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The Nursing diagnosis of nutrition

admin — Wed, 10 Mar 2010 03:04:29 +0000

The Nursing diagnosis of nutrition
Initially, the nutrients in the NANDA diagnosis is “Disturbance nutritional needs less / more than the body needs”. But since the edition of 2000s, the diagnosis was revised to a few:
1. Imbalanced nutrition: less than body requirements (148) or nutritional imbalance: less than body requirements
2. Imbalanced nutrition: more than body requirements (149) or nutritional imbalance: more than body requirements
3. Readiness for enhanced nutrition (150th) or the potential increase in nutrients (nursing diagnosis welfare / wellness)
4. Risk for imbalanced nutrition: more than body requirements (151) or the risk of nutritional imbalance: more than body requirements

Of the four nursing diagnoses, perhaps the first diagnosis is frequently used. The diagnosis of “imbalance nutrition: less than body requirements” is a diagnosis for patients who have nutritional deficiencies intake of less than metobolisme needs. Borrowing the term Carpenito, that there should be a diagnosis of major data, it prioritizes diagnostic sign “weighing less than 20% ideal body weight”. So that when a patient should not eat (only once or twice only) may not be able to lift this diagnosis. Especially if there is no weight data of patients during hospitalization and after care. Anyone ever asks: “If patients do not want to eat because of feeling nauseated, what diagnosis should not lift it?”. Why, lha existing weight loss yet? If that data is “only” because of sickness, why not raise a diagnosis of “sick” (Nausea, NANDA pp. 142-143) alone? The problem is, until the 2007-2008 NANDA, not yet / no diagnosis “Risk nutritional imbalance: less than body requirements”. Maybe if there was such a diagnosis, could have raised this with the nutritional diagnosis diagnostic category of “risk”.
In addition to weight loss, other data for this diagnosis are:
1. stomach cramps
2. abdominal pain
3. diarrhea
4. hair loss
5. underfed
6. less information
7. less interested in food
8. weight loss with food intake adequat
9. misconceptions
10. misinformation
11. pale mucous membranes
12. inability to digest food
13. muscle weakness
14. etc.
Etiology that can be connected:
1. biological factors
2. economic factors
3. inability to absorb foods
4. inability to eat
5. inability to digest food
6. psychological factors.
If data is found not just “sick”, but more than that according to the list of signs of the above symptoms, should raise the risk of diagnosis, although in NANDA’s no risk for this diagnosis. Diagnosis is to risk the “Risk nutritional imbalance: more than body requirements related to ….”. But for the “less than body requirements” was not currently exist.
The diagnosis of “imbalance nutrition: more than body requirements” can be appointed for patients with weight 20% more than ideal BB.
Then there is an interesting question: “If the patient is connected naso Gastric Tube (NGT), whether the diagnosis of nutrients needed to be removed this? Is not there a regular schedule for feeding through NGT earlier, the patient may not have nutritional deficiencies …. “.
In my opinion, this case is similar to the risk of infection for the diagnosis infusion installation or other invasive procedures. Well, why do patients fitted NGT? Because swallowing disorders, decreased awareness, etc.. NGT prior to installation, of course, the nurse will conduct assessments in advance. For example, “Oh, the patient experienced a decrease of consciousness”. Nurses should be lifted diagnosis “Risk of nutritional imbalance: less than body requirements”. Intervention will include: installation of NGT, giving fooding sonde 5 x 400 ml for example. The problem, the nurse then had the assumption that the patient have been installed since the poly NGT or ER, means need not be appointed nutrition diagnosis. The question is: “Nurses provide food through NGT 400 ml. Once you’ve done, the progress notes where she will document this intervention? ”
So, the nurse who put NGT (in poly, ER, or anywhere else), would have had a diagnosis of nutrients that she needs to put NGT. Furthermore, nurses in the inpatient or home care would go through with the intervention of the first nurse who put NGT. The problem: “How can the documentation of nursing process in poly / ER / first place?”

