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Definition

Nutrition less than body requirements is the intake of nutrients insufficient to meet metabolic needs. (Nanda. 2005-2006)

Clinical Manifestations

The clinical manifestations or signs and symptoms of nutrition less than body requirements by nursing diagnosis handbook NIC-NOC include:

A. Subjective

• Abdominal cramps
• Abdominal pain with or without the disease.
• Inability to feel for food.
• Report changes in taste sensation.
• Reported a lack of food.
• Feeling full after eating.

B. Objective

• Not interested in eating.
• Diarrhea.
• There is evidence of lack of food.
• Excessive hair loss.
• Hyperactive bowel sounds.
• Lack of interest in food.
• Sores, inflammation of the oral cavity.

Assessment

1. Nursing history and diet.

• Budget meals, favorite foods, meal times.
• Is there a special diet that is done.
• Is there a decrease and an increase in body weight and how long a period of time?
• Is there a patient's physical status to Increasing diet such as burns and fever?
• Is there a tolerance of food / beverages in particular?

2. Factors that influence diet

• The health status
• Culture and beliefs
• Socioeconomic status.
• Psychological factors.
• Misinformation about food and dieting.

3. Physical Examination

• Physical state: apathetic, lethargic
• Weight loss: obese, lean muscle: flaksia, tone less, unable to work.
• Nervous system: confusion, burning, decreased reflexes.
• Function Gastrointestinal: anorexia, constipation, diarrhea, liver enlargement.
• Cardiovascular: pulse rate more than 100 beats / min, abnormal rhythms, low blood pressure / high.
• Hair: dull, dry, reddish, thin, cracked / broken.
• Skin: Dry, pale, irritable, petechiae, no subcutaneous fat.
• Lips: Dry, cracking, swelling, lesions, stomatitis, mucous membranes pale.
• Gums: bleeding, inflammation.
• Tongue: edema, hyperemesis.
• Teeth: caries, pain, dirty.
• Eyes: conjunctiva pale, dry, exotalmus, signs of infection.
• Nails: brittle.

NURSING DIAGNOSIS AND INTERVENTION
Interventions and Rational

1. Increase intake of food through:

• Reducing interference noisy environments and others.
• Give the medication before meals if indicated.
• Keep patient privacy.

2. Keep the patient's mouth
3. Help the patient if it is not able to eat.
4. Serve foods that are easily digested, in warm, covered, and give a little
but seing.
5. Assess vital signs, sensory and bowel sounds.
6. Monitor laboratory results, such as glucose, electrolytes, albumin, hemoglobin, collaboration with physicians.
7. Provide health education about diet, calorie needs and nursing actions related to nutrition if the patient is using NGT.
8. Fluid / food is not over 150 cc one giving.

• Specific ways to increase appetite.
• Clean mouth Increasing appetite.
• Helping patients eat.
• Increase appetite and intake meal.
• Help assess the patient's condition.
• Monitor nutritional status.
• Improving the knowledge that patients more cooperative.
• Avoid aspiration

Nursing Diagnosis and Nursing Interventions for Nasopharyngeal Carcinoma

Nasopharyngeal carcinoma is a malignancy of the nasopharynx from nasopharyngeal mucosal epithelium or glands found in the nasopharynx. Nasopharyngeal carcinoma is the most carcinomas in the ENT. Most of the clients come to the ENT in a state of advanced or late.

Nursing Diagnosis: Acute Pain related to agency physical injury (surgery)

Objectives: After nursing intervention, client comfort level increases,

evidenced by the level of pain: the client may report pain in workers, frequency of pain, facial expressions, and states of physical and psychological comfort, blood pressure 120/80 mmHg, pulse: 60-100 x / min, respiration: 16-20x/mnt
Control of pain evidenced by client to report symptoms of pain and pain control.

Nursing Interventions:

Pain management:

1. Perform a comprehensive pain assessment, including the location, characteristics, duration, frequency, quality factor and precipitation.
2. Observation nonverbal reactions of discomfort.
3. Use therapeutic communication techniques to determine the client's experience of pain before.
4. Control of environmental factors that affect pain such as room temperature, lighting, noise.
5. Reduce pain precipitation factor.
6. Choose and pain management (pharmacological / non-pharmacological) ..
7. Teach non-pharmacological techniques (relaxation, distraction, etc.) to overcome the pain.
8. Give analgesics to reduce pain.
9. Evaluation of pain reducers / pain control.
10. Collaboration with the doctor if there are complaints about the administration of analgesics to no avail.
11. Monitor client's acceptance of pain management.

Analgesic administration:.

1. Check program providing analgesic; types, dosage, and frequency.
2. Check history of allergy.
3. Determine the analgesic of choice, route of administration and optimal dosage.
4. Monitor vital signs before and after the administration of analgesics.
5. Give analgesics on time especially when pain appears.
6. Evaluation of analgesic efficacy, side effects signs and symptoms.

