Nursing Care Plan

Herniated Nucleus Pulposus

Intervertebral Discs are the cartilage plates that form a cushion between the vertebral bodies. Hard and fibrous material is combined in one capsule. Such as ball bearings in the middle of the disc called the nucleus pulposus. Herniated nucleus pulposus is a rupture of the nucleus pulposus.

Herniated nucleus pulposus into the vertebral bodies can be above or below it, can also directly into the vertebral canal.

Pain can occur in any part such as cervical spine, thoracic (rarely) or lumbar. Clinical manifestations depend on the location, speed of development (acute or chronic) and the effect on surrounding structures. Lower back pain is severe, chronic and recurring (relapse).

Diagnostic Examination
1. Spinal RO: Shows the degenerative changes in the spine
2. MRI: to localize even small disc protrusion, especially for lumbar spinal disease.
3. CT Scan and Myelogram if the clinical and pathological symptoms are not visible on MRI
4. Electromyography (EMG): to localize the specific spinal nerve roots are exposed.


Assessment Nursing Care Plan for HNP Herniated Nucleus Pulposus

1. Anamnesa
The main complaint, history of present treatments, medical history past, family health history.

2. Physical examination
Assessment of the patient's problem consists of onset, location and spread of pain, paresthesias, limited mobility and limited function of the neck, shoulders and upper extremities.
Assessment in the area include palpation of the cervical spine which aims to assess muscle tone and rigidity.

3. Examination Support

Read More : Nursing Care Plan : Nursing Diagnosis and Interventions for HNP Herniated Nucleus Pulposus

Definition of Urethral Stricture

A urethral stricture is a narrowing of a section of the urethra. It causes a blocked or reduced flow of urine which can lead to complications.


Symptoms and signs

Symptoms of urethral stricture is a typical small stream of urine and branched irritation and other symptoms of infection such as frequency, urgency, dysuria, sometimes with infiltrates, abces and fistula. Symptoms are retained urine.


Physical Examination

Anamnese

To find the absence of symptoms and signs of urethral stricture also to look for causes of urethral stricture.

General and local examination

To check on the patient also to change in urethral fibrosis, infiltrates, abscesses or fistulas.

Examination Support

Laboratory: urea, creatinine, to see the renal physiology. Radiological Diagnosis must be made with urethrography. Retrograde urethrography to see the anterior urethra. Antegrade urethrography to see the posterior urethra. Bipoler urethrography is a combination of antegrade and retrograde urethrography examinations. With this examination can be expected in addition to the diagnosis of urethral strictures can be also determined the length of urethral stricture are important for therapy planning / operations.


Basic Concepts of Nursing Care

In nursing care is carried out by using the nursing process. The nursing process is a form of dynamic problem-solving process in an effort to improve and maintain optimal patient through a systematic approach to help patients. Nursing theories and concepts are implemented in an integrated manner in which organized phases which include:

Assessment, Nursing Diagnosis, Interventions, Implementation, Evaluation.

Read More : Nursing Care Plan for Urethral Stricture

Thyroid cancer is a disease in which malignant (cancer) cells form in the tissues of the thyroid gland.

The thyroid is a gland at the base of the throat near the trachea (windpipe). It is shaped like a butterfly, with a right lobe and a left lobe. The isthmus, a thin piece of tissue, connects the two lobes. A healthy thyroid is a little larger than a quarter. It usually cannot be felt through the skin. The thyroid uses iodine, a mineral found in some foods and in iodized salt, to help make several hormones. Thyroid hormones do the following:

• Control heart rate, body temperature, and how quickly food is changed into energy (metabolism).
• Control the amount of calcium in the blood.

There are four main types of thyroid cancer:

• Papillary thyroid cancer: The most common type of thyroid cancer.
• Follicular thyroid cancer. Hürthle cell carcinoma is a form of follicular thyroid cancer and is treated the same way.
• Medullary thyroid cancer.
• Anaplastic thyroid cancer.

