Nanda Books

The following contains some different types of nursing, plus a description of each, including a general overview of the daily tasks involved.

General Nursing

These professionals typically have a strong foundational knowledge in basic nursing care. They can practice in many different types of healthcare settings, including hospitals, clinics, and nursing homes. Their daily tasks involve providing stabilization care, managing stress, administering medications, and provide emergency support as needed.

Nurse Educator

Nurse educators have received advanced and special education in order to not only become registered nurses, but teachers, as well. Some may choose to be full-time educators, while others only take this position in a part time role. Typically, these professionals work in teaching hospitals and nursing schools in a general or specialized area of study. Even if an individual chooses to become a full time educator, they still need to keep current with the latest nursing methods and newest technology.

Occupational Health Nurse

OHNs work with employers and companies to design and develop health and safety programs. Their job is to understand safety and prevention methods in relation to hazardous exposure and workers' illnesses and injuries. These individuals are also typically in charge of emergency preparedness, employee treatment and follow-up, and return-to-work issues.

Intensive/Critical Care Nursing

The role of these nurses is to care for the most unstable and critically ill patients, typically found in intensive care units and emergency departments. Intensive care nurses usually specialize in treating babies, children, or adults. On a day-to-day basis, these professionals will analyze patients in critical condition, give intensive therapy, and maintain life support systems. This career is typically fast-paced and involves a complex working environment.

Diabetes Nursing

These nurses work primarily with patients who have diabetes. Most of their time will be spent helping patients monitor their blood sugar and giving nutritional therapy. These nurses will also be well-versed in the proper diet, exercise, and lifestyle those with diabetes should lead. Some diabetes nurses choose to become diabetes educators, or diabetes nurse consultants.

Social isolation is a state where an individual has decreased or even not at all able to interact with others around them. Patients may feel rejected, not accepted, lonely, and unable to foster meaningful relationships with others.

Social isolation is a lonely condition is expressed by the individual and perceived as being caused by others and as a negative situation that threatens. With characteristics: living alone in the room, inability to communicate, withdrawal, lack of eye contact. Discrepancies or immaturity interests and activities with the development or the age. Preoccupation with his own thoughts, repetition, no meaningful action. Expressing feelings of rejection or loneliness caused by others. Experience different feelings with others, feel uncomfortable with people.

Behavior on the client include:

• Less spontaneous.
• Apathetic (not / ignore environment).
• Moody facial expression.
• Do not want to take care of himself and not pay attention to personal hygiene.
• Reduction or absence of verbal communication.
• No or less conscious environment.
• Intake disturbed eating and drinking.
• Urinary retention and vases.
• Decreased activity.
• Lack of self-esteem.

Stress triggers, generally include stressful life events such as loss, which affects an individual's ability to relate to others and cause anxiety.

Stress triggers, can be grouped into two categories, among others:
1) sociocultural stressors
Stress is caused by social and cultural communities. Events or changes in the socio-cultural life sparked trouble for dealing with others and how to behave.
2) psychological stressors
Stress is caused due to prolonged anxiety and the individual does not have the ability to cope.

Coping Mechanisms

Defense mechanism that is often used on each social disorder are:
1) regression, the progress or retreat behavior.
2) projection, the weakness and lack of self-posed to others.
3) repression, which override impulse or painful memories.
4) isolation, which shy away from interaction with the outside environment.

Assessment

Assessment in patients with social isolation can be done through interviews and observations:

1. The Patient tells feeling lonely or rejected by others.
2. The patient does not feel safe being with other people.
3. The patient said that does not mean the relationship with others.
4. The Patient feel slow and tired of spending time.
5. The patient is not able to concentrate and make decisions.
6. The patient feel worthless.
7. The patient not sure it can continue living.

Nursing Diagnosis and Interventions for Social Isolation

Social isolation: Withdrawn

General purpose: Clients can interact with other people.

Specific purpose:

1. Patients can develop a trusting relationship.
2. Patients can be aware of the causes of social isolation.
3. Patients can interact with other people.

Outcomes:

1. Patients are able to communicate well with the nurses.
2. Patients can mention the causes and signs of withdrawing.
3. Patients are able to interact with caregivers, family, and other patients.

Interventions:

1. Fostering a trusting relationship:

• Say hello to the patient, each time interacting with patients.
• Acquainted with the patient: introduce full name and the name of the nurse call, and ask the patient's full name and nickname patients.
• Ask the patient's feelings and complaints at this time.
• Create a care contract: what nurses will do with the patient, how long it will be done and where the implementation of activities.
• Explain that the nurses will keep confidential the information obtained for the purposes of therapy.
• Show empathy to the patient at all times.
• Fulfill the basic needs of the patient if possible.

2. Helping patients to know the cause of social isolation by means of:

• Ask the patient habit, about the habits of interacting with others.
• Ask causes the patient does not want to interact with others.

3. Helping the patient to recognize the benefits associated with others by sharing the benefits if the patient has a lot of friends.

4. Help patients recognize losses not related to the others, with:

• Discuss the disadvantages, if the patient just shut up and do not get along with others.
• Explain the effect of social isolation on the physical health of the patient.

5. Provide the opportunity to express their feelings can help reduce stress and causes feelings withdraw.


Therapy

Therapeutic group activities: socialization
Therapeutic group activities: socialization is an effort to facilitate the client's ability to socialize with a number of social relationship problems.

Goals:
1. The client is able to introduce their own self-
2. The client is able to get acquainted with members of the group
3. The client is able to converse with members of the group
4. The client is able to convey and discuss the topic conversation
5. The client is able to convey and discuss personal problems to others
6. The client is able to work together in a group socialization game
7. The client is able to express an opinion on the benefits of the activities undertaken.

Setting:
1. Client and therapist, sitting together in a circle
2. The room was comfortable and quiet

Tools
1. Tape recorder
2. Cassette
3. Tennis ball
4. Notebook and pen
5. Schedule patient activity

Methods:
1. Group dynamics
2. Discussion and Q & A
3. Playing the role / simulation

Step activity
1. Preparation
a. Selecting the client as indicated
b. Make contracts with clients
c. Prepare equipment and meeting place

2. Orientation
At this stage the therapist do:
a. Give therapeutic greetings: greetings from therapists
b. Evaluation / validation: asking patients at this time
c. contract:
1) identifies the purpose of activities, which introduce self-own.
2) Explain the following rules
- If there are clients who will leave the group to ask for permission to the client
- Length of activity 45 minutes
- Each client follow up activities completed

3. stage of work
a. Describe the activity, ie cassette tape recorder is turned on and the ball will be circulated counter-clockwise (ie towards the left) and when the tape off the members of the group who held the ball introduce himself.
b. Turn on the tape recorder and tape the opposite tennis balls circulate clockwise.
c. When the tape off, members of the group that holds the ball can turn to mention: greetings, full name, nicknames, hobbies and origin started by therapists as an example.
d. Write nicknames on paper / board name and paste / use
e. Repeat the activity b, c, d until all members of the group gets a turn
f. Give credit to the success of each member of the group members applause.

Nursing care plan for cancer is a guideline in providing care for cancer patients. And made reference to nurses to provide care for cancer patients. Nursing Care Plan for cancer, there are many types, depending on the type of cancer that occurs. For breast cancer, skin cancer, etc.. So expect any patients suffering from a cancer can be given optimal service.

Differentiated cancer based on tissue of origin. For mesodermal tissue that consists of connective tissue, bone, cartilage, fat, muscle to blood vessels called sarcoma.

Osteosarcoma, the bone cancer. And carcinoma is a cancer that is in the epithelial tissue, such as the mucous membranes and glands such as breast cancer, ovarian cancer, and lung cancer. Then myeloma on bone marrow cancers, while blastoma for blood cancers.

There is a term metastatic. Metastasis is the ability of cancer cells to move from one place to another. This switching capability that makes cancer so dangerous because it makes the cancer spread and invade multiple organs at once. Migration of cancer cells from one place to another can be through the blood vessels, lymph vessels, tissue sticking, and in the body cavity.

Regarding the treatment of cancer, there are three main treatment in patients with cancer, through surgery, radiotherapy, and chemotherapy. Surgery is done if the cancer tumor is still small conditions.

