Nurse Blog

Nursing Care Plans For Patient With Obsessive Compulsive Disorder

2012-01-10T16:12:00.000-08:00

Obsessive Compulsive Disorder
This disorder is characterized by involuntary recurring thoughts or images that the individual is unable to ignore and by recurring impulse to perform a seemingly purposeless activity. These obsessions and compulsions serve to prevent extreme anxiety on the part of the individual.
Patients with obsessive-compulsive disorder are prone to abuse alcohol, anxiolytics, or other substances in an attempt to relieve their anxiety. In addition, other anxiety disorders and major depression commonly coexist with obsessive-compulsive disorder. Obsessive-compulsive disorder is typically a chronic condition with remissions and flare-ups. Mild forms of the disorder are relatively common in the population at large.

Causes
The cause of obsessive-compulsive disorder is unknown. Some studies suggest the possibility of brain lesions, but the most useful research and clinical studies base an explanation on psychological theories. Several studies have shown brain abnormalities, such as decreased caudal size and decreased white matter, but results are inconsistent and remain under investigation. In addition, major depression, organic brain syndrome, and schizophrenia may contribute to the onset of obsessive-compulsive disorder.

Nursing Assessment
The psychiatric history of a patient with this disorder may reveal the presence of obsessive thoughts, words, or mental images that persistently and involuntarily invade the consciousness. Common obsessions include thoughts of violence (such as stabbing, shooting, maiming, or hitting), thoughts of contamination (images of dirt, germs, or stool), repetitive doubts and worries about a tragic event, and repeating or counting images, words, or objects in the environment. The patient recognizes that the obsessions are a product of his own mind and that they interfere with normal daily activities but feels powerless to stop them.
The patient's history may also reveal the presence of compulsions irrational and recurring impulses to repeat a certain behavior. Common compulsions include repetitive touching, sometimes combined with counting; doing and undoing (for instance, opening and closing doors or rearranging things); washing (especially hands); and checking (to be sure no tragedy has occurred since the last time he checked). In all cases, obsessive-compulsive behaviors and activities consume more than 1 hour of the patient's time per day. The activities are done to alleviate anxiety triggered by the patient's core fear.
During the assessment interview, determine the patient's personality type. The obsessional personality usually is rigid and conscientious and has great aspirations. He exhibits a formal, reserved manner, with precise and careful movements and posture; he takes responsibility seriously and finds decision-making difficult. He lacks creativity and the ability to find alternate solutions to his problems.Also evaluate the impact of obsessive-compulsive phenomena on the patient's normal routine. He'll typically report moderate to severe impairment of social and occupational functioning.

Nursing Diagnosis

Anxiety
Chronic low self-esteem
Fear
Ineffective coping
Ineffective role performance
Impaired social interaction
Risk for injury
Social isolation

Nursing Key outcomes Nursing Care Plans For Obsessive–Compulsive Disorder

The patient will express feelings of anxiety as they occur.
The patient will develop self-esteem.
The patient will express fears and concerns.
The patient will demonstrate effective social interaction skills.
The patient will cope with stress without excessive obsessive-compulsive behavior.
The patient will reduce the amount of time spent each day on obsessing and ritualizing.
Ritualistic behavior won't produce harmful effects.
The patient will maintain family and peer relationships
Client is able to maintain anxiety at level in which problemsolving can be accomplished.
Client is able to verbalize signs and symptoms of escalating anxiety.
Client is able to demonstrate techniques for interrupting the progression of anxiety to the panic level.

Nursing Interventions Nursing Care Plans For Obsessive–Compulsive Disorder

Approach the patient unhurriedly.
Provide an accepting atmosphere; don't show shock, amusement, or criticism of the ritualistic behavior.
Allow the patient time to carry out the ritualistic behavior (unless it's dangerous) until he can be distracted into some other activity. Blocking this behavior raises anxiety to an intolerable level.
Keep the patient's physical health in mind. For example, compulsive hand washing may cause skin breakdown, and rituals or preoccupations may cause inadequate food and fluid intake and exhaustion. Provide for basic needs, such as rest, nutrition, and grooming, if the patient becomes involved in ritualistic thoughts and behaviors to the point of self-neglect.
Let the patient know you're aware of his behavior. For example, you might say, I noticed you've made your bed three times today; that must be very tiring for you. Help the patient explore feelings associated with the behavior. For example, ask him, What do you think about while you are performing your chores?
Make reasonable demands, and set reasonable limits; make their purpose clear. Avoid creating situations that increase frustration and provoke anger, which may interfere with treatment.
Explore patterns leading to the behavior or recurring problems.
Listen attentively, offering feedback.
Encourage the use of appropriate defense mechanisms to relieve loneliness and isolation.
Engage the patient in activities to create positive accomplishments and raise his self-esteem and confidence.
Encourage active diversional resources, such as whistling or humming a tune, to divert attention from the unwanted thoughts and to promote a pleasurable experience.
Assist the patient with new ways to solve problems and to develop more effective coping skills by setting limits on unacceptable behavior (for example, by limiting the number of times per day he may indulge in obsessive behavior). Gradually shorten the time allowed. Help him focus on other feelings or problems for the remainder of the time.
Identify insight and improved behavior (reduced compulsive behavior and fewer obsessive thoughts). Evaluate behavioral changes by your own and the patient's reports.
Identify disturbing topics of conversation that reflect underlying anxiety or terror.
Observe when interventions don't work; reevaluate and recommend alternative strategies.
Monitor effects of pharmacologic therapy.

Nursing Diagnosis Latex Allergy response

2010-06-28T07:52:00.000-07:00

Nursing Diagnosis Latex Allergy response an allergic response to natural latex rubber products
Related Factors:
No immune mechanism response

Nursing Outcomes
• Immune Hypersensitivity Control
• Symptom Severity
• Tissue Integrity: Skin and Mucous Membranes

Client Outcomes
• Identifies presence of latex allergy
• Lists history of risk factors
• Identifies type of reaction
• States reasons not to use or to have anyone use latex products
• Experiences a latex free environment for all health care procedures
• Avoids areas where there is powder from latex gloves
• States the importance of wearing a Medic Alert bracelet and wears one

Nursing Interventions and Rationales

Allergy Management
Latex Precautions

Take a careful history of clients at risk: health care workers, rubber industry workers, clients with neural tube defects, atopic individuals (asthma, atopic eczema) and food allergies.
Question the client about associated symptoms of itching, swelling, and redness after contact with rubber products, or swelling of the tongue and lips after dental examinations.
Materials and items that contain latex must be identified, and latex free alternatives must be use.
Five principles for management of latex-allergic clients:

1. Recognize the problem,
2. Avoid exposure to latex,
3. Inform the surgeons and operating room nurses,
4. Be prepared to treat anaphylaxis,
5. Be vigilant postoperatively and arrange follow-up care.

Anaphylaxis from latex allergy is a medical emergency and must be treated differently than anaphylaxis from other causes must be placed in a latex-safe environment if necessary create a latex-free environment.

Home Care Interventions patient and Family Teaching

Do not use latex products in care giving.
Assess the home environment for presence of natural latex products.
At onset of care, assess client history and current status of latex allergy response.
Assist client in identifying and obtaining alternatives to latex products.
Provide written information about latex allergy and sensitivity.
Instruct clients to inform health care professionals if they have a latex allergy, particularly if scheduled for surgery.
Teach clients what products contain natural rubber latex and to avoid direct contact with all latex products and foods that trigger allergic reactions.
If necessary Instruct client to carry an autoinjectable epinephrine syringe if at risk for anaphylactic episode.

Nursing Key Outcomes, Nursing Interventions, Patient Teaching For Epilepsy

2010-01-05T08:33:00.000-08:00

Common nursing diagnosis found in nursing care plans for Epilepsy, Ineffective airway clearance, Anxiety, Deficient knowledge (diagnosis and treatment), Fear, Ineffective coping, Risk for injury, Social isolation

Nursing Key outcomes nursing care plans for Epilepsy
Patients with epilepsy will:

Express feelings of decreased anxiety.
Communicate an understanding of the condition and treatment regimen.
Identify any fears or concerns.
Use support systems and develop adequate coping.
Remain free from injury.
Resume active participation in social situations and activities.
Family will use support systems and develop adequate coping

Nursing interventions nursing care plans for Epilepsy

Provide emotional support to patients.
Encourage patient express their fears and concerns. Suggest counseling to help them cope.
Encourage family express their fears and concerns, and sugest to support counseling to help them cope.
Monitor the patient for signs and symptoms of toxicity, such as slurred speech, ataxia, lethargy, dizziness, drowsiness, nystagmus, irritability, nausea, and vomiting. If the patient is taking anticonvulsants
If needed Prepare the patient for surgery.
If necessary, provide preoperative and postoperative care appropriate for the type of surgery the patient is to undergo.

Patient Teaching Discharge And Home Healthcare Guidelines

Be sure that the patient understands all medications, including the dosage, route, action,adverse effects, and need for routine laboratory monitoring of AEDs

Give adequate patient support by developing an understanding of, Answer of any patients questions.
Teach patients dispelling myths. For example, assure them that epilepsy is not contagious and is controllable for most patients who follow a prescribed regimen of medication. Provide assurance that most patients maintain a normal lifestyle.
Explain to the patient and his family the need for compliance with the prescribed drug schedule.
Assure the patient that anticonvulsant drugs are safe when taken as ordered..
Teach the patient about the medication's possible adverse effect drowsiness, lethargy, hyperactivity, confusion, visual and sleep disturbance all of which indicate the need for dosage adjustment. Tell him that phenytoin therapy may lead to hyperplasia of the gums, which may be relieved by conscientious oral hygiene. Instruct the patient to report adverse reactions immediately.
Explain the importance of having anticonvulsant blood levels checked at regular intervals even if the seizures are under control.
Instruct the patient to eat regular meals and to check with his physician before dieting. Explain that maintaining adequate glucose levels provides the necessary energy for central nervous system neurons to work normally. (See Preventing seizures.)
If the patient is needs surgery, provide appropriate preoperative teaching. Explain the care that the patient can expect postoperatively.
Teach the patient's family to Avoid restraining the patient during a seizure
Know which social agencies in your community can help epileptic patients. Refer the patient to the Epilepsy Foundation for general information and to the state motor vehicle department for information about a driver's license.

Nursing Key outcomes, Nursing interventions, and patient teaching Nursing Care Plans for Chronic Renal Failure

2009-10-28T08:59:00.000-07:00

Nursing Key outcomes, Nursing interventions, and patient teaching Nursing Care Plans for Chronic Renal Failure
Key outcome for patients with CRF, patients will:

Report increased comfort.
Maintain hemodynamic status.
Remain oriented to person, place, time, and situation.
Maintain fluid balance.
Verbalize appropriate food choices according to his prescribed diet.
Maintain adequate ventilation and oxygenation.
Demonstrate skill in managing the urinary elimination problem.
Use support resources and exhibit adaptive coping behaviors.
Resume sexual activity to the fullest extent possible.
Maintain adequate urine output.
Verbalize having feelings of control over condition and own well-being.
Remain free from signs or symptoms of infection.
Avoid or minimize complications.
Family members will demonstrate adaptive coping behaviors.
The patient's oral mucous membrane will remain intact.
Family members will verbalize the effects of the patient's condition on the family unit.

Nursing interventions Nursing Care Plans for Chronic Renal Failure (CRF)
The widespread clinical effects of chronic renal failure require meticulous and carefully coordinated supportive care.

Provide good skin care.
Provide good oral hygiene
Offer small, palatable, nutritious meals
Monitor the patient for hyperkalemia. Watch for cramping of the legs and abdomen and for diarrhea.
Carefully assess the patient's hydration status.
Carefully measure daily intake and output.
Monitor for complications.
Encourage the patient to perform deep-breathing and coughing exercises to prevent pulmonary congestion
Maintain aseptic technique.
Carefully observe and document seizure activity. Periodically assess neurologic status.
Observe for signs of bleeding.
Report signs of pericarditis, such as a pericardial friction rub and chest pain.
Schedule medication administration carefully.
If the patient requires dialysis, check the vascular access site for patency and the arm used for adequate blood supply and intact nerve function.
After dialysis, check for disequilibrium syndrome, a result of sudden correction of blood chemistry abnormalities.

Patient teaching Nursing Care Plans for Chronic Renal Failure (CRF)

CRF and ESRD are disorders that affect the patient’s total lifestyle and the whole family. Patient teaching is essential and should be understood by the patient. All teaching should be reinforced at intervals during the patient’s lifetime. Include: Care of peritoneal catheter for dialysis, care of external arteriovenous dialysis access (shunt), care of the arteriovenous fistula, post-transplantation teaching.

Nursing Outcomes Nursing interventions and Patient teaching Nursing care plans for Conduct Disorder

2009-10-26T07:58:00.000-07:00

Nursing outcomes Nursing care plans for Conduct Disorder

Patients Anxiety is maintained at a level at which client feels no need for aggression and will not harm self or others physically or emotionally.
Client will seeks out staff to discuss true feelings.
Client recognizes, verbalizes, and accepts possible consequences of own maladaptive behaviors.
The patient and parents will attend counseling to discuss the patient's illness and learn how to handle his behavior.
Patient will develop effective coping skills to help him process stressors.
Patient will develop effective social interaction and problem solving skills.
Patient will utilize constructive channels to release anger.
Patient will express awareness of how his actions affect others.

Nursing interventions Nursing care plans for Conduct Disorder

Work to establish a trusting relationship with the child. Provide clear behavioral guidelines, including consequences for disruptive and manipulative behavior. Help the child accept responsibility for behavior rather than blaming others, becoming defensive, and wanting revenge.

Nursing Diagnosis and Interventions for Conduct Disorder

Patient teaching Nursing care plans for Conduct Disorder

Teach the child effective coping skills, social skills, and problem-solving skills, and have him demonstrate them in return.
Teach the child to express anger appropriately through constructive methods to release negative feelings and frustrations.
Use role playing to help the child practice handling stress and gain skill and confidence in managing difficult situations.

Nursing Care Plans for Epilepsy

2009-10-20T10:06:00.000-07:00

Epilepsy is a paroxysmal neurological disorder; epilepsy is a condition of the brain characterized by a susceptibility to recurrent seizures. It's also known as seizure disorder. Seizures are paroxysmal events associated with abnormal electrical discharges of neurons in the brain. In most patients, this condition doesn't affect intelligence. Epilepsy characterized by recurrent episodes of convulsive movements or other motor activity, loss of consciousness, sensory disturbances, and other behavioral abnormalities. Epilepsy often considered a syndrome rather than a disease, because epilepsy occurs in more than 50 diseases. Epilepsy usually occurs in patients younger than age 20, patients with Epilepsy achieve good seizure control with strict adherence to prescribed treatment.

Causes for Epilepsy

About half the cases of epilepsy are idiopathic. Nonidiopathic epilepsy may be caused by:

Primary central nervous system CNS disorders include any potential mass effect (tumor, abscess, atrioventricular malformation AVM, aneurysm, or hematoma)
Stroke (especially those that are embolic.).
Genetic abnormalities (E.g. Tuberous sclerosis and phenylketonuria PKU)
Prenatal injuries
Metabolic abnormalities, such as hypocalcemia, hypoglycemia, and pyridoxine deficiency
Brain tumors
Infections, such as meningitis, encephalitis, or brain abscess
Developmental disorders. Epilepsy can be associated with other developmental disorders, such as autism and Down syndrome
Traumatic injury, especially if the dura mater was penetrated
Toxins, such as mercury, lead, or carbon monoxide

Epilepsy occurs in all races and ethnicities, Researchers have also detected hereditary EEG abnormalities in some families, and certain seizure disorders appear to have a familial incidence. Different age groups have distinct associated causes. newborns up until 6 months of age, seizures are generally caused by birth trauma or metabolic disturbances. In children from 6 months to 5 years of age, etiology is related to febrile episodes or metabolic disturbances (hyponatremia, hypernatremia, hypoglycemia, hypocalcemia). In the 5- to 20-year-old group, seizures are primarily idiopathic (50%). In adults from 20 to 50 years of age, a new onset of seizures is almost exclusively caused by trauma or tumors. In older adults, seizures are generally caused by vascular disease cardiac dysrhythmias and Dementia.