Possible signs of thyroid cancer include a swelling or lump in the neck.

Thyroid cancer may not cause early symptoms. It is sometimes found during a routine physical exam. Symptoms may occur as the tumor gets bigger. Other conditions may cause the same symptoms. A doctor should be consulted if any of the following problems occur:

• A lump in the neck.
• Trouble breathing.
• Trouble swallowing.
• Hoarseness.

More :

Nursing Management for Thyroid Cancer: Preoperative, Intraoperative and Postoperative

Cataract


A cataract is a clouding of the lens in your eye. It affects your vision. Cataracts are very common in older people. By age 80, more than half of all people in the United States either have a cataract or have had cataract surgery.

Common symptoms are

• Blurry vision
• Colors that seem faded
• Glare
• Not being able to see well at night
• Double vision
• Frequent prescription changes in your eye wear

Cataracts usually develop slowly. New glasses, brighter lighting, anti-glare sunglasses or magnifying lenses can help at first. Surgery is also an option. It involves removing the cloudy lens and replacing it with an artificial lens. Wearing sunglasses and a hat with a brim to block ultraviolet sunlight may help to delay cataracts.

NIH: National Eye Institute


Having cataracts is often compared to looking through a foggy windshield of a car or through the dirty lens of a camera. Cataracts may cause a variety of complaints and visual changes, including blurred vision, difficulty with glare (often with bright sun or automobile headlights while driving at night), dulled color vision, increased nearsightedness accompanied by frequent changes in eyeglass prescription, and occasionally double vision in one eye. Some people notice a phenomenon called "second sight" in which one's reading vision improves as a result of their increased nearsightedness from swelling of the cataract. A change in glasses may help initially once vision begins to change from cataracts; however, as cataracts continue to progress and opacify, vision becomes cloudy and stronger glasses or contact lenses will no longer improve sight.

Cataracts are usually gradual and usually not painful or associated with any eye redness or other symptoms unless they become extremely advanced. Rapid and/or painful changes in vision are suspicious for other eye diseases and should be evaluated by an eye-care professional.

To detect a cataract, the eye-care provider examines your lens. A comprehensive eye examination usually includes the following:

• Visual acuity test: An eye chart test is used to measure your reading and distance vision.
• Refraction: Your eye doctor should determine if glasses would improve your vision.
• Glare testing: Vision may be significantly altered in certain lighting conditions and normal in others; in these circumstances, your doctor may check your glare symptoms with a variety of different potential lighting sources.
• Potential acuity testing: This helps the ophthalmologist get an idea of what your vision would be like after removal of the cataract. Think of this as the eye's vision potential if the cataract was not present.
• Contrast sensitivity testing: This checks for your ability to differentiate different shades of gray, which is often this limited by cataracts.
• Tonometry: a standard test to measure fluid pressure inside the eye (Increased pressure may be a sign of glaucoma.)
• Pupil dilation: The pupil is enlarged with eye drops so that the ophthalmologist can further examine the lens and retina. This is important to determine if there are other conditions which may ultimately limit your vision besides cataracts.

Source : http://www.emedicinehealth.com/cataracts/page6_em.htm#Exams and Tests

1. Objective data: patient's eye's lens appears cloudy. Both pupils appear to look gray.

Subjective data: patients complaining blurred vision / dim and decreased visual acuity and glare, the patient is difficult to see at night.

Nausea

Nausea is a sensation of unease and discomfort in the upper stomach with an involuntary urge to vomit. It often, but not always, preceded vomiting. A person can suffer nausea without vomiting. Some common causes of nausea are motion sickness, gastroenteritis (stomach infection) or food poisoning, side effects of many medications including cancer chemotherapy, or morning sickness in early pregnancy. Medications taken to prevent nausea are called antiemetics and include diphenhydramine, metoclopramide and ondansetron. Nausea may also be caused by stress and depression.


