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.

Nursing Management for Chronic Kidney Disease

Chronic kidney disease or end stage renal disease (ESRD) is a progressive disorder of renal function and the irreversible failure where the body's ability to maintain metabolism and fluid and electrolyte balance, causing uremia (retention of urea and other nitrogen garbage in the blood). (Brunner & Suddarth, 2001; 1448)

Clinical Manifestations of Chronic Kidney Disease


Clinical manifestations according Suyono (2001) is as follows:

a. Cardiovascular disorders
Hypertension, chest pain, and shortness of breath due to pericarditis, pericardial effusion and heart failure due to fluid retention, heart rhythm disturbances and edema.

b. Pulmonary disorders
Shallow breathing, Kussmaul breathing, cough with thick sputum and ripples, the sound crackles.

c. Gastrointestinal disorders
Anorexia, nausea, and fomitus associated with protein metabolism in the intestine, gastrointestinal tract bleeding, ulceration and bleeding mouth, ammonia breath odor.

d. Musculoskeletal disorders
Restless legs syndrome (RLS) (pains in the legs so that it always moved), burning feet syndrome (tingling and burning, especially on the soles of the feet), tremor, myopathy (weakness and hypertrophy of the muscles of the extremities).

e. Integumentary disorders
Skin pale from anemia and yellowish due to accumulation urokrom, itching caused by toxic, thin and brittle nails.

f. Endocrine disorders
Sexual disorders: decreased fertility and erection, menstrual disorder and amenorrhea. Glucose metabolic disorders, metabolic disorders of fat and vitamin D.

g. Disorders of fluid electrolyte and acid-base balance
Usually the retention of salt and water but can also occur sodium loss and dehydration, acidosis, hyperkalemia, hypomagnesemia, hypocalcemia.

h. hematological System
Anemia is caused by reduced production eritopoetin, so that the stimulus eritopoesis in reduced bone marrow, hemolysis due to reduced life span of erythrocytes in uremia toxic atmosphere, can also malfunction thrombosis and thrombocytopenia.


Nursing Management for CKD is divided into three, namely:

1. Conservative

• Laboratory examination of blood and urine.
• Observation of fluid balance.
• Observe for edema.
• Limit fluid intake.

2. Dialysis

• Peritoneal dialysis: usually done in cases of emergency. While dialysis can be done anywhere that is not acute CAPD (Continuous Ambulatory Peritoneal Dialysis).
• Hemodialysis: Namely; dialysis is performed via invasive action in the vein by using a machine. At first hemodiliasis performed through the femoral region, but to simplify it done: arteriovenous fistula: venous and arterial combine, Double lumen: directly on the heart area (vascularity to the heart).

3. Operation

• Stone retrieval
• Kidney transplant

5 Nursing Management for Hallucinations

According May Thomas Durant (2004) hallucinations can generally be found in patients with psychiatric disorders such as: skizoprenia, depression, delirium and conditions associated with alcohol use, and environmental substances. Based on the assessment results of mental hospital patients found 85% of patients with hallucinations. So I feel compelled to write the case with the provision of nursing care ranging from assessment to evaluation.

1. Creating a therapeutic environment

To reduce the level of anxiety, panic and fear in patients affected by hallucinations, preferably at the beginning of the approach, carried out on an individual basis and keep the eye contact occurs, if the patient can touch or hold. Patients not in isolation either physically or emotionally. Each nurse came into the room or close to the patient, talk with the patient. So also when it will leave the patient should be notified. The patient was told that action will be undertaken. In that room should provide a means in which to stimulate attention and encourage patients to get in touch with reality, such as wall clocks, pictures or wall hangings, magazines and games.

2. Implement treatment programs doctor

Often patients refuse medication that is given with respect to the stimuli received hallucinations. The approach should be persuasive but instructive. Nurses must observe in order to provide correct drug ingested, as well as drug reactions is given.

3. Explores the problems of patients and help overcome existing problems.

Once the patient is more cooperative and communicative, nurses can explore issues that are causing the patient's hallucinations and help resolve any problems. This data collection can also be through the patient's description of the family or others close to the patient.

4. Giving activity in patients.

Patients were invited to enable themselves to perform physical movements, such as exercising, playing or doing activities. This activity can help steer patients to real life and cultivate relationships with other people. Patients in whom draw up a schedule of activities and choose appropriate activities.

5. Involving the family and other officers in the care process.

The patient's family and other officials should be notified about the patient data so that there is unity and continuity in the opinion of the nursing process, for example from a conversation with the patient in the know when it is alone, he often heard the man mocked. But if there are others nearby voices were not audible. The nurse suggested that the patient should not be alone and get busy in a game or activity there. This conversation should be in the patient's family and let petugaslain not to let the patient alone and advice that is given is not contradictory.

Nursing Management of Diabetic Ulcers

Nursing Management of Diabetic Ulcers

Diabetic ulcers are sores, or pain that occurs at the foot of the person who has suffered from diabetes mellitus.

Meanwhile, according to Askandar (2001) Diabetic Ulcers are sores on the feet of red-black and foul smelling due to the blockage that occurred in medium or large vessels in the legs.

The cause of diabetic ulcers

Diabetic ulcers occur because of complications of diabetes mellitus called sensory neuropathy. People with diabetes also have poor blood circulation, thereby causing injury to the toe easily or toes which can lead to ulcer / gangrene.

Diabetic ulcer wound care

• Dressing and wound control and help protect the wound from further damage.
• Keep the circulation in the legs with active passive movement.
• Control blood sugar levels.
• If necessary, collaboration with medical debridement for action.

Prevention to avoid diabetic ulcers

• For patients with diabetes mellitus are at risk for diabetic ulcers should consult immediately to health care. If you experience itching, blisters, blisters between the toes or on the skin around the toes. Pale-colored toes, aching or tingling, skin cracks and breaks, signs of inflammation.
• Clean your feet every day with water that is not too cold or hot and use a soft cloth to clean your toes.
• Use a moisturizing cream on dry skin. Not be used in between the toes.
• Prevent skin irritation on the foot.
• Maintenance / cut nails should be done with caution. Cut nails straight and smooth after immersion for 20 minutes in water, so that the nail is not hard.
• Wear clean socks every day. Socks should not be too tight so that air circulation is not obstructed.
• Avoid using tight shoes to prevent blisters.

Source : http://nanda-nursing-care-plan.blogspot.com/2012/07/nursing-management-of-diabetic-ulcers.html