrine disorders; diabetes mellitus with neuropathy, hypothyroidism, pheochromocytoma, hypercalcemia, enteric glucagon excess.
  3. Pregnancy; Emphasis intestinal motility, increased fluid absorption from the large intestine, decreased physical activity, dietary changes, lack of fluid intake, low fiber diet, the use of iron salts.
  4. Neurogenic; central nervous system disease, brain trauma, spinal injuries kordata, central nervous system tumors, cerebrovascular accident, Parkinson's disease
  5. Psychogenic; Psychogenic to ignore / postpone the urge to defecate, psychiatric disease.
  6. Use of certain drugs


Signs and Symptoms
  1. Signs and symptoms that need to be considered in knowing whether a person is constipated or not:
  2. Keep in mind the condition whether the patient complained of a lack of volume conditions stool during bowel movements, stomach feeling full, pain during bowel movements.
  3. Signs and symptoms such as hard stools, small or dry. Abdominal discomfort, pain, cramps, nausea and vomiting, headache, and fatigue.


 Non- Pharmacological Therapies for Constipation

High Fiber Diet
Nonpharmacologic therapy is first-line therapy in the treatment of constipation by making dietary modifications to increase the amount of fiber consumed. Fibers that are part of the vegetable that is not digested in the intestines will increase stool bulk, liquid stool retention, and increase stool transit in the gut. With fiber therapy is the increased frequency of bowel movements and decrease pressure on the colon and rectum.

Patients are advised to consume at least 10 grams per day of crude fiber. Fruit, vegetables and cereals are examples of food rich in fiber. Raw bran contains about 40% fiber. In addition there are also medicinal product which is the mass of fiber-forming agents such as hydrophilic colloids psylium, methylcellulose or polikarbofil which can produce effects similar to those of high-fiber foods are available in the preparation of tablets, powders or capsules.

Surgery
In some constipated patients required surgery. This is because the presence of colonic malignancy or gastrointestinal tract obstruction that required bowel resection. Besides surgery is also necessary in cases of constipation caused by pheokromositoma.

Biofeedback
Most of the patients of constipation due to pelvic floor dysfunction benefit from the electromyogram biofeedback therapy.

Nursing Care Plan for Acute Tonsillitis

 
Tonsillitis is an inflammation of the tonsils. according to the stage, tonsillitis is divided into three stages, namely:
  1. Acute tonsillitis
  2. Membranous tonsillitis
  3. Chronic tonsillitis

Acute Tonsillitis
Acute definition is an inflammation of the tonsils and sudden in onset.

Etiology
  1. Group A Beta-Hemolytic Streptococcal.
  2. Pneumococcus.
  3. Staphylococcus.
  4. Haemophilus influenzae.

Pathophysiology
  1. Inflammation of the tonsils caused by a virus.
  2. Resulted in the formation of exudate.
  3. Cellulitis tonsils and surrounding areas.
  4. Peritonsilar abscess formation.
  5. Tissue necrosis.

Symptoms
  1. Sore throat and dysphagia.
  2. Patients do not want to eat or drink.
  3. Malaise.
  4. Fever.
  5. Breath odor.
  6. Otitis media is one of the originators.

Management
  1. Bed rest.
  2. Provision of adequate fluids and light diet.
  3. Giving medications (analgesics and antibiotics).
  4. If there is no progress then the alternative actions that can be done is surgery.

Preparation operations may be undertaken
  1. Laboratory tests (hemoglobin, leukocytes, bleeding time).
  2. Give an explanation to the client, treatment and care after surgery.
  3. Fasting 6-8 hours before surgery.
  4. Give antibiotics as prophylaxis.
  5. Give premedication ½ hours before surgery.


Assessment

1. Medical history factors associated with the occurrence of tonsillitis supporters , as well as bio - psycho - socio - spiritual.

2. Circulatory
Palpitations, headache during position changes, decreased blood pressure, bradycardia, body felt cold, pale extremities appear.

3. Elimination
Changes in the pattern of elimination ( urinary incontinence ), abdominal distension, bowel sounds disappearance.

4. Activity / rest
There is a decrease in activity due to body weakness, loss of sensation or parese / plegia , tiredness, difficulty in recuperating from muscle cramps or spasms and pain. The reduced level of consciousness, decreased muscle strength, general body weakness.

5. Nutrition and fluids
Anorexia, nausea and vomiting due to increased ICP ( intracranial pressure ), impaired swallowing, and loss of sensation on the tongue.