Surgery is also not alone, but is usually accompanied by radiotherapy and chemotherapy. On radiotherapy, used laser light (X-rays) to kill cancer cells and is done only in part affected by cancer. It is intended to create damage in other tissues, while chemotherapy to destroy any remaining cancer cells in the body.

In the nursing care plan for cancer, nurses have a very important role, so that the healing process of patients, can take place smoothly. Nurse's role in providing support to patients by diagnosis.

Nurses also find out, psycho-social needs of patients and the spiritual. Nurses also must meet the fluid needs, and patient nutrition in addition to helping clients to succeed through the healing phase. Nurse roles are very important, described in detail in the nursing care for cancer.

Nursing interventions, is the handling of the patient based on conditions.

Nursing interventions, such as the condition of the patient based on the risk of infection, risk of bleeding, the risk of impaired tissue perfusion, fluid balance disorders, and other risks.

Professional nurses are needed in the treatment of cancer and other diseases. Important guidelines to realize that professional nurses and responsive in dealing with cancer.

Osteomalacia, or soft bones, often develops because of a lack of vitamin D. It causes severe bone pain and muscle weakness. In Victorian times the condition often affected children and was called rickets, but today osteomalacia usually affects adults, especially the elderly and/or people of South Asian origin.

The causes of adult osteomalacia are varied, but ultimately result in a vitamin D deficiency:

• Insufficient nutritional quantities or faulty metabolism of vitamin D or phosphorus
• Renal tubular acidosis
• Malnutrition during pregnancy
• Malabsorption syndrome
• Hypophosphatemia
• Chronic renal failure
• Tumor-induced osteomalacia
• Long-term anticonvulsant therapy
• Coeliac disease
• Cadmium poisoning, Itai-itai disease

Symptoms of osteomalacia can include:

• pain felt in your bones – usually felt in your legs, groin, knees and feet
• muscle weakness – usually affects your thighs, shoulders and main trunk of your body
• back pain
• pain caused by slight cracks in the bone (partial fractures) – sometimes these cracks can turn into complete breaks (complete fractures)

As the condition gets worse, pain can be felt everywhere and any movement can be painful.

Osteomalacia in adults starts insidiously as aches and pains in the lumbar (lower back) region and thighs, spreading later to the arms and ribs. The pain is symmetrical, non-radiating and is accompanied by sensitivity in the involved bones. Proximal muscles are weak, and there is difficulty in climbing up stairs and getting up from a squatting position.

Due to demineralization bones become less rigid. Physical signs include deformities like triradiate pelvis and lordosis. The patient has a typical "waddling" gait. However, those physical signs may derive from a previous osteomalacial state, since bones do not regain their original shape after they become deformed.

Pathologic fractures due to weight bearing may develop. Most of the time, the only alleged symptom is chronic fatigue, while bone aches are not spontaneous but only revealed by pressure or shocks.

It differs from renal osteodystrophy, where the latter shows hyperphosphatemia.

Patients who have osteomalacia can take vitamin D, calcium, or phosphate supplements, depending on the individual case. For instance, people with intestinal malabsorption (the intestines cannot absorb nutrients or vitamins properly) may need to take larger quantities of vitamin D and calcium.

Other treatments to relieve or correct osteomalacia symptoms may include:

• Wearing braces to reduce or prevent bone irregularities
• Surgery to correct bone deformities (in severe cases)
• Adequate exposure to sunlight

Prostate cancer is one of the 10 most common diseases that afflict man. Unfortunately, men often are not aware of him until the disease is spread and more difficult to treat. This could be due to too many symptoms. At least, there is a way to recognize the symptoms of prostate cancer. Let us look at the following signs and symptoms:

1. Difficult urination

Could be a feeling of wanting to urinate but nothing comes out, stop when you're urinating, there is still a feeling of wanting to urinate or have to travel frequently to the toilet to urinate due out a little bit. This phenomenon is due to enlargement of the prostate gland is around the urinary tract due to a tumor in it so disturbing voiding process. The prostate gland will be greater with age a person. So check with your doctor to distinguish whether only prostate enlargement or cancer.

2. Pain during urination

This problem is also due to prostate tumors that suppress the urinary tract. However, pain can also be a symptom of prostate infection called prostatitis. It could also be a sign of prostate hyperplasia is not cancerous.

3. Bleeding during urination

These symptoms are rare, but should not be ignored. Immediately see a doctor even if only a little blood ejected, or only faint faint pink. Sometimes a urinary tract infection can also cause these symptoms.

4. Hard erection or sustain an erection

Prostate tumors may cause blood flow to the penis which should increase the time of the erection becomes blocked so hard erection. Could also cause an erection can not ejaculate after. But once again, an enlarged prostate may cause these symptoms.

5. Blood in semen

These symptoms, such as blood in the urine, may arise not so clear. Blood in large quantities and not just cause the color changed to pink. Still worth on alert.

6. Difficult defecation and no other gastrointestinal problems

The prostate gland is located below the bladder and in front of the rectum. As a result, when there is impaired intestinal tumors. But remember, difficult defecation Persistent could also lead to an enlarged prostate gland due to pressure on a continuous basis. Difficult defecation and gastrointestinal disorders may also indicate colon cancer.

7. Continuous pain in the lower back, pelvis or upper thighs

Frequently, prostate cancer spreads in these regions, ie at the lower back, pelvis and hip pain that is difficult to explain in this section can be a sign of disturbance

8. Frequent urination at night

If you often wake up at night more than once just to urinate, check immediately to the doctor.

9. Urine dripping or not strong enough

These symptoms similar to urinary incontinence (wetting). Urine can not be held until slowly out and drip. Or if it was not strong enough flow out.

10. The age of 50 and have risk factors

Because it does not cause symptoms, men who have risk factors should be screened routinely. These risk factors include a family member who had cancer, especially if it's the father, obesity / overweight and smoking is a risk factor for prostate cancer.

Nasopharyngeal carcinoma is a rare tumor arising from the epithelium of the nasopharynx.

Nasopharyngeal carcinoma is difficult to detect early. That's probably because the nasopharnyx isn't easy to examine and symptoms of nasopharyngeal carcinoma mimic those of other more common conditions.

Three subtypes of NPC are recognized in the World Health Organisation (WHO) classification [20]:

• type 1: squamous cell carcinoma, typically found in the older adult population

• type 2: non-keratinizing carcinoma

• type 3: undifferentiated carcinoma

Possible noticeable symptoms of nasopharyngeal carcinoma include:

• A lump in your neck caused by a swollen lymph node
• Blood in your saliva
• Bloody discharge from your nose
• Nasal congestion
• Hearing loss
• Frequent ear infections
• Headaches

Staging of Nasophayngeal Carcinoma

Staging of Nasophayngeal Carcinoma is based on clinical and radiologic examination. Most patients present with Stage III or IV disease.

Stage I is a small tumor confined to nasopharynx.

Stage II is a tumor extending in the local area, or that with any evidence of limited neck (nodal) disease.

Stage III is a large tumor with or without neck disease, or a tumor with bilateral neck disease.

Stage IV is a large tumor involving intracranial or infratemporal regions, an extensive neck disease, and/or any distant metastasis.

No sure way exists to prevent nasopharyngeal carcinoma. However, if you're concerned about your risk of nasopharyngeal carcinoma, you may consider avoiding habits that have been associated with the disease. For instance, you may choose to cut back on the amount of salt-cured foods you eat or avoid these foods altogether.

Treatment for nasopharyngeal carcinoma usually involves radiation therapy, chemotherapy or a combination of the two. You can work with your doctor to determine the exact approach depending on your particular situation.

Thyroid storm, also referred to as thyrotoxic crisis, is an acute, life-threatening, hypermetabolic state induced by excessive release of thyroid hormones (THs) in individuals with thyrotoxicosis.

Symptoms of Thyroid Storm

• Rapid heart beats (palpitations)
• Greatly increased body temperature
• Chest pain
• Shortness of breath
• Anxiety and irritability
• Disorientation
• Increased sweating
• Weakness
• Heart failure

Diagnosis of Thyroid Storm

The following tests are usually performed to diagnose thyroid storm:

• blood cell count,
• electrolyte levels,
• blood sugar level,
• liver function, and
• thyroid hormone levels.