Vomiting

Symptomatic treatment may occur while the underlying illness is being investigated because ideally, nausea and vomiting should resolve when the cause of the symptoms resolves.

Nausea and vomiting are often made worse when the patient is dehydrated, resulting in a vicious cycle. The nausea makes it difficult to drink fluid, making the dehydration worse, which then increases the nausea. Intravenous fluids may be provided to correct this issue.

There are a variety of anti-nausea medications (antiemetics) that may be prescribed. They can be administered in different ways depending upon the patient's ability to take them. Medications are available by pill, liquid, or tablets that dissolve on or under the tongue, by intravenous or intramuscular injection, or by rectal suppository.

Common medications used to control nausea and vomiting include promethazine (Phenergan), prochlorperazine (Compazine), droperidol (Inapsine) metoclopramide (Reglan), and ondansetron (Zofran). The decision as to which medication to use will depend on the specific situation.
www.medicinenet.com

Purpose: devisit fluid and electrolyte resolved

Expected outcomes: The signs of dehydration do not exist, the mucosa of the mouth and lips moist, fluid balance.

Nursing Intervention:

• Observation of vital signs.
• Observation for signs of dehydration.
• Measure infut and output of fluid (fluid balance).
• Provide and encourage families to provide drinking a lot of approximately 2000 - 2500 cc per day.
• Collaboration with physicians in the provision of therafi fluid, electrolyte laboratory tests.
• Collaboration with a team of nutrition in low-sodium fluids.

Nursing Diagnosis: Risk for Fluid Volume Deficit related to a sense of nausea and vomiting

Purpose: Maintaining the balance of fluid volume.

Expected outcomes: The client does not nausea and vomiting.

Nursing Intervention:

• Monitor vital signs.
• Rational: This is an early indicator of hypovolemia.
• Monitor intake and urine output and concentration.
• Rationale: Decreased urine output and concentration will improve the sensitivity / sediment as one suggestive of dehydration and require increased fluids.
• Give fluid little by little but often.
• Rationale: To minimize loss of fluid.
• The risk of infection associated with an inadequate defense of the body, characterized by: body temperature above normal. Respiratory frequency increased.

Gastritis

Gastritis occurs when the lining of the stomach becomes inflamed or swollen.

Gastritis can last for only a short time (acute gastritis), or linger for months to years (chronic gastritis)



Symptoms
Many people with gastritis do not have any symptoms.

Symptoms you may notice are:

• Loss of appetite
• Nausea and vomiting
• Pain in the upper part of the belly or abdomen

If gastritis is causing bleeding from the lining of the stomach, symptoms may include:

• Black stools
• Vomiting blood or coffee-ground like material

Gastritis is diagnosed through one or more medical tests:

• Upper gastrointestinal endoscopy. The doctor eases an endoscope, a thin tube containing a tiny camera, through your mouth (or occasionally nose) and down into your stomach to look at the stomach lining. The doctor will check for inflammation and may remove a tiny sample of tissue for tests. This procedure to remove a tissue sample is called a biopsy.
• Blood test. The doctor may check your red blood cell count to see whether you have anemia, which means that you do not have enough red blood cells. Anemia can be caused by bleeding from the stomach.
• Stool test. This test checks for the presence of blood in your stool, a sign of bleeding.

Treating Gastritis

1. Conservatives on state of acute
If severe disease, patients need to be treated and given fluids per infusion.

• Bed rest
• Fasting, nasogastric tube pairs
• Analgesics, antibiotics

2. When conservative treatment fails or there is a progressive toxemia cholecystectomy needs to be done. It is necessary to prevent the occurrence of complications (gangrene, perforation, empyema, pancreatitis dam kalangitis)
Cholecystectomy should be done also in the repeated attacks

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Heart failure (HF) often called congestive heart failure (CHF) is generally defined as the inability of the heart to supply sufficient blood flow to meet the needs of the body. Heart failure can cause a number of symptoms including shortness of breath, leg swelling, and exercise intolerance. The condition is diagnosed with echocardiography and blood tests. Treatment commonly consists of lifestyle measures (such as smoking cessation, light exercise including breathing protocols, decreased salt intake and other dietary changes) and medications, and sometimes devices or even surgery.