6. Nervous system
Dizziness / syncope, headache, decreased visual field wider / blurred vision, decreased touch sensation, especially in the area of ​​the face and extremities. Comatose mental status, weakness in the extremities, muscle paralise face, aphasia, dilated pupils, decreased hearing.

7. Comfort
Tense facial expressions, headache, restlessness.

8. Breathing
Shortened breath, inability to breathe, apnea, apnea onset period in breathing patterns.

9. Security
Fluctuations of temperature in the room.

10. Psychological
Denial, disbelief, anguish, fear, anxiety.

12 Nursing Diagnosis for Mitral Stenosis

 
Nursing Care Plan for Mitral Stenosis

Mitral stenosis is a narrowing of the mitral valve in the heart. This restricts the flow of blood through the valve. Back pressure which builds up behind the narrowed valve can cause various problems and symptoms. The more severe the narrowing, the more serious the problems.

Mitral stenosis (MS) is characterized by obstruction to left ventricular inflow at the level of mitral valve due to structural abnormality of the mitral valve apparatus. The most common cause of mitral stenosis is rheumatic fever.

Symptoms can include:
  • Shortness of breath. This tends to occur on exercise at first, but occurs at rest if the stenosis becomes worse. This symptom is due to the congestion of blood and fluid in the lungs.
  • Fainting, dizziness or tiredness. If the amount of blood getting through to the ventricle is reduced, the output of blood from the left ventricle to the body is then reduced.
  • Chest pains (angina). This may develop if there is a reduced blood flow to the coronary arteries (the arteries that take blood to the heart muscle).
  • Chest infections. These are common.
  • Coughing up blood-stained sputum. This may occur due to the congestion of blood and fluid in the lungs.
If rheumatic fever is the cause then, typically, symptoms start between the ages of 20 and 50. (That is, 10-20 years after having have had an episode of rheumatic fever as a child.)


12 Nursing Diagnosis for Mitral Stenosis

1. Ineffective individual coping
related to :
  • Situational crisis;
  • Inadequate support systems;
  • Ineffective coping methods.

2. Deficient Knowledge (learning needs)
related to :
  • Lack of knowledge;
  • Misinterpretation of information;
  • Cognitive limitations;
  • Deny the diagnosis.

3. Risk for Fluid Volume Excess
related to :
  • The displacement of the pressure on the congestive pulmonary vein;
  • Decrease in perfusion organ (kidney);
  • Increased retention of sodium / water;
  • Increased hydrostatic pressure, or decreased plasma protein (absorbs liquid in the interstitial area / tissue).

4. Risk for Impaired gas exchange
related to :
  • Alveolar - capillary membrane changes (displacement of fluid into the interstitial area / alveoli).

5. Ineffective breathing pattern
related to:
decreased lung expansion.

6. Anxiety
related to:
  • Threat of loss / death;
  • Situational crisis;
  • Threats to self-concept (self-image).

7. Ineffective Tissue perfusion
related to:
  • Decrease in peripheral blood circulation;
  • Cessation of arterial-venous flow;
  • Decrease in activity.
8. Decreased cardiac output
related to:
  • Obstruction of blood flow from the left atrium into the left ventricle,
  • Presence of ventricular tachycardia,
  • Shortening of the diastolic phase.

9. Imbalanced Nutrition: less than body requirements
related to:
  • Shortness of breath.
10. Impaired Urinary Elimination
related to:
  • Decreased glomerular perfusion;
  • Decrease in cardiac output.
11. Risk for Fluid Volume Deficit
related to:
  • Decrease in cardiac output;
  • Decline in glomerular filtration.

12. Activity intolerance
related to:
  • Decreased cardiac output,
  • Congestive pulmunal.

Fluid and Electrolyte Imbalance - Nursing Care Plan for Vomiting

 
Nursing Care Plan for Vomiting - Nursing Diagnosis : Fluid and Electrolyte Imbalance : less than body requirements.

Vomiting is a symptom, not a disease. Symptoms of this form of discharge of the contents of the stomach and intestines through the mouth, with a force. Vomiting is the body's protective reflex, because it can protect against toxins accidentally ingested. In addition, an attempt vomiting removing toxins from the body and can reduce the pressure caused by the blockage or enlargement of the organ that puts pressure on the digestive tract. Generally vomiting consists of three phases, namely nausea (feeling sick), retching (initial maneuver to vomit) and regurgitation (evisceration stomach / intestine into the mouth).