Investigations of Thyroid Storm

• Investigations for any underlying precipitant - eg, infection screen.
• TFTs: elevated T3 and T4 levels, elevated T3 uptake, suppressed TSH levels.
• Indications of decompensation of homeostasis - eg, renal dysfunction, elevated creatine kinase, electrolyte imbalance (due to dehydration), anaemia, thrombocytopenia, raised white cell count, abnormal LFTs (raised levels of transaminases, lactate dehydrogenase, alkaline phosphatase and bilirubin), hypercalcaemia, hyperglycaemia.
• ECG.
• CXR.
• Arterial blood gases and pH.

Thyroid Storm Self-Care at Home

People experiencing thyroid storm are not able to function normally. Thyroid storm is always a medical emergency. People experiencing symptoms of thyroid storm should be taken to the closest hospital, because thyroid storm is a life-threatening condition.

Glaucoma is an eye disease in which the optic nerve is damaged in a characteristic pattern. This can permanently damage vision in the affected eye(s) and lead to blindness if left untreated.

Glaucoma is a disease that steals the sight of people around the world -- and they typically don't even know they have the disease until it has permanently destroyed at least 40 percent of their vision.

Symptoms of Glaucoma

Glaucoma often is called the "silent thief of sight," because most types typically cause no pain and produce no symptoms until noticeable vision loss occurs.

For this reason, glaucoma often progresses undetected until the optic nerve already has been irreversibly damaged, with varying degrees of permanent vision loss.

But with acute angle-closure glaucoma, symptoms that occur suddenly can include blurry vision, halos around lights, intense eye pain, nausea and vomiting. If you have these symptoms, make sure you see an eye care practitioner or visit the emergency room immediately so steps can be taken to prevent permanent vision loss.

Risk Factors of Glaucoma

• Age over 45 years
• Family history of glaucoma
• Black racial ancestry
• Diabetes
• History of elevated intraocular pressure
• Nearsightedness (high degree of myopia), which is the inability to see distant objects clearly
• History of injury to the eye
• Use of cortisone (steroids), either in the eye or systemically (orally or injected)
• Farsightedness (hyperopia), which is seeing distant objects better than close ones (Farsighted people may have narrow drainage angles, which predispose them to acute [sudden] attacks of angle-closure glaucoma.)

Treatments of Glaucoma

Treatment can involve glaucoma surgery, lasers or medication, depending on the severity. Eye drops with medication aimed at lowering IOP usually are tried first to control glaucoma.

Because glaucoma often is painless, people may become careless about strict use of eye drops that can control eye pressure and help prevent permanent eye damage.

In fact, non-compliance with a program of prescribed glaucoma medication is a major reason for blindness caused by glaucoma.

If you find that the eye drops you are using for glaucoma are uncomfortable or inconvenient, never discontinue them without first consulting your eye doctor about a possible alternative therapy.

Aortic stenosis is the obstruction of blood flow across the aortic valve. The aortic valve has three flaps (cusps). Blood flows through the valve when the left ventricle contracts at the early part of the heartbeat. When the left ventricle relaxes, the aortic valve closes. Then the mitral valve opens to allow more blood into the ventricle ready for the next heartbeat.

The main causes of aortic stenosis include:

• A birth defect of the aortic valve, which normally has three cusps:

• An aortic valve that has only one cusp or is otherwise stenotic from birth
• A bicuspid (two-part) aortic valve with progressive wear and tear

• Progressive calcification of the aortic valve with age (most common in elderly)
• Rarely, scarring of the aortic valve caused by Rheumatic Fever

The classic triad of symptoms in patients with aortic stenosis is as follows :

• Chest pain: Angina pectoris in patients with aortic stenosis is typically precipitated by exertion and relieved by rest
• Heart failure: Symptoms include paroxysmal nocturnal dyspnea, orthopnea, dyspnea on exertion, and shortness of breath
• Syncope: Often occurs upon exertion when systemic vasodilatation in the presence of a fixed forward stroke volume causes the arterial systolic blood pressure to decline

Emergency Care for Aortic Stenosis

A patient presenting with uncontrolled heart failure should be treated supportively with oxygen, cardiac and oximetry monitoring, intravenous access, loop diuretics, nitrates (remembering the potential nitrate sensitivity of patients with aortic stenosis), morphine (as needed and tolerated), and noninvasive or invasive ventilatory support (as indicated). Patients with severe heart failure due to aortic stenosis that is resistant to medical management should be considered for urgent surgery.

Sleep is a routine activity that can rest your mind and soul. But too many of us ignore the hours of sleep. This is due to various factors such as tasks that have been piling up, playing games or browsing the Internet and other activities. Therefore, it is very difficult to get quality sleep for your health. Then, how to get quality sleep ....???

There are so many consequences that can result from reduced hours of sleep you have. Problems with weight, less passionate, troubled heart and body are susceptible to various diseases is the lack of impact of your daily bedtime. Thus the importance of quality sleep tips you should know. Companions, health tips. Here are tips for better sleep quality:

1. Keep doing morning sports activities on a regular basis. This is because, Sports that you do every morning will help you to fall asleep faster at night. So the quality sleep you can get by very easily.

2. Try to create a regular schedule for your sleep every night. By making a night time sleep schedule, then automatically you can get quality sleep easily anyway.

3. Try not to eat foods that are too filling your stomach in while going to sleep. This is because, that too very full stomach will lead to trouble sleeping. A light dinner are strongly advised to make your evening more quality sleep.

4. Try not to carry a cell phone or mobile phone in your bed. So you will not be doing activities like call someone or sms air with someone who can disturb your sleep. So the quality sleep you can easily get away with a cell phone or mobile phone of your bed.

5. Try to turn off your bedroom light before you sleep at night. With the room lights were extinguished will make you sleep more soundly. So the quality sleep you will be able to fulfill.

6. Get to know your habits before bed. So you will be easier to prepare everything to be able to sleep on time and get quality sleep anyway.

7. If you are someone who is always associated with computers, you should turn off your computer when your sleep schedule has arrived. But it is advisable to rest your brain and mind for half an hour before you sleep. So that your mind is more calm and you sleep more soundly and getting quality sleep anyway.

Herpes zoster commonly known as shingles and also known as zona, is a viral disease characterized by a painful skin rash with blisters in a limited area on one side of the body, often in a stripe.

Anyone who has recovered from chickenpox may develop shingles, including children. However, shingles most commonly occurs in people 50 years old or older. The risk of getting shingles increases as a person gets older. People who have medical conditions that keep the immune system from working properly, like cancer, leukemia, lymphoma, and human immunodeficiency virus (HIV) infections, or people who receive drugs that weaken the immune system, such as steroids and drugs given after organ transplantation, are also at greater risk to get shingles.

Shingles usually starts as a rash on one side of the face or body. The rash starts as blisters that scab after three to five days. The rash usually clears within two to four weeks.

Before the rash develops, there is often pain, itching, or tingling in the area where the rash will develop. Other symptoms of shingles can include fever, headache, chills, and upset stomach.

Diagnosis of Herpes zoster

The diagnosis of herpes zoster is usually clinical, with laboratory tests reserved for more atypical cases. The ideal specimen is a swab from the base of burst new vesicles in viral transport
medium. This can be processed for direct fluorescent antibody testing (1–2 hour turnaround time), DNA testing by PCR (turnaround time of one day, but more sensitive especially in older lesions) and
viral culture (takes 1–2 weeks and is less sensitive than PCR). Serology for antibodies to varicella zoster virus usually adds little to the diagnosis and may be falsely negative in early
presentation due to waning IgG antibodies below detectable levels.

Pain Management of Herpes zoster

Treating the pain associated with herpes zoster, particularly in the acute stage, is considered an integral component of management and may have benefits in reducing the severity and incidence of
postherpetic neuralgia. This should follow a stepwise approach based on current Australian guidelines.11 These have been summarised in Table 1. Of note, one double-blind randomised controlled trial showed a reduction in incidence of postherpetic neuralgia at six months by about half with early (within 48 hours of rash
onset) commencement of low-dose amitriptyline 25 mg at night (for 90 days) although caution must be used when treating the elderly.12
Pharmacological management of postherpetic neuralgia follows a similar stepwise approach and may additionally involve the use of gabapentin or pregabalin and topical capsaicin. Transcutaneous
electrical nerve stimulation (TENS) may also be useful.