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The Nursing diagnosis of “elimination”

admin — Wed, 10 Mar 2010 02:31:49 +0000

The Nursing diagnosis of “elimination”
Here are some nursing diagnosis related to the elimination of:
1. Bowel incontinence (p. 22) or incontinence alvi / faeces. Changes in defecation patterns. Could be caused by chronic diarrhea, diet, immobilisasi, stress, medication, lack of hygiene during toileting, etc.. Differentiate with a diagnosis of “Diarrhea”. In this diagnosis, normal faeces, only the pattern are changed. For example once-daily routine, because the factors associated, into two or three days.
2. Diarrhea (p. 71) or diarrhea. The main data is not shaped up faeces with liquid. Primarily Indokator bowel (molten) at least three times in one day. The results of auscultation of the abdomen, abdominal cramps and abdominal pain is a sign of the other symptoms. Factors associated divided into three groups; physiological, psychological and situational. For example because of anxiety, high stress levels, the process of inflammation, irritation, malabsorption, toxicity, travel, alcohol consumption and the influence of radiation.
3. Impaired urinary elimination (p. 234) or urine elimination disorders. Characteristics: dysuria, frequency increased urination, hesitancy, incontinence, nocturia. In NANDA was a little confused. One of the characteristics mentioned for this diagnosis is “retention”. Whereas existing diagnosis of “urinary retention”. Thus it is suggested that patients experienced urinary retention, it becomes immediately appointed diagnosis “urinary retention”. To promote nursing diagnosis “Disturbance elimination of urine”, should be explained where disturbance. If the patient complains often wake to urinate at night, it could be taken “Disturbance elimination of urine: nocturia”. If the patient beser (urinate uncontrollably and constantly), could be appointed as “Disturbance of elimination of urine: incontinence”. And so on, according to data obtained from the study.
4. Readiness for enhanced urinary elimination (p. 235) or the potential increase in the elimination of urine (diagnosis and prosperous).
5. Urinary retention (p. 236) or urinary retention. Unable to empty the urine of lampias. Characteristics: tense blader palpation, pain during urination, until no urine at all. Factors related: spincter strength, high pressure and the urethral resistance (should be evidenced by the results of the examination).
6. Constipation (p. 44) or constipation
7. Perceived constipation (p. 46) or the approximate constipation (self diagnosed clients suffering from constipation, usually associated factor is the culture of trust, family trust, understanding is wrong or thought process disorder)
8. Risk for constipation (p. 47) or the risk of constipation.

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PREVENTING ERRORS IN MAKING NURSING DIAGNOSIS

admin — Mon, 08 Mar 2010 15:28:00 +0000

PREVENTING ERRORS IN MAKING NURSING DIAGNOSIS
1. Do not use medical terms. If you must, merely clarify, with the statement given to the `secondary`.
Ex: b.d cancer mastectomy
2. Not formulate nursing diagnosis as a medical diagnosis
Ex: Risk of pneumonia
3. Do not formulate a nursing diagnosis as a nursing intervention
Ex: Using the potty as often as possible bd urge to urinate
4. Do not use vague terms. Use the term / more specific statement.
Ex: No effective clearance of airway difficulty breathing bd
5. Do not write a repeat of nursing diagnosis doctor’s instructions

Ex: Instructions for fast
6. Do not formulate the two problems at the same time
Ex: aches and fear b.d operating procedures
7. Do not connect the problem with a situation that can not be changed
Ex: The risk of injury b.d blindness
8. Do not write or sign the aetiology / symptoms to the problem
Ex: pulmonary congestion long lay b.d tirah
9. Do not make assumptions
Ex: The risk of the changing role of bd inexperienced new mothers.
10. Do not write a statement that legally unwise
Ex: bd damage the integrity of the skin where the client is not changed every 2 hours.

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CATEGORY OF NURSING DIAGNOSIS

admin — Mon, 08 Mar 2010 15:22:16 +0000

CATEGORY OF NURSING DIAGNOSIS
1. Actual Nursing Diagnosis
Actual nursing diagnosis (NANDA) is the presenting diagnosis, clinical conditions have been validated through the major constraints identified characteristics. Nursing diagnosis has four components: label, definition, limitation characteristics, and related factors.
Label is a description of the diagnosis and definition of characteristics limits. Definition emphasizes the clarity, meaning the right to diagnose. Limitation characteristics are characteristics that refer to clinical guidelines, subjective and objective signs. These limits also refers to the symptoms in the group and refers to the nursing diagnosis, which limits teridiri of major and minor. Factors related to the etiology or supporting factors. These factors may affect changes in health status. Related factors consists of four components: pathophysiology, the action related, situational, and maturasional.
Examples of actual nursing diagnosis: activity intolerance associated with a reduction in oxygen transport, secondary to lay tirah long, marked by shortness of breath, breathing frequency of 30 x / min, pulse 62/mnt-lemah, pale, cyanosis.
2. Nursing Diagnosis Risk