Vomiting occurs through a mechanism that is very complex. The occurrence of vomiting is controlled by the vomiting center in the central nervous system (brain) us. Vomiting occurs when there are certain conditions that stimulate the vomiting center. Stimulation of the vomiting center and then proceed to the diaphragm (the partition between the chest and abdomen) and stomach muscles, resulting in decreased diaphragm and constricting (shrinking) the muscles of the stomach. That in turn resulted in increased pressure in the abdomen especially in the stomach and cause the release of stomach contents through the mouth. Some conditions that can stimulate the vomiting center in which various gastrointestinal disorders in both infections (including gastroenteritis) and non-infectious (such as obstruction of the digestive tract), toxins (poisons) in the digestive tract, balance disorders, and metabolic disorders.

Nursing Care Plan for Vomiting : Fluid and Electrolyte Imbalance : less than body requirements related to excessive fluid output.

Goal: fluid and electrolyte deficits resolved

Outcomes:
  • There are no signs of dehydration,
  • mucosa of the mouth and lips moist,
  • fluid balance.

Intervention:
  • Observation of vital signs.
  • Observation for signs of dehydration.
  • Measure the input and output of fluid (fluid balance).
  • Provide and encourage the family to drink a lot more than 2000 - 2500 cc per day.
  • Collaboration with physicians in fluid therapy, electrolyte laboratory examination.
  • Collaboration with a team of nutrition in low-sodium fluids.

Factors Influencing Health Status of The Elderly

 
There are several factors that affect the mental health of the elderly. These factors shall be addressed wisely so that the elderly can enjoy their life happily. As for some of the factors facing the elderly are greatly affecting their mental health is as follows:

1. Decrease in Physical Condition

After someone entered the elderly, generally ranging seized their physical condition, which is pathological regression (multiple pathology), for example, reduced power, decreased energy, more wrinkled skin, the more teeth fall out, the more brittle bones, etc..

In general, the physical condition of a person who has entered a period of elderly decline exponentially. This all may cause interference or physical dysfunction, psychological and social, which in turn can lead to a state of dependence on others. In the lives of the elderly in order to maintain a healthy physical condition, it is necessary to align with the physical needs psychological and social conditions, so inevitably there must be efforts to reduce the activities of a physical memforsir. An elderly should be able to set a good way of life, such as eating, sleeping, rest and work in balance.



2. Decrease Function and Sexual Potency

Decrease function and sexual potency in the elderly is often associated with a variety of physical disorders such as:
  1. Heart problems.
  2. Metabolic disorders, eg, diabetes mellitus.
  3. Vaginitis.
  4. Recently completed operations: for example prostatectomy.
  5. Malnutrition, due to imperfect digestion or appetite is very less.
  6. The use of certain medications, such as antihypertensives, steroid group, tranquilier.
  7. Psychological factors that accompany the elderly, among others:
    • Sense of taboo or embarrassment when maintaining sexual life of the elderly.
    • Attitudes families and communities that lack support and strengthened by tradition and culture.
    • Fatigue or boredom due to lack of variation in his life.
    • Spouse has died.
    • Sexual dysfunction due to hormonal changes or other mental health problems anxiety, depression, dementia, etc..

3. Changes in Psychosocial Aspects

In general, after entering the elderly then it decreased cognitive and psychomotor function. Cognitive function includes the process of learning, perception, comprehension, understanding, attention and others that cause reactions and behaviors of the elderly become increasingly slow. While psychomotor function (conative) covers matters relating to such will boost the movement, action, coordination, resulting in that the elderly become less nimble.
With the decrease in both functions, the elderly also experience changes in psychosocial aspects related to the state of kepabrikan elderly. Some of these changes can be differentiated based on 5 elderly personality types as follows:
  1. Construction personality , usually this type is not a lot experienced turmoil , calm and steady until very old .
  2. Independent personaliy , there is a tendency in this type of experience post power syndrome , especially if in the future be filled with the elderly are not activities that can provide autonomy on him .
  3. Dependent personality , in this type usually greatly affected family life , family life always harmonious if the elderly are not volatile at times , but if the spouse dies, the spouse left behind will be miserable , especially if you do not get up from his position .
  4. Hostility personality , in this type after entering the elderly are still not satisfied with his life , a lot of desire that is sometimes not in the carefully calculated , causing economic conditions to be messy .
  5. Self Hate Personality , the elderly of this type generally looks miserable , because the behavior itself is difficult aided by others or themselves tend to be difficult .