Osteoarthritis is the most common form of arthritis. Osteoarthritis is a joint inflammation that results from cartilage degeneration. It causes pain, swelling, and reduced motion in your joints. It can occur in any joint, but usually it affects your hands, knees, hips or spine.

For many, although by no means everyone, arthritis seems to be an inevitable part of the aging process, and there are no signs of long-lasting cures in the immediate future. On the positive side, advances in both conventional medical treatment and alternative therapies make living with arthritis more bearable.

Risk factors of Osteoarthritis include:

• Older age
• Having family members with OA
• Obesity
• Joint injury or repetitive use (overuse) of joints
• Joint deformity such as unequal leg length, bowlegs or knocked knees.

The main symptoms of osteoarthritis are:

• pain (particularly when you’re moving the joint or at the end of the day)
• stiffness (especially after rest – this usually eases after a minute or so as you get moving)
• crepitus, a creaking, crunching, grinding sensation when you move the joint
• hard swellings (caused by osteophytes)
• soft swellings (caused by extra fluid in the joint)

Other symptoms can include:

• the joint giving way because your muscles have become weak or the joint structure is less stable
• the joint not moving as freely or as far as normal
• the muscles around your joint looking thin or wasted

Cardiogenic shock is a physiologic state in which inadequate tissue perfusion results from cardiac dysfunction, most often systolic. The most common causes are serious heart complications. Many of these occur during or after a heart attack (myocardial infarction).

Cardiogenic shock most commonly occurs as a complication of acute myocardial infarction (MI). It occurs in 7% of patients with ST-segment elevation MI and 3% with non ST-segment elevation MI. It is a medical emergency requiring immediate resuscitation.

Cardiogenic shock can result from the following types of cardiac dysfunction:

• Systolic dysfunction
• Diastolic dysfunction
• Valvular dysfunction
• Cardiac arrhythmias
• Coronary artery disease
• Mechanical complications

Symptoms of Cardiogenic shock

• Chest pain or pressure
• Coma
• Decreased urination
• Fast breathing
• Fast pulse
• Heavy sweating, moist skin
• Lightheadedness
• Loss of alertness and ability to concentrate
• Restlessness, agitation, confusion
• Shortness of breath
• Skin that feels cool to the touch
• Pale skin color or blotchy skin
• Weak (thready) pulse

Prevention of Cardiogenic shock

Early coronary revascularisation in patients post-myocardial infarction (MI) and adequate treatment of patients with structural heart disease may help to prevent cardiogenic shock.
Better treatment of acute coronary syndrome seems to be reducing the rates of cardiogenic shock.

Multiple sclerosis is a chronic disease that attacks the central nervous system, i.e. the brain, spinal cord and optic nerves. In severe cases the patient becomes paralyzed and/or blind, while in milder cases there may be numbness in the limbs.

People with multiple sclerosis (MS) tend to have their first symptoms between the ages of 20 and 40. Usually the symptoms get better, but then come back. Some may come and go, while others linger.

According to the National Health Service, UK, approximately 100,000 people live with multiple sclerosis in Great Britain. Symptoms usually appear initially between 15 and 45 years of age. Women are twice as likely to get MS than men.

11 Common Symptoms of Multiple Sclerosis :

1. Bladder problems: About 8 in 10 people have bladder problems, which can be treated. You may need to pee often, urgently, need to go at night, or have trouble emptying your bladder fully. Bowel problems, especially constipation, are also common.

2. Dizziness: It's common to feel dizzy or lightheaded. You usually won't have vertigo, or the feeling that the room is spinning.

3. Abnormal sensations: People with MS often say they feel a "pins and needles" sensation. They may also have numbness, itching, burning, stabbing, or tearing pains. About half of people with MS have these uncomfortable symptoms. Fortunately, they can be managed or treated.

4. Fatigue: About 8 in 10 people feel very tired. It often comes on in the afternoon and causes weak muscles, slowed thinking, or sleepiness. It's usually not related to the amount of work you do. Some people with MS say they can feel tired even after a good night's sleep.

5. Difficulty walking: MS can cause muscle weakness or spasms, which make it harder to walk. Balance problems, numb feet, and fatigue can also make walking difficult.

6. Sexual difficulties: These include vaginal dryness in women and erection problems in men. Both men and women may be less responsive to touch, have a lower sex drive, or have trouble reaching orgasm.

7. Muscle spasms: They usually affect the leg muscles. For about 40% of people they are an early symptom of MS. In progressive MS, muscle spasms affect about 6 in 10 people. You might feel mild stiffness or strong, painful muscle spasms.

8. Thinking problems: About half of people with MS have trouble concentrating that comes and goes. For most, this means slowed thinking, poor attention, or fuzzy memory. Rarely, people can have severe problems that make it hard to do daily tasks. MS usually does not change your intellect and ability to read and understand conversation.

9. Speech problems: Sometimes MS can cause people to pause a long time in between words and have slurred or nasal speech. Some people also develop swallowing problems in more advanced stages of MS.

10. Vision problems: Problems with your eyes tend to be one of the first symptoms. They usually affect only one eye and go away on their own. Your sight may be blurry, gray, or have a dark spot in the center. You may suddenly have eye pain and temporary vision loss.

11. Tremors: About half of people with MS have tremors. They can be minor shakes or make it hard to manage everyday activities.

Rabies is a viral disease that causes acute encephalitis in warm-blooded animals. The rabies virus travels to the brain by following the peripheral nerves. The incubation period of the disease is usually a few months in humans, depending on the distance the virus must travel to reach the central nervous system. Once the rabies virus reaches the central nervous system and symptoms begin to show, the infection is virtually untreatable and usually fatal within days.

Rabies Symptoms

Rabies symptoms and signs occur after exposure and may consist of some or many of the following: odd behaviors, delirium, combativeness, loss of muscle function, muscle spasms, drooling, convulsions, pain, and other problems.

Although the majority of rabies infections worldwide originate from bites from infected dogs, other animals (for example, bats, foxes, raccoons, coyotes, wolves) may transmit the disease. Saliva from infected animals and bat guano may also transmit the rabies virus to humans under certain conditions.

Rabies Prevention

Prevention of rabies depends on decreasing the disease in the animal kingdom. Avoid contact with wild animals and strays. Have your pets (including cats, dogs, and ferrets) vaccinated against rabies. Keep pets under control and away from wild animals and strays. Call animal-control services to remove stray animals from your neighborhood.

Rabies Diagnostic

Diagnostic tests for rabies exposure usually involve taking tissue samples (often brain tissue) from the potentially rabies-infected animal exposed to the patient and using immunofluorescence or other immunological techniques to detect the virus in the animal tissue.

Gastritis is inflammation of the stomach lining. The main acute causes are excessive alcohol consumption or prolonged use of nonsteroidal anti-inflammatory drugs (also known as NSAIDs) such as aspirin or ibuprofen. In some cases, the stomach lining may be "eaten away," leading to sores (peptic ulcers) in the stomach or first part of the small intestine. Gastritis can occur suddenly (acute gastritis) or gradually (chronic gastritis). In most cases, gastritis does not permanently damage the stomach lining.


In many cases, gastritis has no symptoms. Common symptoms can include:

• Loss of appetite
• Pain in the upper abdomen just under the ribs
• Nausea or indigestion
• Hiccups
• Vomiting
• Blood in the vomit
• Blood in the bowel actions, if the stomach lining has ulcerated (this turns stools black and is called melaena)
• Weight loss.

Diagnosis:

Several tests can be used to make a diagnosis. These include endoscopy of the stomach, where a thin tube with a light and a camera on the end is inserted down your throat into your stomach. This allows the doctor to see into your stomach and take samples (called a biopsy) from the lining if needed. The laboratory tests you may need will depend on the cause of your gastritis. A stool test may be used to check for the presence of blood, or a biopsy may be taken of the tissues of your esophagus or stomach. A breath test may detect H. pylori, or samples from your esophagus or stomach may be taken to look for this bacteria.


Nursing Assessment for Gastritis

• During the gathering health history, the nurse asked about the signs and symptoms in patients.
• Does the patient have heartburn, can not eat, nausea or vomiting?
• Does the patient have symptoms occur at any time, before or after meals, after ingesting spicy foods or irritants or after ingesting certain drugs or alcohol?
• Does the patient have symptoms associated with anxiety, stress, allergies, eating or drinking too much, or eating too fast? how the symptoms disappear?
• Is there a history of previous gastric or stomach surgery?
• Historical diet plus a new type of diet eaten for 72 hours, would help.
• Full history is essential in helping nurses to identify whether excess dietary frivolous known, associated with current symptoms, whether others in the same patient has symptoms, whether the patient vomited blood, and if the elements are known to have ingested causes.

