Nursing Management of Constipation

Examination begins with inspection of the abdominal area is there any enlargement of the abdomen, stretch or bulge. Further palpation on the surface of the abdomen to assess the strength of the abdominal muscles. Palpation over the faecal mass can be felt in the colon, the presence of a tumor or aneurysm of the aorta. On percussion, among others sought excessive gas gathering, organ enlargement, asietes, or the presence of faecal mass. Auscultation, among others, to listen to the sound of bowel movements, normal or excessive intestinal example on the bridge. Examination of the anal region provide an important clue, for example, is there any hemorrhoids, prolapse, fissures, fistulas, and tumor mass in the anal area can interfere with the process of defecation.

Digital rectal examination should be done, among others, to determine the size and condition of the rectum and the amount and consistency of stool.

Digital rectal can provide information about:

• Rectal tone.
• Sphincter tone and strength.
• Pubo-rectal muscle strength and pelvic floor muscles.
• Is there a mass pile of feces ?
• Is there another mass (eg haemorrhoids) ?
• Is there blood ?
• Are there injury in the anus ?

Physical examination of constipation, most of the abnormalities found are not clear. However, careful examination and thorough needed to find abnormalities that could potentially affect the function of the colon in particular. Beginning with an examination of the oral cavity include gears, oral mucous membrane lesions and tumors that can disrupt a sense of taste and ingestion.

Laboratory tests associated with efforts to detect risk factors cause constipation, such as blood glucose, thyroid hormone levels, electrolytes, anemia associated with bleeding from the rectum, and so on. Other procedures such as anoscopy done routinely recommended in all patients with constipation to find there any fissures, ulcers, haemorrhoids and malignancy.

Abdominal plain radiography should be performed in patients with constipation, especially the occurrence of acute. This examination can detect there a fecal impaction and hard fecal masses that can cause blockage and perforation of the colon. If there were an estimated colonic obstruction, can be followed by barium enema to ensure a place and nature of the obstruction. Intensive examination is done selectively after 3-6 months of treatment of constipation is less successful and performed only at centers managing certain constipation.

Many kinds of drugs that are marketed for constipation, stimulating efforts to provide symptomatic treatment. Meanwhile, when possible, treatment should be directed at the cause of constipation. Long-term use of laxatives that are primarily stimulates intestinal peristalsis, should be limited. Treatment strategy is divided into:

1. Non-pharmacological treatment

Exercise colon: colon train is a suggested form of exercise behavior in patients with otherwise unexplained constipation. Patients are encouraged to hold a regular time each day to take advantage of large bowel movement. The recommended time is 5-10 minutes after eating, so it can take advantage of the gastro-colonic reflex to defecate. It is expected that this habit can cause sufferers to respond to the signs and induce bowel movements, and do not resist or postpone the urge to defecate.

Diet: The role of diet is important for constipation, especially in the elderly group. Epidemiological data indicate that a diet containing plenty of fiber reduces the incidence of constipation and various other gastrointestinal diseases, such as colorectal cancer and diverticular. Fiber increases stool weight and mass and shorten transit time in the gut. To support the benefits of fiber, adequate fluid intake is expected around 6-8 glasses a day, if there are no contraindications for fluid intake.

Sports: Pretty in activities or mobility and exercise help overcome constipation, walk or jog conducted in accordance with the age and ability of the patient, will invigorate the circulation and to strengthen the abdominal muscles of the abdominal wall, especially in patients with atony on the abdominal muscles .


2 Pharmacologic Treatment

If less successful behavior modification, pharmacological therapy is added, and is usually used class of laxative drugs. There are 4 types of laxative drug classes:

Enlarge and soften the stool mass.
Soften and lubricate the stool, this medicine works by lowering the surface tension of the stool, making it easier for water absorption.
Osmotic classes that are not absorbed, so it is quite safe to use, for example in patients with renal failure.
Stimulates peristalsis, thereby increasing the motility of the colon. This group is widely used. It should be noted that this class of laxatives can be used for long-term, can result in plexus mesentericus damage and colonic dysmotility.