Complications for Epilepsy
Associated complications can occur during a seizure:

Anoxia from airway occlusion by the tongue or vomitus and
Traumatic injury could result from a fall while the patient is confused or has an altered level of consciousness.
Drowning

Other life threatening complications

Sudden unexplained death
Status epilepticus

Nursing Assessment Nursing Care Plans for Epilepsy

Signs and symptoms vary Depending on the type and cause of the seizure. Physical findings may be normal if the assessment is performed when the patient isn't having a seizure. If the seizure is associated by a brain tumor, which may reveal signs and symptoms of that problem

Patient’s history of seizure occurrence

Diagnostic tests for Epilepsy

Electroencephalogram EEG
Computed tomography scanning
magnetic resonance imaging (MRI)
Positron emission tomography (PET)
Other helpful tests include serum glucose and calcium studies, skull X-rays, lumbar puncture, brain scan, and cerebral angiography, Neuropsychological tests.

Treatment for Epilepsy
Specific to the type of seizure.

commonly prescribed drugs include phenytoin, carbamazepine, phenobarbital, valproic acid, and primidone administered individually for generalized tonic-clonic seizures and complex partial seizures. Valproic acid, clonazepam, and ethosuximide are commonly prescribed for absence (petit mal) seizures. Lamotrigine is also prescribed as adjunct therapy for partial seizures. Fosphenytoin is an I.V. preparation that's effective in treatment.
Surgical removal of a demonstrated focal lesion to attempt to end seizures
Vagal nerve stimulation
Transcranial magnetic stimulators

Nursing diagnosis Nursing Care Plans for Epilepsy

Ineffective airway clearance related to clonic tonic motor activity and tongue obstruction
Anxiety
Deficient knowledge (diagnosis and treatment)
Fear
Ineffective coping
Risk for injury
Social isolation

Nursing Key outcomes, nursing interventions and Patient teaching Nursing Care Plans for Epilepsy

Nursing care plans for patient’s with Delusional disorders

2009-10-13T09:06:00.000-07:00

Psychiatric nursing care plans for Delusional disorders. Delusional disorders are characterized by false beliefs with a plausible basis in reality. Formerly referred to as paranoid disorders, delusional disorders are known to involve erotomanic, grandiose, jealous, or somatic themes as well as persecutory delusions. Some patients experience several types of delusions; other patients experience unspecified delusions that have no dominant theme. Delusional disorders typically chronic, these disorders often interfere with social and marital relationships but seldom impair intellectual or occupational functioning significantly. (DSM-IV-TR)

Delusional disorder is characterized by the presence of one or more no bizarre delusions that last for at least 1 month. Hallucinatory activity is not prominent. Apart from the delusions, behavior and functioning are not impaired. The following types are based on the predominant delusional theme (AMA, 2000):

Persecutory
Jealous
Erotomanic
Somatic
Grandiose

Causes for Delusional disorders

Hereditary predisposition. Some researchers suggest that delusional disorders are the product of specific early childhood experiences with an authoritarian family structure. sensitive personality is particularly vulnerable to developing a delusional disorder. At least one study has linked the development of delusional disorders to inferiority feelings in the family. Certain medical conditions exaggerate the risks of delusional disorders: head injury, chronic alcoholism, deafness, and aging.

Complications for Delusional disorders

Patient’s irrational beliefs may pose a threat to him or others. Greater patient's rage, the greater the risk of violent behavior or suicide.

Treatment for Delusional disorders

Combination of drug therapy and psychotherapy.
Drug with antipsychotic agents is similar other psychiatric drugs, such as antidepressants and anxiolytics.

Nursing diagnoses Nursing care plans for Delusional disorders

Risk for other-directed violence
Risk for self-directed violence
Social isolation
Anxiety
Disabled family coping
Disturbed personal identity
Disturbed sensory perception (visual, auditory)
Disturbed thought processes
Fear
Imbalanced nutrition: Less than body requirements
Impaired home maintenance
Impaired social interaction
Ineffective coping
Powerlessness
Risk for injury

Nursing Key outcomes nursing care plans for patient’s with Delusional disorders

The patient will consider alternative interpretations of a situation without becoming hostile or anxious. Anxiety is maintained at a level at which client feels no need for aggression.
Client demonstrates trust of others in his or her environment.
Client maintains reality orientation.
Client causes no harm to self or others.
Client demonstrates willingness and desire to socialize with others, voluntarily attends group activities.
Client approaches others in appropriate manner for one-to-one interaction.
The patient and his family will participate in care and prescribed therapies.
The patient will identify internal and external factors that trigger delusional episodes.
The patient will maintain functioning to the fullest extent possible within the limitations of his visual or auditory impairment.
The patient will express all fears and concerns.
Client is able to recognize that hallucinations occur at times of extreme anxiety.
Client is able to recognize signs of increasing anxiety and employ techniques to interrupt the response.
The patient will demonstrate effective social interaction skills in both one-on-one and group settings.
The patient will demonstrate adaptive coping behaviors.
The patient will identify and perform activities that decrease delusions.
The patient will remain free from injury.
The patient will maintain family and peer relationships.

Nursing interventions nursing care plans for patient’s with Delusional disorders

Nursing Care Plans for Chronic Renal Failure

2009-10-11T10:38:00.000-07:00

Chronic renal failure (CRF) refers to irreversible renal dysfunction as manifested by the inability of the kidneys to excrete sufficient fluid and waste products from the body to maintain health. CRF is fatal if it is not treated. Chronic renal failure is usually the end result of a gradually progressive loss of renal function. It also occasionally results from a rapidly progressive disease of sudden onset that gradually destroys the nephrons and eventually causes irreversible renal damage. Few symptoms develop until after more than 75% of glomerular filtration is lost. Then, the remaining normal parenchyma deteriorates progressively and symptoms worsen as renal function decreases.

Chronic renal failure progress stages:

Reduced renal reserve GFR 5% to 50% of normal
Renal insufficiency GFR 20% to 35% of normal
Renal failure GFR 20% to 25% of normal
End stage renal disease GFR less than 20% of normal

Causes for Chronic renal failure (CRF)

Chronic renal failure (CRF) may be caused by either kidney disease or diseases of other systems, chronic renal failure may result from:

Chronic glomerular disease, such as glomerulonephritis
Chronic infections, such as chronic pyelonephritis or tuberculosis
Congenital anomalies, such as polycystic kidney disease
Vascular diseases, such as renal nephrosclerosis or hypertension
Obstructive processes, such as calculi or benign prostatic hypertrophy
Collagen diseases, such as systemic lupus erythematosus
Nephrotoxic agents, such as long-term aminoglycoside therapy
Endocrine diseases, such as diabetic nephropathy
Disorders that impair circulation, such as sickle cell disease.

Complications For Chronic Renal Failure

Complications of CRF include uremia (accumulation of metabolic waste products in the blood and body tissues), anemia, peripheral neuropathy, sexual dysfunction, osteopenia (reduction of bone tissue), pathological fractures, fluid overload, congestive heart failure, hypertension, pericarditis, electrolyte imbalances (hypocalcemia, hyperkalemia, hyperphosphatemia), metabolic acidosis, esophagitis, and gastritis. Even if the patient can tolerate life-sustaining maintenance dialysis or a kidney transplant, he may still have anemia, peripheral neuropathy, cardiopulmonary and GI complications, sexual dysfunction, and skeletal defects.

Nursing Assessment Nursing Care Plans For Chronic Renal Failure

The patient may report a history of ARF (Acute Renal Failure) although usually the patient does not become symptomatic until he or she has a GFR less than 35% of normal. The patient likely complains of oliguria and weight gain. Ask the patient about the color of the urine, whether it is clear or cloudy, and whether it is frothy. The patient may also complain of a metallic taste in the mouth, anorexia, and stomatitis. Elicit a gastrointestinal (GI) history with particular attention to nausea, vomiting, hematemesis, diarrhea, and constipation

Symptoms usually occur by the time the GFR is 20% to 35% of normal, and almost all body systems are affected. Assessment findings reflect involvement of each system; many findings reflect involvement of more than one system.

Renal; Electrolyte imbalances, hyponatremias, Accumulation of potassium causes muscle irritability and then muscle weakness, irregular pulses, and life-threatening cardiac arrhythmias as serum potassium levels increase. Metabolic acidosis.
Cardiovascular; hypertension, cardiac arrhythmias can occur. Heart failure.
Respiratory. Pneumonia, pleural effusion. Kussmaul's respirations occur with metabolic acidosis.
Gastro Intestinal. Inflammation and ulceration of GI mucosa, inspection of the mouth may reveal gum ulceration and bleeding, parotitis, anorexia, nausea, and vomiting caused by esophageal, stomach, or bowel involvement.
Skin.
Neurologic.
Endocrine.
Hematologic.
Musculoskeletal.

Diagnostic tests Nursing Care Plans for Chronic Renal Failure

Various laboratory findings blood urea nitrogen, serum creatinine, sodium, and potassium levels; decreased arterial pH and bicarbonate levels; low hematocrit and hemoglobin levels; decreased RBC
Arterial blood gas analysis.
Renal or abdominal X-ray,
Abdominal computed tomography scan,
Magnetic resonance imaging
Ultrasonography
Renal biopsy
EEG

Treatment for Chronic Renal Failure

The goal of treating Chronic Renal Failure is to prevent progression of the disease, to avoid the morbidity and mortality of end-stage renal disease (ESRD), and to adequately prepare patients for eventual renal replacement therapy. This requires early intervention and adequate follow-up.A low protein diet reduces the production of end products of protein metabolism that the kidneys can't excrete. A high-calorie diet prevents ketoacidosis and the negative nitrogen balance that results in catabolism and tissue atrophy. The diet should restrict sodium, phosphorus, and potassium. Maintaining fluid balance, antihypertensives, Antiemetics, Anemia necessitates iron and folate supplements; severe anemia requires Transfusions. Transfusions relieve anemia only temporarily. Synthetic erythropoietin (epoetin alfa) stimulates the division and differentiation of cells within the bone marrow to produce RBCs. Drug therapy commonly relieves associated symptoms. Hemodialysis or peritoneal dialysis can help control most manifestations of end-stage renal disease. Altering the dialysate can correct fluid and electrolyte disturbances. However, maintenance dialysis itself may produce complications, including protein wasting, refractory ascites, and dialysis dementia. A kidney transplant may eventually be the treatment of choice for some patients with end-stage renal disease.

Nursing diagnosis Nursing Care Plans for Chronic Renal Failure
Primary nursing diagnosis fluid volume excess related to compromised regulatory mechanisms
Common nursing diagnosis found in Nursing Care Plans for Chronic Renal Failure

Acute pain
Decreased cardiac output
Disabled family coping
Disturbed thought processes
Excess fluid volume
Imbalanced nutrition: Less than body requirements
Impaired gas exchange
Impaired oral mucous membrane
Impaired urinary elimination
Ineffective coping
Ineffective sexuality patterns
Ineffective tissue perfusion: Renal
Interrupted family processes
Powerlessness
Risk for infection
Risk for injury

Nursing Key outcomes, Nursing interventions, and patient teaching Nursing Care Plans for Chronic Renal Failure

Nursing care plans for Conduct Disorder

2009-10-09T09:06:00.000-07:00

Aggressive behavior is the hallmark of conduct disorder. The conduct is more serious than the ordinary mischief and pranks of children and adolescents. The disorder is more common in boys than in girls, and the behaviors may continue into adulthood, often meeting the criteria for antisocial personality disorder a child with this disorder fights, bullies, intimidates, and assaults others physically or sexually, and is truant from school at an early age. Typically, the patient has poor relationships with peers and adults and violates others' rights and society's rules. Conduct disorder evolves slowly over time until a consistent pattern of behavior is established.

Causes for Conduct Disorder

Studies have suggested that conduct disorder has both biological (including genetic) and psychosocial components. Roughly 30% to 50% of patients with conduct disorder also have attention deficit hyperactivity disorder (ADHD).

Predisposing Factors for Conduct Disorder

Physiological: Birth Temperament, Genetics
Psychosocial: Peer Relationships, Theory of Family Dynamics

Parental rejection
Inconsistent management with harsh discipline
Early institutional living
Frequent shifting of parental figures
Large family size
Absent father
Parents with antisocial personality disorder and/or alcohol dependence
Association with a delinquent subgroup
Marital conflict and divorce
Inadequate communication patterns
Parental permissiveness

Complications for Conduct Disorder
The prognosis is worse in children with earlier onset; these children are more likely to develop antisocial personality disorder as adults. Social complications may include poor performance in school and substance abuse, and the child may suffer physical injury from fights or accidents due to risk-taking behaviors. Patients with conduct disorder also tend to have higher incidences of other psychological disorders, including ADHD, oppositional-defiance disorder, mood disorders, anxiety disorders, depression, and learning difficulties

Nursing Assessment Nursing care plans for Conduct Disorder
Signs and symptoms of conduct disorder include: abusing others sexually, cheating in school, cruelty to animals, engaging in precocious sexual activity, fighting with family members and peers, skipping classes, smoking cigarettes, speaking to others in a hostile manner, stealing or shoplifting, using drugs or alcohol, vandalizing or destroying property.

Uses physical aggression in the violation of the rights of others.
The behavior pattern manifests itself it virtually all areas of the child’s life (home, school, with peers, and in the community).
Stealing, fighting, lying, and truancy are common problems.
There is an absence of feelings of guilt or remorse.
The use of tobacco, liquor, or no prescribed drugs, as well as the participation in sexual activities, occurs earlier than the peer group’s expected age.
Projection is a common defense mechanism.
Low self-esteem is manifested by a “tough guy” image. Often threatens and intimidates others.
Characteristics include poor frustration tolerance, irritability, and frequent temper outbursts.
Symptoms of anxiety and depression are not uncommon.
Level of academic achievement may be low in relation to age and IQ.
Manifestations associated with ADHD (e.g., attention difficulties, impulsiveness, and hyperactivity) are very common in children with conduct disorder.

Treatment for Conduct Disorder
Treatment focuses on coordinating the child's psychological, physiologic, and educational needs. A structured living environment with consistent rules and consequences can help reduce a variety of symptoms. Parents need to be taught how to deal with the child's demands. Juvenile justice interventions may also be used. Medication can be useful as an adjunct to treatment. Overt aggression responds to many medications, such as antipsychotics, lithium, clonidine, and selective serotonin reuptake inhibitors. ADHD, if present, must also be addressed.

Nursing diagnosis nursing care plans for Conduct Disorder

Risk for self-directed or other-directed violence
Defensive coping
Impaired social interaction
Ineffective coping
Low self esteem
Nursing Diagnosis Anxiety
Disabled family coping
Noncompliance
Impaired adjustment
Interrupted family processes

Nursing Key outcomes, Nursing interventions, and patient teaching nursing care plans for Conduct Disorder

Nursing Key outcomes, Nursing interventions and Patient teaching Nursing Care Plans for Bulimia Nervosa

2009-10-07T07:59:00.000-07:00

Nursing Key outcomes Nursing Care Plans for Bulimia Nervosa, The patient will:

State strategies to reduce levels of anxiety.
Express positive feelings about self.
Have regular bowel elimination patterns.
Acknowledge change in body image.
Verbalize feeling well rested.
Display appropriate eating patterns, including regular, nutritious meals.
Participate in decision-making about case.
Interact with family or friends.
Fluid balance will remain stable, with intake equal to or greater than output.

Nursing interventions Nursing Care Plans for Bulimia Nervosa

• Supervise the patient during mealtimes and for a specified period after meals, usually 1 hour. Set a time limit for each meal. Provide a pleasant, relaxed environment for eating.
• Using behavior modification techniques, reward the patient for satisfactory weight gain.
• Establish a contract with the patient, specifying the amount and type of food to be eaten at each meal.
• Encourage the patient to recognize and verbalize her feelings about her eating behavior. Provide an accepting and nonjudgmental atmosphere, controlling your reactions to her behavior and feelings.
• Encourage the patient to talk about stressful issues, such as achievement, independence, socialization, sexuality, family problems, and control.
• Identify the patient's elimination patterns.
• Assess the patient's suicide potential.
• Refer the patient and her family to the National Eating Disorders Association and the National Association of Anorexia Nervosa and Associated Disorders as sources of additional information and support.