Heart failure is the inability of the heart to pump blood in sufficient quantities to meet the networking needs for nutrients and oxygen. The fundamental mechanisms of heart failure, including damage to the contractile properties of the heart, leading to cardiac output is less than normal. Common underlying conditions including atherosclerosis, atrial hypertension, and inflammatory or degenerative disease of the heart muscle. A number of systemic factors to support the development and severity of heart failure. Increased metabolic rate (eg, fever, coma, tiroktoksikosis), hypoxia and anemia requiring an increase in cardiac output to meet the need of oxygen.

In developing countries, the most common cause is coronary artery disease leading to myocardial infarction and non-functioning myocardium (ischemic cardiomyopathy). The most common cause is an alcoholic cardiomyopathy, viral myocarditis (including HIV infection), and dilated cardiomyopathy with no definite cause (idiopathic cardiomyopathy). Hypertension remains a cause of significant congestive heart failure. Besides heart valve disease is also a cause of heart failure, but now somewhat rare heart valve disease leading to heart failure. Aortic stenosis remain common causes and can be corrected.

Pathophysiology of Heart Failure
In case of heart failure, the body has several adaptations in both the heart and systemically. If both ventricular stroke volume is reduced due to suppression of contractility or afterload was increased, the volume and end-diastolic pressure in the two chambers of the heart increased. This will increase the length of myocardial fibers end-diastolic, systolic rise time becomes shorter. If this condition persists, ventricular dilatation occurs. Cardiac output at rest but can still be good, but the increase in diastolic pressure that lasts longer / chronicle will spread to both the atrium and the pulmonary circulation and the systemic circulation. Finally, capillary pressure will increase which will lead to transudation of fluid and edema arising systemic or pulmonary edema. Decrease in cardiac output, especially if associated with a reduction in arterial pressure or decreased renal perfusion, will activate several neural and humoral systems. Increased activity of the sympathetic nervous system will stimulate myocardial contraction, heart rate and veins; recent changes that will increase blood volume sentral.yang further increase preload. Although these adaptations are designed to increase cardiac output, adaptation itself can interfere with the body. Therefore, tachycardia and increased myocardial contractility can stimulate the occurrence of ischemia in patients with coronary artery disease earlier and increased preload may worsen pulmonary congestion.

Activation of the sympathetic nervous sitem will also increase peripheral resistance; adaptation designed to maintain perfusion to vital organs, but if activation is meningkatmalah will reduce flow to the kidneys and tissues. Peripheral vascular resistance may also be a major determinant of ventricular afterload, so that excessive sympathetic activity can improve the function of the heart itself. One important effect is a decrease in cardiac output decreased renal blood flow and filtration rate decreased glomerolus, which will cause sodium and fluid retention. Sitem renin - angiotensin - aldosterone system will also be activated, leading to increased peripheral vascular resistance and a subsequent increase in left ventricular afterload as sodium and fluid retention. Heart failure is associated with increased levels of arginine vasopressin in the circulation increases, which also is vasokontriktor and inhibiting the excretion of fluids. In heart failure increased atrial natriuretic peptide due to increased atrial pressure, which indicates that here there is resistance to the effects of natriuretic and vasodilator.

Planning and Implementation

Objective

The main objective may include elimination of body waste products are adequate; reduction / elimination of pain; increased activity tolerance; obtain optimal levels of nutrients; maintain fluid and electrolyte balance; decreased anxiety; understand about the diagnosis, surgical procedures and self-care after discharge; maintain optimal tissue healing ; periostomal adequate skin protection; excavation and disclosure of feelings and problems of colostomy and its influence on the self.

1. Maintaining elimination
The frequency and consistency of bowel movements monitored.
Laxatives and enemas prescription.
Patients who show signs of progression toward total obstruction prepared for surgery.

2. Eliminate Pain
Analgesic prescription.
Environment is conducive to relaxation by dimming the lights, turning off the TV or radio, and limiting visitors and phone if desired by the patient.
Offer additional comfort measures: change of position, rubbing his back, and relaxation techniques.

3. Increasing Tolerance Activities
Assess the patient's level of tolerance activity.
Change and schedule activities to allow for an adequate period of bed rest in an attempt to reduce fatigue patients.
Komponendarah Therapy prescription when a patient suffering from severe anemia.
Improved postoperative activity and tolerance monitored.

4. Providing nutritional measures
If the patient's condition permits, a diet high in calories, protein, carbohydrates, and low preoperative residual given for several days to provide adequate nutrition and minimize peristaltic cramps by reducing excess.
Liquid Diet full 24 hours preoperatively, to replace nutrient depletion, vitamins and minerals.
Daily weighing is recorded, and the doctor notified when there is weight loss when receiving parenteral nutrition.