Risk nursing diagnosis is a clinical decisions about individuals, families or communities that are vulnerable to having problems than individuals or other groups in the same situation or similar.
Validation to support the diagnosis of risk is the risk factor that shows a state in which increased vulnerability to the client or group and does not use restriction characteristics. Writing this diagnosis adalag formula: PE (problem & etiology).
Example: The risk of transmission of pulmonary TB associated with a lack of knowledge about the risk of pulmonary TB infection, characterized by client families often ask the client what the disease and no efforts of families to avoid the risk of transmission (allowing the client before it without coughing and nose shut).
3. Possible Nursing Diagnosis
Is a statement about the alleged problems still require additional data in the hope that still needed to ensure the main symptoms and signs of risk factors.
Example: Possible interference self concept: self-image associated with mastectomy action.
4. Nursing Diagnosis ESTATE
Prosperous nursing diagnosis is clinical conditions of individuals, groups, or society in transition from level to level specific health better health. Diagnsosis making this way is to combine a positive statement in the function of each functional health patterns as a validated assessment tool. In determining the welfare of nursing diagnosis, showed an increase of health functions into positive functions.
For example, a young couple who became parents had melaprkan positive function in the role of relationship patterns. Nurses can use information and the birth of a new baby in addition to the family unit, to help families maintain an effective relationship patterns.
Example: medical help-seeking behavior associated with less knowledge about the role of new parent.
5. Nursing Diagnosis Syndrome
Nursing diagnosis nursing diagnosis of the syndrome is composed of a group of actual nursing diagnosis or risk, which is expected to appear as an event or a particular situation.
Example: lack of self-care syndrome associated with physical weakness.

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The Nursing diagnosis of “elimination”

FORMULATION PROCESS NURSING DIAGNOSIS

admin — Mon, 08 Mar 2010 15:17:25 +0000

FORMULATION PROCESS NURSING DIAGNOSIS
1. Classification and Data Analysis
Grouping the data is grouped client data or a particular situation where the client has health problems or nursing based on the criteria of the problem. grouping data can be compiled based on the pattern of human response (NANDA taxonomies) and / or patterns of health functions (Gordon, 1982);
Human Response (NANDA Taxonomy II):
a. Exchange
b. Communication
c. Related
d. Values
e. Options
f. Moving
g. Interpretation
h. Knowledge
i. Feeling
Function Health Patterns (Gordon, 1982):

a. Perceptions of health: health management pattern
b. Nutrition: the pattern of metabolism
c. Pattern of elimination
d. Activities: training patterns
e. Sleep: the pattern of resting
f. Cognitive: perceptual patterns
g. Perception of self: self-concept pattern
h. Role: the pattern of relationships
i. Sexuality: patterns of reproductive
j. Köping: stress tolerance pattern
k. Value: patterns of belief
2. Identify client problems
Client is a state issue or a situation where clients need help to maintain or improve their health status, or died peacefully, which can be done by nurses according to their ability and authority he has
Identification of client problems are divided into: patients are not a problem, patients who may have a problem, patients who have a potential problem that most likely have a problem and patients who have actual problems.
a. Determining the excess clients
If the client meets the criteria standards of health, nurses and concluded that the client has the advantage of certain things. Excess funds can be used to improve or help solve problems facing clients.
a. Determining the client’s problem
If the client does not meet the standard criteria, then the client is experiencing limitations in terms of health and I need help.
a. Determining problems experienced by clients
At this stage, it is important to determine the client’s potential problems. For instance found any signs of wound infection in clients, but the lab test results, do not indicate a disorder. In accordance with the theory, then the infection will occur. The nurse then concluded that the immune system the client is not able to fight infection.
a. Determination of the decision
- No problem, but needs to improve the status and function (welfare): there is no indication of the response of nursing, increased health status and habits, and her health promotion initiatives to ensure the presence or absence of the alleged problem.
- Issues likely (possible problem): the pattern of data collected to ensure the complete presence or absence of problems allegedly
- Actual problems, risk, or syndrome: not able to care for clients’ problems and refused treatment, began to design the planning, implementation, and evaluation to prevent, reduce, or solve problems.
- Collaborative problem: consult your professional health workers and ompeten working collaboratively on these issues. Collaborative problem is physiological complications resulting from pathophysiology, associated with treatment and other situations. The task is to monitor the nurse, to detect the status of clients and collaborative with medical personnel to the appropriate treatment.
3. Validate nursing diagnosis
Is connected with the classification of symptoms and signs which then refers to the completeness and accuracy of data. For completeness and accuracy of data, cooperation with clients is very important to trust each other, so getting the right data.
At this stage, nurses validate existing data accurately, is done with the client / family and / or the community. Validation was conducted by asking questions or reflective statement to the client / family about the clarity of data interpretation. Once the nursing diagnosis made, then the validation should be done.
4. Establishing nursing diagnoses according to the priorities
After the nurse group, identify, and validate the data significantly, then the duty nurse at this stage is to formulate a nursing diagnosis. Nursing diagnosis can be actual, risk, syndrome, the possibility and wellness.
Establishing nursing diagnoses should be ordered by the berlandaskabn needs Maslow’s hierarchy (except for cases kegawat daruratan – use priority based on “life threatening”):
a. Based on Maslow’s hierarchy: physiological, safety, comfort, safety, love and belonging, self-esteem and self-actualization
b. Griffith-Kenney Christensen: the threat of life and health, resources and funds available, the role and the client, and the scientific principles and practice of nursing.