Nursing interventions for bulimia nervosa base on its nursing diagnosis:

Nursing Diagnosis Imbalanced nutrition: Less than body requirements

If client is unable or unwilling to maintain adequate oral intake, physician may order a liquid diet to be administered via nasogastric tube.
Nursing care of the individual receiving tube feedings should be administered.
In collaboration with dietitian, to provide realistic (according to body structure and height) weight gain, determine number of calories required to provide adequate nutrition.
Explain to patient’s behavior modification program as outlined by physician.
Explain benefits of compliance with prandial routine and consequences for noncompliance.
Sit with client during mealtimes for support and to observe amount ingested. Give to the patient a time limit for meals.
Client should be observed for at least 1 hour following meals.
Client may need to be accompanied to bathroom.
Weigh client daily; use same scale, if possible.
Do not discuss food or eating with client.

Nursing Diagnosis Deficient fluid volume

Teach client importance of daily fluid intake of 2000 to 3000 ml. This information is required to promote client safety and plan nursing care. Keep strict record of intake and output.
Weigh client daily; use same scale, if possible.
Assess and document condition of skin turgor and any changes in skin integrity.
Hot water and soap are drying to the skin, .Discourage client from bathing every day if skin is very dry.
Monitor laboratory serum values, and notify physician of significant alterations.
Client should be observed for at least 1 hour after meals and may need to be accompanied to the bathroom if self-induced vomiting is suspected.
Assess and document moistness and color of oral mucous membranes.
To minimizing risk of tissue infection. Encourage frequent oral care to moisten mucous membranes, reducing discomfort from dry mouth, and to decrease bacterial count.
Help client identify true feelings and fears that contribute to maladaptive eating behaviors.

Nursing Diagnosis Ineffective coping

Establish a trusting relationship with.
When nutritional status has improved, begin to explore with client the feelings associated with his or her extreme fear of gaining weight,
Explore family dynamics. Help client to identify his or her role contributions and their appropriateness within the family system
Initially, allow client to maintain dependent role. To deprive the individual of this role at this time could cause his or her anxiety to rise to an unmanageable level.
Give Positive reinforcement to increases self-esteem and encourages the client to use behaviors that are more acceptable.
Explore with client ways in which he or she may feel in control within the environment, without resorting to maladaptive eating behaviors.

Patient teaching Nursing Care Plans for Bulimia Nervosa

To monitor the treatment progress Teach the patient how to keep a food journal.
Teach about risks abuse of laxative, emetic, and diuretic to the patient.
To help the patient gain control over her behavior and achieve a realistic and positive self-image provide assertiveness training.
If the patient is taking a prescribed tricyclic antidepressant, instruct her to take the drug with food. Warn her to avoid consuming alcoholic beverages; exposing herself to sunlight, heat lamps, or tanning beds; and discontinuing the medication unless she has notified the physician.

Nursing Key outcomes, interventions, and Patient teaching Nursing Care Plans for Abruptio Placentae (placenta abruption)

2009-09-24T08:44:00.001-07:00

Nursing Key outcomes, interventions, and Patient teaching Nursing Care Plans for Abruptio Placentae (placenta abruption)

Key outcomes Nursing Care Plans for Abruptio Placentae (placenta abruption) the patient will:

Express feelings of comfort.
Express feelings of reduced anxiety.
Communicate feelings about the situation.
Discuss fears and concerns.
Use available support systems, such as family and friends, to aid in coping.
Remain hemodynamically stable.
Patient's fluid volume will remain within normal parameters.

Nursing interventions Nursing Care Plans for Abruptio Placentae (placenta abruption)

Monitor Vital sign; blood pressure, pulse rate, respirations, central venous pressure, intake and output, and amount of vaginal bleeding.
Monitor fetal heart rate electronically.
If vaginal delivery is elected, provide emotional support during labor.
Because of the neonate's prematurity, the mother may not receive an analgesic during labor and may experience intense pain. Reassure the patient of her progress through labor, and keep her informed of the fetus's condition.
Encourage the patient and her family to verbalize their feelings. Help them to develop effective coping strategies. Refer them for counseling, if necessary.

Patient teaching Nursing Care Plans for Abruptio Placentae (placenta abruption)

Teach the patient to identify and report signs of placental abruption, such as bleeding and cramping.
Explain procedures and treatments to allay patient's anxiety.
Teach the patient to notify the doctor and come to the hospital immediately if she experiences any bleeding or contractions.
Prepare the patient and her family for the possibility of an emergency cesarean delivery, the delivery of a premature neonate, and the changes to expect in the postpartum period. Offer emotional support and an honest assessment of the situation.
Tactfully discuss the possibility of neonatal death. Inform the patient that the neonate's survival depends primarily on gestational age, the amount of blood lost, and associated hypertensive disorders.
Inform the patient that frequent monitoring and prompt management greatly reduce the risk of death.
Inform the patient that she is at much higher risk of developing abruptio placentae in subsequent pregnancies.

Nursing Care Plans for Bulimia Nervosa

2009-09-17T08:35:00.000-07:00

Bulimia nervosa the binge and purge syndrome is an eating disorder, the essential features of bulimia nervosa include eating binges followed by feelings of guilt, humiliation, and self deprecation guilt, and anxiety over fear of weight gain. Characterized by extreme overeating, followed by self induced vomiting and abuse of laxatives, diuretics, strict dieting or fasting to overcome the effects of the binges. Unless the patient devotes an excessive amount of time to binging and purging, bulimia nervosa seldom is incapacitating.

Bulimia nervosa usually begins in adolescence or early adulthood and can occur simultaneously with anorexia nervosa. The disorder occurs predominantly in females and begins in adolescence or early adult life. Between 1% and 3% of adolescent and young females meet the diagnostic criteria for bulimia nervosa; 5% to 15% have some symptoms of the disorder.

Causes for Bulimia Nervosa

The exact cause of bulimia is unknown, but bulimia is generally attributed to a combination of psychological, genetic, and physiological causes. Such factors include family disturbance or conflict, sexual abuse, maladaptive learned behavior, struggle for control or self-identity, cultural overemphasis on physical appearance, and parental obesity. Bulimia nervosa is strongly associated with depression. Predisposing Factors to Anorexia Nervosa and Bulimia Nervosa

Complications for Bulimia Nervosa

Dental caries result from repetitive vomiting in bulimia nervosa.
Erosion of tooth enamel.
Parotitis
Gum infections.
Arrhythmias and even sudden death result from electrolyte imbalances.
Ipecac syrup intoxication can cause cardiac failure in patients who rely on this drug to induce vomiting.
Esophageal tears and gastric ruptures rare complications.
Mucosal damage can occur if patient with bulimia nervosa use laxatives and enemas.
Potential psychiatric complication of bulimia nervosa is suicide.
Bulimia nervosa patients are more prone to psychoactive substance use disorders.

Nursing Assessment Nursing Care Plans for Bulimia Nervosa

Patient history of bulimia nervosa is characterized by episodic binge eating several times per day. Commonly reports a binge eating episode during which she continues eating until abdominal pain. The Bulimia Nervosa patient usually preferred food that sweet, soft, and high in calories and carbohydrate. Unlike the anorexic nervosa patient bulimic patient usually can keep her eating disorder hidden, because patient's weight frequently fluctuates, but usually stays within the normal range through the use of diuretics, laxatives, vomiting, and exercise. The patient may complain of abdominal and epigastric, Amenorrhea, Painless swelling of the salivary glands, hoarseness, throat irritation or lacerations, and dental erosion. A Bulimia Nervosa patient commonly is perceived by others as a perfect person’s, However, the patient's psychosocial history may reveal an exaggerated sense of guilt, symptoms of depression, childhood trauma (especially sexual abuse), parental obesity, or a history of unsatisfactory sexual relationships.

Symptomatology for Bulimia Nervosa

Patients with Bulimia Nervosa usually solitary and secret and patients with Bulimia Nervosa able to consume thousands of calories in one binge episode.
Loss of control to stop eating After the binge has begun
After binge eats, the individual engages in inappropriate compensatory measures to avoid gaining weight, like self-induced vomiting, excessive use of laxatives, diuretics, or enemas, and extreme exercising.
Eating binges may be viewed as pleasurable but are followed by intense self criticism and depressed mood.
Patient with Bulimia Nervosa usually within normal weight range, some a few pounds underweight, and some a few pounds overweight.
Obsession with body image and appearance is a predominant feature of this disorder.
Binges usually alternate with periods of normal eating and fasting.
Excessive vomiting may lead to problems with dehydration and electrolyte imbalance.
Gastric acid in the vomitus may contribute to the erosion of tooth enamel.

Treatment for Bulimia Nervosa
Treatment of bulimia nervosa may continue for several years. Interrelated physical and psychological symptoms must be treated simultaneously.

Nursing diagnosis Nursing Care Plans for Bulimia Nervosa

Anxiety
Chronic low self-esteem
Constipation
Deficient fluid volume
Disturbed body image
Disturbed sleep pattern
Imbalanced nutrition: Less than body requirements
Ineffective coping
Social isolation

Nursing Key outcomes, interventions, Patient teaching Nursing Care Plans for Bulimia Nervosa

Child Abuse Picture

2009-09-15T07:57:00.000-07:00

Interesting picture about child abuse from KPAI child abuse organizations

"Sadly the one place they should feel safe is the one place they fear most"

Child abuse picture 1 KPAI Advertising

Child abuse picture 2 KPAI Advertising

Child abuse picture

Nursing Care Plans for Abruptio Placentae (placenta abruption)

2009-09-13T07:25:00.000-07:00

Abruptio placentae also called placental abruption occur when the placenta prematurely separates from the uterine wall, usually after the 20th week of gestation, producing hemorrhage. This disorder may be classified according to the degree of placental separation and the severity of maternal and fetal symptoms. It is characterized by a triad of symptoms: vaginal bleeding, uterine hypertonus, and fetal distress. It can occur during the prenatal or intrapartum period

Abruptio placentae is most common in multigravidas usually in women older than age 35 and is a common cause of bleeding during the second half of pregnancy. On heavy maternal bleeding generally necessitates termination of the pregnancy. The fetal prognosis depends on the gestational age and amount of blood lost. The maternal prognosis is good if hemorrhage can be controlled.

Grading System for Abruptio Placentae (placenta abruption)

Grade 0 Less than 10% of the total placental surface has detached; the patient has no symptoms; however, a small retroplacental clot is noted at birth.

Grade I approximately 10%–20% of the total placental surface has detached; vaginal bleeding and mild uterine tenderness are noted; however, the mother and fetus are in no distress.

Grade II Approximately 20%–50% of the total placental surface has detached; the patient has uterine tenderness and tetany; bleeding can be concealed or is obvious; signs of fetal distress are noted; the mother is not in hypovolemic shock.

Grade III More than 50% of the placental surface has detached; uterine tetany is severe; bleeding can be concealed or is obvious; the mother is in shock and often experiencing coagulopathy; fetal death occurs.

Central abruption, the separation occurs in the middle, and bleeding is trapped

Between the detached placenta and the uterus, concealing the hemorrhage.

Marginal abruption, separation begins at the periphery and bleeding accumulates between

The membranes and the uterus and eventually passes through the cervix, becoming an external hemorrhage.

Causes for Abruptio Placentae (placenta abruption)

The cause of abruptio placentae is unknown; however, any condition that causes vascular changes at the placental level may contribute to premature separation of the placenta. Predisposing factors include:

Traumatic injury.
Placental site bleeding from a needle puncture during amniocentesis,
Chronic or pregnancy induced hypertension.
Multiparity
Short umbilical cord
Dietary deficiency
Smoking
Advanced maternal age
Pressure on the vena cava from an enlarged uterus.

The spontaneous rupture of blood vessels at the placental bed may result from a lack of resiliency or to abnormal changes in the uterine vasculature. The condition may be complicated by hypertension or by an enlarged uterus that can't contract sufficiently to seal off the torn vessels. Consequently, bleeding continues unchecked, possibly shearing off the placenta partially or completely.

Complications for Abruptio Placentae (placenta abruption)

Hemorrhage and shock.
Renal failure,
Disseminated intravascular coagulation.
Maternal and fetal death.

Nursing Assessment Nursing Care Plans for Abruptio Placentae (placenta abruption)

Abruptio placentae produces a wide range of clinical effects, depending on the extent of placental separation and the amount of blood lost from maternal circulation.

Obtain patient history obstetric history. Determine the date of the last menstrual period to calculate the estimated day of delivery and gestational age of the infant. Inquire about alcohol abuse, tobacco, and drug usage, and any trauma or abuse situations during pregnancy

Mild abruptio placentae with marginal separation usually report mild to moderate vaginal bleeding, vague lower abdominal discomfort, and mild to moderate abdominal tenderness.
Moderate abruptio placentae are about 50% placental separation usually report continuous abdominal pain and moderate, dark red vaginal bleeding. Onset of symptoms may be gradual or abrupt. Vital signs may indicate impending shock. Palpation reveals a tender uterus that remains firm between contractions.
Severe abruptio placentae about 70% placental separations patient usually report abrupt onset of agonizing, unremitting uterine pain (described as tearing or knifelike) and moderate vaginal bleeding. Vital signs indicate rapidly progressive shock. Palpation reveals a tender uterus with boardlike rigidity. Uterine size may increase in severe concealed abruptions.

Psychosocial Assessment to understanding patient’s situation and also the significant other’s degree of anxiety, coping ability, and willingness to support the patient

Diagnostic tests for Abruptio Placentae (placenta abruption)

Pelvic examination under double setup
Ultrasonography
Decreased hemoglobin level
Decreased platelet count.
Periodic assays for fibrin split products aid in monitoring the progression of abruptio placentae and in detecting DIC.

Treatment for Abruptio Placentae (placenta abruption)

Medical Treatment management goals of abruptio placentae are to assess, control, and restore the amount of blood lost and to deliver a viable infant and prevent coagulation disorders.

Nursing diagnoses Nursing Care Plans for Abruptio Placentae (placenta abruption)

Primary nursing diagnosis nursing care plans for abruptio placentae (placenta abruption) fluid volume deficit related to blood loss

Common nursing diagnosis fond in Nursing Care Plans for Abruptio Placentae (placenta abruption):

Acute pain
Anxiety
Deficient fluid volume
Dysfunctional grieving
Fear
Ineffective coping
Ineffective tissue perfusion: Cardiopulmonary

Nursing Key outcomes, interventions, and Patient teaching Nursing Care Plans for Abruptio Placentae (placenta abruption)

Nursing outcomes, interventions, Patient teaching, Nursing Care Plans for Preeclampsia Pregnancy Induced Hypertension

2009-09-12T09:41:00.000-07:00

Nursing outcomes, interventions, Patient teaching, Nursing Care Plans for Preeclampsia Pregnancy Induced Hypertension

Nursing Key outcomes Nursing Care Plans for Preeclampsia, The patient will:

Be able to perform activities of daily living without excessive fatigue.
Identify strategies to reduce anxiety.
Maintain optimal functioning within the confines of the visual impairment.
Maintain orientation to environment.
Verbalize fears and concerns
Demonstrate adaptive coping behaviors.
Exhibit signs of adequate cerebral and peripheral perfusion.
Avoid complications.
Fluid volume will remain within normal parameters.
The patient's urine output will remain within normal limits.

Nursing interventions Nursing Care Plans for Preeclampsia

Monitor the patient vital sign regularly for changes in blood pressure, pulse rate, respiratory rate, fetal heart rate, vision, level of consciousness, and deep tendon reflexes and for headache unrelieved by medication.
Immediately report changes.
Assess these signs before administering medications.
Monitor the extent and location of edema.
Elevate affected extremities to promote venous return.
Assess fluid balance by measuring intake and output and by checking daily weight.
Provide a quiet, darkened room until the patient's condition stabilizes.
Enforce strict bed rest.
Provide emotional support for the patient and family.
Explain to patients and family if the patient's condition necessitates premature delivery.

Patient teaching Nursing Care Plans for Preeclampsia

Teach the patient and her family how to identify and report signs and symptoms of preeclampsia and eclampsia.
Instruct the patient to maintain bed rest as ordered.
Advice her to lie in a left lateral position to increase venous return, Elevate affected extremities, cardiac output, and renal blood flow.
Stress the importance of adequate nutrition in the prenatal period.
Advise the patient to avoid foods high in sodium.
Explain the importance of scheduling and keeping prenatal visits.

