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Nursing Care Plan for Dysphagia

Nursing Care Plan for Dysphagia
Dysphagia is the medical term for difficulty swallowing symptoms.
Swallowing disorders can occur in all age groups resulting from congenital abnormalities, structural damage, and / or medical condition. in patients who have had a stroke, and in patients who are admitted hospital acute or chronic care facilities.

Dysphagia is classified into two major groups, namely oropharyngeal dysphagia (or transfer dysphagia) and esophageal dysphagia.

1. Oropharyngeal dysphagia

Oropharyngeal dysphagia arises from abnormalities in the oral cavity, pharynx, and esophagus, can be caused by stroke, Parkinson's disease, neurological disorders, muscular dystrophy Oculopharyngeal, decreased flow of saliva, xerostomia, dental problems, oral mucosal abnormalities, mechanical obstruction (malignancy, osteofi, increasing the upper esophageal sphincter tone, radiotherapy, infection, and drugs (sedatives, anticonvulsants, antihistamines). oropharyngeal dysphagia symptoms are difficulty swallowing, including the inability to recognize food, difficulty putting food in the mouth, inability to control food and saliva in the mouth, difficulty to start swallowing, coughing and choking during swallowing, weight loss is not clear why, changes in eating habits, recurrent pneumonia, voice alteration (wet voice), nasal regurgitation. Upon examination, treatment can be done with techniques postural, swallowing maneuvers, dietary modification, environmental modification, oral sensory awareness technique, vitalstim therapy, and surgery. Bilatidak untreated, dysphagia can lead to aspiration pneumonia, malnutrition, or dehydration.

2 . Esophageal dysphagia

Esophageal dysphagia arises from abnormalities in the corpus of the esophagus , the lower esophageal sphincter , or gastric cardia . Usually caused by esophageal stricture , esophageal malignancy , esophageal rings and webs , achalasia , scleroderma , spastic motility disorders including diffuse esophageal spasm and non-specific esophageal motility disorders . Food is usually held some time after ingestion , and it will be as high as suprasternal notch or behind the sternum as the site of obstruction , oral or pharyngeal regurgitation , changes in eating habits , and recurrent pneumonia . If there is a solid and liquid food dysphagia , most likely a motility problem . When the patient initially experienced solid food dysphagia , but subsequently with liquid food dysphagia , it is most likely a mechanical obstruction . After being able to distinguish between problems motility and mechanical obstruction , it is important to pay attention to whether temporary or progressive dysphagia . Dysphagia can be caused motility while diffuse esophageal spasm or nonspecific esophageal motility disorder . Progressive motility dysphagia can be caused by scleroderma or achalasia with a burning sensation in the area of chronic heartburn , regurgitation , respiratory problems , or weight loss . Dysphagia can be caused by temporary mechanical esophageal ring . And progressive mechanical dysphagia can be caused by esophageal stricture or esophageal malignancy . When it can be concluded that the disorder is esophageal dysphagia , then the next step is a barium examination or upper endoscopy . Barium examination should be performed before endoscopy to avoid perforation . When the suspected presence of achalasia on barium examination , then performed manometry for diagnosis of achalasia . When suspected esophageal strictures , then endoscopy . If no abnormalities are suspected as above , the endoscope can be done prior to barium examination . Normal endoscopy , should be continued denganmanometri , and if manometry is also normal , then the diagnosis is functional dysphagia . Thorax is simple to pneumonia.CT examination and MRI scans provide a good overview of structural abnormalities , especially when used to evaluate patients with dysphagia who is suspected due to central nervous system disorders . Having known the diagnosis , the patient is usually sent to the ENT , gastrointestinal , pulmonary , or oncology , depending on the cause . Consultation with a dietician is also necessary , as most patients will need your dietary modification .


Nursing Assessment for Dysphagia

Nursing Assessment is necessary in patients with impaired swallowing or disphagya include:
  • History of previous illness
  • History of stroke
  • History of use of medical devices: tracheostomy, NGT, mayo tube, ETT, post endoscopy examination
  • History surgery laryx blood, pharynx, esophagus, thyroid
  • Postoperative oral region
  • Physical examination
  • Mouth shape is not symmetrical
  • Seemed an inflammation of the pharynx
  • Presence of candida in oral / mouth
  • Pharyngeal edema


Nursing Diagnosis for Dysphagia

1. Impaired Swallowing
2. Risk for Imbalanced Nutrition: less than body requirements
3. Risk for aspiration

Nursing Management for Dysphagia

NCP Dermatitis - Gordon's 11 Functional Health Patterns

NCP Dermatitis - Gordon's 11 Functional Health Patterns
Gordon's 11 Functional Health Patterns - Nursing Care Plan for Dermatitis

1. Health Perception-Health Function
  • A history of previous infection.
  • Previous treatment failed.
  • History of taking certain drugs, eg., Vitamins; herbs.
  • Are there regular consultation to the doctor.
  • Personal hygiene is lacking.
  • Unhealthy environment, living overcrowding.