When encountered severe chronic constipation and can not be solved by means of the above, surgery may be needed. Pasa generally, if not found a blockage due to the presence of a mass or volvulus, surgery was not performed.

Risk for Decreased Cardiac Output - NCP Acute Myocardial Infarction (STEMI)

Nursing Care Plan for AMI with ST elevation (STEMI)

Definition

Acute myocardial infarction is the destruction of tissue due to inadequate blood supply so that coronary blood flow is reduced. (Brunner & Suddath, 2002)

Acute myocardial infarction is the death of myocardial tissue caused by myocardial coronary blood damage, due to the inadequate blood flow. (Carpenito, 2000)

Acute myocardial infarction is ischemia or necrosis of the heart muscle caused by decreased blood flow through one or more coronary arteries. (Doengos, 2000)


Etiology

According to Noer, 1999; 103 caused by

a. Causal factors:

1. Oxygen supply to the heart is reduced due to:
a. Vascular factors: Atherosclerosis, spasm, arteritis.
b. Circulation Factor: hypotension, aortic stenosis, insufficiency.
c. Blood factors: anemia, hypoxemia, polycythemia.

2 Cardiac output increased
For example: Activity, emotional, eating too much, anemia, hyperthyroidism.

3. Increased myocardial oxygen demand at:
Myocardial damage, myocardial hypertrophy, diastolic hypertension.


b. Predisposing factors
1 Biological factors that can not be changed:
a. Age over 40 years.
b. Gender. The incidence is higher in men, whereas in women increases after menopause.
c. Heredity.
d. Race.

2 Risk factors that can be changed
a. Major; Hyperlipidemia, hypertension, heavy smoking, diabetes, obesity, a diet high in saturated fat.
b. Minor; physical activity, pattern type A personality (emotional, aggressive, ambitious, competitive).


Clinical Manifestations

Acute myocardial infarction usually occurs in men over 40 years and having artheriosklerosis. In the coronary vessels and is often accompanied by arterial hypertension. The attack also occurs in women and young men, early 30s or even 20s. Women who use the contraceptive pill and smoke have a very high risk. However, the overall incidence of myocardial infarction in men is higher than women at all ages.

Chest pain that lasted all of a sudden and continuous, located at the bottom of the sternum and upper abdomen is the main symptom that usually appears. Pain will be felt increasingly heavy can spread to the shoulder and arm, usually the left arm. Unlike the pain of angina pain arises spontaneously (not after heavy work or emotional disorders) and persist for several hours to several days and will not go away with rest or nitroglycerin. In some cases the pain may spread to the chin and neck, pain is often accompanied by shortness of breath, pallor, cold sweats, dizziness, light-headedness, nausea, vomiting (Brunner & Suddarth, 2002)


Pathogenesis

AMI with ST elevation (STEMI) usually occurs when coronary blood flow decreased abruptly after occlusion of thrombus on atherosclerotic plaque that already exists. STEMI occurs when a coronary artery thrombus occurs rapidly at the site of vascular injury, where the injury is triggered by factors such as smoking, hypertension, and lipid accumulation. In STEMI classical pathological picture consists of rich red fibrin thrombus, which is believed to be the basis of so STEMI respond to thrombolytic therapy. Furthermore, the location of plaque rupture, various agonists (collagen, ADP, epinephrine, serotonin) triggers platelet activity, which in turn will produce and release thromboxane A2 (potent vasoconstrictor local). In addition, platelet activation triggers a conformational change in the receptor glycoprotein IIb / IIIa. After experiencing a conversion function, the receptor has a high affinity for the amino acid sequence in soluble adhesion proteins (integrins) such as von Willebrand factor (vWF) and fibrinogen, both of which are multivalent molecules that can bind to two different platelets simultaneously, resulting in crosslinking of platelets and aggregation.