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SETUP REQUIREMENTS NURSING DIAGNOSIS

admin — Mon, 08 Mar 2010 15:07:08 +0000

SETUP REQUIREMENTS NURSING DIAGNOSIS
1. Formulation should be clear and concise client response to the situation or circumstances that faced
2. Spesifi and accurate (certainly)
3. Can be a statement of the cause
4. Providing guidance on nursing care
5. Can be implemented by nurses
6. Mencerminan client’s health condition.

THINGS THAT NEED TO BE FOR DETERMINING THE NURSING DIAGNOSIS

1. Oriented to the clients, families and communities
2. Are actual or potential
3. Can be addressed by nursing interventions
4. Stating that the health problems of individuals, families and communities, as well as the factors causing these problems.

REASON FOR WRITING Nursing Diagnosis
1. Provide comprehensive nursing care
2. Provide unity of language in nursing profession
3. Improving communication between colleagues and other health professions
4. Help formulate the expected results / objectives in ensuring appropriate quality of nursing care, so that more accurate selection of interventions and serve as guidelines in conducting evaluations
5. Creating standards of nursing practice
6. Provide basic nursing service quality improvement.

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KNOW NURSING DIAGNOSIS

admin — Mon, 08 Mar 2010 07:03:03 +0000

DEFINITIONS
Nursing diagnosis is a clinical decision about the response of individuals, families and communities about the health problems of actual or potential, which based on education and experience, nurses are akontabilitas can identify and provide for certain interventions to maintain, reduce, limit, stop and change a client’s health status (Carpenito , 2000; Gordon, 1976 & NANDA).
Nursing diagnosis is determined based on analysis and interpretation of data obtained from the study nursing clients. Nursing diagnosis provides a description of the problem or the health status of a real client (actual) and is likely to occur, where the solution can be done within the limits of authority of the nurse.
COMPONENT NURSING DIAGNOSIS
Nursing diagnosis formulation contains three main components, namely:
1. Problem (P / problem), is a picture of a client state of nursing actions which can be given. Problem is the gap or deviations from normal conditions that should not happen.
Objectives: to explain the health status of the client or the client’s health problems are clearly and briefly as possible. Nursing diagnoses have been prepared using an agreed standard (NANDA, Doengoes, Carpenito, Gordon, etc.), so that:

a. Nurses can communicate with a term generally understood
b. And facilitate access to nursing diagnosis
c. As a method to identify differences in nursing problems with medical problems
d. Increasing cooperation in defining nursing diagnoses from assessment data and nursing interventions that can improve the quality of nursing care.
2. Etiology (E / cause), it shows the causes of conditions or health problems that give direction to nursing therapy. The reasons include: behavior, environment, interaction between behavior and environment.
The elements in the identification of etiology:
a. Pathophysiology of disease: is all the disease process, acute or chronic which can lead / support problems.
b. Situational: personal and environmental (lack of knowledge, social isolation, etc.)
c. Medications (associated with the treatment program / treatment): the limitations of the institution or hospital, and is unable to provide care.
d. Maturasional:
Adolesent: dependence on the
Young Adult: marriage, pregnancy, parenthood
Adults: career pressure, signs of puberty.
3. Sign & symptom (S / signs & symptoms), is characteristic, signs or symptoms, which is the information needed to formulate a nursing diagnosis.
So the formula is a nursing diagnosis: PE / PES.