Nursing Diagnosis for Gastritis

Based on all the data assessment, nursing diagnosis is the major include the following:

1. Anxiety related to treatment.
2. Imbalanced Nutrition, Less Than Body Requirements related to inadequate nutrient inputs.
3. Risk for Fluid Volume Deficit related to insufficient fluid intake and excessive fluid loss due to vomiting.
4. Knowledge Deficit: on the management of diet and disease processes.
5. Acute Pain related to gastric mucosal irritation.

Peptic Ulcer Disease is the most common ulcer of an area of the gastrointestinal tract that is usually acidic and thus extremely painful. Four times as many peptic ulcers arise in the duodenum—the first part of the small intestine, just after the stomach—as in the stomach itself.

The main symptom of peptic ulcer is upper abdominal pain which can be dull, sharp, or burning. (Bloating and burping are not symptoms of peptic ulcer, and vomiting, poor appetite, and nausea are uncommon symptoms of peptic ulcer.)

Symptoms of a peptic ulcer can be :

• abdominal pain, classically epigastric strongly correlated to mealtimes. In case of duodenal ulcers the pain appears about three hours after taking a meal;
• bloating and abdominal fullness;
• waterbrash (rush of saliva after an episode of regurgitation to dilute the acid in esophagus - although this is more associated with gastroesophageal reflux disease);
• nausea, and copious vomiting;
• loss of appetite and weight loss;
• hematemesis (vomiting of blood); this can occur due to bleeding directly from a gastric ulcer, or from damage to the esophagus from severe/continuing vomiting.
• melena (tarry, foul-smelling feces due to oxidized iron from hemoglobin);
• rarely, an ulcer can lead to a gastric or duodenal perforation, which leads to acute peritonitis. This is extremely painful and requires immediate surgery.

Prevent and Treat Peptic Ulcer Disease Naturally

The best efforts to prevent ulcer disease is to eat on time, that is regular and not excessive, a balanced lifestyle and healthy, hygiene, and avoid stress.

As for treating ulcer disease can naturally use the following herbal ingredients:

The first drug ulcer disease (Avocado)

Ulcer disease, the first drug that is using avocado fruit seeds. To make it, wash the avocado seed, with boiled water, then grated avocado seed and mix 100 cc of boiled water with grated avocado seed before, then strain.

Rules used ulcer drugs:
mild ulcer disease, drinking juice avocado seeds 1 a day;
Chronic ulcer disease, drinking juice avocado seed 2 times a day, morning and evening, until healed.

The second drug ulcer disease (Turmeric)
The second ulcer drug use turmeric herb. To make it, take 2 segment turmeric, then peeled and cleaned, then grated turmeric, add boiled water, and squeeze to take out the juice.

For rules of use, drink twice a day, in the morning before eating and at night before bed.

That prescription natural remedy to overcome ulcer disease, which is down termurun been handed down by our ancestors. Hopefully ulcer disease herbal medicine can help those of you who are experiencing ulcer disease, whether mild, moderate or chronic.

Benign prostatic hyperplasia (BPH) is an increase in size of the prostate. Also called benign enlargement of the prostate (BEP), adenofibromyomatous hyperplasia and benign prostatic hypertrophy.

Prostate enlargement is very common as men age -- symptoms usually develop around age 50 and by age 60, most men have some degree of BPH. At age 85, men have a 90% chance of having urination problems caused by BPH. It' s important to note that BPH is not cancer, and it does not put you at increased risk for developing prostate cancer.

Causes of Benign Prostatic Hyperplasia :

Nobody knows the basic cause of BPH. Research shows that testosterone, the male hormone, or dihydrotestosterone, a chemical produced when testosterone breaks down in a man's body, may cause the prostate to keep growing. Another theory is that changes in the ratio of testosterone and estrogen (female hormone) as men age cause the prostate to grow.

Some over the counter medications for colds or allergies can drastically worsen BPH.

Symptoms of Benign Prostatic Hyperplasia :

• Needing to urinate frequently
• Difficulty starting urination
• Stopping and starting while urinating
• Urinating frequently at night (nocturia)
• Dribbling after urination ends
• Being unable to empty your bladder
• Blood in the urine (BPH can cause small blood vessels to burst)
• Recurrent urinary tract infections (UTIs)

Pathophysiology of BPH

Both the glandular epithelial cells and the stromal cells (including muscular fibers) undergo hyperplasia in BPH. Most sources agree that of the two tissues, stromal hyperplasia predominates, but the exact ratio of the two is unclear.

Anatomically, BPH is most strongly associated with the posterior urethral glands (PUG) and transitional zone (TZ) of the prostate. The earliest microscopic signs of BPH usually begin between the age of 30 and 50 years old in the PUG, which are posterior to the proximal urethra. However, the majority of growth eventually occurs in the TZ. In addition to these two classic areas, the peripheral zone (PZ) of the prostate is also involved to a lesser extent. Since prostatic cancer also occurs in the PZ, BPH nodules in the PZ are often biopsied to rule out cancer.

Angina pectoris is the result of myocardial ischemia caused by an imbalance between myocardial blood supply and oxygen demand.

An episode of angina is not a heart attack. Having angina means you have an increased risk of having a heart attack.

• A heart attack is when the blood supply to part of the heart is cut off and that part of the muscle dies (infarction).
• Angina can be a helpful warning sign if it makes the patient seek timely medical help and avoid a heart attack.
• Prolonged or unchecked angina can lead to a heart attack or increase the risk of having a heart rhythm abnormality. Either of those could lead to sudden death.

People who are at risk of angina are:

• Men above 55 years old,
• Women above 65 years old,
• Obese or overweight,
• Cigarette smokers,
• Having high blood pressure,
• Having high cholesterol levels,
• Physically inactive,
• Having kidney disease,
• Having diabetes mellitus, and
• Having family history of premature cardiovascular disease (men who suffer from heart disease below the age of 55 or women who suffer from the same disease below 65 year old).

Generally, angina pectoris is recognized in two types:

• Stable angina is found more often in people. The symptoms of this type occur regularly and are predictable. Usually, people with this type suffer from the chest discomfort during exercise and stress, or after consuming heavy meals. Generally, the symptoms last not more than five minutes and improve when the patient rests or takes medications such as nitroglycerin, amlodipine besylate, or ranolazine.
• Unstable angina is found less often but more serious than the first type. Unlike the stable one, the occurrence of unstable angina cannot be predicted. The symptoms of this type also tend to be more severe. Unstable angina usually creates more pain and occurs longer and more frequent. Usual medication or resting cannot improve the symptoms. While unstable angina differs from heart attack, it is often noted as the precursor to heart attack.

Your doctor or nurse will examine you and measure your blood pressure. Tests that may be done include:

• Coronary angiography
• Coronary risk profile (special blood tests)
• ECG
• Exercise tolerance test (stress test or treadmill test)
• Nuclear medicine (thallium) stress test
• Stress echocardiogram

Your doctor may give you one or more medicines to help prevent you from having angina.

• ACE inhibitors to lower blood pressure and protect your heart
• Beta-blockers to lower heart rate, blood pressure, and oxygen use by the heart
• Calcium channel blockers to relax arteries, lower blood pressure, and reduce strain on the heart
• Nitrates to help prevent angina
• Ranolazine (Ranexa) to treat chronic angina

Appendicitis is a condition characterized by inflammation of the appendix. The appendix is a small pouch attached to the beginning of your large intestine. It is classified as a medical emergency and many cases require removal of the inflamed appendix, either by laparotomy or laparoscopy.

The main symptom of appendicitis is abdominal pain. Symptoms of appendicitis may take 4-48 hours to develop. Other symptoms include:

• loss of appetite,
• nausea,
• vomiting,
• lack of appetite, and
• fever.