5. Maintaining Fluid and Electrolyte Balance
Record input and output, including vomiting, which will provide accurate data on fluid balance.
Limit entries oral food and fluids to prevent vomiting.
Give antiemetics as indicated.
Insert a nasogastric tube in the pre surgery to drain fluid and prevent the accumulation of abdominal distension.
Insert indwelling catheter to monitor urine output of every hour. Output of less than 30 ml / h was reported that intravenous fluid therapy can be adjusted.
Monitor and elktrolit IV fluids, especially serum to detect hypokalemia and hyponatremia, which occurs due to loss of gastrointestinal fluids.
Assess TTV to detect hypovolemia: tachycardia, hypotension and decreased number of beats.
Assess hydration status, decreased skin turgor, dry mucous membranes, concentrated urine, and urine specific gravity increased reported.

6. Lowers Anxiety
Assess the patient's level of anxiety and coping mechanisms used.
Efforts to provide support, including the provision of privacy when desired and instruct patients to practice relaxation.
Take time to listen to the phrase, sadness or questions raised by patients.
Set up a meeting with the pastor when the patient wants, the physician when the patient expects discussion of treatment or prognosis.
Another Stoma Patients may be asked to visit when the patient expressed an interest to talk to them.
To improve the comfort of patients, nurses must prioritize relaxation and behavioral empathy.

7. Prevent Infection
Give antibiotics such as kanamycin sulfate (Kantrex), erythromycin (erythromycin), and Neomycin Sulfate as prescribed, to reduce intestinal bacteria in preparation for bowel surgery.
Preparations given by mouth to reduce the bacterial content of the colon and soften and reduce the bulk of the contents of the colon.
Selian, the intestine can also be cleaned with enemas, or colonic irrigation.

8. Pre Operative
Assess the patient's level of need on diagnosis, prognosis, surgical procedures, and the desired level of function after surgery.
The required information about the patient's physical preparation for surgery, the appearance and maintenance of the expected post-op wound, colostomy care techniques, dietary restriction, pain control, and management of drug incorporated into the education material.

Assertive Behavior

Assertive behavior is the ability to express thoughts, feelings, opinions directly, honestly and in an appropriate manner and according to the delivery that does not hurt or harm themselves or others. Some aspects of assertive behavior, which is trying to reach the goal, the ability to express feelings, say hello or greet others, showing an effective and honest, ask the reason, talk about themselves, appreciate the compliments from others, denial, staring at the speaker, and response against fear. From the above, the possibility of assertive behavior can affect emotional intelligence.

Tips for assertive behavior that can be used are :

• Determine a definite attitude, whether you want to agree or not. If you are unsure of your choice, then you can ask for time to think until you get certainty. If you're feeling confident and will certainly your own choice, then it will be easier to declare it and you also feel more confident.
• If it is not clear what is requested to you, ask for clarity or clarification.
• Give an explanation for your rejection brief, clear and logical. Lengthy explanation would only invite arguments of others.
• Use words were firm, such as directly saying "no" to deny, rather than "I am less likely to agree .. it seems to me less agree ... I am not able to ....."
• Make sure that your posture also expresses or reflects the "language" with thoughts and verbalize your ... Often people subconsciously reject the request of others, but with the opposite attitude, such as laughing and smiling.
• Use the words "I'm not going to ...." or "I have decided to ....." from the "I can not ....". Because the words "I've decided to ...." show more assertiveness on the attitude that you show.
• If you are dealing with someone who constantly urges you but you also have repeatedly rejected, then the alternative attitudes or actions that you can do: silence, changing the subject, or even stop talking.
• You do not need to apologize for your refusal to say (because you think it will hurt or uncomfortable for others) ... Actually, you'd better say, emphatically like: "I understand that this news is not fun for you ..... but frankly I've decided to ... "
• Do not be easy to feel guilty! you are not responsible for the lives of others ... or the happiness of others.
• You can negotiate with the other side so that both sides get a middle road, without having to sacrifice feelings, desires and interests of each.

Categories assertive behavior include: the principle of assertive is a skill people to say no, to ask for help or for help of others, the ability to express feelings positive or negative, and the skills to carry out the initiative began. Forms of assertive behavior as skills, expressing emotions both verbally and non-verbally. There are 3 categories of assertive behavior: assertive refusal to soften the words, such as: sorry!, Assertive praise that express positive feelings, such as respect, love, love, admire, praise and gratitude; Third is assertive assertive demand that occurs when someone asked someone else to do something that allows a person needs or objectives achieved without pressure or coercion. In addition to those three things, anger also included one category assertive. In anger, people expressed annoyance, dissatisfaction or discrepancy between what he hopes the fact that he received (Iriani, 2009). Advantages behave assertively, by stating what a person's feelings or emotions will not be controlled by someone else, effectively interact, much appreciated others, become more confident and have a sense of satisfaction

There are seven characteristics of a person suffering from a mental disorder, if these traits can be identified by either the disorder be detected very quickly, the sooner a mental disorder is detected then the handling is also faster. Seeing the show on television that displays the number of occurrences Suicide, it is necessary that public participation suicides could be reduced.