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Nursing Care Plan Pneumonia

Nursing Care Plan Pneumonia

admin — Mon, 08 Mar 2010 06:31:59 +0000

Nursing Care Plan Pneumonia

1. Breath Pattern ineffectiveness associated with pulmonary infection

Characteristics:

Cough (both productive and non productive), shortness of breath, Tachipnea, breath sounds limited, retracted, fever, diaporesis, ronchii, Cyanosis, leukocytosis.

Destination:

Children will experience breathing pattern characterized by effective:
- The sound is clean and lung breath the same on both sides
- Within the limits of body temperature from 36.5 to 37.2 OC
- The rate of breathing in the normal range
- There is no coughing, Cyanosis, retracted and diaporesis

Intervention

* Conduct assessments every 4 hours of respiration rate, temperature, and signs of airway effectively.
R: Evaluation and reassessment of the actions that will / have been given.

* Perform a scheduled chest Phisioterapi
R: Remove the secretion of the airway, preventing obstruction

* Give Oxygen moist, review the effectiveness of therapy
R: Increased lung tissue oxygen supply

* Give appropriate antibiotics and antipyretics order, review the effectiveness and side effects (rash, diarrhea)
R: Eradication of the bacteria as a factor of disturbance causa

* Perform a gradual suction
R: Helping clean the airway

* Record the results of Pulse Oximeter when installed, every 2 – 4 hours
R: Evaluation of therapeutic success periodic / health team action.

2. Fluid Volume Deficit related to the reduction in fluid intake

Characteristics:

Loss of appetite / drinking, lethargy, fever., Vomiting, diarrhea, dry mucous membranes, poor skin turgor, decreased urine output.

Destination:
Children get an adequate amount of fluid indicated by:

* Adequate Intake, either oral or Intra Venous

* No adan lethargy, vomiting, diarrhea

* Body temperature in normal

* Urine output adequate

Intervention:

* Note the intake and output
R: Evaluation strict intake and output needs

* Review and record the temperature every 4 hours, signs of fluid and conditions devisit Intra Venous line
R: Convincing fluid fulfillment

* Perform mouth care every 4 hours
R: Increasing the clearance sal indigestion, increased appetite / drinking

Other diagnosis:

1. Changes Nutrition: Less than needs associated with anorexia, vomiting, increased calorie consumption secondary to infection

2. Change of comfort associated with headache, chest pain

3. Activity intolerance related to respiratory distress, latergi, decreased intake, fever

4. Anxiety associated with hospitalisasi, respiratory distress

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NURSING CARE CLIEN WITH ASTHMA

admin — Mon, 08 Mar 2010 05:03:16 +0000

MEDICAL CONCEPTS ASTHMA

I. DEFINITIONS
Asthma is a disease caused by the increased response of the trachea and bronchi to various stimuli are marked by narrowing of bronchial secretions or bronkhiolus and excess – excess of glands – glands in the bronchus mucosa

II. Aetiology
1. Extrinsic Factors
Asthma is caused by a hypersensitivity reaction caused by IgE reacts to antigens contained in the air (antigen – inhalation), such as house dust, pollen – pollen and animal fur
2. Intrinsic Factor
• Infection:
- The virus that causes influenza is the virus, respiratory syncytial virus (RSV)
- Bacteria, such as pertussis and streptokokkus
- Mushrooms, such as Aspergillus
• weather:
changes in air pressure, air temperature, wind and humidity associated with the acceleration
• irritant chemicals, perfumes, cigarette smoke, air pollutants
• Emotional: fear, anxiety and tension
• Excessive activity, such as running

III. Pathology

Asthma is a lung disease with typical cirri of the airways is very easy to react to stimulation series of very young or the originator of the manifestations of an asthma attack. Acquired disorders are:
1. Bronchial muscle to contract (there narrowing)
2. Bronchial mucous membrane udema
3. Production of more mucus, sticky and thick, thus causing all three channels into a narrow hole bronchus and children will be able to cough and even shortness of breath. The attack itself may be lost or missing, with the help of drugs.
In the early stages of the attack looks pale mucosa, there were edema and increased secretions. Lumen narrowing due to bronchial spasm. Visible blood vessels congestion, infiltration of eosinophils cells in a secret location within the airway lumen. If attacks occur often or chronic and long will be seen deskuamasi (peeling) epithelium, bosal hyaline membrane thickening, hyperplasia elastin fibers, as well as hyperplasia and bronchial muscle hypertrophy. In severe attacks of asthma or to have chronic bronchial obstruction by thick mucus.
In asthma arising imunologik reaction, the reaction of antigen – antibody caused the release of chemical mediators that can cause this pathological abnormalities. Chemical mediators are:
a. Histamine
- Contraction of smooth muscle
- Dilatation of capillaries and veins contraction, resulting in edema
- Increased secretion of glandular dimukosa bronchus, bronkhoilus, mukosaa, nose and eyes
b. Bradikinin
- Bronchus smooth muscle contraction
- Increasing the permeability of blood vessels
- Vasodepressor (drop in blood pressure)
- Increased secretion of sweat and salivary glands
c. Prostaglandin
- Bronkokostriksi (especially prostaglandin F)