Diagnosis is based on patient history (symptoms) and physical examination backed by an elevation of neutrophilic white blood cells. Histories fall into two categories, typical and atypical. Typical appendicitis usually includes abdominal pain beginning in the region of the umbilicus for several hours, associated with anorexia, nausea or vomiting. The pain then "settles" into the right lower quadrant (or the left lower quadrant in patients with situs inversus totalis), where tenderness develops. The combination of pain, anorexia, leukocytosis, and fever is classic. Atypical histories lack this typical progression and may include pain in the right lower quadrant as an initial symptom. Atypical histories often require imaging with ultrasound and/or CT scanning.

Nursing Diagnosis for Appendicitis: Acute Pain related to distention of the intestinal tissue.

Goal: Pain will be solved
Expected outcomes: normal breathing. normal circulation.

Intervention:

1) Assess the level of pain, location and characteristics of pain.
Rationale: To determine the extent of pain and is an indicator of early to be able to give further action.

2) Encourage deep breathing.
Rationale: deep breathing, can breathe oxygen adequately, so that the muscles into relaxation so as to reduce pain.

3) Perform gate control.
Rationale: The gate control large diameter nerve stimulating small-diameter nerve so that pain stimuli are not forwarded to the hypothalamus.

4) Give analgesics.
Rationale: As a prophylactic in order to relieve pain (if already know the symptoms for sure).

Blood deficiency or anemia is a disease that can strike anyone, anytime. The effects of anemia are inherently different in each person:

• In adult men: weak, tired, lethargic, and neglect, as well as dizziness, usually accompanied dizzy eyes.
• In children: anemia can reduce learning ability and concentration, inhibited physical growth, brain development, and increase the risk of infectious disease.
• In women: anemia lowered immune system so easily hurt, lower work productivity, lowered fitness.
• In adolescent girls: lower learning ability and concentration, impair growth, so the height is not optimal.
• In pregnant women: a moment can cause bleeding, or during childbirth, increasing the risk of having a baby with low weight, whereas in patients with severe anemia may cause the death of the pregnant mother and the baby.

Overall, anemia can also result from the body's metabolism is not smooth. This disease can be treated with blood booster drugs, and dietary intake of green, which supports such as soybeans, because the nutrients can make the symptoms of anemia was reduced and then disappeared, this is because the body's immune system may increase again.

Consuming soy on a regular basis can increase the body's metabolism and immunity, because the high levels of isoflavones found in soy beans. Besides soybeans rich in vitamins A, B, E, calcium and phosphorus.

Many ways to enjoy soy beans, with a wide range of processed products, one that I like most of the processed soy is soy milk, which is easily obtained with the cheap but still healthy and definitely delicious.

Graves disease is an autoimmune disorder that leads to overactivity of the thyroid gland (hyperthyroidism). The thyroid is a small gland in the front of the neck. It makes hormones called T3 and T4 that regulate how the body uses energy. Thyroid hormone levels are controlled by the pituitary, which is a pea-sized gland in the brain. It makes thyroid stimulating hormone (TSH), which triggers the thyroid to make thyroid hormone.

Many factors are thought to play a role in getting Graves' disease. These might include:

• Genes. Some people are prone to Graves' disease because of their genes. Researchers are working to find the gene or genes involved.
• Gender. Hormones might play a role, and might explain why Graves' disease affects more women than men.
• Stress. Severe emotional stress or trauma might trigger the onset of Graves' disease in people who are prone to getting it.
• Pregnancy. Pregnancy affects the thyroid. As many as 30 percent of young women who get Graves' disease have been pregnant in the 12 months prior to the onset of symptoms. This suggests that pregnancy might trigger Graves' disease in some women.
• Infection. Infection might play a role in the onset of Graves' disease, but no studies have shown infection to directly cause Graves' disease.

Nursing Diagnosis for Graves' Disease : Risk for Impaired Skin Integrity related to changes in the mechanism of protection of the eyes; damage eyelid closure / exophthalmos.

Goal: Able to identify measures to provide protection to the eyes and prevention of complications.

Interventions and Rationale:

Independent:

1. Observation periorbital edema, impaired eyelid closure, narrow field of vision, excessive tears. Note the presence of photophobia, taste any thing outside the eye and pain in the eyes.
Rationale: common manifestation of excessive adrenergic stimulation associated with thyrotoxicosis who require support to a resolution of the crisis intervention can eliminate symptomatology.

2. Evaluation of visual acuity, report any blurred vision or double vision (diplopia).
Rational: Oftalmopati infiltrative (Graves disease) is the result of an increase in retro-orbital tissue, which creates exophthalmos and lymphocyte infiltration of extra-ocular muscles that cause fatigue. The emergence of visual impairment, can worsen or improve independence therapy and clinical course of disease.

3. Instruct the patient to use dark glasses, when awake and closed with a blindfold over sleep as needed.
Rationale: Protecting corneal damage if the patient can not turn a blind eye to perfect as edema or fibrosis due to fat pad.

4. The head of the bed elevated and limit the use of salt if indicated.
Rationale: Reducing tissue edema when there are complications such as chronic heart failure which can aggravate exophthalmos.

5. Instruct the patient to exercise extra-ocular eye muscles if possible.
Rationale: Improve circulation and maintain eye movements.

6. Give the patient the opportunity to discuss their feelings about the changes in the size or shape of body image to improve the self-image.
Rationale: The ball slightly bulging eyes, causing a person is not attractive, it can be reduced by wearing makeup, wearing glasses.

One of the most powerful ways to relieve tension and bring peace into your being is with breathing relaxation techniques. Working with your breath is effective, convenient, and free. Let's explore how to use the breath to bring a state of deep relaxation, profound peace, and well being into the body.

Step One:

Position: sit up straight, no physical movement, eyes closed. Palms closed and stuck on the thigh.

Breath: breathing techniques combined, normal naturally.

Time: 5-10 minutes.

After sitting upright and slowly closed his eyes, start by loosening all the muscles of your body. Starting from the neck muscles and shoulders, relax slowly. After that try to the other body parts that are still tense.

Begin to explore every part of the body with the mind visualization, from the tip of your toes, slowly climbed up into the crown of the head. Keep your eyes closed to relax.

After the whole body feels loose, limp and comfortable; enjoy that position for a moment and calm breathing, slow rhythm with no arrests at all. Keep your entire body feel good.

Step Two:

Position: sit up straight, no physical movement, eyes closed. Open palms, back of hands flat on your thighs.

Breath: breathing techniques combined, normal naturally.

Time: 5-10 minutes.

Position as you did in Step One, but open palms upward with back of his hand against the thigh.

Feel it with all parts of your body; mood, situation or condition of the room where you are practicing. Once you feel comfortable throughout your body, point the attention to the center of the open palms. Feel the sensation or vibration or anything that happens in the palm of the hand.

Step Three:

Position: standing straight, eyes closed, arms at your sides.

Breath: breathing techniques combined, normal naturally.

Time: 5-10 minutes.

After standing position you feel good and comfortable, place most of your attention on both arms, from the shoulder slowly descend into the upper arm, forearm and elbow until finally palms. Attention to the center of the palm.

After a while you may feel a sensation in the hands or vibrations in the arm and shoulder. Follow only if the vibration or energy is finally lift the arm up slowly, then down again. Stay tuned vibration or other sensations that lifts your arms without muscle power. Raised by itself, not on your willpower.

If you are someone who is less sensitive, so do not feel anything, just keep calm and relaxed. This does not mean you fail or do not benefit from this exercise. Exercise is not just physical, but also if the mind and soul.

Step Four:

Position: standing straight, eyes closed, palms facing each other in front of the chest, but do not touch (there is distance).

Breath: breathing techniques combined, normal naturally.

Time: 5-10 minutes.

Once you are comfortable position, place most of your attention on both arms, from the shoulder, slowly down to the arm, elbow and forearm and then palms. Direct your attention to the center of the palm.

After a while maybe you will feel a sensation or vibration energy in the palm of the hand. When a sensation or vibration energy in the palm of your hand was moving, just follow the movement, do not resist. Take hold of your hand movement without muscle power.

Rheumatoid arthritis is an autoimmune disease that causes inflammation in your joints. In RA, for reasons no one fully understands, the immune system – which is designed to protect our health by attacking foreign cells such as viruses and bacteria – instead attacks the body’s own tissues, specifically the synovium, a thin membrane that lines the joints.

The cause of rheumatoid arthritis is not yet known. Most scientists agree that a combination of genetic and environmental factors is responsible. Researchers have identified genetic markers that cause a tenfold greater probability of developing rheumatoid arthritis.

