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Tuesday, July 15, 2014

COPD - Gordon's Functional Health Patterns

Chronic Obstructive Pulmonary Disease (COPD) is a chronic lung disease that is progressive, meaning that the disease lasts a lifetime and is slowly getting worse from year to year. In the course of this disease are the phases of acute exacerbation. Various factors play a role in the course of the disease, among other risk factors are factors that cause or aggravate diseases such as smoking, air pollution, environmental pollution, infections, genetics and climate change.

The degree of airway obstruction occurs, and the identification of components that allow for reversibility. Phase course of the disease outside the lung and other diseases such as sinusitis and chronic pharyngitis. That ultimately these factors make further deterioration occurs sooner. To undertake the management of COPD should be considered these factors, so that the better treatment of COPD. Chronic obstructive pulmonary disease is a broad classification of disorders that includes chronic bronchitis, bronchiectasis, emphysema and asthma, which is an irreversible condition associated with dyspnea on exertion and a decrease in the flow of air in and out of the lungs.

Lately the disease is more interesting to talk about because of the prevalence and mortality rate continues to increase. The increasing age of human life and to overcome other degenerative diseases, COPD is very disturbing quality of life of advanced age. Industry that can not be separated by air pollution and the environment as well as the habit of smoking is a major cause.

COPD - Gordon's Functional Health Patterns

Health Perception-Health Function
1) Past medical history, history of productive cough more than 2 weeks.
2) Smokers, examine shelter, ventilation, sunlight, pollution sources around the home, contact with smokers.
3) Difficulty mobilization and expenditure sputum, presence haemoptoe.
4) inadequate treatment.

Nutritional Metabolic Pattern
1) Anorexia
2) Nausea
3) Weight loss
4) Difficulty in eating or digestion

Activity Exercise Pattern
1) Weakness
2) Muscle cramps
3) Shortness of breath, cough

Sleep-Rest Pattern
1) Disruption of sleep patterns
2) Shortness of breath at night

Cognitive-Perceptual Pattern
1) Headache

Role-Relationship Pattern
1) Changes in the role.
2) Depression

Sexuality-Reproductive Pattern
1) Decrease in sexual activity because of shortness of breath

Coping-Areas Management Pattern
1) Sometimes the negative emotions that arise because of shortness of breath
2) Manipulation.
3) Isolation
4) Increased dependency

Saturday, July 12, 2014

7 Examination of Pleural Effusion

1. Chest X-rays

Chest X-rays are usually the first step for diagnosing pleural effusion, the results of which indicate the presence of fluid. Surface of the liquid contained in the pleural cavity will form a shadow-like curves, the lateral surface area is higher than the medial surface. When the horizontal surface of the lateral to medial sure the air contained in the cavity that can come from outside or inside the lung itself.
Another thing that can be seen in the photograph chest, mediastinal pleural effusion is classified on the opposite side of the liquid. However, if there is atelectasis on the same side with the fluid, mediastinal will remain in place.

2. CT scan of the chest

CT scan clearly depicts the lungs and fluid and can indicate the presence of pneumonia, lung abscess or tumor.

3. Ultrasound chest

Ultrasound can help determine the location of the collection of small amounts of fluid, so that the discharge can be done.

4. Thoracocentesis

Aspiration of pleural fluid is useful as a tool for diagnostic and therapeutic thoracocentesis should be performed in a sitting position. Location aspiration is at the bottom of the lungs, interrupted ribs to the posterior axillary line 9 with a needle no. 14 or 16. Discharge should be no more than 1000 to 1500 cc in every aspiration, if the aspiration is done at once in large quantities, it will cause pleural shock (hypotension) or pulmonary edema. Pulmonary edema occurs because the lungs are rapidly developing.

5. Biopsy

Histologic examination of one or a few examples of pleural tissue can indicate 50-75% of cases the diagnosis of pleurisy, tuberculosis, and lung tumors. When the results of the first examination is not satisfactory, it can be re-examined. Biopsy complication was pneumothorax, hemothorax, the spread of infection in the chest wall.

Nursing Diagnosis Pleural Effusion : Ineffective Breathing Patter related to decline in lung expansion secondary to the buildup of fluid in the pleural cavity.

6. Analysis of pleural fluid

Pleural effusion diagnosis based on history and physical examination, and confirmed by chest x-ray. With the lateral decubitus position thoracic images can be seen the presence of fluid in the pleural cavity as at least 50 ml, while the position of the AP or PA with at least as much fluid in the pleural cavity of 300 ml. On chest x-ray AP or PA position angle costophreicus found any that are not sharp.

7. Bronchoscopy

Bronchoscopy is sometimes done to help find the source of the collected fluid.

Pathophysiology of Chronic Pancreatitis

Pancreatitis (inflammation of the pancreas) is a serious disease of the pancreas with an intensity that can range from relatively mild disorders and self-limiting disease goes up quickly and fatal not react to various treatments. (Brunner, Sudarth, 2002, KMB)

Chronic pancreatitis is an inflammation of the pancreas characterized by destruction of the anatomical and functional progressive in the pancreas.

Pathophysiology of Chronic Pancreatitis

Consumption of alcohol is too long will result in the destruction of pancreatic cells and the formation of protein blockage. Destruction as a result of alcohol will result in injury to the pancreas are replaced with connective tissue. Formation of connective tissue will increase the pressure in the pancreas. Both the formation of connective tissue and blockage of protein will result in mechanical obstruction on pancreatic duct, choleductus, and duodenum. This condition would be aggravated by atrophy of ductal epithelium, inflammation as a result of irritation of the pancreatic secretion.

Pancreatic obstruction will result in distension of the pancreas that stimulates the pain receptors that can spread to the abdominal area and back. These conditions gave rise to complaints of severe abdominal pain radiating to the back.

Damage that occurs in the pancreas can systematically improve the response of gastric acid as one of defense to reduce the level of damage. However, this advantage will only stimulate gastric response to increase rhythmic contractions that can increase nausea and vomiting. In addition to the decrease in pancreatic secretion due to damaged cells will also have an impact on the decline or impaired absorption of food. Conditions nausea, anorexia, impaired absorption of food will result in meeting the needs of people with impaired nutrition.

Decreased secretion of pancreatic involvement will not affect the protein and good fats. Faecal fat will contain many elements that cause a froth, the stench in feces and increased frequency of defecation.

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