IV. Clinical manifestations
1. Wheezing
2. With long expiratory dyspnea, use of accessory muscles of respiration
3. nostril breathing
4. dry cough (not productive) because the secret thick and narrow the airway lumen
5. diaphoresis
6. cyanosis
7. abdominal pain due to involvement of the abdominal muscles in breathing
8. anxiety, and decreased levels of labile kesadarn
9. intolerant of activities: eating, playing, walking, even talking

V. STADIUM ASTHMA
1. Stage I
Time of the bronchial wall edema, proksisimal cough, irritation and dry cough. Sputum that is thick and collect foreign materials that stimulate coughing
2. Stage II
Increased bronchial secretions and coughing with a lot of clear sputum and frothy. At this stage the child will begin to feel shortness of breath trying to breathe more deeply. Lengthwise and expiratory wheezing sound. Additional breathing muscles look works. There is retracted sternal supra, epigastrium and may also broke ribs. Children prefer to sit down and bowed, his hands pressed to the edge of the bed or chair. Children looked nervous, pale, sianosisi around the mouth, the thorax forward and more round and move slowly on your breathing. In younger children, tend to occur abdominal breathing, retracted supra-sternal and intercostal.
3. Stage III
Obstruction or spasm of the bronchial heavier, very little air flow so that the sound barely audible sigh.
This stage is very dangerous because it is frequently thought to have improved. As well as suppressed cough. Shallow breathing, irregular and sudden respiratory rate rises.

VI. COMPLICATIONS
1. Status asmatikus
2. Chronic bronchitis, bronkhiolus
3. Ateletaksis: lobari segmental bronchus because of obstruction by the lenders
4. Pneumo thoracic
Work of breathing increases, increased O2 requirements. People acid is unable to meet the needs of a very high O2 required to breathe against bronkhiolus spasms, swelling bronkhiolus, and ukus m thick. Situation may cause ioni magnitude pneumothoraks due to ventilation teklanan
5. Death

VII. DIAGNOSTIC EXAMINATION
1. Disease history or physical examination
2. Chest X-ray
3. Examination of lung function: decreased tidal volume, vital capacity, eosinophils are increased in blood and sputum
4. Examination allergies (radioallergosorbent test; RAST)
5. Blood gas analysis – pH initially increased, PaCO2 and Pao2 falls (mild Respiratory alkalosis due to hyperventilation); then decreased pH, Pao2 decreased and increased PaCO2 (respiratory acidosis)

VIII. Management
1. Prevention of allergy exposure
2. Acute attacks with oxygen nasal or face mask
3. Parenteral fluid therapy
4. Appropriate medication therapy program
- Beta 2-agonist to reduce bronkospasme, bronchial smooth muscle mendilatasi
• Albuterol (proventil, Ventolin)
• Tarbutalin
• Epinephrine
• Metaprotenol
- Metilsantin, such as aminophylline and theophylline have the effect bronkodilatasi
- Anticholinergics, such as atropine metilnitrat or bronchodilator effect of fluoxetine has a very good
- Corticosteroids given IV (hydrocortisone), orally (mednison), inhalation (dexamethasone)

NURSING CARE CONCEPT
I. ASSESSMENT
1. History of asthma or allergies and asthma attacks before, allergies and respiratory problems
2. Review knowledge of children and parents about the disease and treatment
3. Psychosocial History: trigger factor, stress, exercise, habits and routines, previous treatment
4. Physical examination
a. Respiratory
- Short Breath
- Wheezing
- Retraction
- Tachypnoea
- Dry cough
- Ronkhi
b. Cardiovascular
- Tachycardia
c. Neurologic
- Fatigue
- Anxiety
- Difficulty sleeping
d. Musculoskeletal
- Intolerans activities
e. Integumentary
- Cyanosis
- Pale
f. Psychosocial
- No cooperative during treatment
5. Kaji hydration status
- Status of mucous membrane
- Skin turgor
- Urine output
II. Diagnosis
1. Disruption of gas exchange, ineffective airway clearance bd bronkospasme and mucosal udema
2. Fatigue b.d. hypoxia and increased work of breathing
3. Changes in nutritional status is less than the needs of bd GI distress
4. Risk of fluid volume deficiency b.d. pernapsan increased and decreased oral intake
5. Anxiety b.d. hospitalisasi and respiratory distress
6. Changes b.d. family process Chronic conditions
7. Lack of knowledge b.d. disease process and treatment]