1. Withdraw from social interaction: one begins to have a desire to be alone, have a very high imagination and enjoy an atmosphere of solitude, solitude prolonged atmosphere makes people enjoy the solitude and lead to the emergence of fantasy - fantasy false, if the fantasy - the fantasy turns into a real perception and perception is believed by the person in question will begin to speak for themselves, speak with fantasy etc.
2. Having trouble orienting time, people and places. A person experiencing an inability to remember where it is located and at what she was, a person with this orientation difficulties occur because the memory is just spin on the problem - a problem that he thinks, so he lost the ability to recognize the time and place.
3. Experiencing memory loss and severe cognitive power: when asked to perform a simple calculation then he is not able to do with ease, an easy calculation becomes a difficult task for them.
4. Neglecting appearance and personal hygiene: people with psychiatric disorders ignore the appearance and personal hygiene, self-image negativ so they assume the appearance is not important, even some people with severe mental disorders are bare and not wearing roam Everywhere - everywhere.
5. Having emotional lability: can experiencing rapid mood changes, changes fluctuating makes difficult mental disorders to be controlled, which is very light stimulus could make them angry or even sad excess excess.
6. It has a strange behavior: locked himself dikamar, talking to himself, laughed to himself, angry over a light stimulus, arrived - arrived crying, walking - paced, running without a clear direction and purpose.
7. Have an aversion to do everything: they are trying not to do anything - anything even angry when asked to do anything - anything.

If you find some of these symptoms, it is good to immediately bring the person concerned to the psychiatrist, Doctor Specialist Mental, Mental Hospital or Clinic Healing mental disorders so that patients could still be helped as soon as possible.

Definition

Schizophrenia is a chronic psychotic disorder, the person who experienced it can not assess the reality of the good and bad self-understanding (Kaplan and Sadock, 1997).

Symptom

Primary includes changes thought processes, emotional distress, willingness, and otisme. While secondary symptoms include delusions, hallucinations, catatonic symptoms.

Secondary manifestations to adjust to primary disorder. Schizophrenia is divided into several types, namely simplex, hebefrenik, catatonic, paranoid, not detailed, residual (Maslim, 2000). Of the several types of schizophrenia is given for paranoid schizophrenia. This type is characterized by a preoccupation with one or more delusions or hallucinations, and no behavioral disorganization or catatonic type. In classic paranoid type schizophrenia is characterized mainly by the presence of delusions of greatness, or delusions chase, the course of disease rather constant. Thoughts drift (flight of ideas) are more commonly found in mania, more frequent incoherence in schizophrenia (Maramis, 1998). Time criteria based on the theory of Townsend (1998), who said the condition of the client lives unpredictable, because at any time subject to change.

Delusions are beliefs about the contents of a mind that does not correspond to reality or do not match the intelligence and cultural background, firmly maintained that belief and can not be changed. Mayer-Gross in Maramis (1998) divides delusions in 2 groups, namely primary and secondary. Primary delusions arise illogical, without any external cause. Whereas secondary delusions usually sounds logical, can be followed and a way to explain other symptoms of schizophrenia, delusions named after it, one of which is the delusion of greatness

Delusions of greatness is delusional increased capacity, power, knowledge, identity, or special relationship with a deity or famous person (Kaplan and Sadock, 1997). This opinion is also supported by Kusuma (1997) which states that the degree of delusional grandeur can be stretched a mild exaggeration to actual characteristics of the psychotic delusions of greatness. Fill eg delusions patients have an important discovery or has an unknown talent or excellent health.

Etiology

a. Predisposition

1) Biology
Paranoid schizophrenia caused by central nervous system abnormalities, ie diensefalon / by post mortem changes / an artifact at a time to make preparations. Endocrine disruption also affected, this theory associated with the onset of schizophrenia at the time of puberty, pregnancy or puerperium time and time climacterium. Likewise with metabolic disorders, it is because the people who have schizophrenia appear pale and unhealthy, the tip extremity cyanosis, decreased appetite and weight loss. This theory is supported by the Adolf Meyer stating that a constitutional inferior / physical illness can affect the onset of paranoid schizophrenia.

According Schebel (1991) in Townsend (1998) also say that schizophrenia is a disability since birth, the chaos of the pyramidal cells in the brain, which the brain cells in normal neatly.

Neurological disorder that affects the limbic system and the basal ganglia are associated with the incidence of delusions. Suspicion because of a neurological disorder that is not accompanied by disturbances of intelligence, tend to have a complex delusional. While delusions are accompanied by disturbances of intelligence often a simple supposition (kaplan and Sadock, 1997).

2) Psychological
According to Carpenito (1998), clients with a feeling of suspicion projecting essentially the suspect. On the client with delusions of greatness are feeling inadequate and worthless. First time to deny his own feelings, and then projecting his feelings on the environment and end up having to explain to others. What is someone thinking about an event affect your feelings and behavior. Some of the changes in thinking, feeling or behavior will lead to other changes. The impact of the change was one of them was hallucinations, can occur in one's mind as clearly hear, see, feel, or taste of the phenomenon, according to the time, the irrational belief that ironically produced discontent, a character who "must" and "should.