2. Nutritional Metabolic Pattern
  • Daily diet: the number of meals, meal times, how many times a day to eat.
  • Habit of eating certain foods: oily, spicy.
  • Preferred food types.
  • Decreased appetite.
  • Vomiting.
  • Weight loss.
  • Poor skin turgor, dry, scaly, cracked, bump.
  • Changes in skin color, there are patches, itching, burning or stinging.

3. Elimination Pattern
  • Frequent sweating.
  • Ask urination and bowel patterns.

4. Exercise Activity Pattern
  • Fulfillment disrupted everyday.
  • General weakness, malaise.
  • Tolerance to low activity.
  • Easy to sweat when doing light activity
  • Changes in breathing patterns while doing the activity.
5. Sleep-Rest Pattern
  • Trouble sleeping at night because of stress.
  • Nightmare.
6. Cognitive-Perceptual Pattern
  • Changes in concentration and memory.
  • Knowledge of the disease.
7. Self-Perception Pattern
  • Feeling insecure or inferior.
  • Feelings of isolation.
8. Role-Relationship Pattern
  • Living alone or married.
  • Frequency of interaction is reduced.
  • Changes in physical capacity to carry out the role.
9. Sexuality-Reproductive Pattern
  • Interference with the biological needs a partner.
  • The use of drugs that affect hormones.
10. Coping-Areas Management Pattern
  • Emotionally unstable.
  • Anxiety, fear of illness.
  • Disorientation, restlessness.

11. Value belief system
  • Changes in the client's self in worship.
  • Religion.

Want to Have Ideal Body

Want to Have Ideal Body
There is no one thing that will be difficult to say if indeed we still do not give a trial. If it has never tried anything we just stay quiet, like a diet program. Many have also complained to feel very hard and difficult to be able to succeed in the program. One that can be very difficult to say soon is making a radical change. This is better done with a small stage, but later changes could also be a part of your own lifestyle.

Some of that must know if there is a small change that can make a life style in daily, but will get a very good hasill and ideal future.

Here is a thing that should be done in order to get the ideal body :

For those of you who despise often eat in front of the news channel. If you eat in front of the news channel was doing or playing in front of the screen whether it's a laptop or gadget. Therefore you have to eat at the table, in order to concentrate on the value of calories are eaten. Then fill with the food menu calorie menu right.
  1. Buy a small plate. Most of them ate the portion corresponding to their plate, that is the purpose for a small plate. We will be a little more food than usual with a large plate.
  2. Eat slowly. Chew slowly way, the sooner you are still not satisfied to chew. Chew till soft, put a spoon in while you're still chewing earlier. Try'll definitely get used to.
  3. The most important activity is increased further yan sweat outside. Such as sports and gymnastics. To burn calories you are not required to exercise on weight alone, you can replace with your daily activities. Like choosing to take the stairs rather than the elevator. If traveling in near the goal, we can walk with our feet.

2 Nursing Interventions for Malaria

2 Nursing Interventions for Malaria
1. Ineffective Tissue perfusion related to a decrease in the cellular components needed for the delivery of oxygen and nutrients in the body.

Nursing Intervention:

1. Maintain bed rest to help with maintenance activities.
Rational: reduce myocardial workload and oxygen consumption, maximizing the effectiveness of tissue perfusion.

2. Monitor the blood pressure trend, noting the development of hypotension and changes in pulse pressure.
Rational: hypotension will develop along with the germs that invade the blood.

3. Monitor the quality, the strength of peripheral pulses.
Rational: at the beginning of a strong rapid pulse due to an increase in cardiac output, pulse weak or slow due to ongoing hypotension, decreased cardiac output and peripheral vaso constriction.

4. Assess respiratory rate and depth of quality. Note the severe dyspnea.
Rationale: increased respiration occurs in response to the direct effects of the bacteria on the respiratory center. Breathing becomes shallow in the event of respiratory insufficiency, raises the risk of acute respiratory failure.