III. INTERVENTION
1. Disruption of gas exchange, ineffective airway clearance bd bronkospasme and mucosal udema
Destination:
- The child will show marked improvement in gas exchange:
o no wheezing and retracted
o cough decreased
o reddish color
- Child does not show 95%?acid base imbalance disorder characterized by oxygen saturation
Intervention:
a. Kaji RR, auscultation of breath sounds
P/: as a source of data pewrubahan before and after treatment
b. Give high Fowler’s position or semi-Fowler
P /; develop lung expansion
c. Encourage your child to practice a deep breath and cough effectively
P /: to help clean mucus from the p [aru and breath in improving oxygenation
d. Apply suction if necessary
P /: help out secret which can not be issued by the children themselves
e. Do physiotherapy
P /: help pengeluaransekresi, lung expansion menmingkatkan
f. Provide oxygen according to the program
P /: improve oxygenation and reduce the secretion
g. Monitor expenditures peningkatn sputum
P /: as an indication of a failure on the lung
h. Give appropriate indications bronchodilator
P /: breathing muscles are relaxed and steroids to reduce inflammation

2. Fatigue b.d. hypoxia and increased work of breathing
Goal: Children demonstrate marked reduction in fatigue iritabel not, can participate and increase capacity in activities
Intervention:
a. sign – a sign of hypoxia / hypercapnea; fatigue, agitation, increased HR, increased RR
P /: early detection to prevent hypoxia can prevent further fatigue
b. Avoid frequent intervention is not important which can make the child tired, give adequate rest
P /: Get plenty of rest can reduce stress and enhance comfort
c. Ask parents to always accompany the child
P /: Reducing fear and anxiety
d. Provide adequate rest and sleep from 8 to 10 hours each night
P /: adequate rest and sleep enough to reduce fatigue and increase resistance to infection
e. Teach stress management techniques
P /: Bronkospasme may be due to emotional and stress

3. Changes in nutritional status is less than the needs of bd GI distress
Goal: Children will show a decrease GI distress characterized by:
Decrease nausea and vomiting, the improvement of nutrition / intake

Intervention:
a. Give small portions but often 5 to 6 times a day with food that he liked
P /: small but frequent meals provide the energy needed, the stomach is not too full, thus providing the opportunity for absorption of food. Food mendporong children preferred to eat and increase the intake
b. Give soft foods, low fat, use color
P /: spicy foods high in fat and can increase the GI distress that it is difficult to digest
c. Instruct to avoid foods that cause allergies
P /: It can cause acute attacks in children are sensitive

4. Risk of fluid volume deficiency b.d. pernapsan increased and decreased oral intake
Destination:
Children can maintain adequate hydration characterized by elastic skin turgor, moist mucous membranes, fluid intake according to age and weight, urine output: 1-2 ml / kg/d
Intervention:
a. skin turgor, monitor urine output every 4 hours
P /: to know the level of hydration and fluid needs
b. Maintain appropriate indication of parenteral therapy and monitor the excess fluid
P /: excess fluid can cause udema pulmonar
c. After the acute phase, and parents encourage children to drink 3-8 glasses / day, depending on age and weight children
P /: children need enough fluids to maintain hydration and acid base balance to prevent shock

5. Anxiety b.d. hospitalisasi and respiratory distress
Destination:
Decreased anxiety, marked by the child calm and able to express their feelings

Intervention:
a. Teach relaxation techniques; exercise deep breath, guided imagination
P /: diverting attention during episodes of asthma can reduce fear and anxiety
b. Provide play therapy as an indication
P /: play therapy can reduce the effects of hospitalisasi and anxiety
c. Informed about the care, treatment and condition of the child
P /: reducing fear and losing control of himself

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Angina pectoris,DEFINITIONS,Aetiology,CLINICAL FEATURES,RISK FACTORS for angina pectoris