Coagulation cascade is activated by exposure of tissue factor on endothelial cells are damaged. Factor VII and X are activated, resulting in the conversion of prothrombin into thrombin, which then converts fibrinogen into fibrin. The coronary arteries are involved then will experience the occlusion by thrombus composed of platelets and fibrin aggregates. On rare occasions, STEMI may also be caused by occlusion of the coronary arteries caused by coronary embolism, congenital abnormalities, coronary spasm and systemic inflammatory diseases.



Nursing Care Plan for Acute Myocardial Infarction with ST Elevation (STEMI)

Nursing Diagnosis : Risk for Decreased Cardiac Output related to decreased constriction ventricular function, cardiac muscle degeneration.

Outcomes:

• Lowering episodes of dyspnea, angina, and dysrhythmias.
• Identify the behavior to decrease the heart's workload.

Nursing Interventions:

Independent

1. Monitor cardiac rhythm and frequency.
R /: Tachycardia and cardiac dysrhythmias may occur when attempting to increase cardiac output responds to fever. Hypoxia and acidosis due to ischemia.

2 Auscultation of heart sounds. Note the distance / tone heart, murmurs, S3 and S4 gallops.
R /: To provide early detection of complications such as CHF, cardiac tamponade.

3 Encourage bed rest in a semi-Fowler's position.
R /: Lowering cardiac workload, maximize cardiac output.

4 Provide comfort measures such as changes in position and back rub, and entertainment activity in cardiac tolerance.
R /: Improve relaxation and redirect the attention.

5. Encourage use of stress management techniques such as breathing exercises and guided imagery.
R /: This behavior can control anxiety, increase relaxation and decrease the work of the heart.

6 Evaluation of complaint fatigue, dyspnea, palpitations, chest pain continuously. Note the presence of breath sounds adventisius, fever.
R /: The clinical manifestations of CHF that can accompany endocarditis or myocarditis.


Collaborative

1 Give oxygen complement.
R /: Increase the availability of oxygen to myocardial function and decrease the effects of anaerobic metabolism, which occurs as a result of hypoxia and acidosis.

2 Give drugs in accordance with indications such as digitalis, diuretics.
R /: Can be given to increase myocardial contractility and decrease the workload of the heart in the presence of CHF (miocarditis).

3 Give Antibiotic / anti-microbial.
R /: Given to address the identified pathogens, prevent further heart damage.

4 Assist in emergency pericardiocentesis.
R /: The procedure was done in a bed can to lower the pressure in the fluid around the heart.

5. Prepare patients for surgery if indicated.
R /: Replacement valves may be required to improve cardiac output.

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

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.

Imbalanced Nutrition: Less Than Body Requirements related to Tongue Cancer

Nursing Care Plan for Tongue Cancer

DEFINITION

Tongue cancer is a malignant neoplasm arising from epithelial tissue with the tongue-shaped mucosal squamous cell carcinoma (stratified squamous epithelial cells) and occur as a result of chronic stimulation, as well as some specific diseases (premalignant). This cancer can infiltrate into the surrounding area, in addition to doing it limfogen and hematogenous metastases.


ETIOLOGY

Some of the causes of malignant cancer of the tongue has been suspected, but by the experts has been no statement can be made explicitly. However, there is some suspicion that the malignant cancer of the tongue occurs because there is a relationship with some specific disorders or certain diseases. Several studies have found that the disease syphilis, both in the case of active or at least had no previous history of syphilis, often found together with a malignant cancer of the tongue. Martin reported that 33% of patients suffering from malignant cancer of the tongue also had syphilis disease. There are several other diseases that cause malignant cancer of the tongue include poor oral hygiene, chronic trauma and disorders of alcohol and tobacco. A number of cases have been observed where the malignant cancer of the tongue arising in place in accordance with the source of chronic irritation such as dental caries or tooth decay with a lot of calculus, and is also usually due to the installation of dentures or prostheses that position is not suitable.