3) Genetic
Heredity also determines the onset of schizophrenia. This is evidenced by studies in families with schizophrenia and especially twins one egg. Morbidity for the stepsister of 0.9 to 1.8%, siblings 7-15% of children with one parent who had schizophrenia 7-16%, if both parents had schizophrenia 40-68%, twins two eggs (heterozygot) 2-15%, one egg twins (monozygot) 61-86% (Maramis, 1998).

b. Precipitation
This factor can be sourced from internal and external.

Sociocultural stressors
Stress that accumulates to support the onset of schizophrenia and other psychotic disorders (Stuart, 1998)

psychological stressors
The intensity of high anxiety, feelings of guilt and sin, punishment of self, a sense of inadequacy, unbridled fantasy and dream-dream or hope that does not go up, is a source of suspicion. Delusions may develop if there is a great passion of wrath, insult and hurt deep.

The symptoms of delusions
Type of paranoid schizophrenia have symptoms of a typical primary delusions, accompanied by delusions and hallucinations-delusions secondary (Maramis, 1998). According to Kaplan and Sadock (1997), the condition of clients who experience delusions are:

a. Mental status
1) On mental status examination, the results showed a very normal, unless there is a clear system of abnormal delusional.
2) Mood wahamnya clients consistent with the content.
3) On suspicion suspicious, suspicious behavior obtained.
4) On the delusions of greatness, found discussion about increasing self-identity, has a special relationship with a famous person.
5) The system wahamnya, checking the possibility to feel the quality of mild depression.
6) Clients with delusions, hallucinations do not have a stand / settle, unless the client with delusions touch or smell. On some clients likely to be found hallucinations hear.

b. Sensory and cognition
1) On the supposition, there is no abnormality in orientation, except that it has specific delusions about the time, place and situation.
2) Memory and cognitive processes client is intact (intact).
3) Clients delusions almost always have insight (power point) not less ugly.
4) Clients trustworthy information unless harm him. The best decision for examiners in determining the condition of the client is to assess the behavior of the past, the present and planned.

Appendicitis Preoperative Care

1. Preoperative preparation in the treatment room

1. Observation

Within 8-12 hours after onset of complaints, signs and symptoms of appendicitis are often unclear. In this state close observation is necessary. Patients were asked to complete bed rest and fasting. Laxatives should not be given when suspected appendicitis or other forms of peritonitis. Abdominal and rectal examination and blood tests (leukocyte count and type) repeated periodically. X-ray of the abdomen and thorax erect performed to look for other possible complications. In most cases, the diagnosis is established denagn localized pain in the lower right area within 12 hours after onset of complaints.

2. Intubation if necessary

3. Antibiotics

4. Shave the area of ​​operation

Shaving the area of ​​operation is intended to prevent infection in surgery because the area is not shaved hair can be a hiding place for germs and also interfere / hinder the process of healing and wound care. Nevertheless there are certain conditions that do not require shearing before oprasi, for example in wound incision in the patient's arm.



2. Radiological examination and laboratory

1. Radiological examinations, such as: Photo thoracic, abdominal, bone photo (fracture area), USG (ultrasonography), CT scan (computerized tomography scan), MRI (Magnetic Resonance Imaging), BNO-IVP, Renogram, Cystoscopy, Mammography, CIL (Colon in the Loop), EKG / ECG (Electrocardiography), ECHO, EEG (Electroencephalography), etc..

2. Laboratory examinations, such as the examination of blood: hemoglobin, leukocyte count, lymphocyte count, erythrocyte sedimentation rate, platelet count, total protein (albumin and globulin), electrolytes (potassium, sodium, and chloride), clotting time, bleeding time, urea, creatinine, BUN , etc.. Can also be done on bone marrow examination if the disease associated with blood disorders.

Examination of Blood Sugar Levels
Examination of Blood Sugar Levels conducted to determine whether the patient's role in blood sugar levels normal range or not. Blood Sugar Testing is usually done by fasting 10 hours (fasting at 10 pm, and blood drawn at 8 am) and also examined Blood Sugar Levels 2 hour PP (post-prandial).


3. Mental and psychological preparation

Mental preparation is important in the process of preparation for the surgery, because of mental patients who are not ready or unstable can affect his physical condition.

Surgery is a potential or actual threat to a person of integrity who could evoke physiological and psychological stress reactions (Barbara C. Long)

Examples of physiological changes that arise due to anxiety / fear, among others:

1. Patients with a history of hypertension when experiencing anxiety before surgery can lead to patients difficult to sleep and blood pressure will be increased so that the operation can be canceled.
2. Female patients who are anxious about the operation to menstruate earlier than usual, so that the operation had to be postponed. Everyone has a different view in the face of the operating experience that will give a different response, but the real fear and anxiety experienced by each person is always in the face of surgery.

