Nursing Diagnosis and Interventions for Cirrhosis of the Liver


Nursing Diagnosis 1.

Self-Care Deficit related to fatigue and the presence of ascites.

Goal: The client is able to care for themselves.
Expected outcomes: The client is able to show self-care activities.

Interventions :

1. Give the rest during the acute phase.
Rationale: Increased rest and tranquility providing the energy that is used for healing.

2. Give light activity during bed rest.
Rationale: Bed rest time, can reduce the ability, this is precisely the case due to the limited activities that disrupt the rest period.

3. If the client is tired, limit visits of family or friends.
Rationale: Increase rest and tranquility providing the energy that is used for healing.


Nursing Diagnosis 2.

Imbalanced Nutrition Less Than Body Requirements related to anorexia.

Goal: Nutrition clients are met.
Expected outcomes: The client is able to exhibit a lifestyle to improve or maintain an appropriate body weight, showed weight gain goals with laboratory values, and freely sign of malnutrition.

Interventions:

1. Observation vital signs.
Rationale: To determine the general state of the client.

2. Monitor dietary intake, or the number of calories and provide little in the frequency often.
Rationale: Eat a lot harder when the client anorexia. Anorexia is also the worst during the day, make food intake difficult in the afternoon.

3. Provide oral care before meals.
Rationale: Eliminate sense, it can not increase the appetite.

4. Monitor blood glucose.
Rationale: hyperglycemia or hypoglycemia can occur require changes in diet or insulin administration.

5. Collaboration: Consultation with a dietitian to provide a diet in accordance with the client's needs with the input of fat and protein as tolerated.
Rationale: Allows to create a diet program for individual needs. Protein restriction is indicated in severe diseases like hepatitis.


Nursing Diagnosis 3.

Risk for Impaired tissue integrity related to bed rest, ascites and edema.

Goal: Do not damage the integrity of the skin.

Expected outcomes: Identify the risk factors and shows the behavior or technique to prevent skin damage.

Interventions:

1. Elevate the lower extremities.
Rationale: Improves venous return and decrease edema in the extremities.

2. Keep the sheets dry and free of creases.
Rational: Humidity increase pruritus and improve skin damage.

3. Cut fingernails to short, and give the gloves if desired.
Rationale: Prevent clients from injury to the skin, especially at bedtime.

4. Give the massage at bedtime.
Rational: Beneficial to improve sleep by reducing skin irritation.

Nursing Diagnosis for Glaucoma (Pre and Post Operative)


Glaucoma is a group of eye diseases causing optic nerve damage. Glaucoma often affects both eyes, usually to varying degrees. One eye may develop glaucoma quicker than the other.Glaucoma is a condition which can affect sight, usually due to build up of pressure within the eye.

The exact causes of optic nerve damage from glaucoma is not fully understood, but involves mechanical compression and/or decreased blood flow of the optic nerve. Although high eye pressure sometimes leads to glaucoma, many people can also develop glaucoma with "normal" eye pressure.

There are four main types of glaucoma:
  • Acute angle-closure glaucoma – which often has severe symptoms
  • Chronic open-angle glaucoma – the most common type which often has few symptoms
  • Developmental glaucoma – a rare condition affecting young babies
  • Secondary glaucoma – caused by other conditions or eye treatments

Nursing Diagnosis for Glaucoma (Pre Operative)

1. Disturbed Sensory Perception (visual) related to the reception of sensory disturbances, impaired organ status.

2. Pain (acute / chronic) related to an increase in intra-ocular pressure (IOP)
characterized by nausea and vomiting.

3. Anxiety related to physiological factors, changes in health status, pain, possibility / reality vision loss.

4. Deficient Knowledge (learning needs) about the condition, prognosis, and treatment related to less exposed / do not know the source.



Nursing Diagnosis for Glaucoma (Post Operative)

1. Pain (acute / chronic) related to the surgical incision.

2. Risk for injury related to increased IOP, vitreous loss.

3. Risk for infection related to invasive procedures.

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.

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