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Angina pectoris

A. DEFINITIONS
1. Angina pectoris is chest pain due to ischemic infarction generated and temporary or reversible. (The basics of nursing kardiotorasik, 1993)
2. Angina pectoris is a chronic syndrome, in which the client had an attack of typical chest pain that is like a button, or feel heavy in the chest that sometimes spreads to the left arm which arise at the time and soon lost activity when the activity stops. (Prof. Dr. Sjaifoellah H. M. Noer, 1996)
3. Angina pectoris is a term used to describe the type of discomfort that are usually located in the region retrosternum. (Practical Guide Cardiovascular)

B. Aetiology
1. Ateriosklerosis
2. Coronary artery spasm
3. Anemia
4. Arthritis
5. Aortic insufficiency

C. RISK FACTORS

1. Can be Modified (Modified)
a. Diet (hyperlipidemia)
b. Cigarettes
c. Hypertension
d. Stress
e. Obesity
f. Less activity
g. Diabetes Mellitus
h. Use of oral contraceptives
2. Can not be changed
a. Age
b. Gender
c. Ras
d. Hereditary
e. Personality Type A

D. ATTACK trigger
Trigger that can cause attacks include:
1. Emotions
2. Stress
3. Heavy physical work
4. Eve is too hot and humid
5. Too full
6. Many smoking

E. CLINICAL FEATURES
1. Substernal chest pain radiating retrosternal ataru to the neck, throat, internal regions of the scapula or the left arm.
2. Quality of pain like a heavy pressure, such as pressing, hot, sometimes just a bad feeling in the chest (chest discomfort).
3. Duration of pain lasted 1 to 5 minutes, no more daari 30 minutes.
4. Pain lost (reduced) when a break or giving nitroglycerine.
5. Accompanying symptoms: shortness of breath, feeling tired, sometimes comes a cold sweat, palpitations, dizzines.
6. EKG: ST segment depression, inverted T wave seen.
7. EKG is often normal at the time the attack did not arise.

F. TYPE ATTACKS
1. Stable angina pectoris
? classically associated with exercise or activity that increases oxygen demand niokard.
? pain go away with rest or cessation of activities.
? pain duration from 3 to 15 minutes.
2. Unstable angina pectoris
? nature, places and spread of chest pain can be similar to stable angina pectoris.
? Adurasi attacks can occur for longer than stable angina pectoris.
? triggers can occur in a state of rest or on mild tigkat activities.
? Less responsive to nitrate.
? More often found depresisegmen ST.
? It can be caused by atherosclerotic plaque rupture, spasmus, thrombus or platelet aggregate.
3. Prinzmental angina (variant angina).
? chest pain or pain occur at rest, often the morning.
? Pain caused koroneraterosklerotik vessels spasmus.
Elevaasi ? ECG showed ST segment.
? Tend to develop into acute myocardial infaark.
? arrhythmias may occur.

G. Pathophysiology and Pathways
Mechanism of occurrence of angina pectoris based on ketidakadekuatan supplied oxygen to the cells resulting from myocardium kekauan luminal narrowing of the arteries and coronary arteries (coronary ateriosklerosis). It is not known exactly what causes ateriosklerosis, it is clear that no single factor was responsible for the development of ateriosklerosis. Ateriosklerosis is penyakir coronary arteries are most commonly found. As the workload of a network increases, the oxygen demand also increases. If demand increases in the healthy heart is dilated and artei coronary megalirkan more blood and oxygen keotot heart. However, if the coronary arteries have narrowed due to kekauan or ateriosklerosis and can not be dilated in response to the increased need for oxygen, then there ischemic (lack of blood supply) myocardium.
The presence of endothelial injury resulting in a loss of production No (Oksid0 nitrate which is used to inhibit a variety of reactive substances. In the absence of this function can menyababkan smooth muscle to contract and arising spasmus aggravate coronary luminal narrowing due to a myocardial oxygen supply decreases. Refinements or block is not cause such symptoms appear until they’ve been achieving 75%. If the narrowing is more than 75% and triggered by the excessive activity of the coronary blood supply will be reduced. myocardium cells use anaerobic glycogen for their energy needs. metabolism produces lactic acid which lowers pH myocardium and cause pain. If kenutuhan energy heart cells decreases, the oxygen supply becomes inadequate and muscle cells to re-establish oxidative phosphorylation energy. This process does not produce lactic acid. With the disappearance of lactic acid pain will subside.

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nursing care angina pectoris
NURSING CARE TO CLIENTS WITH ACUTE myocardial INFARCTION
acute myocardial infarction