Various reasons can cause fear / anxiety patients face surgery include:

• Fear of pain after surgery
• Fear of physical changes, be ugly and not functioning normally (body image)
• Fear of malignancy (when the diagnosis is established is uncertain)
• Fear / anxiety experienced by people dama conditions that havethe same disease.
• Fear / horror facing the operating room, surgical equipment and personnel.
• Scared to death while sedated / unconscious again.
• Fear of the operation fails.

Fear and anxiety that may be experienced by patients can be detected by the physical changes such as:

• Increased pulse rate and respiration
• Hand movements uncontrolled
• Palms were moist
• Restless
• Asks the same question over and over again
• Difficulty sleeping
• Frequent urination.

Nurses need to assess the coping mechanisms used by the patient in the face of stress. Besides, the nurse should assess the things that could be used to assist patients in dealing with fear and anxiety, such as the nearest person, the level of the patient's progress, the supporting factors / support system.

To reduce and cope with anxiety patients, nurses can ask anything related to the preparation of the operation, such as:

• Experience previous operation
• Understanding the patient about the purpose / reason for surgery
• Knowledge of patients about physical preparation and support operations.
• Knowledge of the patient about the situation / condition of the operating room and operating room personnel.
• Knowledge of the patient about the procedure (pre, intra, post surgery)
• Knowledge of exercises to do before surgery and should
• After running operations, such as deep breathing exercises, effective cough, ROM, etc..

Inadequate mental preparation can affect the decision making of patients and their families. So it is not uncommon that patients refuse surgery previously approved and patients usually go home without surgery and a few days later came back to the hospital After feel ready and this has, to delay the operation should have been done a few days / weeks ago. Therefore, the patient's mental preparation becomes important to be noticed and supported by the family / significant other patients.

Mental preparation can be done with the help of family and caregivers. The presence and involvement of the family is very supportive patient mental preparation. Families only need to accompany the patient prior to surgery, providing patients with the prayers and support words reassuring patients and confirm the patient's decision to undergo surgery.

The role of nurses in providing mental support can be done in various ways:

1. Helping patients to know about the actions experienced by patients before surgery, to provide information to patients about the time of surgery, the things that will be experienced by the patient during the operation, showing where operating rooms, etc.. By knowing the various information during the operation it is expected that patients becoming better prepared for the operation, though there are families who do not want the patient to know about various matters related to the operation that will be experienced by the patient.

2. Giving an explanation before any operations preparatory action in accordance with the level of development. Use clear and simple language. For example: if the patient must be fasting, the nurse will explain when to start fasting and until when, useful for what, and if the blood is taken, the patient should be given an explanation of the purpose of blood tests done, etc.. Expected by providing complete information, the anxiety experienced by patients will be lowered and mentally prepare patients well.

3. Provide opportunities for patients and their families to inquire about any procedures. And provide opportunities for patients and families to pray together before patient transfer to the operating room.

4. Correcting saah understanding about surgery and other things because of misconceptions will cause anxiety in patients.

5. Collaboration with physicians associated with the provision of pre-medication drugs, such as valium and diazepam tablets before bed to decrease patient anxiety and sleep so that patients can rest needs are met.

Healthy Living are all ways that can be done to maintain and improve one's health. As these methods are:

1. Eating foods that are nutritious and balanced

Considerable evidence suggests that diet is one of the factors that affect a person's health. With the added person's age, the body's metabolic rate tends to drop, therefore, for the nutritional needs of the elderly, need to be met adequately. Caloric needs of the elderly is reduced, it is caused by the reduction of calories basis of physical activity. Calories are calories needed basis to conduct activities of the body in a state of rest, for example: for the heart, intestine, respiratory, kidney, and so on. So the calorie needs for the elderly should be tailored to their needs. Instructions for elderly menu is as follows:

1. Menu for the elderly should contain nutrients from various food ingredients consisting of: manpower agents, builders and regulators.
2. The number of calories that are good for the elderly consume 50% is carbohydrate, which is sourced from komplex carbohydrate (vegetables, legumes, whole grains).
3. Should the amount of fat in the diet is limited, especially animal fat.
4. The food should contain large amounts of fiber are derived from fruits, vegetables and various starches, which are consumed by the number of stages.
5. Using a high-calcium foods, such as non-fat milk, yogurt, fish.
6. Foods that contain large amounts of iron, such as beans, liver, spinach, or green vegetables.
7. Limit the use of salt, avoid foods that contain alcohol.
8. Food should be easy to chew.
9. Some excellent sources of nutrients should be from fresh ingredients and easy to digest.
10. Avoid foods that are too sweet, savory, and fried.
11. Eating tailored to the needs.

2. Drinking water 1.5 - 2 liters

Humans need to drink to replace lost body fluids after conducting its activities, and the water we drink at least 1.5 to 2 liters per day.

Water is of great significance for our body, because water helps the body function, prevent the onset of various diseases in the urinary tract such as bladder stones, kidney stones and others. Water is also a lubricant for the function of bone and hinges, so when the body is dehydrated, then the function, durability and flexibility also decreases bone, especially bone legs, hands and arms. Though the bones are the main support for the body to perform the activity. Another benefit of drinking water is to prevent constipation. To prepare food in the intestine so the body needs water. Of course, without enough water can not be maximal gut works, revealing constipation.