CLINICAL MANIFESTATION

Signs of cancer that often appears on the tongue is a mass or ulcer, although in most patients the lesions eventually become painful, of course, this happens if there is secondary infection. The tumors can be started as superficial ulcers who have induration with a slightly protruding edge and may progress to infiltrate the inside of the tip of the tongue which may cause fixation or induration that looks much changed its surface.

Typical lesions arise on the edge of the lateral or ventral surface of the tongue. While the small number of cancer cases arise on the surface of the tongue dorsum of the tongue, usually in patients with a history of previous syphilitic glossitis or who are experiencing syphilitic glossitis. In 1554 reported cases of carcinoma of the tongue by frazel and lucas only 4% occurred on the dorsum of the tongue. Lesions on the lateral edge of the uneven distribution between the base of the tongue and the third from the middle of the tongue. Lesions near the base of the tongue, especially not clear because these lesions do not cause symptoms until it is a little further even manifestations that appear only in the form of sore throat and dysphagia. Special places the emergence of these tumors is very important because of lesions in the posterior part of the tongue usually have a high degree of malignancy, early metastasis and the prognosis is very poor, mainly because of the difficulty in treating it.



Nursing Diagnosis for Tongue Cancer

Imbalanced Nutrition: Less Than Body Requirements related to inability to ingest adequate nutrition due to oral conditions.

Goal: Nutrition met.

Outcomes:

• Age-appropriate weight.
• Increased appetite.
• No nausea / vomiting.

Intervention:
1. Measure body weight every day.
R /: To determine the occurrence of weight loss and determine the level of change.

2. Eating foods that do not stimulate (soft / pureed).
R /: To help repair intestinal absorption.

3. Encourage clients to eat in the warm.
R /: warm Circumstances can increase appetite.

4. Encourage clients to eat little but often.
R /: To meet the food intake.

5. Provide diet high in calories, protein and minerals and low in residual substances.
R /: To meet the adequate nutrition.

6. Collaboration antipyretic drug administration.
R /: To reduce and even eliminate nausea and vomiting.

Gigantism Nursing Diagnosis: Altered Family Processes

Gigantism is a condition of a person that excess growth, with great height and above normal. Gigantism is caused by excessive amounts of growth hormone. There are no high definition refer as "giants." adult height.

Gigantism is a condition of a person that excess growth, with a large height above normal and is caused by the secretion of growth hormone (GH) excessive and occurs before adulthood or before epiphyseal closure process. (Corwin, 2007)

Growth hormone is a hormone produced by the anterior pituitary which works to increase the growth and metabolism in target cells. Hormone target cells are located in almost all parts of the body. Growth hormone also plays a role in synthesizing somatomedin the liver, to stimulate the epiphyseal growth plate. Metabolic impact of GH is the mobilization of free fatty acids in adipose tissue and muscle glucose metabolism barriers and in adipose tissue.

Pituitary gigantism often occurs as a result of excessive GH secretion due to the onset of pituitary tumors in children before epiphyseal closing. Gigantism usually affects children aged 6-15 years.

Gigantism is a protein hormone increases in many tissues, increasing the decomposition of fatty acids and adipose tissue and blood glucose levels. Gigantism occurs in children when the period skeleton still has the potential to grow, or at pre-puberty.

Gigantism is caused by excessive secretion of GH. This condition can be caused by pituitary tumors that secrete GH or because of abnormalities of the hypothalamus which leads to excessive GH secretion. Gigantism can occur when the state of excess growth hormone occurs before epiphyseal bone plates close or still in its infancy. The cause of excess growth hormone production is mainly in the tumor cells somatrotop which produces growth hormone.