Nursing Care Plans for Preeclampsia Pregnancy Induced Hypertension

2009-09-11T21:11:00.000-07:00

Pregnancy Induced Hypertension PIH is a potentially life-threatening disorder that usually develops after the 20th week of pregnancy. It typically occurs in nulliparous women and may be nonconvulsive or convulsive.

The cause of Preeclampsia is unknown it is often called the “disease of theories” because many causes have been proposed, yet none has been well established. occure approximately 7% of all pregnant women. Almost preeclampsia case occurs before the fetus is term. primary goals in nursing care plan for preeclampsia is prevent seizures, intracranial hemorrhage, and serious organ damage in the mother and to deliver a healthy term infant. Preeclampsia, the nonconvulsive form of the disorder, is marked by the onset of hypertension after 20 weeks of gestation. It develops in about 7% of pregnancies and may be mild or severe. The incidence is significantly higher in low socioeconomic groups. Eclampsia, the convulsive form, occurs between 24 weeks' gestation and the end of the first postpartum week. The incidence increases among women who are pregnant for the first time, have multiple fetuses, and have a history of vascular disease.

About 5% of women with preeclampsia develop eclampsia; of these, about 15% die of eclampsia or its complications. Fetal mortality is high because of the increased incidence of premature delivery Pregnancy Induced Hypertension PIH and its complications are the most common cause of maternal death in developed countries.

Causes for Preeclampsia

The cause of PIH is unknown. Geographic, ethnic, racial, nutritional, immunologic, and familial factors may contribute to preexisting vascular disease, which, in turn, may contribute to its occurrence. Age is also a factor. Adolescents and primiparas older than age 35 are at higher risk for preeclampsia. Other theories include a long list of potential toxic sources, such as autolysis of placental infarcts, autointoxication, uremia, maternal sensitization to total proteins, and pyelonephritis.

Complications for Preeclampsia

Intrauterine growth retardation (or restriction),
Placental infarcts, and
abruptio placentae.
Other possible complications include stillbirth of the neonate, seizures, coma, premature labor, renal failure, and hepatic damage in the mother.

Nursing Assessment Nursing Care Plans for Preeclampsia

A patient with mild preeclampsia typically reports a sudden weight gain,
The patient's history reveals hypertension
Inspection reveals generalized edema, especially of the face. Palpation may reveal pitting edema of the legs and feet.
Deep tendon reflexes may indicate hyperreflexia.
Oliguria
Blurred vision caused by retinal arteriolar spasms,
Epigastric pain or heartburn, irritability, and emotional tension.
Patient may complain of a severe frontal headache.

In a patient with severe preeclampsia:
Blood pressure readings increase to 160/110 mm Hg or higher on two occasions, 6 hours apart, during bed rest. Also,
Ophthalmoscopic examination may reveal vascular spasm, papilledema, retinal edema or detachment, and arteriovenous nicking or hemorrhage.

Diagnostic Highlights Nursing Care Plan For Preeclampsia
Hemolysis, elevated liver enzyme levels, and a low platelet count (HELLP syndrome) characterize severe eclampsia. A unique form of coagulopathy is also associated with this disorder.

Urine for protein and creatinine
Uric acid
Blood urea nitrogen (BUN)
Liver enzymes: AST, ALT, LDH,Bilirubin
Platelets
Coagulation studies
RBC (red blood cell)
Hgb (hemoglobin)
Hct (hematocrit)

Preeclampsia Treatment
Therapy for patients with preeclampsia is intended to halt the progress of the disorder specifically, the early effects of eclampsia, such as seizures, residual hypertension, and renal shutdown and to ensure fetal survival. Some physicians advocate the prompt inducement of labor, especially if the patient is near term; others follow a more conservative approach. Therapy may include:

complete bed rest in the preferred left lateral lying position to enhance venous return
an antihypertensive, such as methyldopa or hydralazine
magnesium sulfate to promote diuresis, reduce blood pressure, and prevent seizures if the patient's blood pressure fails to respond to bed rest and the antihypertensive and persistently rises above 160/100 mm Hg, or if central nervous system irritability increases.
If fetal life is endangered cesarean section or oxytocin inducement may be required to terminate the pregnancy.

Nursing diagnoses Nursing Care Plans for Preeclampsia

Activity intolerance
Anxiety
Disturbed sensory perception (visual)
Disturbed thought processes
Excess fluid volume
Fear
Impaired urinary elimination
Ineffective coping
Ineffective tissue perfusion: Cerebral, peripheral
Risk for injury

Key outcomes, Nursing interventions , Patient teaching , Nursing Care Plans for Preeclampsia Pregnancy Induced Hypertension

Nursing Care Plans for Endometriosis

2009-09-05T08:51:00.000-07:00

Nursing Care Plans for Endometriosis. Endometriosis is a hormonal and immune system disease characterized by a benign growth of endometrial tissue that occurs atypically outside of the uterine cavity. When endometrial tissue appears outside the lining of the uterine cavity, endometriosis results. Such ectopic tissue is generally confined to the pelvic area, most commonly around the ovaries, uterovesical peritoneum, uterosacral ligaments, and the cul-de-sac, but it can appear anywhere in the body.

This ectopic endometrial tissue responds to normal stimulation in the same way that the endometrium does. During menstruation, the ectopic tissue bleeds, which causes inflammation of the surrounding tissues. This inflammation causes fibrosis, leading to adhesions, which produce pain and infertility. Active endometriosis usually occurs between ages 30 and 40. Severe symptoms of endometriosis may have an abrupt onset or may develop over many years. This disorder usually becomes progressively more severe during the menstrual years but tends to subside after menopause.

Causes for Endometriosis

The direct cause is unknown, but the most predominant theory is the retrograde menstruation theory, research focuses on the following possible causes:

Transportation (retrograde menstruation). During menstruation, the fallopian tubes expel endometrial fragments that implant outside the uterus.
Formation in situ. Inflammamsstion or a hormonal change triggers coelomic metaplasia.
Induction. The endometrium chemically induces undifferentiated mesenchyma to form endometrial epithelium. (This is the most likely cause.)
Immune system defects. Endometriosis may result from a specific defect in cell mediated immunity.

Complications for Endometriosis
Primary complication

Infertility.

Other complications

Spontaneous abortion,
Anemia due to excessive bleeding.
Emotional problems resulting from infertility.

Nursing Assessment Nursing Care Plans for Endometriosis

Patient History Elicit a complete history of the woman’s menstrual, obstetric, sexual, and contraceptive practices
The patient may complain of cyclic pelvic pain, infertility and, the classic symptom, acquired dysmenorrhea.
The patient typically reports pain in the lower abdomen, vagina, posterior pelvis, and back. This pain usually begins from 5 to 7 days before menses, reaches a peak, and lasts for 2 to 3 days.
Patient may complain of deep-thrust dyspareunia (ovaries and cul-de-sac);
suprapubic pain, dysuria, and hematuria
painful defecation, rectal bleeding with menses, and pain in the coccyx or sacrum
nausea and vomiting that worsen before menses and abdominal cramps
Palpation may disclose multiple tender nodules on uterosacral ligaments or in the rectovaginal septum.
Palpation may also uncover ovarian enlargement in the presence of endometrial cysts on the ovaries or thickened, nodular adnexa.

Diagnostic tests for Endometriosis
Laparoscopy
Scoring and staging system created by the American Society for Reproductive Medicine quantifies endometrial implants according to size, character, and location.

Stage I is minimal disease (0 to 5 points);
Stage II signifies mild disease (6 to 15 points);
Stage III, moderate disease (16 to 40 points); and
Stage IV, severe disease (more than 40 points).

Treatment for Endometriosis
The stage of the disease and the patient's age and desire to have children are considered in determining the course of treatment.

Conservative therapy for young women who want to bear children with androgens, which produce a temporary remission in Stages I and II.
Progestins and hormonal contraceptives also relieve symptoms.
Gonadotropin releasing analogues, such as leuprolide, suppress estrogen production.
Laparoscopy, used for diagnostic purposes, can also be used therapeutically to lyse adhesions, remove small implants, and cauterize implants. The goal is to remove as much of the ectopic endometrial tissue as possible
Laparoscopy also permits laser vaporization of implants. This surgery is usually followed with hormonal therapy to suppress the return of endometrial implants.
Surgery may be needed to rule out cancer.
Conservative surgery is possible, but the treatment of choice for women who don't want to bear children or for those who have extensive disease (Stages III and IV) is a total abdominal hysterectomy with bilateral salpingo-oophorectomy.
Minor gynecologic procedures are contraindicated immediately before and during menstruation.

Nursing diagnosis nursing care plans for endometriosis
Primary nursing diagnosis nursing care plans for endometriosis
Pain, chronic, related to cramping, internal bleeding, swelling, and inflammation during the menstrual cycle
Common nursing diagnosis found on nursing care plans for endometriosis:

Anxiety
Chronic pain
Deficient knowledge (diagnosis and treatment)
Disturbed body image
Fear
Ineffective coping
Risk for infection
Sexual dysfunction

Key outcomes Nursing Care Plans for Endometriosis

Comfort level, Pain control, Depression control, Pain: Disruptive effects, Pain: Psychological response
Patient will identify strategies to reduce anxiety.
Patient will express feelings of comfort.
Patient and her family will express understanding of the disorder and its treatment.
Patient will express feelings about self.
Patient will discuss fears and concerns.
Patient will develop adequate coping behaviors.
Patient will remain free from signs and symptoms of infection.
Patient will verbalize feelings regarding sexual impairment.

Patient teaching Nursing Care Plans for Endometriosis

Ensure that the patient understands the dosage, route, action, and side effects before going home.
Explain all procedures and treatment options. Clarify misconceptions about the disorder, associated complications, and fertility.
Advise adolescents to use sanitary napkins instead of tampons. This can help prevent retrograde flow in girls with a narrow vagina or small vaginal meatus.
Because infertility is a possible complication, counsel the patient who wants children not to postpone childbearing.
Advise the patient to have an annual pelvic examination and a Pap test.

Encourage the patient to be alert to her emotions, behavior, physical symptoms, diet, and rest and exercise. Encourage the patient to maintain open communication with her significant other and her family to discuss concerns she may have about the disease process.

Nursing interventions, Key outcomes nursing care plans for Autistic disorder

2009-09-03T09:00:00.000-07:00

Nursing Key Outcomes Nursing Care Plans For Autistic Disorder

The patient and his family will express reduced levels of anxiety.
Anxiety is maintained at a level at which client feels no need for self mutilation
Client initiates interactions between self and others, and use eye contact, facial responsiveness, and other nonverbal behavior
The patient's family will openly share feelings about the present situation.
As much as possible, the patient will demonstrate age-appropriate skills and behaviors.
The patient will perform self care activities independently.
The patient will develop peer relationships.
The patient’s family will identify and contact available resources as needed.
The patient and his family will practice safety measures and take safety precautions in the home.
The patient won't engage in self-destructive behaviors.
The patient will interact with family or friends.

Nursing interventions nursing care plans for Autistic disorder

Reduce self destructive behaviors.
Physically stop the child from harming himself.
Give verbal or physical reinforcement.
Foster appropriate use of language.
Provide positive reinforcement when the child indicates his needs correctly.
Encourage development of self esteem.
Encourage self care.
Encourage acceptance of minor environmental changes.
Provide emotional support to the parents.
Refer them to the Autism Society.

Nursing interventions nursing care plans for Autistic disorder based on nursing diagnosis

Nursing Diagnosis Risk for self mutilation

Intervene to protect child when self mutilate behaviors, Safety tools like helmet may be used to protect against head banging, hand mitts to prevent hair pulling, and appropriate padding to protect extremities from injury during hysterical movements.
Try to determine if self mutilate behaviors occur in response to increasing anxiety, and if so, to what the anxiety may be attributed.
To establish trust, Work on one to one basis with child.

Nursing Diagnosis Impaired social interaction

Build trust relationship with the child.
Provide child with familiar objects such as favorite toys, or favorite blanket.
Convey a manner of warmth, acceptance, and availability as client attempts to fulfill basic needs.
Do not force interactions.
Give positive reinforcement for eye contact. Gradually introduce use eye contact, facial responsiveness, and other nonverbal behavior
Support client with nurse presence as he or she endeavors to relate to others in the environment.

Nursing Diagnosis Impaired verbal communication

Maintain consistency in assignment of caregivers. Consistency facilitates trust and enhances the caregiver’s ability to understand the child’s attempts to communicate.
Anticipate and fulfill client’s needs until satisfactory communication patterns are established. Anticipating needs helps to minimize frustration while the child is learning communication skills.
Use the techniques of consensual validation and seeking clarification to decode communication patterns.
Use face to face approach.

Nursing Diagnosis Disturbed personal identity

Function in a one to one relationship with the child to establishment of trust.
Assist child to recognize separateness during self-care activities, such as dressing and feeding.
Point out, and assist child in naming, own body parts.
Gradually increase amount of physical contact, using touch to point out differences between client and nurse.
Cautious in using touch until trust is established, client may be interpreted as threatening.
Use mirrors and drawings or pictures of the child to reinforce the child’s learning of body parts and boundaries.

Nursing Diagnosis Anxiety
Nursing Diagnosis Compromised family coping
Nursing Diagnosis Delayed growth and development
Nursing Diagnosis Dressing or grooming self-care deficit
Nursing Diagnosis Interrupted family processes
Nursing Diagnosis Risk for injury
Nursing Diagnosis Risk for self-directed violence
Nursing Diagnosis Social isolation

Patient teaching and home health guidance for Autistic disorder

Give knowledge to the parents about Autistic disorder to Help parent understand that the cause of this condition is unknown.
Teach the parents how to physically care for the child's needs.
Teach the parents how to identify signs of excessive stress and coping skills to use under these circumstances.
Emphasize that they'll be ineffective caregivers if they don't take the time to meet their own needs in addition to those of their child.

Nursing care plans for Autistic disorder

2009-08-31T08:38:00.000-07:00

Autistic disorder is a severe, pervasive developmental disorder marked by unresponsiveness to social contact, gross deficits in intelligence and language development, ritualistic and compulsive behaviors, restricted capacity for developmentally appropriate activities and interests, Autistic disorder is characterized by a withdrawal of the child into the self and into a fantasy world of his or her own creation. Activities and interests are restricted and may be considered somewhat bizarre. The disorder is rare, but occurs 4 to 5 times more often in males than in females. Onset of symptoms is prior to age 3. The course is chronic and often persists into adulthood.

Causes for Autistic disorder

The causes of autistic disorder remain unclear but are thought to include psychological, physiologic, and sociologic factors. Previously, it was thought that most parents of autistic children were intelligent, educated people of high socioeconomic status; recent studies suggest that this may not be true. The parents of an autistic child may appear distant and unaffectionate toward the child. However, because autistic children are clearly different from birth, and because they are unresponsive or respond with rigid, screaming resistance to touch and attention, parental remoteness may be merely a frustrated, helpless reaction to this disorder, not its cause.

Some theorists consider autistic disorder related to:

Genetics. An increased risk of autistic disorder exists among siblings of individuals with the disorder (APA, 2000). Studies with both monozygotic and dizygotic twins have also provided evidence of a genetic involvement.
Neurological Factors. Abnormalities in brain structures or functions have been correlated with autistic disorder (National Institute of Mental Health [NIMH], 2002). Certain developmental problems, such as postnatal neurological infections, congenital rubella, phenylketonuria, and fragile X syndrome, also have been implicated.

Complications for Autistic disorder

Autistic disorder may be complicated by epileptic seizures
Depression is common in adolescence and early adulthood
During periods of stress, catatonic phenomena, such as excitement or posturing, or an undifferentiated psychotic state with delusions and hallucinations may occur.

Nursing Assessment nursing care plans for Autistic disorder

Primary characteristic of autistic disorder is unresponsiveness to people. Patient with this disorder won't cuddle, avoid eye contact and facial expression, and are indifferent to affection and physical contact. Parents may report that the child becomes rigid or flaccid when held, cries when touched, and shows little or no interest in human contact. As the patient grows older, his smiling response is delayed or absent. He doesn't lift his arms in anticipation of being picked up or form an attachment to a specific caregiver.

Failure to form interpersonal relationships.
Impairment in communication verbal and nonverbal, nonverbal expressions may be inappropriate or absent.
Bizarre responses to the environment.
Extreme fascination for objects that move.
Unreasonable insistence on following routines in precise detail.
Marked distress over changes in trivial aspects of environment.
Stereotyped body movements.