Common causes of heart failure include myocardial infarction and other forms of ischemic heart disease, hypertension, valvular heart disease, and cardiomyopathy. The term "heart failure" is sometimes incorrectly used to describe other cardiac-related illnesses, such as myocardial infarction (heart attack) or cardiac arrest, which can cause heart failure but are not equivalent to heart failure.

The symptoms of congestive heart failure vary among individuals according to the particular organ systems involved and depending on the degree to which the rest of the body has "compensated" for the heart muscle weakness.

• An early symptom of congestive heart failure is fatigue. While fatigue is a sensitive indicator of possible underlying congestive heart failure, it is obviously a nonspecific symptom that may be caused by many other conditions. The person's ability to exercise may also diminish. Patients may not even sense this decrease and they may subconsciously reduce their activities to accommodate this limitation.
• As the body becomes overloaded with fluid from congestive heart failure, swelling (edema) of the ankles and legs or abdomen may be noticed. This can be referred to as "right sided heart failure" as failure of the right sided heart chambers to pump venous blood to the lungs to acquire oxygen results in buildup of this fluid in gravity-dependent areas such as in the legs. The most common cause of this is longstanding failure of the left heart, which may lead to secondary failure of the right heart. Right-sided heart failure can also be caused by severe lung disease (referred to as "cor pulmonale"), or by intrinsic disease of the right heart muscle (less common)
• In addition, fluid may accumulate in the lungs, thereby causing shortness of breath, particularly during exercise and when lying flat. In some instances, patients are awakened at night, gasping for air.
• Some may be unable to sleep unless sitting upright.
• The extra fluid in the body may cause increased urination, particularly at night.
• Accumulation of fluid in the liver and intestines may cause nausea, abdominal pain, and decreased appetite.

Nursing Assessment for Congestive Heart Failure

a. Identity

b. Food or liquid
Symptoms:

• Loss of appetite
• Nausea and vomiting
• Swelling of the extremities
• Diit high salt or fat, sugar and caffeine

c. Elimination
Symptoms:

• Decreased urination, dark urine
• Urination at night
• Diarrhea or constipation

d. Activity / rest
Symptoms:

• Fatigue or tiredness constantly throughout the day
• Insomnia
• Chest pain with activity

e. Circulation
Symptoms:

• History of hypertension
• Cardiac surgery
• Anemia
• Endocarditis

f. Ego integrity
Symptoms:

• Anxiety, worry and fear
• Stress-related illnesses

g. Comfort
Symptoms:

• Chest pain, acute or chronic angina
• Muscle pain

h. Respiratory
Symptoms:

• Dyspnea on exertion, while sitting or sleeping with multiple pillows

i. Social interaction
Symptoms:

• Decreased participation in usual social activities

j. Security
Symptoms:

• Changes in mental function
• Loss of strength or muscle tone
• skin blisters

Nursing Diagnosis for Congestive Heart Failure

Decreased cardiac output related to

• Changes in myocardial contractility or inotropic changes.
• Changes in frequency, rhythm, cardiac conduction.
• Structural changes. (eg, valve abnormalities, ventricular aneurysm)

Activity intolerance related to

• Weakness, fatigue.
• Changes in vital signs, presence of dysritmia.
• Dyspnea.
• Pale.
• Sweating.

Excess fluid volume related to

• The decline in glomerular filtration rate (decrease in cardiac output) or increased production of ADH and sodium and water retention.

Risk for impaired skin integrity related to

• Bed rest.
• Edema, decreased tissue perfusion.