The most frequent cause of gigantism is a pituitary adenoma, but gigantism has been observed in boys aged 2.5 years with hypothalamic tumor secreting GHRH which can be complicated, especially in the pancreas that secrete the already large number of GHRH (Arvin, 2000).

Some people have vision problems and behavior. In most cases recorded abnormal growth become apparent at puberty, but this situation has been established as early as the newborn period in a child and at the age of 1 month. In gigantism, soft tissues such as muscle and other continue to grow. Gigantism can be accompanied by visual disturbances when the tumor enlarges to suppress chiasma opticum which is the optic nerve pathways.

The following are symptoms of gigantism caused by excess secretion of GH:

• The signs of glucose intolerance.
• Nose width, enlarged tongue and rough face.
• Excessive growth of the mandible.
• Teeth become separated.
• Finger and thumb to grow thicker.
• Melting and weaknesses.
• Loss of vision in the visual field examination carefully because the optic nerve khiasma depressed eyes.

Nursing Diagnosis for Gigantism: Altered Family Processes related to families with gigantism.

Goal:

• Preparing the family to be able to care for members with gegantisme.
• Families can adapt to the disease.

Outcomes:

• Families can cope with problems arising from the presence of signs and symptoms that appear and deliver or provide a suitable environment to the client's condition.

Intervention and rationale:

1. Provide emotional support to families and clients.
R /: Families can receive clients.

2. Encourage parents to express their feelings.
R /: Families can adapt to the client's illness.

3. Encourage clients to share a sense of helplessness, shame, fear associated with disease manifestations.
R /: To solve problems that arise.

4. Acting as an advocate and liaison clients and families, with other health care team members.
R /: Preparing families to care for the client.

5. Encourage clients to socialize with their surroundings.
R /: Motivating clients.

6. Encourage client involvement in recreational and diversionary activities are age-appropriate.
R /: Increase client confidence.

Nursing Diagnosis for Biliary Atresia

Nursing Care Plan for Biliary Atresia

Biliary atresia is a serious disease which occurs in one in 10,000 children and is more common in girls than boys and in newborns of Asian and African-American than in Caucasian newborns. The cause of biliary atresia is unknown, and treatment is only partially successful.

Biliary atresia occurs due to prolonged inflammatory process that causes progressive damage to the extrahepatic biliary duct, causing bile flow resistance. Thus, biliary atresia is the absence or small lumen in part or all of extrahepatic biliary tract that causes bile flow resistance. As a result, the blood in the liver and bile salt buildup and increased direct bilirubin.

Biliary atresia is an inhibition in the pipes / ducts that carry bile from the liver to the gallbladder to. It is a congenital condition, which means that at birth.

The etiology of biliary atresia is not known with certainty. Some experts claim that genetic factors play a role, which is associated with a chromosomal abnormality trisomy 17, 18 and 21; as well as the presence of anomalous organs in 30% of cases of biliary atresia. However, most authors suggest that biliary atresia is the result of an inflammatory process that damages the biliary duct, could be due to infection or ischemia.

Some children, especially those with a fetal form of biliary atresia, often have other birth defects in the heart, spleen, or intestines.

An important fact is that biliary atresia is not a hereditary disease. Cases of biliary atresia have occurred in identical twins, where only one child with the disease. Biliary atresia is most likely caused by an event that occurs during fetal life or around the time of birth. The possibility that "triggers" may include one or a combination of the following predisposing factors:

• viral or bacterial infection
• problems with the immune system
• abnormal bile components
• errors in the development of liver and bile duct
• hepatocelluler dysfunction

Infants with biliary atresia usually appear healthy when they were born. Symptoms of the disease usually appear within the first two weeks of life. The symptoms include:

• Jaundice, yellowing of the skin and eyes due to the very high levels of bilirubin (bile pigment) in the bloodstream. Jaundice is caused by an immature liver is common in newborns. It usually goes away within the first week to 10 days of life. An infant with biliary atresia usually appear normal at birth, but jaundice develops in two or three weeks after birth.
• Dark urine caused by a buildup of bilirubin (a breakdown product of hemoglobin) in the blood. Bilirubin is then filtered by the kidneys and removed in the urine.
• Pale stools, because there is no staining of bilirubin or bile into the intestine to color the stool. Also, the abdomen may become swollen due to enlargement of the liver.
• Weight loss, jaundice develops when the rate increases.
• Gradual degeneration of the liver causing jaundice, jaundice, and hepatomegaly, Channel intestine can not absorb fats and fat-soluble in water, causing malnutrition conditions, deficiency of fat-soluble in water as well as failure to thrive.

Nursing Diagnosis for Biliary Atresia

1) Hyperthermia related to inflammatory damage due to progressive extrahepatic biliary duct.

2) Ineffective breathing pattern related to an increase in abdominal distension.

3) Imbalanced Nutrition: Less Than Body Requirements related to anorexia and impaired absorption of fat.
characterized by weight loss and conjunctival pallor.

4) Impaired bowel elimination (diarrhea) related to intestinal malabsorption.
characterized by liquid stool, increased frequency of bowel movements (more than 3 times daily), increased bowel sounds.

5) Impaired skin integrity related to accumulation of bile salts in the network.
characterized by pruritis.

6) Deficient fluid volume related to nausea and vomiting.

7) Anxiety related to lack of information about the disease due to lack of knowledge.

Impaired Urinary Elimination and Risk for Infection r/t Urethral Stricture

Urethral stricture is more common in men than women, especially because of the difference in length of the urethra. (C. Long, Barbara; 1996 case 338)

Urethral stricture causing disturbances in micturition, urinary flow ranging from shrinking until completely unable to drain urine out of the body. Urine can not get out of the body can lead to many complications, with the heaviest complication is kidney failure.

Urethral stricture may occur:

1. Congenital
Urethral stricture may occur separately or in conjunction with other urinary tract anomalies.

2. Learned.
Urethral injury (due to the insertion of surgical equipment for transuretral surgery, indwelling catheters, or cystoscopy procedure).
Injuries due to stretching.
Injuries due to accidents.
Urethritis gonorheal untreated.
Muscle spasm.
External pressure eg tumor growth.
(C. Smeltzer, Suzanne;2002 hal 1468 dan C. Long , Barbara;1996 hal 338)

3. Postoperative
Some operations on the urinary tract can cause urethral strictures, such as prostate surgery, surgery with endoscopic instruments.

4. Infection
Infection is the most frequent factors that cause urethral strictures, such as infection by gonococcal bacteria that cause gonorrhea urethritis or non urethral gonorrhea has infected several years earlier, but now it is rare due to the use of antibiotics, most of these strictures located in the pars membranacea, although also found in places other; chlamydia infection is now a major cause but can be prevented by avoiding contact with infected individuals or using condoms.

Clinical manifestations

Beam strength and decreased urine output.
Symptoms of infection.
Urinary retention.
The presence of back flow and trigger cystitis, prostatitis, and pyelonephritis.
(C. Smeltzer, Suzanne; 2002 case 1468)



Nursing Care Plan for Urethral Stricture

Nursing Diagnosis for Urethral Stricture : Impaired Urinary Elimination related to Post-Op Cystotomy.

Nursing Interventions:

1. Monitoring of urine output and characteristics.
Rationale: Detecting interference elimination pattern: urination early.

2. Maintaining a constant bladder irrigation for 24 hours.
Rationale: Preventing blood clots block the flow of urine.

3. Maintaining patency of foley catheter with irrigation.
Rationale: Preventing blood clots clogging the catheter.

4. Ensuring fluid intake (2500-3000).
Rationale: To smoothen the flow of urine.

5. Once the catheter is removed, continue to monitor the symptoms of bladder elimination disorders.
Rationale: Detecting early bladder elimination disorders.