Common Nursing Diagnoses Found On Nursing Care Plans For Autistic Disorder

Risk for self mutilation
Impaired social interaction
Impaired verbal communication
Disturbed personal identity
Anxiety
Compromised family coping
Delayed growth and development
Dressing or grooming self-care deficit
Interrupted family processes
Risk for injury
Risk for self-directed violence
Social isolation

Nursing interventions, Key outcomes nursing care plans for Autistic disorder

Nursing diagnosis Nursing Care Plans Attention Deficit Hyperactivity Disorder (ADHD)

2009-08-29T08:33:00.000-07:00

Common Nursing Diagnosis and Interventions found on Nursing Care Plans Attention Deficit Hyperactivity Disorder (ADHD)

Risk for self directed or other directed violence
Defensive coping
Impaired social interaction
Ineffective coping
Low self esteem
Noncompliance
Anxiety (moderate to severe)
Compromised family coping
Imbalanced nutrition: Less than body requirements
Ineffective family therapeutic regimen management
Interrupted family processes
Risk for impaired parenting

Key outcomes nursing diagnosis Nursing Care Plans Attention Deficit Hyperactivity Disorder (ADHD)

Patient and his family will report concern about difficulties in social interactions.
Patient and his family will communicate understanding of special dietary needs.
Patient will demonstrate effective social interaction skills.
Patient and his family will comply with the prescribed treatment regimen.
Patient's family will discuss the impact of the patient's illness and feelings about it with a health care professional.
Parents will utilize support groups and other community resources.
Patient will acknowledge and respond to efforts by others to establish communication.

Nursing interventions for ADHD

Set realistic expectations and limits because the patient with attention deficit hyperactivity disorder is easily frustrated
Always remain calm and consistent with the child.
Keep all your instructions to the child short and simple.
Provide praise and rewards whenever possible.
Provide the patient with diversional activities suited to his short attention span.
Help the parents and other family members develop planning and organizing systems to help them cope more effectively with the child's short attention span.

Nursing interventions for ADHD related to nursing diagnosis:
Nursing diagnosis Risk for self directed or other-directed violence

Observe client’s behavior frequently.
Observe for suicidal behaviors: Verbal statements, such as “ statement going to kill myself”
Determine suicidal intent and available means. Ask how where and when you plan to kill yourself
Obtain contract from client not to harm self and agreeing to seek out staff when ideation occurs.
Help client to recognize when anger occurs and to accept those feelings
Act as a role model for appropriate expression of angry feelings.
Give positive reinforcement.

Nursing diagnosis Defensive coping

Encourage client to recognize and verbalize feelings of inadequacy and need for acceptance from others and to recognize how these feelings provoke defensive behaviors
Provide immediate, fact, nonthreatening feedback for unacceptable behaviors
Help client identify situations that provoke defensiveness
Practice with role play for appropriate responses
Give positive feedback for acceptable behaviors
Evaluate and discuss with client the effectiveness of the new behaviors and any modifications for improvement

Nursing diagnosis Impaired social interaction

Develop trust relationship
Give to the client’s constructive criticism and positive reinforcement for client’s efforts
Give Positive feedback to client
Provide group situations for client

Nursing diagnosis Ineffective coping

Provide safe environment for continuous large muscle movement, If client is hyperactive
Provide large motoric activities
Do not debate, argue, rationalize, or bargain with the client.
Explore with client and discus alternative ways of handling frustration that would be most suited for client

Nursing diagnosis Low self esteem

Nursing diagnosis Anxiety

Establish a trusting relationship
Maintain an atmosphere of calmness
Offer support during times of elevated anxiety, Use of touch is comforting for some clients
When anxiety diminishes, help client to recognize specific events that preceded onset of anxiety.
Provide help to client to recognize signs of escalating anxiety
On escalating anxiety provide tranquilizing medication, as ordered

Nursing diagnosis Compromised family coping
Nursing diagnosis Imbalanced nutrition: Less than body requirements
Nursing diagnosis Ineffective family therapeutic regimen management
Nursing diagnosis Interrupted family processes
Nursing diagnosis Risk for impaired parenting

Patient teaching Nursing Care Plans Attention Deficit Hyperactivity Disorder (ADHD)

Make certain that the parents fully understand the child's prescribed medication regimen.
Teach the patient and family about any adverse reactions that may occur, emphasizing those that may require immediate medical attention.
Encourage the parents to provide the child with nutritious snacks such as fruit to supplement his dietary intake.
Refer the parents to appropriate support groups.

Predisposing Factors for Attention Deficit Hyperactivity Disorder (ADHD)

2009-08-27T08:11:00.000-07:00

The patient with attention deficit hyperactivity disorder has difficulty focusing his attention, engaging in quiet passive activities, or both. Some patients have an attention deficit without hyperactivity; they're less likely to be diagnosed and receive treatment. Although attention deficit hyperactivity disorder is present at birth, diagnosis before age 4 or 5 is difficult unless the child exhibits severe symptoms. Some patients, however, aren't diagnosed until they reach adulthood. Attention deficit hyperactivity disorder is thought to be a physiologic brain disorder with a familial tendency. Some studies indicate that it may result from altered neurotransmitter levels in the brain. Scientists are not sure what causes ADHD, although many studies suggest that genes play a large role. Like many other illnesses, ADHD probably results from a combination of factors. In addition to genetics, researchers are looking at possible environmental factors, and are studying how brain injuries, nutrition, and the social environment might contribute to ADHD

Predisposing Factors for Attention Deficit Hyperactivity Disorder (ADHD)

Physiological

Genetics. A number of studies have indicated that hereditary factors may be implicated in the predisposition to ADHD. Siblings of hyperactive children are more likely than normal children to have the disorder.
Biochemical. Abnormal levels of the neurotransmitters dopamine, norepinephrine, and possibly serotonin have been suggested as a causative factor.
Prenatal, Perinatal, and Postnatal Factors. Maternal smoking during pregnancy has been linked to ADHD . Premature birth, fetal distress, precipitated or prolonged labor, and perinatal asphyxia have also been implicated. Postnatal factors include cerebral palsy, epilepsy, and other central nervous system abnormalities resulting from trauma, infections, or other neurological disorders.

Psychosocial

Environmental Influences Disorganized or chaotic environments or a disruption in family equilibrium may predispose some individuals to ADHD. A high degree of psychosocial stress, maternal mental disorder, paternal criminality, low socioeconomic status, and foster care have been implicated.

Nursing Care Plans Attention Deficit Hyperactivity Disorder (ADHD)

2009-08-27T07:49:00.000-07:00

Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common childhood disorders and can continue through adolescence and adulthood. Attention-deficit hyperactivity disorder (ADHD) is characterized by a persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequent and severe than is typically observed in individuals at a comparable level of development (APA, 2000). The patient with attention deficit hyperactivity disorder has difficulty focusing his attention, engaging in quiet passive activities, or both. Some patients have an attention deficit without hyperactivity; they're less likely to be diagnosed and receive treatment. Although attention deficit hyperactivity disorder is present at birth, diagnosis before age 4 or 5 is difficult unless the child exhibits severe symptoms. Some patients, however, aren't diagnosed until they reach adulthood. Males are three times more likely to be affected than females. The presence of other psychiatric disorders also needs to be determined, this disorder occurs in roughly 3% to 5% of school-age children.

Causes for Attention Deficit Hyperactivity Disorder (ADHD)

Attention deficit hyperactivity disorder is thought to be a physiologic brain disorder with a familial tendency. Some studies indicate that it may result from altered neurotransmitter levels in the brain. Scientists are not sure what causes ADHD, although many studies suggest that genes play a large role. Like many other illnesses, ADHD probably results from a combination of factors. In addition to genetics, researchers are looking at possible environmental factors, and are studying how brain injuries, nutrition, and the social environment might contribute to ADHD

Predisposing Factors Attention Deficit Hyperactivity Disorder (ADHD)

Complications for Attention Deficit Hyperactivity Disorder (ADHD)

Emotional and social complications can result from the child's impulsive behavior, inattentiveness, and disorganization in school. Hyperactivity can also lead to poor nutrition.

Assessment Nursing Care Plans Attention Deficit Hyperactivity Disorder (ADHD)

The patient is usually characterized as a fidgeted and a daydreamer. He may also be described as inattentive and lazy. The parents may state that their child is intelligent but that his school or work performance is sporadic. They may also report that he has a tendency to jump quickly from one partly completed project, thought, or task to another. If the child is younger, the parents may note that he has difficulty waiting in line, remaining in his seat, waiting his turn, or concentrating on one activity long enough to complete it. An older child or an adult may be described as impulsive and easily distracted by irrelevant thoughts, sights, or sounds. He may also be characterized as emotionally labile, inattentive, or prone to daydreaming. His disorganization becomes apparent when, for example, he has difficulty meeting deadlines and keeping track of school or work tools and materials.

Difficulties in performing age-appropriate tasks
Highly distractible
Extremely limited attention span
Shifts from one uncompleted activity to another
Impulsivity, or deficit in inhibitory control, is common
Difficulty forming satisfactory interpersonal relationships
Disruptive and intrusive behaviors inhibit acceptable social interaction
Difficulty complying with social norms
Some children with ADHD are very aggressive or oppositional. Others exhibit more regressive and immature behaviors.
Low frustration tolerance and outbursts of temper are common.
Boundless energy, exhibiting excessive levels of activity, restlessness, and fidgeting
Often described as “perpetual motion machines,” continuously running, jumping, wiggling, or squirming
They experience a greater than average number of accidents, from minor mishaps to more serious incidents that may lead to physical injury or the destruction of property.

Predisposing Factors Attention Deficit Hyperactivity Disorder (ADHD)
Common Nursing Diagnoses and Interventions for Attention Deficit Hyperactivity Disorder (ADHD)

Nursing outcomes, interventions, and Patient teaching for Anorexia Nervosa

2009-08-13T08:26:00.000-07:00

Anorexia nervosa is a clinical syndrome in which the person has a morbid fear of obesity. It is characterized by the individual’s gross distortion of body image, preoccupation with food, and refusal to eat. The disorder occurs predominantly in females

Goals/Objectives Nursing Care Plans for Anorexia Nervosa
Short-Term Goal
Client will gain weight (amount to be established by client, nurse, and dietitian) pounds per week
Long-Term Goal
By discharge from treatment, client will exhibit no signs or symptoms of malnutrition.

Key outcomes Nursing Care Plans for Anorexia Nervosa
The patient will:

Engage in appropriate physical activities.
Verbalize strategies to reduce anxiety.
Express positive feelings about self.
Resume a normal bowel elimination pattern.
Demonstrate skills appropriate for age.
Acknowledge change in body image.
Maintain body temperature within the normal range.
Achieve target weight.
Demonstrate ability to practice two new coping behaviors.
Participate in decision-making about care.
Comply with the treatment regimen.
Interact with family or friends.
Fluid balance will remain stable, with intake equal to or greater than output.

Nursing interventions Nursing Care Plans for Anorexia Nervosa:

If client is unable or unwilling to maintain adequate oral intake, physician may order a liquid diet to be administered via nasogastric tube. Nursing care of the individual receiving tube feedings should be administered according to established hospital procedures.
Sit with client during mealtimes for support and to observe amount ingested, Client should be observed for at least 1 hour following meals. This time may be used by client to discard food stashed from tray or to engage in self- induced vomiting.
During hospitalization, regularly monitor vital signs, nutritional status, and intake and output. Weigh the patient daily
Negotiate an adequate food intake with the patient. Be sure that she understands that she'll need to comply with this contract or lose privileges.
Frequently offer small portions of food or drinks if the patient wants them. itself.
Anticipate a weight gain of about 1 lb/week.
If edema or bloating occurs after the patient has returned to normal eating behavior, reassure her that this phenomenon is temporary
Encourage the patient to recognize and assert her feelings freely.
If a patient receiving outpatient treatment must be hospitalized, maintain contact with her treatment team to facilitate a smooth return to the outpatient setting.

Patient teaching Nursing Care Plans for Anorexia Nervosa

Emphasize to the patient how improved nutrition can reverse the effects of starvation and prevent complications.
Teach the patient how to keep a food journal, including the types of food eaten, eating frequency, and feelings associated with eating and exercise.
Advise the pateint's family to avoid discussing food with him.

Nursing Care Plans for Hypertension

2009-08-02T08:31:00.000-07:00

Hypertension Description is a persistent or intermittent elevation of systolic arterial blood pressure above 140 mm Hg or diastolic pressure above 90 mm Hg. Hypertension is a chronic disease, primary goals in Hypertension Nursing Care Plan is to reduce the blood pressure to less than 140/90.

Hypertension classified:

Primary (essential) accounts for over 90% of cases and is often referred to as idiopathic, since the underlying cause is not known.
Secondary hypertension results from a number of conditions that impair blood pressure regulation, and accounts for only 5% to 8% of all cases of hypertension
Malignant hypertension, results from either type and can cause blood pressures as high as 240/150 mm Hg, possibly leading to coma and death.

Cause of Hypertension:

Cause of primary hypertension is not known; however, associated with risk factors such as genetic predisposition, stress, obesity, and a high-sodium diet.
Secondary hypertension results from disorders that impair blood pressure regulation, particularly renal, endocrine, vascular, and neurological disorders, hypertensive disease of pregnancy (toxemia) and use of estrogen-containing oral contraceptive
Malignant hypertension is also not known, but it may be associated with dilation of cerebral arteries and generalized arteriolar fibrinoid necrosis, which increases intracerebral blood flow

Ethnic/Racial African Americans and elderly people are most prone to hypertension and its complications.

Physical Examination Hypertension Nursing Care Plan:

Appear symptom-free in early stages, although flushing of the face may be present
Fundoscopic examination of the retina may reveal hemorrhage
Measure blood pressure in both arms three times 3 to 5 minutes apart while the patient is at rest in the sitting, standing, and lying positions.
Hypertension should not be diagnosed on
The basis of one reading unless it is greater than 210/120 mm hg.

Diagnostic Highlights Hypertension Nursing Care Plan

Blood urea nitrogen
Serum creatinine
Total cholesterol
Triglycerides
Electrocardiogram

Because Hypertension is chronic disease and a major cause of stroke, cardiac disease, and renal failure, Hypertension nursing diagnosis on nursing care plan for Hypertension many associated with the Knowledge deficit about Diet, Disease process, Health behaviors, Medication, prescribed activity, Treatment regime and lifestyle

Primary Hypertension nursing diagnosis is knowledge deficit related to chronic disease management,

Possible nursing diagnosis which is commonly found in nursing care plan for Hypertension

Fatigue
Ineffective coping
Ineffective tissue perfusion: Cardiopulmonary
Noncompliance: Therapeutic regimen
Risk for injury

Nursing outcomes Hypertension nursing care plan, Patients will:

Identify appropriate food choices.
Express that he has more energy.
Demonstrate adaptive coping behaviors.
Maintain adequate cardiac output and hemodynamic stability.
Comply with his therapy regimen.
Remain free from complications

Patient Teaching and Home Healthcare Guide on Hypertension nursing care plan

Teach the patient to use a self-monitoring blood pressure cuff and to record the reading at least twice a week.
Tell the patient to take his blood pressure at the same hour each time, with out more than usually activity preceding the measurement.
Tell the patient and family to keep a record of drugs used in the past.
To encourage compliance with antihypertensive therapy, suggest establishing a daily routine for taking medication. Warn the patient that uncontrolled hypertension may cause stroke and heart attack. Tell him to report any adverse reactions to prescribed drugs. Advise him to avoid high-sodium antacids and over-the-counter cold and sinus medications containing harmful vasoconstrictors.
Help the patient examine and modify his lifestyle behavior.
Suggest stress-reduction groups, dietary changes, and an exercise program.
Encourage a change in dietary habits. Help the obese patient plan a reducing diet.
Tell to the patients to avoid high-sodium foods, table salt, and foods high in cholesterol and saturated fat.

Nursing Care Plans for Anorexia Nervosa

2009-07-31T11:21:00.000-07:00

Anorexia nervosa is an eating disorder of complex and life-threatening proportions. It is an illness of starvation that is brought on by a severe disturbance of body image and a morbid fear of obesity.