5. Give parenteral fluids.
Rational: to maintain tissue perfusion, a large amount of fluid may be required to support the circulation volume.

2. Deficient Knowledge: about the disease, prognosis and treatment needs related to lack of exposure / recall errors of interpretation of information, cognitive limitations.

Nursing Intervention:

1. Review the disease process and future expectations.
Rational: provides basic knowledge of where the patient can make a choice.

2. Provide information on the administration of drugs, drug interactions, side effects, and adherence to the program.
Rational: to increase understanding and enhance cooperation in healing and reducing recurrence of complications.

3. Discuss the need for proper nutritional intake and balanced.
Rationale: The need for optimal healing and general wellbeing.

4. Encourage periods of rest and activity scheduled.
Rational: energy savings and improve healing.

5. Review the need for personal hygiene and environmental cleanliness.
Rationale: Exposure control helps the environment by reducing the amount of the existing causes of disease.

6. Identify the signs and symptoms that require medical evaluation.
Rational: early recognition of progression / recurrence of infection.

7. Emphasize the importance of antibiotic treatment as needed.
Rational: the use of the prevention of infection.

Read More : http://screware.blogspot.com/2013/06/malaria-5-nursing-interventions.html

5 Nursing Interventions for Dengue Hemorrhagic Fever

Nursing Diagnosis and Interventions for Dengue Hemorrhagic Fever

Nursing Diagnosis 1. : Hyperthermia related to the process of dengue virus infection.

Goal: Normal body temperature
Outcomes:
Body temperature between 36-37 0 C
Muscle pain disappeared

Intervention:

1. Provide / encourage patients to drink plenty of 1500-2000 cc / day (as tolerated)
Rational: To replace fluids lost due to evaporation.

2. Instruct the patient to wear clothing that is thin and easy to absorb sweat.
Rationale: Providing a sense of comfort and easy thin clothing absorbs sweat and does not stimulate an increase in body temperature.

3. Observation of intake and output, vital signs (temperature, pulse, blood pressure) every 3 hours once or more often.
Rational: Detecting early dehydration and to know the balance of fluids and electrolytes in the body. Vital Signs is a reference to determine the patient's general condition.

4. Collaboration: intravenous fluids and appropriate drug delivery program.
Rationale: Fluid replacement is essential for patients with a high body temperature. Particular drug to lower the patient's body temperature.


Nursing Diagnosis 2. : Risk for Fluid Volume Deficit related to intravascular fluid into the extravascular migration.

Objective: Not happening fluid volume deficit
Outcomes:
Input and output balanced
Vital signs within normal limits
There is no sign of pre-shock
Capilarry refill less than 3 seconds

Intervention:
1. Monitor vital signs every 3 hours / more often.
Rationale: Vital sign help identify fluctuations in intravascular fluid.

2. Observation of capillary refill.
Rational: Indications adequacy of peripheral circulation.

3. Observation of intake and output. Note the color of urine / concentration.
Rationale: Decrease in urine output concentrated suspected dehydration.

4. Suggest to drink 1500-2000 ml / day (as tolerated).
Rational: To consume body fluids orally.

5. Collaboration: intravenous fluid administration.
Rational: It can increase the amount of body fluid, to prevent shock hipovolemic.


Nursing Diagnosis 3. : Risk for Shock Hypovolemic related to excessive bleeding, intravascular fluid into the extravascular migration.

Objective: Not happening hypovolemic shock
Hasl criteria:
Vital signs within normal limits

Intervention:
1. Monitor patient's general condition.
Raional: To monitor the condition of the patient during treatment, especially when there is bleeding. Nurses immediately know the signs of pre-shock / shock.

2. Observation of vital signs every 3 hours or more
Rationale: Nurses need to continue to observe the vital signs to ensure there is no pre-shock / shock.

3. Explain to patients and families sign of bleeding, and immediately report if there is bleeding.
Rationale: By involving the patient and family, then the signs of bleeding can be immediately identified and prompt action, and the right can be given immediately.

4. Collaboration: intravenous fluid administration.
Rationale: Intravenous fluids needed to cope with the severe loss of body fluids.

5. Collaboration: examination: HB, PCV, platelets.
Rationale: To determine the level of leakage of blood vessels experienced by patients and to take further action reference.

Read More : http://nanda-nurse-diary.blogspot.com/2013/05/dengue-hemorrhagic-fever-5-nursing.html
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