Nursing Diagnosis for Urethral Stricture : Risk for Infection

Nursing Interventions :

1. Monitoring of vital signs, reported symptoms of shock and fever.
Rationale: Prevent before the shock.

2. Monitoring urine color of fresh red blood, not dark red, a few hours after the new surgery.
Rationale: Urine color change from dark red to red fresh on day 2 and 3 after surgery.

3. Counseling to patients in order to prevent the Valsalva maneuver.
Rationale: Can irritate, prostate bleeding in the early postoperative period due to pressure.

4. Preventing the use of a rectal thermometer, rectal examination at least 1 week.
Rational: It can cause bleeding.

5. Maintaining aseptic techniques of urinary drainage system, irrigation if necessary alone.
Rationale: Minimizing the risk of entry of germs that can cause infection.

6. Ensuring intake that much.
Rational: It can lower the risk of infection.

Knowledge Deficit and Acute Pain - Nursing Interventions for Angina Pectoris

Angina pectoris is a clinical syndrome of chest pain due to transient myocardial ischemia. Myocardial ischemia is a condition where the heart muscle is deprived of oxygen, but has not suffered damage and is reversible, which is the diagnostic tool ECG showed ST depression or T inversion.

Based on clinical symptoms, Angina pectoris divided into two stable angina pectoris and unstable angina pectoris. Stable angina pectoris is a chest pain incident lasted no more than 15 minutes, the originators is a physical activity or trigger factors such as stress. Chest pain can be relieved by rest or medication (sublingual nitroglycerin). Unstable angina pectoris is chest pain incident lasted more than 15 minutes with intensity and increasing frequency whenever recurrence. Lighter trigger factors, can occur at rest. Were classified as unstable angina pectoris that patients with angina in the last 2 months felt increasingly burdensome with frequency quite often (can occur 3 times a day), patients with angina that is increasing rapidly, but the lighter trigger factors, patients with angina attacks at rest.

Characteristics of chest pain in angina pectoris can be used as a benchmark based on the location of pain, pain quality, quantity pain, accompanying symptoms. Location of pain can be found in the middle of the chest, retrosternal or substernal or pericardial area, which can be accompanied by radiation to the neck, jaw, shoulder, down to the arm (usually the left arm). The quality of pain may be dull pain like the taste crushed, or heaviness in the chest area, a strong sense of urgency, a sense of pressure. Pain associated with activity and reduced or cured by rest, therapy was not associated with changes in the movement of the breath and body position changes. Quantity pain lasting, pain is usually intermittent with increasing intensity or reduced or controlled. Pain that occurs continuously throughout the day or even a few days is usually not painful angina pectoris. Other symptoms that may accompany angina pectoris include nausea, vomiting, sweating, difficulty breathing, anxiety, and fatigue.


Nursing Diagnosis for Angina Pectoris : Knowledge Deficit (learning need) regarding Events, treatment needs related to lack of information.

Intervention:

1. Emphasize the need to prevent angina attacks.
2. Instruct to avoid the factors / situations as the originator of angina episodes.
3. Assess the importance of weight control, smoking cessation, dietary changes and exercise.
4. Show / encourage clients to monitor their own pulse during activity, avoid stress.
5. Discuss the steps taken in the event of an attack of angina.
6. Encourage clients to follow the specified program.

Nursing Diagnosis for Angina Pectoris : Acute Pain related to myocardial ischemia.

Intervention:

1. Assess the factors that aggravate the pain.
2. Advise for a complete rest during episodes of angina (first 24-30 hours) with a semi-Fowler position.
3. Observation of vital signs every 5 minutes every attack of angina.
4. Create a quiet environment, limit the visitor when necessary.
5. Give soft foods and let clients break 1 hour after meals.
6. Staying with clients who are experiencing pain or looking worried.
7. Teach distraction and relaxation techniques.
8. Collaboration treatment.