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Impaired Gas Exchange related to Asthma

Nursing Care Plan for Asthma

Impaired Gas Exchange : Excess or deficit in oxygenation and/or carbon dioxide elimination at the alveolar-capillary membrane

Defining Characteristics:
  • Visual disturbances;
  • decreased carbon dioxide;
  • dyspnea;
  • abnormal arterial blood gases;
  • hypoxia;
  • irritability;
  • somnolence;
  • restlessness;
  • hypercapnia;
  • tachycardia;
  • cyanosis (in neonates only);
  • abnormal skin color (pale, dusky);
  • hypoxemia;
  • hypercarbia;
  • headache on awakening;
  • abnormal rate, rhythm, depth of breathing;
  • diaphoresis;
  • abnormal arterial pH;
  • nasal flaring

Asthma is a chronic, or life long, disease that can be serious—even life threatening. There is no cure for asthma. The good news is that it can be managed so you can live a normal, healthy life.

Asthma is a lung disease that makes it harder to move air in and out of your lungs. There are three things that you should know about asthma:
  1. Asthma is chronic. In other words, you live with it every day.
  2. It can be serious – even life threatening.
  3. There is no cure for asthma, but it can be managed so you live a normal, healthy life.


Nursing Diagnosis for Asthma

Impaired Gas Exchange related to CO2 retention, increased secretion, increased respiration, and a disease process.

1) Goal
  • The client will maintain adequate gas exchange and oxygenation.

2) Expected Outcomes
  • Frequency of breathing 16-20 times / min
  • Pulse frequency 60-120 times / min
  • Normal skin color, no dipnea and blood gas analysis within normal limits

3) Interventions
  • Monitoring of respiratory status every 4 hours, blood gas analysis, income and output.
  • Place client in semi-Fowler position.
  • Give intravenous therapy as directed.
  • Give oxygen through a nasal cannula 4 l / min, then adapt the results of PaO 2.
  • Give the medication that has been prescribed and observe if there are signs of toxicity.

4) Rational
  • To identify the indications towards progress or deviations from the client.
  • Upright position allowing better lung expansion.
  • To enable rapid rehydration and can assess the situation for vascular administration of emergency drugs.
  • Giving oxygen to reduce the burden of respiratory muscles.
  • Treatment to restore bronchial conditions as the previous conditions.
  • For ease breathing and prevent atelectasis.

Nursing Assessment for Dengue Hemorrhagic Fever

Dengue Haemorrhagic Fever (DHF) is a disease caused by the dengue virus which is transmitted through the bite of Aedes aegypti and Aedes albopictus which causes disturbances in capillary blood vessels and the blood clotting system, resulting in bleeding.

Dengue hemorrhagic fever (DHF) is a specific syndrome that tends to affect children under 10 years of age. It causes abdominal pain, hemorrhage (bleeding), and circulatory collapse (shock).

Symptoms such as headache, fever, exhaustion, severe joint and muscle pain, swollen glands (lymphadenopathy), and rash. The presence (the "dengue triad") of fever, rash, and headache (and other pains) is particularly characteristic of dengue fever.
Nursing Assessment for Dengue Hemorrhagic Fever.

Assessment

a. Subjective data
  • Weak.
  • Heat or fever.
  • Headache.
  • Anorexia, nausea, thirst, painful swallowing.
  • Heartburn.
  • Pain in the muscles and joints.
  • Stiffness throughout the body.
  • Constipation.

b. Objective data
  • High body temperature, shivering, redness of the face looks.
  • Dry oral mucosa, bleeding gums, tongue dirty.
  • Red spots appear on the skin (petechiae), torniquet test (+), epistaxis, ecchymosis,
  • Hyperemia of the throat.
  • Epigastric tenderness.
  • On palpation palpable enlarged liver and spleen.
  • On shock (degree IV) rapid and weak pulse, hypotension, cold extremities, restlessness, peripheral cyanosis, shallow breathing.

Laboratory tests in DHF will be found:
  • Ig G positive dengue.
  • Thrombocytopenia.
  • Hemoglobin increase> 20%.
  • Hemoconcentration (hematocrit increased).
  • Blood chemistry workup showed hypoproteinemia, hyponatremia, hypochloremic.

On day 2 and 3 occur leukopenia, neutropenia, aneosinofilia, increased lymphocytes, monocytes, and basophils
  • SGOT / SGPT may be increased.
  • Urea and blood pH may be elevated.
  • Bleeding time elongated.
  • Metabolic acidosis.
  • On urine examination found mild albuminuria.

Catheterization Technique and Management of Urinary Retention

Urinary retention is a urological emergency most common and can occur anytime and anywhere.

Means that a doctor or nurse wherever he served, or will likely ever encounter this disorder. Therefore, the question must be able to detect the disorder and can then start handling it correctly.

When urinary retention not handled properly, will result in complications that aggravate morbidity of patients concerned. Basically do not need special equipment or skills to detect and handle patients with urinary retention, anything that causes the disorder.

Problems that are often encountered :
  • Urinary retention was not detected because it is unthinkable abnormality, the patient did not complain or say that can still pee on a regular basis (paradoxical incontinence).
  • Retention add to the suffering or causing harmful complications, even be permanent and this can happen because the doctor or nurse to handle the disorder without regard to the specified requirements, inexperienced or does not have the required equipment.

In this paper, will be described in the fundamental causes of urinary retention, how to detect and correct way of handling and will be presented as well as some tips to keep in mind.

Urinary retention is a condition where the sufferer can not remove the accumulated urine in the bladder so that the maximum capacity of the bladder is exceeded.