Causes for Anorexia Nervosa

Complications for Anorexia Nervosa
Serious medical complications can result from the

Malnutrition,
Dehydration,
Electrolyte imbalances

It’s caused by prolonged starvation, vomiting, or laxative abuse:

For example, malnutrition may cause hypoalbuminemia and subsequent edema or hypokalemia, leading to ventricular arrhythmias and renal failure.
Poor nutrition and dehydration, coupled with laxative abuse, produce changes in the bowel similar to those in chronic inflammatory bowel disease.
Frequent vomiting can cause esophageal erosion, ulcers, tears, and bleeding as well as tooth and gum erosion and dental caries.
Cardiovascular complications can be life-threatening and include decreased left ventricular muscle mass, chamber size, and myocardial oxygen uptake, reduced cardiac output, hypotension, bradycardia, electrocardiographic changes, heart failure, and sudden death, possibly caused by ventricular arrhythmias.
Amenorrhea may occur when the patient loses about 25% of her normal body weight. It usually is associated with anemia.
Possible complications of prolonged amenorrhea include estrogen deficiency and increasing the risk of calcium deficiency and osteoporosis
Infertility.

Treatment for Anorexia Nervosa

A team approach to care ”combining medical management, nutritional counseling, and individual, group, or family psychotherapy or behavior modification therapy” is the best approach. Treatment is difficult, and results may be discouraging. Many clinical centers are now developing inpatient and outpatient programs specifically for managing eating disorders.

Treatment may include:

Behavior modification
All forms of psychotherapy, from psychoanalysis to hypnotherapy
Vitamin and mineral supplements
Group, family, or individual psychotherapy

Nursing diagnoses Nursing Care Plans for Anorexia Nervosa

Activity intolerance
Anxiety
Chronic low self-esteem
Constipation
Deficient fluid volume
Delayed growth and development
Disturbed body image
Hypothermia
Imbalanced nutrition: Less than body requirements
Ineffective coping
Ineffective denial
Noncompliance
Social isolation

Nursing outcomes, interventions, and Patient teaching Nursing Care Plans for Anorexia Nervosa

Predisposing Factors for Somatoform Disorders

2009-07-30T18:12:00.000-07:00

The patient with a somatoform disorder complains of physical signs and symptoms and typically travels from physician to physician in search of treatment. Physical examinations and laboratory tests can’t uncover an organic basis for the patient's signs and symptoms, nor are the somatic symptoms due to the effects of alcohol or recreational or prescription drugs. They're prevalent in 5% of the primary practice and include a variety of conditions that differ in symptoms and whether they're intentionally produced.

Predisposing Factors for Somatoform Disorders

Psychosocial

Psychodynamic: Some psychodynamicists view hypochondriasis as an ego defense mechanism. They hypothesize that physical complaints are the expression of low self-esteem and feelings of worthlessness, and that the individual believes it is easier to feel something is wrong with the body than to feel something is wrong with the self. The psychodynamic theory of conversion disorder proposes that emotions associated with a traumatic event that the individual cannot express because of moral or ethical unacceptability are “converted” into physical symptoms. The unacceptable emotions are repressed and converted to a somatic hysterical symptom that is symbolic in some way of the original emotional trauma.
Family Dynamics: Some families have difficulty expressing emotions openly and resolving conflicts verbally. When this occurs, the child may become ill, and a shift in focus is made from the open conflict to the child’s illness, leaving unresolved the underlying issues that the family cannot confront openly. Thus, somatization by the child brings some stability to the family, as harmony replaces discord and the child’s welfare becomes the common concern. The child in turn receives positive reinforcement for the illness.
Sociocultural/Familial Factors: Somatic complaints are often reinforced when the sick role relieves the individual from the need to deal with a stressful situation, whether it be within society or within the family. When the sick person is allowed to avoid stressful obligations and postpone unwelcome challenges, is excused from troublesome duties, or becomes the prominent focus of attention because of the illness, positive reinforcement virtually guarantees repetition of the response.
Past Experience with Physical Illness: Personal experience, or the experience of close family members, with serious or lifethreatening illness can predispose an individual to hypochondriasis. Once an individual has experienced a threat to biological integrity, he or she may develop a fear of recurrence. The fear of recurring illness generates an exaggerated response to minor physical changes, leading to hypochondriacal behaviors.
Cultural and Environmental Factors: Some cultures and religions carry implicit sanctions against verbalizing or directly expressing emotional states, thereby indirectly encouraging “more acceptable” somatic behaviors. Cross-cultural studies have shown that the somatization symptoms associated with depression are relatively similar, but the “cognitive” or emotional symptoms such as guilt are predominantly seen in Western societies.In Middle Eastern and Asian cultures, depression is almost exclusively manifested by somatic or vegetative symptoms. Environmental influences may be significant in the predisposition to somatization disorder. Some studies have suggested that a tendency toward somatization appears to be more common in individuals who have low socioeconomic, occupational, and educational status.

Physiological

Genetic. Studies have shown an increased incidence of somatization disorder and hypochondriasis in first-degree relatives, implying a possible inheritable predisposition (Sadock & Sadock, 2003). Genetic or familial patterns are thought to play a contributing role in primary insomnia, primary hypersomnia, narcolepsy, sleep terror disorder, and sleepwalking.
Biochemical. Decreased levels of serotonin and endorphins may play a role in the etiology of pain disorder.
Medical Conditions. A number of medical conditions, including sleep apnea, endocrine or metabolic disorders, infectious or neoplastic disease, and CNS lesions, have been associated with insomnia and/or hypersomnia. Neurological abnormalities, particularly in the temporal lobe, may be related to precipitation of night terrors.

Anorexia Nervosa

2009-07-30T09:02:00.000-07:00

Anorexia nervosa is an eating disorder of complex and life-threatening proportions. It is an illness of starvation that is brought on by a severe disturbance of body image and a morbid fear of obesity. The key feature of anorexia nervosa is self imposed starvation resulting from a distorted body image and an intense and irrational fear of gaining weight, even when obviously emaciated. An anorexic patient is preoccupied with her body size, describes herself as fat and commonly expresses dissatisfaction with a particular aspect of her physical appearance.

Anorexia nervosa and bulimia nervosa can occur simultaneously. In anorexia nervosa, the refusal to eat may be accompanied by compulsive exercising, self-induced vomiting, or abuse of laxatives or diuretics. Anorexia nervosa usually occurs in females. It occurs primarily in adolescents and young adults but may also affect older females and, occasionally, males. The prognosis varies but improves if the patient is diagnosed early or if she wants to overcome the disorder and seeks help voluntarily. The highest mortality is associated with a psychiatric disturbance. One-third of these deaths can be attributed to suicide. And only half of people with anorexia nervosa recover completely.

Causes For Anorexia Nervosa

No one knows exactly what causes anorexia nervosa. But are probably combinations of biologic, psychological, and social factors. Abnormalities in central neurotransmitter activity are suggested by an alteration in serotonin metabolism. Psychological factors are the most frequently offered explanations. Researchers in neuroendocrinology are seeking a physiologic cause but have found nothing definite. Clearly, social attitudes that equate slimness with beauty play some role in provoking this disorder, family factors also are implicated. Most theorists believe that refusing to eat is a subconscious effort to exert personal control over life or to protect oneself from dealing with issues surrounding sexuality. Anorexia nervosa is generally associated with an enmeshed family system where there are high performance expectations, rigid rules, and disturbed communication patterns. Another theory posits that anorexia nervosa occurs at the time of puberty as a person’s way of avoiding adult responsibility and body image.

Nursing Care Plans for Anorexia Nervosa

Somatoform Disorders Care Plans

2009-07-21T19:58:00.000-07:00

Include in Somatoform disorders:

Body dysmorphic disorder
Conversion disorder
Hypochondriasis
Pain disorder
Somatization disorder

Body dysmorphic disorder: This disorder, formerly called dysmorphophobia, is characterized by the exaggerated belief that the body is deformed or defective in some specific way. The most common complaints involve imagined or slight flaws of the face or head, such as thinning hair, acne, wrinkles, scars, vascular markings, facial swelling or asymmetry, or excessive facial hair (APA, 2000).

Conversion disorder, Conversion disorder is a loss of or change in body function resulting from a psychological conflict, the physical symptoms of which cannot be explained by any known medical disorder or pathophysiological mechanism. The most common conversion symptoms are those that suggest neurological disease such as paralysis, aphonia, seizures, coordination disturbance, akinesia, dyskinesia, blindness, tunnel vision, anosmia, anesthesia, and paresthesia.

Hypochondriasis, Hypochondriasis is an unrealistic preoccupation with the fear of having a serious illness. The DSM-IV-TR suggests that this fear arises out of an unrealistic interpretation of physical signs and symptoms. Occasionally medical disease may be present, but in the hypochondriacal individual, the symptoms are grossly disproportionate to the degree of pathology. Individuals with hypochondriasis often have a long history of doctor shopping and are convinced that they are not receiving the proper care.

Pain disorder, the essential feature of pain disorder is severe and prolonged pain that causes clinically significant distress or impairment in social, occupational, or other important areas of functioning (APA, 2000). This diagnosis is made when psychological factors have been judged to have a major role in the onset, severity, exacerbation, or maintenance of the pain, even when the physical examination reveals pathology that is associated with the pain.

Somatization disorder. Somatization disorder is a chronic syndrome of multiple somatic symptoms that cannot be explained medically and are associated with psychosocial distress and long-term seeking of assistance from health care professionals. Symptoms can represent virtually any organ system but commonly are expressed as neurological, gastrointestinal, psychosexual, or cardiopulmonary disorders. Onset of the disorder is usually in adolescence or early adulthood and is more common in women than in men. The disorder usually runs a fluctuating course, with periods of remission and exacerbation.

Psychiatric Nursing

2009-07-19T19:34:00.000-07:00

Psychiatric Nursing
A specialized area of nursing practice, employing the wide range of explanatory theories of human behaviour as its sciene and purposeful use of self as its art

Inguinal Hernia Video

2009-06-28T20:04:00.000-07:00

Although in this Inguinal Hernia Video does not describe about inguinal hernia complications, or inguinal hernia symptoms but it’s a nice way to learn about inguinal hernia repair. Below is the Inguinal Hernia repair Video

NANDA Nursing Diagnosis for Acute Pain

2009-06-15T05:28:00.000-07:00

Related factors R/T trauma, injuring agents (biological, chemical, physical, psychological)

Suggestion on using Nursing Diagnosis Acute Pain:
Distinguish between acute pain with the chronicles pain. One of the two sets is that diagnosis of a painful time. ONSET acute pain is less than 6 months, while the painful chronicles ONSET it’s more than 6 months.

Definition Nursing Diagnosis for Acute Pain:

Unpleasant sensory and emotional experience arising from actual or potential tissue damage or described in terms of such damage (International Association for the Study of Pain); sudden or slow onset of any intensity from mild to severe with an anticipated or predictable end and a duration of less than 6 months

Subjective data: from patient usually Verbal report of pain
Objective data: Observed evidence of pain, protective gestures avoid pain, Change in muscle tone, Expressive; restlessness, moaning, crying, vigilance, irritability, sighing

Nursing Outcomes Client Will:

Report pain is relieved / controlled.
Follow prescribed pharmacological regimen.
Verbalize methods that provide relief.
Demonstrate use of relaxation skills and diversional activities as indicated for individual situation.

Nursing Priority Nursing Diagnosis for Acute Pain

To Assess Etiology/Precipitating Contributory Factors:
Evaluate Client’s Response To Pain:
Assist Client To Explore Methods For Alleviation/Control Of Pain

Sample Clinical Applications using Nursing Diagnosis for Acute Pain:

Traumatic Injuries
Surgical Procedures
Infections
Cancer
Burns
Skin Lesions
Gangrene
Thrombophlebitis
Pulmonary Embolus
Neuralgia

alcohol addiction

2009-06-13T08:13:00.000-07:00

alcohol addiction

What you need:
alcohol addiction rehabilitation

Nursing Care Plan for Hypertension

2009-06-13T07:40:00.000-07:00

Hypertension Description is a persistent or intermittent elevation of systolic arterial blood pressure above 140 mm Hg or diastolic pressure above 90 mm Hg. Hypertension is a chronic disease, primary goals in Hypertension Nursing Care Plan is to reduce the blood pressure to less than 140/90.

Hypertension classified:

Primary (essential) accounts for over 90% of cases and is often referred to as idiopathic, since the underlying cause is not known. Secondary hypertension results from a number of conditions that impair blood pressure regulation, and accounts for only 5% to 8% of all cases of hypertension. Malignant hypertension, results from either type and can cause blood pressures as high as 240/150 mm Hg

Cause of Hypertension:

Cause of primary Hypertension is not known. However, associated with risk factors such as genetic predisposition, stress, obesity, and a high-sodium diet.

Secondary Hypertension results from disorders that impair blood pressure regulation, particularly renal, endocrine, vascular, and neurological disorders, hypertensive disease of pregnancy (toxemia) and use of estrogen-containing oral contraceptive

Malignant Hypertension is also not known, but it may be associated with dilation of cerebral arteries and generalized arteriolar fibrinoid necrosis, which increases intracerebral blood flow.

Ethnic/Racial African Americans and elderly people are most prone to hypertension and its complications.

Physical Examination Nursing Care Plan for Hypertension

Appear symptom-free in early stages, although flushing of the face may be present
Fundoscopic examination of the retina may reveal hemorrhage
Measure blood pressure in both arms three times 3 to 5 minutes apart. patient is at rest in the sitting, standing, and lying positions. Hypertension should not be diagnosed on the basis of one reading unless it is greater than 210/120 mm Hg.

Diagnostic Highlights Nursing Care Plan for Hypertension

Blood urea nitrogen
Serum creatinine
Total cholesterol
Triglycerides
Electrocardiogram

Nursing diagnosis Nursing Care Plan for Hypertension

Because Hypertension is chronic disease and a major cause of stroke, cardiac disease, and renal failure, Hypertension nursing diagnosis on nursing care plan for Hypertension many associated with the Knowledge deficit about Diet, Disease process, Health behaviors, Medication, prescribed activity, Treatment regime and lifestyle

Primary Hypertension nursing diagnosis is knowledge deficit related to chronic disease management,
Possible nursing diagnosis which is commonly found in nursing care plan for Hypertension

Fatigue
Ineffective coping
Ineffective tissue perfusion: Cardiopulmonary
Noncompliance: Therapeutic regimen
Risk for injury

Nursing outcomes Nursing Care Plan for Hypertension, Patients will:

Identify appropriate food choices.
Express that he has more energy.
Demonstrate adaptive coping behaviors.
Maintain adequate cardiac output and hemodynamic stability.
Comply with his therapy regimen.
Remain free from complications

Patient Teaching and Home Healthcare Guide, Nursing Care Plan for Hypertension

Teach the patient to use a self-monitoring blood pressure cuff and to record the reading at least twice a week.
Tell the patient to take his blood pressure at the same hour each time, with out more than usually activity preceding the measurement.
Tell the patient and family to keep a record of drugs used in the past.
To encourage compliance with antihypertensive therapy, suggest establishing a daily routine for taking medication. Warn the patient that uncontrolled hypertension may cause stroke and heart attack. Tell him to report any adverse reactions to prescribed drugs. Advise him to avoid high-sodium antacids and over-the-counter cold and sinus medications containing harmful vasoconstrictors.
Help the patient examine and modify his lifestyle behavior.
Suggest stress-reduction groups, dietary changes, and an exercise program.
Encourage a change in dietary habits. Help the obese patient plan a reducing diet.
Tell to the patients to avoid high-sodium foods, table salt, and foods high in cholesterol and saturated fat.

Nursing assessment videos; Head to toe

2009-06-11T07:15:00.000-07:00

Want to improve your nursing assessment skills, whether in Geriatric nursing assessment, medical surgical nursing, or pediatric nursing assessment. What you need is to see directly when the nursing assessment is done to the patient. If you can not see its done why don’t you see the nursing assessment videos. Below is a complete head to toe nursing assessment videos.
Enjoy it’s, hopefully its will improve your nursing assessment skills

What Is a Nursing Diagnosis for CHF

2009-06-09T08:02:00.000-07:00

What Is a Nursing Diagnosis for CHF? Congestive Heart Failure CHF is the inability of the heart to pump blood in sufficient amount to meet the needs of the network nutrient and oxygen. The fundamental mechanism of heart failure including the nature of the damage contractile from the heart, leading to less pump sufficient blood from the normal heart. General conditions that underlie including atherosclerosis, atrial hypertension, and infections diseases or degenerative heart muscle. A number of systemic factors and can support the development of the illness of heart failure. Increased metabolic rate (for example: fever, coma, tiroktoksikosis), and anemia hypoxia need an increase in sufficient blood pump to meet the needs of the heart of oxygen. For many patients, the symptoms of heart failure restrict the ability to perform activities of daily living, severely affecting quality of life. Advances in diagnostic and therapeutic techniques have greatly improved the outlook for these patients, but the prognosis still depends on the underlying cause and its response to treatment.