Nursing Diagnosis and Interventions of Activity Intolerance in Elderly

 
Assessment

1. Physical examination:
  • Musculoskeletal: decreased tone, strength, muscle size and endurance; range of motion of joints and skeletal strength.
  • Cardiovascular: the formation of thrombosis, thrombophlebitis signs include: erythema, edema, tenderness and signs of positive Humans.
  • Respiration: atelectasis and pneumonia symptoms, early signs include an increase in temperature and heart rate.
  • Integument: ischemia injury against the first tissue is inflammatory, early changes seen on the surface of the skin as an irregular area of erythema.
  • Urinary function: physical signs such as urinating a little and often, lower abdominal distension and bladder limits that can be touched.
  • Gastrointestinal: constipation and faecal going small, hard and dry.
  • Environment: bathroom without handles, loose rugs, lighting is not adequate, a high ladder, slippery floor and toilet seat that lowers the client mobility.

2. Assessing the skeletal body: The deformity and alignment. Abnormal bone growth due to bone tumors. Shortening of limb, amputation and body parts that are not in anatomical alignment. Abnormal angulation of the long bones or movement at a point other than the joints usually indicate the presence of fractures.

3. Assessing the spine:
  • Scoliosis (curvature of the lateral deviation of the spine)
  • Kyphosis (curvature of the spine increase the chest)
  • Lordosis (quack, the curvature of the lumbar spine over)
4. Assessing joint system: Broad movement was evaluated both active and passive, deformity, stability, and the lumps, the joint stiffness.

5. Assessing muscle system: The ability to change the position, muscle strength and coordination, and the size of each muscle. Limb circumference to mementau or atropfi edema, muscle pain.

6. Assessing how patients walk: The irregular movements are not considered normal. If one limb shorter than the other. A variety of neurological conditions associated with abnormal gait (eg walking spastic hemiparesis way - stroke, patients go step by step - lower motor neuron disease, patients walked vibrate - Parkinson's disease).

7. Assessing the skin and the peripheral circulation: palpation of the skin can indicate a temperature hotter or colder than others and the edema. Peripheral circulation was evaluated by assessing peripheral pulses, color, temperature and capillary refill time.

8 . Assessment of functional status :
  • Baths : Told independent when in client activity just need help to scrub or clean up a certain portion of the body member , said the dependent if the client requires assistance to more than one body part .
  • Dress : Independent if unable to take his own clothes in a closet or drawer .
  • To the toilet : Independent when the elderly can not afford to own a toilet , getting out of the toilet and hem itself . Dependent when it need a bed pan or pot .
  • Transferring : Independent themselves when able to climb down from a bed or wheelchair . Dependent if always require assistance for activities above or unable to perform one or more activities of transferring .
  • Continence : Independent shitting themselves when able ( urinary and defecation ) . When dependent on one or both of micturition or sefekasi require enema or catheter .
  • Eating : Independent if it is able to bribe their own food , take away from the plate .


Nursing Diagnosis and Interventions of Activity Intolerance in Elderly

Nursing Diagnosis : Impaired Physical Mobility related to depression

Goal : Depression can be resolved and activities to do.

Outcomes:

Clients can perform daily activities , and depression disappeared .

Intervention :
  1. The prevention of osteoporosis , either through medical intervention , nutrition , as well as lifestyle adjustments .
  2. The prevention of falls in accordance with the results of the assessment of the environmental factors as well as risk factors does surgery on the risk of environmental factors .
  3. Maintenance of strength and resilience of the musculoskeletal system , which includes daily exercise conditioning program both isometric and isotonic muscle contraction , strengthening and aerobic activity , nutrition and protein anabolism to increase bone formation and attitude of commitment to exercise .
  4. Maintaining the flexibility of the joints involved in range of motion exercises , proper positioning and activities of daily living .
  5. Maintenance of normal ventilation and hyperinflation include mobilization and eliminate secretions .
  6. Maintenance of adequate circulation include supporting measures to maintain vascular tone , compression stockings to put external pressure on the limbs and adequate fluid intake to prevent dehydration effect on blood volume .
  7. Maintenance of urinary and bowel function were normal relies on nutritional support and environmental structure and routines to facilitate elimination .

7 Minimum Standards of Antenatal Care

 
Antenatal Care (ANC) is a prenatal care provided by a midwife or doctor to the mother during pregnancy to optimize mental and physical health of pregnant women, so as to face childbirth, childbirth preparation, breastfeeding, and the return of normal reproductive health (Manuaba, 1998) .

Antenatal antenatal examination is done to check on the mother and fetus at regular intervals, followed by efforts to correct the deviations found (Antenatal Care Guidelines on Basic Service Level, 2004: 1).