Micturition process:

Bladder has a dual function
1. Accommodate urine as a "reservoir". In this phase, the bladder muscle (detrusor) in a state of relaxation while in a state of tense sphincter (closing). When urine volume reaches physiological capacity (in adults ranges between 250-400 ml), there will be a stimulus to micturition, but the process can still be suspended because of micturition retained by the concerned. When urine volume reaches maximum capacity (in adults ranges between 500-600 ml), increasing stimulation for micturition, causing discomfort and micturition process can still be put on hold while the urethral sphincter tense eksternum consciously (striped muscles).

2. Emptying the contents, called micturition process. This event requires cooperation harmoniously coordinated between detrusor contraction and sphincter relaxation so that the urine that had gushed out until the pot is empty.
In the second phase of the above, the drainage of the bladder to prevent urine back into the ureters (to prevent reflux).
Micturition process will run smoothly when the detrusor and sphincter in good condition, normal function (coordinated in harmony) and there are no obstacles in the urethra.

Cause of urinary retention.
  • Detrusor weakness.
  • injury / disorder in the spinal cord, nerve fiber damage (diabetes mellitus), detrusor experience stretching / dilation is excessive for a long time.
  • Impaired coordination of detrusor-sphincter (dis-synergies)
  • injury / spinal cord disorders in the cauda equina.
  • Constraints on the way out the urine:
    • urethral stricture
    • abnormal prostate gland (BPH, Ca)
    • urethral stones
    • urethral damage (trauma)
    • blood clot in the lumen of the bladder (clot retention) etc..

Result of urinary retention
  • Bladder expands beyond the maximum capacity so that the pressure inside of the walls lumennya and voltage will increase.
  • If this situation is allowed to continue, increased pressure within the lumen will obstruct the flow of urine from the kidney and ureter, causing hydroureter and hydronephrosis and renal failure occurs slowly.
  • When the pressure within the bladder increases and exceeds the resistance in the urethra, the urine will radiate over and over again (in small amounts) by the patient uncontrollably, while the bladder remains full of urine. This situation is called: paradoxical incontinence or "overflow incontinence"
  • Voltage of the bladder wall continued to rise until the limit of tolerance is reached and after this limit is passed, the bladder muscle will be dilated so that the capacity of the bladder exceeds the maximum capacity, with the force of contraction of the bladder muscles will shrink.
  • Urinary retention is a predilection for the occurrence of urinary tract infection (UTI) and when this happens, it can lead to serious conditions such as acute pyelonephritis, urosepsis, particularly in elderly patients.


Management of Urinary Retention

When the diagnosis of urinary retention is enforced correctly, management determined based on issues related to the cause of retention of urine.

Catheterization

Conditions
  • Performed by the principles of aseptic
  • Use catheter Nelaton / type that is not too big, kind of Foley
  • Sought no pains to avoid spasm of the sphincter.
  • Cultivated with a closed system when the catheter remains.
  • Given prophylactic antibiotics before insertion of a catheter (usually not needed antibiotics at all). Catheters were maintained as short as possible, just along still needed.
Catheterization technique
  • Foley Catheter sterile, for adult size 16-18 F.
  • Disinfection with desinfektans effective, does not irritate the skin of the genitalia (no alcohol)
  • Topical anesthesia in patients who are sensitive to 2-4% xylocaine jelly. Jelly is at once acts as a lubricant. (On stone or urethral stricture, resistance will be felt when entering the jelly)
  • Spread with jelly sterile catheter inserted into the urethra. In the female patient is usually no problem. In the male patients, a catheter is inserted gently until urine flows (always note the number and color / aspect urine), then the balloon was developed by 5-10 ml. .
  • When it was decided to settle, the catheter is connected to a sterile reservoir bag and maintained as a closed system.
  • Catheter in fixation with plaster on the skin proximal thigh or inguinal region and labored to lead kelateral penis, this is to prevent necrosis due to pressure on the ventral part of the urethra in the area penoskrotal.

Function Theory in Behavior Change

This theory is based on the assumption that individual behavior change depending on the needs. This means that a stimulus that can cause changes in a person's behavior when the stimulus is understandable in the context of the person's needs. According to Katz (1960) was based behavior-backs by the needs of the individual concerned. Katz assume that:
  • Behavior has an instrumental function, meaning that it can function and provide services to the needs. A person can act (behave) positive to the object for the fulfillment of their needs. Conversely, if the object can not meet their needs then it will behave negatively. For example, people want to make a toilet, the toilet if really has become needs.

  • Behavior serves as a defense mecanism or as a defense in the face of the environment. That is, the behavior, the actions, to protect human threats coming from outside. For example, people can avoid dengue fever, as the disease is a threat to himself.

  • Behavior serves as a receiver object, and the giver of meaning. In the role of the action, a constantly adjust to the environment. With the day-to-day actions are someone has done decisions with respect to the object or stimulus encountered. Decisions that result in such actions (done spontaneously and in a short time. Example, if a person feels headache, then quickly, without thinking long, he will act to overcome the pain by buying drugs in a stall and then drink it , or other measures.

  • Behavior as a function of one's self expressive values ​​in responding to a situation. Expressive value is derived from the concept of one's self and a reflection of the heartstrings. Therefore, the behavior can be a screen where all people can be self-expression. For example, people who are angry, happy, upset, and so can be seen from the behavior or actions.

This theory believes that the function of the behavior of the function has to face the world outside the individual, and constantly adapt to their environment according to their needs. Therefore, in the conduct of human life seemed to change constantly and relative terms.