What is a nursing diagnosis for CHF?
Primary nursing diagnosis congestive heart failure CHF is; Decreased CO related to an ineffective ventricular pump, but there is common nursing diagnosis for CHF patients:

Activity intolerance
Decreased cardiac output
Excess fluid volume
Fatigue
Imbalanced nutrition: Less than body requirements
Impaired gas exchange
Ineffective airway clearance
Ineffective breathing pattern
Ineffective tissue perfusion: Cardiopulmonary

Anxiety Disorders nursing care plan

2009-06-06T09:39:00.000-07:00

Anxiety disorders categorized as follows:

Panic Disorder (with or without Agoraphobia)
Agoraphobia Without History of Panic Disorder
Social Phobia
Specific Phobia
Obsessive Compulsive Disorder
Post traumatic Stress Disorder
Acute Stress Disorder
Generalized Anxiety Disorder
Anxiety Disorder Due to a General Medical Condition
Substance-Induced Anxiety Disorder

Patients experience a panic attack under following conditions:

As the predominant disturbance, with no apparent precipitant
Exposed to a phobic stimulus
Attempts are made to curtail ritualistic behavior
Psychologically traumatic event

Sign and Symptoms include:

Pounding, rapid heart rate, Feeling of choking or smothering, Difficulty breathing, Pain in the chest, Feeling dizzy or faint, Increased perspiration, Feeling of numbness or tingling in the extremities, Trembling, Fear that one is dying or going crazy, Sense of impending doom, Feelings of unreality

Causes for Anxiety Disorders
The etiology of Anxiety Disorders is unknown but may have Predisposing Factors of Anxiety Disorders divide into Physiological and Psychosocial risk factor:

Physiological

Biochemical: unusual Biochemical levels have been noted implicated in the etiology of Anxiety Disorders such as increased levels of norepinephrine noted in panic and generalized anxiety disorders, elevations of blood lactate in clients with panic disorder, Decreased levels of serotonin usually found on patient with obsessive compulsive disorder
Genetic
Medical or Substance-Induced

Psychosocial

Psychodynamic Theory: view focuses on the inability of the ego to intervene when conflict occurs between the id and the superego, producing anxiety.
Cognitive Theory: faulty, distorted, or counterproductive thinking patterns accompany or precede maladaptive behaviors and emotional disorders

Common Nursing Diagnosis found on Anxiety Disorders nursing care plan

Anxiety (panic)
Ineffective coping
Powerlessness
Social isolation
Self care deficit
Chronic low self-esteem
Decisional conflict (excessive worry)
Impaired social interaction
Fear

Nursing outcomes, Nursing interventions, Patient teaching for Anxiety Disorders click here

How to Use Anxiety NANDA Nursing Diagnosis

2009-06-05T19:20:00.000-07:00

Diagnosis Definition for Anxiety is feeling Vague uneasy or discomfort or dread accompanied by an autonomic response (the source often nonspecific or unknown to the individual), a feeling of apprehension caused by anticipation of danger. It is an alerting signal that warns of impending danger and enables the individual to take measures to deal with threat.

Defining Characteristics Nursing Diagnosis Anxiety is Expressed concerns due to change in life events, insomnia Fear of unspecific consequences, Shakiness

Sample Clinical Applications Using Nursing Diagnosis Anxiety:

Surgery
Cancer, e.g. breast cancer, lung cancer, kidney cancer, prostate cancer
Mental health disorders such as : Anxious behavior, Ritualistic behaviors
Major life changes/events
Hospital admissions
Hyperthyroidism,
Drug intoxication
Drug abuse

Suggestions when nurses carry out Nursing Care Plans for Anxiety and using Nursing Diagnosis Anxiety Nursing Diagnosis Anxiety must be different from fear, At Nursing Diagnosis Anxiety nurse helps the patient identify the causes of Anxiety, or when it cannot be identified nurse will help patients to express Anxiety. While in the diagnosis fear, the nurse will move the cause of fear or overcome a specific fear.

Nursing outcome Nursing Care Plans for Anxiety

Patient will Verbalize awareness of feelings of anxiety
Patient will appear relaxed and report anxiety is reduced to a manageable level.
Patient will identify healthy ways to deal with and express anxiety.
Demonstrate problem-solving skills.
Use resources/support systems effectively.

Nursing Priority Nursing Care Plans For Anxiety

Assess level of anxiety
Assist client to identify feelings and begin to deal with problems
Provide measures to comfort and aid client to handle problematic
To promote wellness
Teaching/discharge considerations

Online Nursing Care Plan Sample

2009-06-02T08:29:00.000-07:00

Online sample of nursing care plans nursing diagnosis and intervention, in Medical Surgical, Cardiovascular disorders, Neoplasm, Endocrine Disorders, Obstetric Gynecologic Disorders, Pediatric, and Psychiatric nursing care plans sample

Below is the complete list of care plan:

Medical Surgical Care Plans Nursing care plan sample:

Cardiovascular disorders Nursing care plan sample

Neoplasm Nursing care plan sample

Endocrine Disorders Nursing care plan sample

Diabetes mellitus Nursing care plan

Obstetric Gynecologic Disorders Nursing care plan sample

Pediatric Nursing care plan sample

Psychiatric nursing care plans sample

Alzheimer disease Nursing care plan sample
Hypertension nursing care plans

Bipolar Disorders nursing care plans

2009-05-24T07:37:00.000-07:00

Bipolar disorder is an affective disorder marked by severe pathologic mood swings, these disorders are characterized by mood swings from profound depression to extreme euphoria (mania), with intervening periods of normalcy
The diagnostic picture for bipolar Disorders depression is identical to major depressive disorder, with one exception. For Bipolar Disorders client must have a history of one or more manic episodes

Bipolar I Disorder
Bipolar I disorder is the diagnosis given to an individual who is experiencing, or has experienced, a full syndrome of manic or mixed symptoms. The client may also have experienced episodes of depression.
Bipolar II Disorder
Bipolar II disorder is characterized by recurrent bouts of major depression with the episodic occurrence of hypomania. This individual has never experienced a full syndrome of manic or mixed symptoms.
Cyclothymic Disorder
The essential feature is a chronic mood disturbance of at least 2 years’duration, involving numerous periods of depression and hypomania, but not of sufficient severity and duration to meet the criteria for either bipolar I or II disorder. There is an absence of psychotic features.

Common Nursing Diagnoses for Bipolar Disorders

Chronic low self-esteem
Disturbed personal identity
Disturbed thought processes
Impaired social interaction
Ineffective coping
Ineffective health maintenance
Ineffective role performance

Other resource for Bipolar Disorders care
Psychiatric Mental Health Nursing: A Clinical Approach!
Manual of Psychiatric Nursing Care Plans!

Nursing Degrees Online

2009-05-05T08:26:00.000-07:00

Gets nursing degree on Online nursing degree program
The typical nursing degrees:

LPN - Licensed Practical Nurse or Licensed Vocational Nurse (LVN) An LPN program is a diploma program that takes about a year. As an LPN you'll be able to do some patient care under the direction of doctors and registered nurses.
ADN - Associates Degree in Nursing - An ADN typically takes about two years to complete and is generally given at a community college.
BSN - Bachelor of Science in Nursing a BSN is a four year program that prepares you to work in most care settings.
Registered Nurse (RN)
Master of Science in Nursing (MSN)

How about getting Nursing Degrees Online

Swine flu HealthMap

2009-05-03T08:19:00.000-07:00

Swine flu Health Map, Find Latest Information on Swine Flu in interactive map

Click Here To find more About it

Cognitive Behavioral Therapy (CBT) Video Tutorial

2009-04-30T05:56:00.000-07:00

Cognitive behavioral Therapy (CBT) is one of psychotherapy approach that most applied and have been proven effective in various disturbances, including depression and anxiety. Assumptions that underlie Cognitive behavioral Therapy (CBT), especially for cases of depression that comes from emotional disturbances distortion (aberration) in thinking. Improvements in emotional state can only be achieved if the longstanding change patterns of thinking during the process of therapy. Similarly, in patients who have maladaptive patterns of thinking (cognitive dysfunction) and behavioral disorder.

By understanding and changing the pattern of behavioral disorder, the patient is expected to make changes and able to control the symptoms

Cognitive behavioral Therapy (CBT) focused on the problem-solving therapy is focused on the "here and now", which looked as individual decision makers about the important goal or problem to be solved in the process of therapy.

Below, is video tutorial of Cognitive Behavioral Therapy (CBT)

Cognitive Behavioral Therapy (CBT) Video Tutorial 1

Cognitive Behavioral Therapy (CBT) Video Tutorial 2

Donate Umbilical Cord Blood

2009-04-29T05:37:00.000-07:00

Recently I found an article about Donate Umbilical Cord Blood, some interesting fact how Umbilical Cord Blood was thrown away in the past, when a baby was born, but now, blood from the umbilical cord can be collected after your baby's birth and donated to a public cord blood bank to help someone with a life-threatening disease. Such as Leukemia, Lymphomas and other Blood Cancers, Bone Marrow Failure Disorders, Myelodysplastic/Myeloproliferative Disorders, Inherited Metabolic Disorders, Inherited Immune System Disorders.

Umbilical cord blood cells are not the same as embryonic stem cells because umbilical cord blood cells are taken from the baby's umbilical cord and placenta after the baby is born, and not from an embryo.

Patients with leukemia and other life-threatening diseases need a transplant bone marrow donor or umbilical cord blood unit. If you donate cord blood to a public bank, the cord blood can be transplanted into any patient whose doctor selects the cord blood unit as the best match for that patient.

But in my country, this Umbilical Cord Blood Donations program probably will never be able to work, why..?

In Indonesia culture, especially java cultural we assume that Umbilical Cord and placenta is something sacred, and valuable. Is a part of a new born baby and they will not Donate Umbilical Cord Blood and placenta to anyone.
We will save in a pottery, called kendil and in a ceremony we will buried it in the corner of the house. Give it a light of a senthir or teplok lamp for 30 day, so not to be dig by animals.
Kendil Pottery

Some interesting culture isn’t, find more about it here

Nanda Nursing Diagnoses Gordon’s Functional Health Patterns

2009-04-15T10:24:00.000-07:00

Gordon's functional health patterns is a method developed by Marjory Gordon in1987 used by nurses in the nursing process to provide more comprehensive nursing assessment of the patient, as a guide for establishing a comprehensive nursing assessment data base. These 11 categories make possible a systematic and standardized approach to data collection, and enable the nurse to determine the following aspects of health and human function:
Gordon’s Functional Health Patterns:
1. Health Perception Health Management Pattern
2. Nutritional Metabolic Pattern
3. Elimination Pattern
4. Activity Exercise Pattern
5. Sleep Rest Pattern
6. Cognitive Perceptual Pattern
7. Self Perception Self Concept Pattern
8. Role Relationship Pattern
9. Sexuality Reproductive
10. Coping Stress Tolerance Pattern
11. Value-Belief Pattern

Nanda Nursing Diagnosis On Gordon’s Functional Health Patterns

Health Perception Health Management Pattern
Contamination
Disturbed energy field
Effective therapeutic regimen management
Health-seeking behaviors (specify)
Ineffective community therapeutic regimen management
Ineffective family therapeutic regimen management
Ineffective health maintenance
Ineffective protection
Ineffective therapeutic regimen management
Noncompliance (ineffective Adherence)
Readiness for enhanced immunization status
Readiness for enhanced therapeutic regimen management
Risk for contamination
Risk for infection
Risk for injury
Risk for perioperative positioning injury
Risk for poisoning
Risk for sudden infant death syndrome
Risk for suffocation
Risk for trauma
Risk-prone health behavior

Nutritional Metabolic Pattern
Adult failure to thrive
Deficient fluid volume: [isotonic]
[Deficient fluid volume: hyper/hypotonic]
Effective breastfeeding [Learning Need]
Excess fluid volume
Hyperthermia
Hypothermia
Imbalanced nutrition: more than body requirements
Imbalanced nutrition: less than body requirements
Imbalanced nutrition: risk for more than body requirements
Impaired dentition
Impaired oral mucous membrane
Impaired skin integrity
Impaired swallowing
Impaired tissue integrity
Ineffective breastfeeding
Ineffective infant feeding pattern
Ineffective thermoregulation
Interrupted breastfeeding
Latex allergy response
Nausea
Readiness for enhanced fluid balance
Readiness for enhanced nutrition
Risk for aspiration
Risk for deficient fluid volume
Risk for imbalanced fluid volume
Risk for imbalanced body temperature
Risk for impaired liver function
Risk for impaired skin integrity
Risk for latex allergy response
Risk for unstable blood glucose

Elimination Pattern
Bowel incontinence
Constipation
Diarrhea
Functional urinary incontinence
Impaired urinary elimination
Overflow urinary incontinence
Perceived constipation
Readiness for enhanced urinary elimination,
Reflex urinary incontinence
Risk for constipation
Risk for urge urinary incontinence
Stress urinary incontinence
Total urinary incontinence
Urge urinary incontinence
[acute/chronic] Urinary retention

Activity Exercise Pattern
Activity intolerance
Autonomic dysreflexia
Decreased cardiac output
Decreased intracranial adaptive capacity
Deficient diversonal activity
Delayed growth and development
Delayed surgical recovery
Disorganized infant behavior
Dysfunctional ventilatory weaning response
Fatigue
Impaired spontaneous ventilation
Impaired bed mobility
Impaired gas exchange
Impaired home maintenance
Impaired physical mobility
Impaired transfer ability
Impaired walking
Impaired wheelchair mobility
Ineffective airway clearance
Ineffective breathing pattern
Ineffective tissue perfusion
Readiness for enhanced organized infant behavior
Readiness for enhanced self care
Risk for delayed development
Risk for disorganized infant behavior
Risk for disproportionate growth
Risk for activity intolerance
Risk for autonomic dysreflexia
Risk for disuse syndrome
Sedentary lifestyle
Self-care deficit
Wandering

Sleep Rest Pattern
Insomnia
Readiness for enhanced sleep
Sleep deprivation

Cognitive-Perceptual Pattern
Acute confusion
Acute pain
Chronic confusion
Chronic pain
Decisional conflict
Deficient knowledge
Disturbed sensory perception
Disturbed thought processes
Impaired environmental interpretation syndrome
Impaired memory
Readiness for enhanced comfort
Readiness for enhanced decision making
Readiness for enhanced knowledge
Risk for acute confusion
Unilateral neglect

Self-Perception-Self-Concept Pattern
Anxiety
disturbed Body image
Chronic low self-esteem
Death anxiety
Disturbed personal identity
Fear
Hopelessness
Powerlessness
Readiness for enhanced hope
Readiness for enhanced power
Readiness for enhanced self-concept
Risk for compromised human dignity
Risk for loneliness
Risk for powerlessness
Risk for situational low self-esteem
Risk for [/actual] other-directed violence
Risk for [actual/] self-directed violence
Situational low self-esteem

Role-Relationship Pattern
Caregiver role strain
Chronic sorrow
Complicated grieving
Dysfunctional family processes: alcoholism (substance abuse)
Grieving
Impaired social interaction
Impaired verbal communication
Ineffective role performance
Interrupted family processes
Parental role conflict
Readiness for enhanced communication
Readiness for enhanced family processes
Readiness for enhanced parenting
Relocation stress syndrome
Risk for caregiver role strain
Risk for complicated grieving
Risk for impaired parent/infant/child attachment
Risk for relocation stress syndrome
Social isolation

Sexuality-Reproductive
Ineffective sexuality patterns
Rape-trauma syndrome
Sexual dysfunction

Coping-Stress Tolerance Pattern
Compromised family coping
Defensive coping
Disabled family coping
Impaired adjustment
Ineffective community coping
Ineffective coping
Ineffective denial
Post-trauma syndrome
Readiness for enhanced community coping
Readiness for enhanced coping
Readiness for enhanced family coping
Risk for self-mutilation
Risk for suicide
Risk for post-trauma syndrome
Self-mutilation
Stress overload

Value-Belief Pattern
Impaired religiosity
Moral distress
Readiness for enhanced religiosity
Readiness for enhanced spiritual well-being
Risk for impaired religiosity
Risk for spiritual distress
Spiritual distress

http://www.scribd.com/doc/6418349/Gordons-11-Functional-Health-Patterns
http://www.sonoma.edu/users/k/koshar/n340/N345_Gordon_FHP.html
http://www.efn.org/~nurses/nanda.html
http://www.scribd.com/doc/8465961/NANDA-Nursing-Diagnosis-2008
http://martihand.wordpress.com/nanda-approved-nursing-diagnoses-creative-nursing-interventions-cni/

Psychiatric Nursing Care Plans For Alterations In Psychosocial Adaptation

2009-04-12T20:04:00.000-07:00

Nursing Care Plans Diagnosis for common psychiatric disorders, several common psychiatric disorders may arise or become evident during infancy, childhood, or adolescence. There are, however, several disorders that appear during the early developmental years and are identified according to the child’s ability or inability to perform age-appropriate tasks.