7 Minimum Standards Antenatal Care

According to Saifuddin (2002) Antenatal care covers a lot of things, but in the application of the minimum standards of known operations consist of:

1. Measure weight
During pregnancy is between 0.3-0.5 kg per week. When gestational age was associated with weight gain during early pregnancy ± 1 kg, then the second and third trimester, respectively increases of 5 kg. At the end of pregnancy weight gain total is 9-12 kg. If there is excessive weight gain should be considered towards the risk as swelling, multiple pregnancy, hydramnios, and a great kid.

2. Measure blood pressure
During pregnancy, high blood pressure when more than 140/90 mmHg. When blood pressure increases, ie 30 mmHg systolic or more and or diastolic 15 mm Hg or more. These abnormalities may progress to preeclampsia and eclampsia if not handled properly.

3. Measure the height of fundus of uterus

Normal fundus height is as follows:
12 weeks: 1-2 fingers above the symphysis.
16 weeks: halfway between the symphysis-center.
20 weeks: 3 fingers under center.
24 weeks: tall center.
28 weeks: 3 fingers above the center.
32 weeks: mid-center - processus xiphoideus.
36 weeks: three fingers below the processus xiphoideus.
40 weeks: midway between the processus xiphoideus - center (Mochtar, 1998)

4. TT immunization
Giving TT, will lead to a protective effect when given at least twice with a minimum interval of 4 weeks. Except if the mother had previously received TT twice in the last pregnancy or at the time of the TT pretty bride was given only once.

5. Provision of iron tablets
Basically giving iron tablets initially treated with a single daily tablet as soon as possible after the nausea passes.

6. Tests for sexually transmitted diseases.
During pregnancy, mothers should be tested for sexually transmitted diseases such as HIV / AIDS, Gonorrhoe, syphilis. That is because very influential on the fetus. If found disease - sexually transmitted diseases should be addressed.

7. Counseling
Preparation refers to higher health care, need to be prepared because the maternal and infant mortality due to delay in reaching health facilities.

Headaches During Pregnancy - Prevention and Pain Management

 
Headaches experienced during the first trimester due to the rapidly changing hormone levels, resulting in increased blood volume in the body. In addition, feelings of stress which is often plagued pregnant women is also one of the triggers of these symptoms. There are several types of headaches that can occur during pregnancy. One of them is feeling like a squeezing pain on both sides of the head or the back of the neck.

Many women who experience tension headaches during pregnancy and this may become more severe during the first trimester. This type of headache is usually caused by lack of sleep and depression during pregnancy. However, the increased levels of the hormone can also be one cause.

Mothers who are pregnant should not take carelessly known cure for fear of affecting the fetus in the womb. Most of headache medications may have harmful effects or unknown impact on infant development.


Prevention

For that to know a few things that can prevent the occurrence of headaches during pregnancy :
  1. Avoiding triggers, various things are known can be a trigger like eating late, certain smells or foods consumed.
  2. Physical activity in your daily routine, such as walking every day or doing light aerobic exercise.
  3. Perform relaxation exercises, soothing activities such as yoga, deep breathing and visualization can help keep headaches.
  4. Eat small meals but more frequently, so they can keep blood sugar levels stable and prevent headaches. If you do not eat for 2-3 hours, a quick snack consumption, such as biscuits. This will immediately raise blood sugar levels.
  5. Consume enough fluids to keep the body well hydrated. Immediately drink water or juice.
  6. Maintain a regular sleep schedule, due to fatigue and lack of sleep can contribute to headaches during pregnancy, and be sure to go to bed and wake up at the same time even on weekends.
  7. Maintain good posture, due to poor posture or muscle tension can cause headaches, especially the weight gain to support the pregnancy.
  8. First of all, sit down first. This method helps reduce the pain (because blood flow to the head so much smoother), also prevents falling pregnant women.
  9. If it will change the position of the body, do it slowly. For example, if you stand up from a lying position, try to sit down, then stand slowly.

But if the inevitable headaches and attacking pregnant women , then do the following steps :
  1. Do the rest by lying in a dark room or dim , quiet atmosphere and eyes closed .
  2. Using warm compresses to the eyes , face and temples or forehead , or could also try a cold compress on the back of the neck .
  3. Ask someone to do massage on the shoulders and neck to relieve tension , or massaging the temples also can help . Actually , headache disorders are not severe .
But , if the second trimester headaches for the first time ( both with impaired vision or not , abdominal pain , skyrocketing weight gain , and swelling of the face or hands ) , soon to consult a midwife or a doctor . Could be , blood pressure and urine should be examined in the laboratory to see the possibility of developing pre - eclampsia or pregnancy poisoning . This is also the reason for the importance of antenatal care on a regular basis .