And mineral water or plain water is better than coffee, black tea, soft drinks, alcoholic beverages, ice and syrup. Even the drinks are not good for health and should be avoided, especially for the elderly who have certain diseases such as diabetes, high blood pressure, obesity and so on.

3. Regular exercise and appropriate

Increasing age, physical fitness level will drop. Decreased ability will be more visible after the age of 40 years, so when the elderly the ability to fall between 30-50%. Therefore, if the elderly want to exercise should choose according to age group, with the possibility of disease. Exercise elderly should be provided with a variety of benchmarks, such as mild or moderate loads, a relatively long time, or are aerobics and calisthenics, not competitive or play.

Some examples of exercise in accordance with the above restrictions, namely, on foot, with all forms of the game that there are elements of golf such as walking, hiking, hill climbing, gymnastics with little difficulty factor and recreational sports can be given. With human muscle exercises can further inhibit the rate of degenerative changes.

4. Rest, adequate sleep

One-third of the time in human life is to sleep. It is believed that sleep is very important for the maintenance of health and the healing of disease, because sleep beneficial to save energy, improve the body immunity and speed up the healing process as well as sleeping sickness body repair body parts that are worn. Most people will feel fresh and healthy after the break. So rest and enough sleep is essential to good health.

5. Maintain cleanliness of the body and the environment

The meaning here is not only keeping the cleanliness of the body, but also the cleanliness of the environment, space, and also the clothes in which people live. That includes cleaning the body are: a shower at least 2 times a day, wash hands before eating or after doing something with your hands, cleaning or shampooing at least 1 time a week, brush your teeth after each meal, clean the nails and holes (ears, nose, navel , anus, vagina, penis), wear shoes when out of the house and put on clean clothes.
Environmental hygiene, house or yard, away from the litter and puddles. In the room or the house, clean the dust and dirt every day, cover the food on the table. Clothing, bed linen, curtains, carpet, whole house, including the bathroom and the toilet should be cleaned periodically.
But keep in mind and realize that the physical condition necessary medapat help from others, but when the elderly are still able to be independent and only attempted briefed.

6. Taking nutritional supplements necessary

In the elderly will be a wide range of organ deterioration, so the metabolism in the body decreases. This led to meet the needs of most nutrients in most elderly are not being met adequately. Therefore, if necessary, the elderly are encouraged to consume nutritional supplements. But keep in mind and consider nutritional supplementation should be consulted and received permission from the health officer.

7. Regular health check

Periodic health examinations and health counseling are key to the success of efforts to elderly health care. Despite not being sick elderly should periodically check their health, because the periodic inspection diseases can be detected early so treatment is easier and faster, and if there are risk factors that cause the disease can be prevented. Follow the instructions and advice of a doctor or health worker, hopefully can achieve long life and stay healthy.

8. Mental and spiritual calm and balanced

To achieve the healthy life is not just physical health that must be considered, but also the mental and spiritual.

9. Recreation

To eliminate fatigue after the move for a week then do recreation. Recreation does not have to be expensive, it can be adapted premises condition and capabilities. Recreation can be done on the beach near the house, the garden near the house or yard if you have a large yard with family and children and grandchildren, sit back and relax in the open. Recreation can refresh the brain, the mind and relaxes the muscles that have been tired from daily activities.

10. Healthy relationships with others

Maintain good relationships with family and friends, because healthy living is not only sane but also must be healthy socially. With the good relationship with family and friends can make life more meaningful that will further encourage a person to keep, maintain and improve their health due to longer enjoy being with the people who loved and cherished.

11. Back to nature

As has been the case, the modern lifestyle has encouraged people to change their lifestyle such as eating fast food, canned food, bottled chili sauce, canned drinks, fruit and vegetable preserves, rarely moving because everything or work can be more easily done with the modern technology such as washing with a washing machine, sweeping the floor with a vacuum cleaner, although traveling by vehicle is near and can be done by foot. This kind of lifestyle is not good for your body and health because our bodies become spoiled, because less moving, the body becomes damaged because of unhealthy foods so that the body becomes flabby and prone diseases.

Therefore, one way to live a healthy life is back to nature or back closer to nature. We do not have to stay away from technology but at least we should avoid canned food, canned beverages, preserved foods, ready meals and have to consume more vegetables and fruits and also fresh drinking water.

12. All that is done, not excessive

To create a healthy living everything we do should not be excessive because it is not made ​​better but instead will make things worse. So do something or do it in accordance with the needs.

Appendicitis is a condition in which the appendix becomes inflamed, swollen, pus-filled. The appendix is a small pocket in the form of a small finger. It is on the right side of the abdomen, connected to the colon. Appendicitis is considered to be a serious illness and the most efficient treatment at the time being involves medical surgery. Appendicitis is therefore a surgical emergency and it can be efficiently overcome only by removing the diseased appendix from the body.