Common symptoms of rheumatoid arthritis include:

• painful, swollen joints
• stiffness
• tiredness (fatigue), depression and irritability
• anaemia
• flu-like symptoms, such as feeling generally ill, feeling hot and sweating.

Less common symptoms include:

• weight loss
• eye inflammation
• rheumatoid nodules
• inflammation of other parts of your body.

Because the exact cause of Rheumatoid Arthritis is unknown, there is no causative treatment that can cure this disease. It should really be explained to the patient so that the treatment given out aimed at reducing complaints / symptoms of slowing progression of the disease.

The main objective of the program management / treatment is as follows:

• To relieve pain and inflammation.
• To maintain joint function and a maximum capacity of patients.
• To prevent and or correct deformity that occurs in the joints.
• Maintaining independence so as not to depend on others.

Management / Treatment of patients with Rheumatoid Arthritis, as follows:

1. Education

Adequate education about the disease to patients, their families and anyone connected with patients. Education will include understanding the pathophysiology (disease progression), the cause and estimated travel (prognosis) of the disease, all components of the program including the management of complex drug regimens, aid resources to cope with the disease and effective method of management provided by the health care team . The education process should be carried out continuously.

2. Rest - Sleep

Are important, because rheumatic usually accompanied by severe fatigue. Although fatigue can arise every day, but there was a time when people feel better or heavier. Patients should be split into several times a day time activity time followed by a period of rest.

3. Physical Exercise and Termoterapia

Specific exercises can be beneficial in maintaining joint function. This exercise includes active and passive movements at all joints pain, at least twice a day. Medication for pain relief should be given before starting the exercise. Hot compresses on the sore and swollen joints may reduce pain. Paraffin bath with adjustable temperature and bath with hot and cold temperatures can be done at home. Exercise and termoterapia is best regulated by the health workers who have received special training, such as a physical therapist or occupational therapist. Excessive exercise can damage the supporting structure of the joints that are already weakened by a disease.

4. Diet / Nutrition

Rheumatic Patients do not require a special diet. There are a number of ways giving a diet with a variety of diverse, but all unsubstantiated. The general principle to obtain a balanced diet is important.

5. Drugs

Medications are an important part of the whole program rheumatic disease management. The drugs are used to reduce pain, relieve inflammation and to try to change the course of the disease.

Pyelonephritis is a type of urinary tract infection (UTI) that affects one or both kidneys.

Pyelonephritis is caused by a bacterium or virus infecting the kidneys. Though many bacteria and viruses can cause pyelonephritis, the bacterium Escherichia coli is often the cause. Bacteria and viruses can move to the kidneys from the bladder or can be carried through the bloodstream from other parts of the body. A UTI in the bladder that does not move to the kidneys is called cystitis.

Symptoms of pyelonephritis can vary depending on a person’s age and may include the following:

• fever
• vomiting
• back, side, and groin pain
• chills
• nausea
• frequent, painful urination

Nursing Diagnosis : Acute Pain related to infection of the kidneys

Goal: pain in the kidneys is reduced

Expected outcomes: No pain on urination, no pain on percussion pelvis.

Interventions and Rationale

1. Assess the intensity, location, and factors that aggravate or relieve pain.
R /: Pain is a great sign of infection.

2. Give adequate rest and activity levels that can be tolerant.
R /: Clients can rest and muscles can relax.

3. Encourage drinking plenty of 2-3 liters if no contraindications
R /: To assist clients in urination.

4. Give analgesics according to the treatment program.
R /: Analgesic block the path of pain.

5. Monitor urine output to changes in color, odor and voiding patterns, input and output every 8 hours and monitor the results of urinalysis repeated.
R: To identify indications of progress or deviations from expected results.

6. Record the location, the length of the intensity scale (1-10) spread pain.
R /: To help evaluate the place of obstruction and cause pain.

7. Provide comfortable action, bleak back rub, the rest.
R /: Improve relaxation, reduce muscle tension.

8. Assist or encourage the use of focused relaxation breathing.
R /: Helps redirect the attention and for muscle relaxation.

9. Give perineal care.
R /: To prevent contamination of the urethra.


Nursing Diagnosis: Anxiety related to lack of information about the disease process, prevention methods, and home care instructions.

Goal: Anxiety is reduced

Expeected Outcome : Clients say taste anxiety diminished

Interventions and Rationale:

1. Assess the level of anxiety.
R /: To determine the severity of the client's anxiety.

2. Give the client the opportunity to express feelings.
R /: In order for the client to have passion and want empathy to care and treatment.

3. Give support to the client.

4. Give spiritual encouragement.

5. Give an explanation of the illness.
R /: In order to fully understand the client's illness experiences.

Kidney infection (pyelonephritis) is a specific type of urinary tract infection (UTI) that generally begins in your urethra or bladder and travels up into the kidneys. Pyelonephritis is a kidney infection usually caused by bacteria that have traveled to the kidney from an infection in the bladder.

Kidney infection typically occurs when bacteria enter to the urinary tract through the tube that carries urine from the body (urethra) and begin to multiply. Bacteria from an infection elsewhere in the body also can spread through the bloodstream to the kidneys.

Women have more bladder infections (also called urinary tract infections) than men do because the distance to the bladder from skin, where bacteria normally live, is quite short and direct. However, the infection usually remains in the bladder.

Nursing Diagnosis for Pyelonephritis : Impaired Urinary Elimination (dysuria, urge, frequency, and or nocturia) related to a kidney infection.

Goal: either elimination pattern

Expected outcomes : improved client elimination pattern, there was no sign of urinary disorders (urgency, oliguric, dysuria)

Nursing Interventions and Rationale:

1. Measure and record urine each time urination.
R /: To determine the changes in color and to determine the input / out put.

2. Instruct to void every 2-3 hours.
R /: To prevent the buildup of urine in the urinary vesicles.

3. Palpation of the bladder every 4 hours.
R /: To determine the presence of bladder distension.

4. Help clients to the restroom, use bedpans / urinals.
R /: To facilitate clients in urination.

5. Help clients get a comfortable position to urinate.
R /: So that the client is not difficult to urinate.

6. Encourage increased fluid intake.
R /: Increased hydration rinse bacteria.

7. Observations of changes in mental status:, behavior or level of consciousness.
R /: Accumulated residual uremic and electrolyte imbalance can be toxic to the central nervous system.

Dysmenorrhea is the medical term for pain with menstruation. There are two types of dysmenorrhea: "primary" and "secondary". Dysmenorrhea is often defined simply as menstrual pain, or at least menstrual pain that is excessive.

Menstrual pain is often used synonymously with menstrual cramps, but the latter may also refer to menstrual uterine contractions, which are generally of higher strength, duration and frequency than in the rest of the menstrual cycle.

Difference Between Primary Dysmenorrhea and Secondary Dysmenorrhea

Primary dysmenorrhea is common menstrual cramps that are recurrent and are not due to other diseases. Cramps usually begin one to two years after a woman starts getting her period. Primary dysmenorrhea is the most common type of dysmenorrhea, affecting more than 50% of women, and quite severe in about 15%. Primary dysmenorrhea is more likely to affect girls during adolescence. Fortunately for many women, the problem eases as they mature, particularly after a pregnancy. Pain usually begins 1 or 2 days before or when menstrual bleeding starts and is felt in the lower abdomen, back, or thighs and can range from mild to severe. Pain can typically last 12 to 72 hours and can be accompanied by nausea, vomiting, fatigue, and even diarrhea.

Secondary dysmenorrhea is menstrual pain that is generally related to some kind of gynecologic disorder. Secondary dysmenorrhea is pain that is caused by a disorder in the woman's reproductive organs, such as endometriosis, adenomyosis, uterine fibroids, or infection. Most of these disorders can be easily treated with medications or surgery. Secondary dysmenorrhea is more likely to affect women during adulthood. Pain from secondary dysmenorrhea usually begins earlier in the menstrual cycle and lasts longer than common menstrual cramps. The pain is not typically accompanied by nausea, vomiting, fatigue, or diarrhea.

Symptoms of Dysmenorrhea

A medical history and pelvic exam alone may provide enough information for the doctor to determine whether the cramps are caused by primary dysmenorrhea. In primary dysmenorrhea, the pelvic exam is normal between menses. Examination during menses may produce discomfort but no abnormal findings.