Nursing Care Plan for Cushing's Syndrome

 
Definition of Cushing's syndrome

Cushing's syndrome is a condition caused by hyperadrenocorticism, is more often found in women, due to neoplasms in the adrenal cortex / anterior pituitary, or a result of long-term intake of glucocorticoids for therapeutic interest (Dorland).

Etiology of Cushing's syndrome
  • Excessive activity of the adrenal cortex
  • Corticosteroids / ACTH excess
  • Adrenal cortex hyperplasia.

Symptoms of Cushing's syndrome

Most people with Cushing syndrome will have:
  • Upper body obesity (above the waist) and thin arms and legs
  • Round, red, full face (moon face)
  • Slow growth rate in children

Skin changes that are often seen:
  • Acne or skin infections
  • Purple marks (1/2 inch or more wide) called striae on the skin of the abdomen, thighs, and breasts
  • Thin skin with easy bruising

Muscle and bone changes include:
  • Backache, which occurs with routine activities
  • Bone pain or tenderness
  • Collection of fat between the shoulders (buffalo hump)
  • Rib and spine fractures (caused by thinning of the bones)
  • Weak muscles

Women with Cushing syndrome often have:
  • Excess hair growth on the face, neck, chest, abdomen, and thighs
  • Menstrual cycle that becomes irregular or stops
Men may have:
  • Decreased or no desire for sex
  • Impotence
Other symptoms that may occur with this disease:
  • Mental changes, such as depression, anxiety, or changes in behavior
  • Fatigue
  • Headache
  • Increased thirst and urination

Management of Cushing's Syndrome

As more Cushing's Syndrome is caused by a pituitary tumor than adrenal tumor, the treatment is often directed at the pituitary gland.
  1. Transsphenoidal hypophysectomy, surgical removal of the tumor.
  2. Radiation pituitary gland, takes several months to control the symptoms.
  3. Adrenalectomy, the treatment of choice for patients with primary adrenal hypertrophy.
  4. Baffle adrenal enzyme preparations (ie, metyrapon, aminoglutethimide, mitotane, ketoconazole) to reduce hiperadrenalisme if due to ectopic ACTH secretion.


 Nursing Care Plan for Cushing's Syndrome

Nursing Diagnosis for Cushing's Syndrome
  1. Risk for injury and Risk for infection related to weakness and changes in protein metabolism and inflammatory response.
  2. Self-care Deficit: weakness, feeling of tiredness, muscle atrophy and changes in sleep patterns.
  3. Impaired skin integrity related to edema, impaired healing and the skin is thin and fragile.
  4. Disturbed Body Image related to changes in physical appearance, sexual dysfunction and decreased activity levels.
  5. Disturbed Thought Processes related to fluctuations in emotions, irritability and depression.

Tips to Lowering Blood Sugar in Diabetes

 
Lowering Blood Sugar in Diabetes Mellitus is very difficult to do, the key appropriate diet is often overlooked so that blood sugar levels continue to rise. In normal people, blood sugar levels can be reabsorbed by the cells to be processed into energy as a source of human motion. Whereas in diabetic patients, a simple sugar remains in the blood stream and cause blood sugar levels to rise. Therefore, for patients with diabetes need to add fibrous foods in the daily diet.

Reduce Excess Fat

Excess fat will affect the sensitivity of cells to insulin substances in the body, which then disrupt the function of insulin to absorb blood sugar. This will result in a rise in blood sugar levels drastically. Reduce excess fat to lower blood sugar is best, of course with regular exercise. Burn fat also aims to maintain a healthy weight and reduce the risk of cardiovascular disease. In this regard, please note.

Herbs for Diabetes Patients

Herbs are believed to reduce blood sugar levels naturally very much. The type of these plants include; bitter melon, turmeric, ceremai, bitter, mango leaves, gotu kola, ginseng, red betel leaf. That need to be considered in the use of herbs to lower blood sugar levels, is about the possibility of hypoglycemia. The use of herbal plants is certainly for a while, and not good if consumed continuously. To keep the best blood sugar levels naturally by adjusting the diet.

How to cultivate food for people with diabetes

Processing of food consumed will affect how patients with diabetes keep blood sugar levels. For example, to cook the rice to be consumed by people with diabetes is to use a regular pan is heated on the stove, not the engine or electric rice cooker appliance. It aims to keep the unraveling of complex carbohydrates into simple carbohydrates, and trigger a rise in blood sugar levels.

