NCP Hirschsprung's Disease : Assessment, Nursing Diagnosis and Interventions

Nursing Care Plan for Hirschsprung's Disease

Assessment of Hirschsprung's Disease

1. Activity / rest

• Symptoms: Malaise, changing patterns of rest / sleep associated with pain, limitations.

2. Ego Integrity

• Symptoms: Anxiety, fear, feelings of helplessness parents.

3. Elimination

• Symptoms: Constipation can be accompanied by diarrhea.
• Symptoms: Abdominal distension progressively, until the thin abdominal wall veins visible, peristaltic activity can be observed.

4. Food / fluid

• Symptoms: Anorexia, nausea, vomiting, weight loss.
• Signs: Decrease subcutan fat / muscle mass, weakness, a sign of malnutrition and growth failure.

5. Pain / comfort

• Symptoms: Abdominal pain.
• Signs: Facial expressions grimacing, moaning / crying, behavioral distraction, abdominal tenderness / distension.

6. Extension / learning

• Parent questions related to the disease, care and treatment of children.
• Patient's discharge plan: Requires assistance / demonstration how irrigation and colostomy care, the ability to assess the incidence of abdominal distension and obstruction.

Nursing Diagnosis and Interventions for Hirschsprung's Disease - Preoperative

1. Altered Bowel Elimination: observations related to hypertrophy and distention of the proximal colon.

Goal: Observation does not happen.

Outcomes:

• Clients say can defecate.
• Normal intestinal peristalsis.

Interventions:
1 Assess the client's pattern of elimination.
R /: Identify custom client to facilitate further action.

2 Encourage clients to drink water from 1500 to 2000 cc / day.
R /: Adequate fluid intake can improve the balance between absorption in the colon and fluid intake, thereby preventing the formation of a hard feeces.


2. Imbalanced Nutrition: Less Than Body Requirements related to intake less.

Goal: Fulfillment of nutrients can be resolved.

Outcomes:

• Clients no nausea and vomiting.
• Inkate adequate.
• Clients are not weak.

Interventions:
1 Monitor food intake.
R /: Adequate intake affect the healing process.

2 Provision of adequate calories and balanced meals.
R /: Caloric intake helps the body to maintain homeostasis.

3 Encourage clients to spend a portion of their food.
R /: Adequate intake can assist in improving the general state of the client.


3. Anxiety related to ineffective coping.

Goal: Anxiety is resolved.
Outcomes:

• Cheerful facial expressions.
• Clients and their families are not asked again about his illness.
• Clients and their families have hope of recovery.

Interventions:
1 Assess the level of anxiety.
R /: Make it easy for the next action.

2 Give the opportunity to the clients and their families to express his feelings.
R /: Thus the client and his family was relieved to express feelings.



Nursing Diagnosis and Interventions for Hirschsprung's Disease - Postoperative

1. Acute Pain related to the continuity of body tissues.

Goal: The client expresses a sense of comfort pain reduced / lost.
Outcomes:

• Clients complained of pain at the surgical wound.
• Cheerful facial expressions.
• Vital signs within normal limits.
• Relationships within normal limits.

Interventions:
1 Assess and record the location and duration of pain.
R /: Knowing the client's perception and reaction to pain as an effective basis for further intervention.

2 Give a fun position.
R /: Reduce emphasis on muscle and prevent muscle spasms that can cause pain.

3 Observation of vital signs every 2 hours.
R /: Practice deep breathing slowly and regularly will help to relax the muscles so that the supply of O2 to the tissue smoothly, thus reducing pain.

4 Implementation of appropriate analgesic drug administration programs.
R /: Analgesic serves to inhibit stimuli that are not perceived pain, so that pain is reduced / lost.


2. Disturbed Sleep Pattern related to postoperative wound pain.

Goal: Sleep patterns resolved.
Outcomes:

• Clients sleep 7-8 hours.
• Clients seem cheerful.

Interventions:
1 Assess sleep patterns and intirahat clients.
R /: Knowing the disturbance of rest / sleep clients to determine further intervention.

2 Create a pleasant environment.
R /: A quiet environment can provide peace to rest and sleep.

3 Encourage clients to a lot of rest and enough sleep.
R /: Adequate sleep can give a fresh taste to the clients and accelerate the healing process.

Constipation and Deficient Fluid Volume - NCP for Hirschsprung's Disease

Nursing Care Plan for Hirschsprung's Disease

Symptoms and signs can vary based on the severity of their condition sometimes appear soon after birth. At other times they may not appear until the baby grows into a teenager or adult.

In the new birth signs may include :

• Failure to issue a stool in the first day or two of birth.
• Vomiting : include vomit green liquid called bile - digestive fluid produced in the liver.
• Constipation or gas.
• Diarrhea.

In children older, signs may include :

• Distended abdomen.
• Slight weight gain.
• Problems in the absorption of nutrients, which leads to weight loss, diarrhea or keduanyadan delay or slow growth.
• Infection of the colon, especially newborn child or young ones, which can include enterocolitis, a serious infection with diarrhea, fever and vomiting and sometimes dangerous colonic dilatation. In children or older adults, symptoms may include constipation and low values ​​of red blood cells (anemia) due to blood loss in the stool.

Nursing Diagnosis for Hirschsprung's Disease

1. Risk for constipation related to narrowing of the colon, secondary, mechanical obstruction.

Goal: normal defecation pattern

Outcomes: the patient does not experience constipation, maintain a patient's defecation every day.


Interventions:

1. Observations bowel sounds, and check the patient for abdominal distention. Monitor and record the frequency and stool characteristics.
2. Record intake and output accurately.
3. Encourage the patient to consume 2.5 L of fluid every day, if there are no contraindications.
4. Perform defecation program. Patients in the upper chamber pot or commode at certain times each day, as close as possible to time the usual defecation (if known).
5. Provide a laxative, enema, or suppository according to instructions.

Rational:

1. To plan an effective treatment in preventing constipation and faecal impaction.
2. To assure hydration and fluid replacement therapy.
3. To improve hydration and fluid replacement therapy.
4. To assist adaptation to the normal physiological function.
5. To increase the elimination of solid stool or gas from the digestive tract, monitor effectiveness.

Nursing Diagnosis for Hirschsprung's Disease

2. Risk for Deficient Fluid Volume related to discharge fluid from vomiting, inability absorps water by instentinal.

Goal: fluid requirements are met

Outcomes: elastic and normal skin turgor, CRT less than < 3 seconds

Interventions:

1. Measure the patient's body weight each day before breakfast.
2. Measure fluid intake and urine output to fluid status.
3. Monitor urine specific gravity.
4. Check the mucous membranes in the mouth every day.
5. Determine what is the preferred fluid of patients and save the liquid in a patient's bedside, as instructed.
6. Monitor serum electrolyte levels.

Rational:

1. To help detect changes in fluid balance.
2. Decrease intake or increased fluid output increase deficits.
3. Increased specific gravity of urine indicates dehydration. Low urine specific gravity, indicating excess fluid volume.
4. Dry mucous membranes is an indication of dehydration.
5. To increase intake.
6. Changes in electrolyte values ​​may indicate the onset of fluid imbalance.