Below is example Nursing care plans of several disorders that appear during the early developmental years and Common NANDA nursing care plans diagnosis, that may occur:

Psychiatric Nursing care plans for Mental retardation
Common NANDA nursing care plans diagnosis:
• Risk for injury
• Self-care deficit
• Impaired verbal communication
• Impaired social interaction

Psychiatric Nursing care plans for autistic disorder
Common NANDA nursing care plans diagnosis:
• Risk for self-mutilation
• Impaired social interaction
• Impaired verbal communication
• Disturbed personal identity

Psychiatric Nursing care plans for disturbed personal identity
Common NANDA nursing care plans diagnosis:
• Risk for self-directed or other-directed violence
• Defensive coping
• Impaired social interaction
• Ineffective coping
• Low self-esteem
• Anxiety (moderate to severe)
• Noncompliance

Psychiatric Nursing care plans for disruptive behavior disorders
Attention-Deficit/Hyperactivity Disorder
Common NANDA nursing care plans diagnosis:
• Risk for self-directed or other-directed violence
• Defensive coping
• Impaired social interaction
• Ineffective coping
• Low self-esteem
• Anxiety

Psychiatric Nursing care plans for tourette’s disorder
Common NANDA nursing care plans diagnosis:
• Risk for self-directed or other-directed violence
• Impaired social interaction
• Low self-esteem

Psychiatric Nursing care plans for separation anxiety disorder
Common NANDA nursing care plans diagnosis:
• anxiety (severe)
• ineffective coping
• impaired social interaction

List Of NANDA Approved Nursing Diagnosis 2009-2011

2009-04-04T08:57:00.000-07:00

NANDA Approved Nursing Diagnosis 2007-2008 contains 188 nursing diagnosis, latest NANDA-I Approved Nursing Diagnosis 2009-2011 contains an additional 21 new nursing diagnosis, 9 revisions diagnosis and some of diagnosis are not used again. Total nursing diagnosis at this time is 205 nursing diagnosis.

Nanda I usually revised every 2 years, but this time NANDA I publish a list of NANDA Nursing Diagnosis for period of three years.
for complete list of NANDA Approved Nursing Diagnosis 2009-2011,here !

Psychiatric Care For Elderly

2009-03-11T07:18:00.001-07:00

In many country more and more people are becoming of age, the extended family way of living is changing in to a more individual way of living and family members don’t live in the same village or city anymore. Family planning ,finding jobs, different ways of living and tradition and culture are making that people have to look for a new balance in life.In a few decades there has been a very big change in the way people are living, and the life expectancy is increasing . It also means that people will have health problems, need information about health promotion and guidance to stay healthy.
As a nurse we have different roles:
you are a nursing professional, a director, designer, coach and professional practitioner.

It means you have to combine theory, experience, social skills and personal qualities to make sure that your psycho geriatric patient is feeling well, has a safe environment . You have to be able to work in a multidisciplinary way, work evidence based, patient centered and cope with family members, stress, change psychogeriatric is becoming a very important issue, and for nurses a big challenge.
People becoming of age can develop problems:

Caused by aging, stress, health and coping:

problems with hearing and vision
short term and long term memory
loneliness
suspicious behavior

Caused by psychogeriatric disorders:

dementia
Restless behavior
Disorientation
Memory disorders
Aggression

caused by mental health disorders:

Aggressive behavior
Hallucination
Wondering

Caused by anxiety disorders:

panic disorders
phobias
obsessive compulsive disorders

This behavior can be observed when a person is still at home, living with the family, in day care centers, homes for the elderly, nursing homes, hospitals and psychiatric hospitals. So nurses must develop skills to observe and diagnose to come to the right diagnoses and guidance of the patient and the family. Keeping your patient in his own environment for as long as possible is an important goal, guidance, helping family to cope with the situation can prevent that the patient must go to a nursing home or hospital

Nursing therapeutic climate:
There are different approaches in psychogeriatric.
For patients that need guidance use the reality and orientation training
For patients that need care we use Validation therapy
For patients that need nursing we use Activating senses and relaxation. Snoozling developed for mentally retarded persons is also very effective for patients with psychogeriatric problems.
At the moment the emotion oriented approach is introduced because it gives patients the feeling that they are accepted, feel safe and the approach follows the needs of the patient

NANDA nursing diagnosis and behaviors that correspond in psychiatric nursing

2009-03-09T09:38:00.000-07:00

Behavior of patients is one of the data required in nursing Assessment. behavior Assessment is the most important basis in nursing care planning for patient with mental Disorders, behavioral changes are the first symptoms of the disease in some mental Disorders. Following is a list of common Behavior of mental Disorders and related NANDA nursing diagnosis which correspond to the behaviors and which may be used in Nursing care plans for the client in psychiatric nursing:

Behaviors:
Aggression, hostility, Manic hyperactivity
NANDA Nursing Diagnosis:
Risk for injury; Risk for otherdirected violence

Behaviors:
Anorexia or refusal to eat
NANDA Nursing Diagnosis:
Imbalanced nutrition: Less than body requirements

Behaviors:
Difficulty making important life decision
NANDA Nursing Diagnosis:
Decisional conflict

Behaviors:
Anxious behavior
Ritualistic behaviors
NANDA Nursing Diagnosis:
Anxiety (Specify level)

Behaviors:
Confusion; memory loss
NANDA Nursing Diagnosis:
Confusion acute/Confusion chronic; Disturbed thought processes

Behaviors:
Delusions
NANDA Nursing Diagnosis:
Disturbed thought processes

Behaviors:
Difficulty with interpersonal relationships
Seductive remarks; inappropriate sexual behaviors
NANDA Nursing Diagnosis:
Impaired social interaction

Behaviors:
Denial of problems
Substance use (denies use is a problem)
NANDA Nursing Diagnosis:
Ineffective denial

Behaviors:
Depressed mood or anger turned inward
NANDA Nursing Diagnosis:
Complicated grieving

Behaviors:
Disruption in capability to perform usual responsibilities
NANDA Nursing Diagnosis:
Ineffective role performance

Behaviors:
Difficulty accepting new diagnosis or recent change in health status
NANDA Nursing Diagnosis:
Risk for injury
Risk-prone health behavior

Behaviors:
Dissociative behaviors depersonalization, derealization
NANDA Nursing Diagnosis:
Disturbed sensory perception

Behaviors:
Depressed mood or anger turned inward
NANDA Nursing Diagnosis:
Complicated grieving

Behaviors:
Detoxification; withdrawal from substance
NANDA Nursing Diagnosis:
Risk for injury

Behaviors:
Expresses anger at God
NANDA Nursing Diagnosis:
Spiritual distress

Behaviors:
Expresses feelings of disgust about body or body part
NANDA Nursing Diagnosis:
Disturbed body image

Behaviors:
Fails to follow prescribed therapy
NANDA Nursing Diagnosis:
Ineffective therapeutic regimen management

Behaviors:
Expresses lack of control over personal situation
NANDA Nursing Diagnosis:
Powerlessness

Behaviors:
Flashbacks, obsession with traumatic experience, nightmares
NANDA Nursing Diagnosis:
Post trauma syndrome

Behaviors:
Highly critical of self or others
NANDA Nursing Diagnosis:
Low self-esteem

Behaviors:
Hallucinations
NANDA Nursing Diagnosis:
Disturbed sensory perception

Behaviors:
Inability to meet basic needs
NANDA Nursing Diagnosis:
Self-care deficit

Behaviors:
Insomnia or hypersomnia
NANDA Nursing Diagnosis:
Disturbed sleep pattern

Behaviors:
Loose associations or flight of ideas
NANDA Nursing Diagnosis:
Impaired verbal communication

Behaviors:
Manipulative behavior
Physical symptoms as coping behavior
Substance use as a coping behavior
NANDA Nursing Diagnosis:
Ineffective coping

Behaviors:
Multiple personalities; gender identity disturbance
NANDA Nursing Diagnosis:
Disturbed personal identity

Behaviors:
Loss of a valued entity, recently experienced
NANDA Nursing Diagnosis:
Risk for complicated grieving

Behaviors:
Orgasm problems with lack of sexual desire
NANDA Nursing Diagnosis:
Sexual dysfunction

Behaviors:
Overeating
compulsive
NANDA Nursing Diagnosis:
Risk for imbalanced nutrition: More than body requirements

Behaviors:
Projection of blame; rationalization of failures denial of personal responsibility
NANDA Nursing Diagnosis:
Defensive coping

Behaviors:
Phobias
NANDA Nursing Diagnosis:
Fear

Behaviors:
Potential or anticipated loss of significant entity
NANDA Nursing Diagnosis:
Grieving

Behaviors:
Self-inflicted injuries
NANDA Nursing Diagnosis:
Self-mutilation/Risk for selfmutilation

Behaviors:
Sexual behaviors difficulty,limitations, or changes inreported dissatisfaction
NANDA Nursing Diagnosis:
Ineffective sexuality patterns

Behaviors:
Stress from caring for chronically ill person
NANDA Nursing Diagnosis:
Caregiver role strain

Behaviors:
Stress from locating to new environment
NANDA Nursing Diagnosis:
Relocation stress syndrome

Behaviors:
Suicidal
NANDA Nursing Diagnosis:
Risk for suicide; Risk for selfdirected violence

Behaviors:
Suspiciousness
NANDA Nursing Diagnosis:
Disturbed thought processes; ineffective coping

Behaviors:
Withdrawn behavior
NANDA Nursing Diagnosis:
Social isolation

Behaviors:
Vomiting, excessive, selfinduced
NANDA Nursing Diagnosis:
Risk for deficient fluid volume

Nursing Process

2009-03-08T20:48:00.000-07:00

The nursing process in general defined as problem-solving approach in a systematic to provide nursing care plan to each person. Nursing process is used to help nurses practice nursing systematically solve problems in nursing. By using this method, a nurse can demonstrate responsibility and accountability on the responsibility of the client, so that the quality of nursing practice can be improved.

Nursing care and the quality can be achieved if the implementation of nursing care meant as an honor that belongs to the nurses in the show as an honor held by nurses in the show due to nurture the humane, safe, and in accordance with professional standards and ethics of sustainable nursing
Questions that relate to nursing behaviors in a variety of client situations are presented according to the steps of the nursing process:

Assessment: Establishing a database about a client
Diagnosis: Identifying the client’s health care needs and selecting goals of care
Outcome Identification: Establishing criteria for measuring achievement of desired outcomes
Planning: Designing a strategy to achieve the goals established for client care
Implementation: Initiating and completing actions necessary to accomplish the goals
Evaluation: Determining the extent to which the goals of care have been achieved

Indonesian Psychiatric Nursing History

2009-02-11T00:52:00.000-08:00

Mental health is a condition that allows the development of physical, intellectual, emotional optimally from someone and the development of this in harmony with other people.
Although there is no universal definition of mental health, mental health is a positive situation by people who can be responsible, displays self-awareness, is self-directive, is reasonably worry free, and can cope with usual daily tensions. Such individuals function well in society, are accepted within a group, and are generally satisfied with their lives.

Psychiatric mental health nursing
It is a specialized area of nursing practice that uses theories of human behavior as its scientific framework and requires the purposeful use of self as its art of expression. It is concerned with promoting optimum health for society. Comprehensive services focus on prevention of mental illness, health maintenance, management of and referral for mental and physical health problems, diagnosis and treatment of mental disorders, and rehabilitation (Haber & Billings, 1993).

Indonesian psychiatric nursing history

Prehistoric times psychiatric nursing history
Begin with prehistoric times when primitive people believed spirits possessed the body and had to be driven out to cure.
Therapy: removing the spirits

1882
First Mental Hospital Indonesia (Bogor)
1902 : Lawang Mental Hospital
1923 : Magelang Mental Hospital
1927 : Sabang Mental Hospital
psychiatric nursing care use custodial care system. isolation and treatment of restrain

1910
Psychiatric nursing care start to try and avoid costodial care and restraints

1920
psychiatric nursing Care fokus in disease (Curative Care model)

1930
Therapy started working as agricultural land use for people with mental illness
During World War II and Japanese occupation, psychiatric nursing care is not developed

1947
New development in October 1947. government formed Jawatan Urusan Penyakit Jiwa

1966
indonesian government issued mental health laws UU Kesehatan Jiwa No.3 thn 1966

1975
PPDGJ I published on 1975

1970
the private sector also starting take a role in mental health problems

1990-2000
Focus on preventive/community based service, using various primary preventive approaches, such as mental health center, partical, hospital service, day care centers, home health care and hospital care

List Of NANDA Approved Nursing Diagnosis 2007-2008

2009-02-03T01:43:00.000-08:00

List of NANDA Nursing diagnosis Accepted for Use and Research 2007-2008: Divided into 13 domains and 47 classes, below the full list of 13 Domains and 47 classes NANDA Nursing diagnosis. And complete list of NANDA Nursing diagnosis based on alphabetical order.

Domains Health Promotions
Health awareness
Health management

Domains nutrition's
ingestion
digestion
Absorption
Metabolism
Hydration

Domains Elimination/exchange
Urinary System
Gastrointestinal System
Integumentary system
Pulmonary System

Domains Activity/Rest
Sleep/Rest
Activity/Exercise
Energy Balance
Cardiovascular-pulmonary Responses
Self-Care

Domains Perception/Cognition
Attention
Orientation
Sensation/Perception
Cognition
Communication

Domains Self Perception
Self-Concept
Self-Esteem
Body Image

Domains Role Relationship
Caregiving Roles
Family Relationship
Role Performance

Domains Sexuality
Sexual Identity
Sexual Function
Reproduction

Domains Coping/Stress Tolerance
Post-Trauma Responses
Coping Responses
Neuro-behavioral Stress

Domains Life Principles
Values
Beliefs
Values/Belief/action Congruence

Domains Safety/protection
infection
Physical Injury
Violence
Enviromental Hazards
Defensive Processes
Thermoregulation

Domains Comfort
Physical Comfort
Environmental Comfort
social Comfort

Domains Growth/Development
Growth
Development

Other resource for Nursing Diagnoses:
NANDA Nursing Diagnoses, Definitions and Classification 2009-2011!
Nursing Diagnosis An Evidence Based Guide to Planning Care
Nursing Diagnoses in Psychiatric Nursing!

NANDA Nursing diagnosis Book

LINK: Nanda.org

NANDA-I Publications

First Day as Psychiatric Nurses

2009-01-31T08:01:00.000-08:00

Started about 5 years ago When first entered as a nurse in the mental hospital as a Psychiatric nurses. first things that came in my mind about violent behavior of mental patients to nurses. violence against psychiatric nurses is the main issue in my nurse community. As a nurse, you certainly do not want to get injured, bruised, and hematoma at the time of duty. Even until now I have to always alert for patients who behave aggressively. have not been done research the number of violence against psychiatric nurses in the mental hospital, where I work. maybe because of poor reporting and record-keeping I can not determine the exact amount of violence against psychiatric nurses.

But I must still carry out my duty as a Psychiatric nurses