Cooking vegetables for diabetics, should not be too long. It is intended that the content of complex carbohydrates and nutrients in vegetables are not damaged. Diabetes sufferers, should also reduce fried foods. As a substitute, you can stir frying, grilling or using a vacuum frying techniques with particular cookware.

7 Ways to Take Care of Elderly Affected Hypertension

 
Hypertension is a condition where a person experiences an increase in blood pressure above normal indicated by the systolic number (top) and the bottom number (diastolic) blood pressure on examination using a blood pressure measuring device either in the form of mercury cuff (sphygmomanometer) or other digital devices .

The normal value of a person's blood pressure with height, weight, activity level and general health normal is 120/80 mmHg. In daily activities, normal blood pressure is stable with a numeric value range. But in general, the numbers decreased blood pressure during sleep and increased time when activity or exercise.

Here are some important things to consider in caring for elderly people who have hypertension:

1. Elderly affected by hypertension, decreased organ function, including the sense of taste. Usually the elderly will likely feel less salt or food was bland, although according to the usual size, salinity was fitting. Because of this, you need to do is to add sugar or spices cooking on food, but it is recommended not to use because of the flavor flavoring has a high salt content. In addition, if you want to buy food such as snacks and fast food, consider the salt content listed on the packaging.

2. Reduce foods containing sodium to less than 100 mmol / day (less than 6 g of sodium chloride, or less than 2.4 g of sodium per day).

3. Help the elderly to reduce weight up to a healthy weight and eat a diet rich in fruits and vegetables.

4. Help the elderly to limit consumption of caffeine and alcohol.

5. Accompany the elderly to light exercise such as walking, tai-chi, gymnastics heart that can be done 3-5 times / week for 30-45 minutes. However, avoid the habit of standing in a long time and perform strenuous activities, such as going up - and down the stairs.

6. Remind elderly, to change positions slowly. For example, when Elderly want to stand up from a lying position, preferably in advance Elderly sitting for about 5 minutes. If it does not feel dizzy, then stand slowly.

7. Help the elderly to measure blood pressure to elderly health worker, clinic or other health facility.

Home Health Care for The Elderly

 
Metabolic diseases such as hypertension, diabetes mellitus, osteoporosis, and stroke often complained about by parents in the elderly stage.

Older people with age above 50 years old are very susceptible to diseases, which include: diabetes mellitus, hypertension, and Osteoporosis. Therefore, for early prevention, you should always remind parents to avoid foods that are hard, dense, and too salty, sour or sweet.

Diet for the Elderly

Then you also have to adjust their diet. Reducing the share of food in the elderly needs to be done, because the energy needs of the parents dropped so drastically. In order not to affect the stamina and health of the elderly, you can make gradual reduction in size of the meal. You should also begin to provide food that is rather soft, easily digested by the stomach.

Right Food for the Elderly

In addition to adjusting the diet, other things that are needed to maintain the health of the elderly is that calcium can be obtained from drinking milk. Calcium is a substance used to strengthen bones, prevent body bent and reduce osteoporosis. so drinking milk on a regular basis, is highly recommended for the elderly.

Other substances are also very important for the elderly is Omega 3. Substances that are very useful for the body, can be obtained from fish, vegetables, fruit and fish oil, with the aim to prevent the occurrence of symptoms of stroke in elderly parents.

Right Sport for the Elderly

In addition to providing nutritious food intake for the elderly and maintaining the proper diet, you also have to set a routine exercise for the elderly. Indeed sporting activities undertaken not as heavy as you are still young. However, for the elderly walking is the simplest activity and relatively safe. Walking activity can train the heart muscle strength, leg and maintain smooth breathing for the elderly.

Conclusion:
  • Metabolic diseases such as diabetes mellitus, hypertension, stroke and osteoporosis often complained of by the elderly,
  • To keep Health Care, can be done with lifestyle and healthy eating, as well as light exercise on a regular basis.

The Scope of Nursing Research

 
The scope of nursing research problem is divided into six (6) scope of the research problem, namely:

A. Basic Nursing and Nursing Management
  1. Development of concepts and theories of nursing
    Focuses on the study of theory that has been there to convince the public, that the science of nursing is different with other health professions, as well as the spesific knowledge in the nursing field, consisting of:
    1. Adaptation theory. (Calista Roy)
    2. Self-care deficits. (Orem)
    3. Environmental health. (Florence Nightingale)
    4. The concept of nursing practice models. (Betty Neuman)
  2. Issue of basic human needs
    Study of the causes and efforts to meet basic needs, include:
    1. Oxygenation problems
    2. Nutritional problems
    3. Fluid and electrolyte problems
    4. Elimination problem
  3. Nursing Education
    1. Curriculum development and implementation
    2. Students and faculty
    3. Learning methods
    4. Evaluation system
  4. Nursing Management
    1. The role and performance of nurses
    2. Nursing management system
    3. The role and performance of nursing committee
  5. The role and function of professional organizations
    1. Organizational roles within nursing practice system (Registration, license, legalization).
    2. Role of standard-setting organizations within nursing practice.
    3. Organization's role in the development of the higher education system of nursing.
B. Pediatric Nursing
Scope of pediatric nursing research, based on a philosophy of nursing children (Biopsychosocial) children due to hospitalization and nursing roles in children and families, including:
  1. Impact of hospitalization.
  2. Developmental problems of children.
  3. Child immunization issues.
  4. Nursing care problems of children with disorders body system.

C. Maternity Nursing
The scope of this study focused on women of childbearing age couples, prenatal, natal and post natal and reproductive disorders, include:
  1. Problems of pregnant women
  2. Maternal intrapartum problems (I - IV) and nursing care of low birth weight babies, assessment - evaluation)
  3. Postpartum maternal problems (vulvar hygiene, breast care, postnatal exercises, how to breastfeed)
  4. Maternal problems with reproductive disorders (early detection of reproductive disorders, anxiety Ca cervix)

D. Medical-surgical Nursing and Emergency
In the scope of medical-surgical nursing, research focusing on askep clients with impaired adult body systems approach to the nursing process.
  1. Scope of Medical Surgical Nursing Science
    • Immune system
      1. Effect of regular exercise to increase endurance.
      2. The effect of vitamin A on the production of leukocytes.
      3. Relationship anxiety with immune function.
    • Respiration and oxygenation system
      1. Differences in the effectiveness of the use of masks and hoses oxygenation (catheter)
      2. The most effective nursing interventions for the treatment of clients with hoarding thick secretions in the airways.
    • Cardiovascular system
      1. Effect of physical exercise on health improvement coronary heart patients.
      2. O2 delivery methods are most effective to improve / maintain PaCO2.
      3. Terapy influence relaxation to decrease pain angina pectoris clients.
    • Neural system
      1. Effectiveness of the method in dealing with acute pain distraction postoperative patients.
      2. Effectiveness with warm water immersion in overcoming the pain of dislocation.
      3. The most effective method for detecting early impairment of consciousness.
    • Urinary system
      1. Educational relationship with dietary adherence clients with kidney stones.
      2. Influence the frequency of sexual intercourse on the incidence of BPH.
      3. BPH influence on the formation of urinary tract stones.
    • Gastrointestinal tract
      1. Dietary adherence relationship to the incidence of peptic ulcers in clients with gastritis.
      2. The most effective method in reducing pain in NGT installation.
      3. Effect of frequency / number of smoking on the incidence of gastritis.
    • Endocrine system
      1. Client compliance with diabetes mellitus, the diet
      2. The most effective method in dealing with hypoglycemia
      3. Client adherence diabetes mellitus, the blood sugar control
  2. Scope of Emergency Nursing
    • Respiratory gravity
      1. Early detection of severe breathing method on the client
      2. The role of nurses in addressing severe breathing
      3. Technical development chest physio therapy
    • Cardiovascular gravity
      1. The role of the nurse within the gravity handlers cardio-vaskuer (use of DC sock)
    • Psychiatric emergency
      1. Effective methods of binding (restrain) client rampage 
      2. The role of the nurse within the handling of client rage, depression and suicide attempts.
E. Psychiatric Nursing Science
  1. Scope of application of the nursing process
    • Influence on the development of therapeutic modalities klein depression.
    • Development of therapeutic communication techniques
    • Development of therapeutic modalities
  2. Therapeutic group activities
    • Effective methods of activity therapy for depression client
  3. Therapeutic environment / environmental manipulation
    • Effectiveness of preventive home visits to clients relapse of mental disorder
    • Recurrence relation with the client receiving the surrounding environment.
F. Nursing Community, Family and Gerontic
  1. Scope of Community
    • Ommunity participation in efforts to improve public health.
    • Maternal perception of the implementation of ante-natal
    • TB patient compliance in the implementation of therapy (DOTS)
  2. Scope of family
    • Terapiutik communication effectiveness in a family approach
    • Family roles to the treatment of pulmonary Tb
    • Perceptions of family heads towards family planning program
  3. Scope Gerontic
    • Method approach is effective in elderly
    • The role of nurses within nutritional needs of the elderly
    • Effect of occupational therapy on stress reduction elderly.

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