Appendicitis can be either acute or chronic. Acute appendicitis develops faster and the presence of the illness is easier to detect. Chronic appendicitis is slower to evolve and it is more difficult to diagnose. Charles Darwin's theory that although the appendix has no use for modern humans, which could have been an organ our ancestors used to digest plants. Recent studies indicate it may be a dedicated environment for friendly bacteria that aid digestion and fight infection.

Causes for appendicitis include one or more of these two factors: a difficulty within the appendix, an abnormal change in tissue accompanied by the death of cells within appendix and the attack of bacteria. Appendicitis usually occurs after an digestive tract infection, or when the tube connecting the large intestine and appendix is blocked by trapped feces or food. The causes of appendicitis may include invasion of bacteria or other microorganism. Under such circumstances, bacteria multiplies within the organ and then appendix starts to swell and then as a result gets filled with pus, a fluid formed in the infected tissue which contains white blood cell and cellular debris.

Although appendicitis can't be effectively prevented, it is thought that a diet rich in fibers may reduce the chances of developing the illness. According to statistics, appendicitis affects about 6-7 percent of the population in the United States and Europe. Statistics also indicate that in the last decade both the number of people diagnosed with appendicitis and the mortality rate of the patients have considerably decreased. However, appendicitis is a serious illness and can be life-threatening if it is not treated in time.

Appendicitis medication is most often treated with combination of surgery and antibiotics. Drug therapies like antibiotics and medications are often taken to ease nausea. An appendectomy is the removal of the appendix through a slim cut in a person's abdomen that could be several inches in length. Certain herbs and supplements also help in preventing appendicitis, strengthen the immune system, or help recover from surgery quickly. Eating green vegetables, sprouts, tomatoes, peas, beans, may offer supplemental protection against appendicitis. Acupuncture is often helpful in relieving pain, control peristalsis together with improvement in blood flow.

The main symptom of appendicitis is the pain often accompanied with fever and vomiting but tenderness at a particular point in the abdomen is often recognized as the hallmark of the disease. Appendicitis pain can affect all genders and it can occur at any age with varying levels of severity. Person feels pain in abdomen in a diffused and un-localized manner, on being asked about the location of the pain; patients typically circle the central part of the abdomen where as it is only in close vicinity. Nature of the appendicitis pain will finally localize to the right lower quadrant of the abdomen.

An interesting aspect of appendicitis is that it can be very difficult to detect and diagnose correctly, due to the unspecific character of its symptoms. In some cases, the patients might not have any symptoms at all (elderly people, people that have previously suffered surgical interventions, people with HIV, people with diabetes and overweight people). The form of appendicitis that generates no specific symptoms is called atypical appendicitis. The rate of mortality among patients with atypical appendicitis is very high.

Hyperthyroidism is when a lot of bodily hormone is made via an overactive Thyroid. Listed below are several of the general causes of hyperthyroidism: Unhealthy diet, Medications, Cancers, Having a baby as well as an auto-immune disease called Graves Disease. Indications of an overactive thyroid gland include losing weight, shakes, tremors, elevated perspiration, a regular feeling of getting very hot, insomnia, accelerated frequency of bowel motions, Pre Menstrual Tension, bigger menstruating flow, a pounding heart, goiter and protruding eyeballs. Mental health and emotional alterations such as despression symptoms, waves of rage, hostility, panic symptoms and sleepiness are also typical in the case of an overactive human gland.

Common physical findings are tachycardia and a bounding pulse with a wide pulse present with forceful apical pulse and a systolic ejection murmur due to increased flows. Cardiac arrhythmias are common, particularly supraventricular tachycardia and atrial fibrillation. Atrial fibrillation occurs in 10% to 20% of patients with hyperthyroidism. Therefore, thyrotoxicosis should always be suspectedin patients with atrial fibrillation and the thyroid function should be checked. Findings of hyperthyroidism: tachycardia, bounding pulse, forceful apical impulse, widened pulse pressure, and systolic ejection murmur. Cardiac arrhythmias are common, especially atrial fibrillation. Thyrotoxicosis in patients with atrial fibrillation.

Treatment of underlying hyperthyroidism usually leads to reversal of cardiac symptoms. If atrial fibrillation is present, the risk of embolization is high and anticoagulation should be instituted. Cardioversion should not be attempted until a euthyroid state is achieved.

Nursing Diagnosis for Hyperthyroidism

Disturbed Thought Processes related to physiological changes, increased CNS stimulation / quicken mental activity

Expected outcomes:

• Maintain reality orientation generally
• Recognizing the change in thinking / behavior and causes

Nursing Intervention:

• Assess the patient's thought processes, such as memory, attention span, orientation to place, time or person
• Note the change in behavior
• Present at reality are continuously and clearly without a fight illogical thoughts
• Provide a safe measures such as bearing on enghalang bed, soft binding tight supervision
• Encourage your family or someone close to other woods to visit paisen. Provide support as needed.

collaboration

• Giving sedatives as indicated