In secondary dysmenorrhea, there may be findings on physical exam. Additional tests may include radiologic studies (including ultrasound) and laparoscopy (involves inserting a tiny, flexible lighted tube through a small incision just below the navel to view the internal abdominal and pelvic organs).

Hyperemesis gravidarum is extreme, persistent nausea and vomiting during pregnancy that can lead to dehydration. Mild cases are treated with dietary changes, rest and antacids. More severe cases often require a stay in the hospital so that the mother can receive fluid and nutrition through an intravenous line (IV).

Diet to Relieve Symptoms of Hyperemesis Gravidarum

1. Speak to a dietitian about ensuring the nutritional adequacy of your diet during pregnancy and nutrition strategies to improve nausea and vomiting symptoms.

2. Speak to your health care provider about your symptoms and how they affect you. They may recommend a safe and effective medication to treat your nausea and/or vomiting and to prevent the progression of the condition.

3. Eat frequent small meals every two to three hours.

4. Eat dry crackers 15 minutes before getting out of bed in the morning.

5. Try eating cold food rather than hot food (cold foods have less odour).

6. Drink fluids half an hour before a meal or half an hour after a meal. Avoid drinking with your meal to prevent becoming overfull.

7. Drink about eight glasses of liquid during the day to avoid dehydration.

8. Do not skip meals needlessly.

9. Avoid spicy foods.

10. Avoid foods high in fat.

11. Herbal teas containing peppermint or ginger or other ginger-containing beverages may ease nausea.

12. Protein-containing snacks are helpful (e.g. yoghurt and fruit; wholegrain crackers with sliced cheese).

13. Sugar free mineral waters or soda waters can assist in settling nausea.

14. If odours bother you while cooking, try to improve ventilation in your kitchen area.

15. If possible, ask someone to assist you in the preparation of your meal.

Studies estimate that nausea and vomiting occurs in 50 to 90 per cent of pregnancies. For the majority of cases morning sickness is not a serious condition and it does not place you or your baby at any risk.

Hyperemesis gravidarum is the most severe form of morning sickness a pregnant woman can have. Hyperemesis gravidarum, or severe morning sickness, typically lasts until the 21st week of gestation, but there are cases where pregnant women suffer throughout the pregnancy.

The most severe form of nausea and vomiting in pregnancy is called hyperemesis gravidarum. This condition can place you and your baby at some risk as the nausea and vomiting prevent you from retaining and utilising food and fluids.

Morning Sickness:

1. Nausea sometimes accompanied by vomiting

2. Nausea that subsides at 12 weeks or soon after.

3. Vomiting that does not cause severe dehydration.

4. Vomiting that allows you to keep some food down.


Hyperemesis Gravidarum:

1. Nausea accompanied by severe vomiting.

2. Nausea that does not subside.

3. Vomiting that causes severe dehydration.

4. Vomiting that does not allow you to keep any food down.

A urinary tract infection is an infection that can happen anywhere along the urinary tract. When it affects the lower urinary tract it is known as a simple cystitis (a bladder infection) and when it affects the upper urinary tract it is known as pyelonephritis (a kidney infection).

UTIs are diagnosed usually by isolating and identifying the urinary pathogen from the patient; there are some home tests available for presumptive diagnosis.

The most common cause of UTIs are bacteria from the bowel that live on the skin near the rectum or in the vagina, which can spread and enter the urinary tract through the urethra. Once these bacteria enter the urethra, they travel upward, causing infection in the bladder and sometimes other parts of the urinary tract.

Symptoms

May have an infection if have any of these symptoms:

• Feel pain or burning when urinate.
• Feel like have to urinate often, but not much urine comes out when do.
• Belly feels tender or heavy.
• Urine is cloudy or smells bad.
• Have pain on one side of the back under ribs. This is where kidneys are.
• Have fever and chills.
• Have nausea and vomiting.

7 Nursing Diagnosis for UTI

1. Acute pain
related to:
inflammation and infection of the urethra, bladder and other urinary tract structures.

2. Hyperthermia
related to:
inflammatory reaction

3. Impaired Urinary Elimination
related to:
frequent urination, urgency and hesistancy

4. Risk for Fluid Volume Deficit
related to:
excessive evaporation and vomiting

5. Disturbed Sleep Pattern
related to:
pain and nocturia

6. Imbalanced Nutrition, Less Than Body Requirements
related to:
anorexia

7. Anxiety
related to:
crisis situations, coping mechanisms are ineffective

8. Knowledge Deficit: about condition, prognosis, and treatment needs
related to:
lack of sources of information.

Gastritis is an inflammation of the gastric mucosa, may be acute or chronic. Acute Gastritis, stomach disorders are the most common cause of gastric mucosal redness, edema, and erosion surfaces.

Chronic gastritis is common among the elderly and people with pernicious anemia. It is often present as chronic atrophic gastritis, gastric mucosal layer where all inflamed, with a reduced number of cells and parietal head. Acute or chronic gastritis can occur at any age.

Causes of Gastritis :

1. Consumption of unhealthy foods, such as chili (or allergic reactions) or alcohol.
2. Drugs such as aspirin and nonsteroidal anti-inflammatory agents, cytotoxic agents, caffeine, corticosteroids, anti-metabolites, phenylbutazone, and indomethacin.
3. Ingestion of toxins, especially dichlorodiphenyltrichloroethane, ammonia, mercury, carbon tetrachloride, or corrosive substances.
4. Endotoxin bacteria, such as staphylococci, Escherichia coli, and Salmonella.

Complications of Gastritis

1. Bleeding
2. Shock
3. Perforation
4. Peritonitis
5. Gastric cancer.

Signs and symptoms of patients with gastritis

Patients with acute gastritis usually feel discomfort in epigastrium, indigestion, cramps, anorexia, nausea, hematemesis, and vomiting. Patient's symptoms may last several hours to several days. Chronic gastritis may explain the same phenomenon, only experienced mild epigastric discomfort, or just a vague complaint. For example, patients may report spicy or fatty food intolerance or mild epigastric pain.

Patients with chronic atrophic gastritis is often asymptomatic.
On examination, the patient may appear normal or show signs of distress such as fatigue, grimacing, and anxious, depending on the severity of symptoms. If stomach bleeding has occurred, it may appear pale and vital signs may reveal tachycardia and hypotension. Inspection and palpation may reveal abdominal distention, tenderness, and guarding. Auscultation may reveal increased bowel sounds.

Gastritis Nursing Diagnosis

1. Acute Pain
2. Knowledge Deficit: (diagnosis and treatment)
3. Imbalanced Nutrition, Less Than Body Requirements
4. Ineffective Individual Coping
5. Risk for Fluid Volume Deficit

Expected outcomes:

1. Patients are able to express a feeling of comfort.
2. Patient expressed understanding about the disorder and treatment regimen.
3. Patients were able to maintain body weight.
4. Patients did not express concerns about the current conditions.
5. Patients were able to maintain normal fluid volume.

Gastritis Nursing Interventions:

1. Provide physical and emotional support.
2. Provide antiemetics and replace I.V. fluid appropriate order, as well as monitor fluid intake and output and electrolyte levels.
3. Give a soft diet food preferences into account.
4. Encourage eat little, but often to reduce the amount of gastric secretion resulting in pain.

Paralytic Ileus is a paralysis of the intestine. It is a complicated medical condition that is characterized by partial or total non-mechanical obstruction of the large or small intestine. This blockage occurs when the intestinal muscles suffer a paralysis. Even a partial paralysis that makes the intestinal muscles inactive is enough to cause this disorder. Such a state of inactivity makes it difficult for food to pass through the intestine. It creates an intestinal blockage and gives rise to serious complications.

Paralytic ileus can affect any part of the intestine. Causes can include:

• Abdominal surgery
• Pelvic surgery
• Infection
• Certain medications, including antidepressants and pain medications that affect muscles and nerves
• Muscle and nerve disorders, such as Parkinson's disease

Nursing Diagnosis for Paralytic Ileus : Risk for Hypovolemic Shock
related to: the lack of body fluid volume.

Goal: hypovolemic shock does not occur.

Expected outcomes:

• Vital signs are within normal limits,
• volume of body fluid balance,
• fluid intake met.

Interventions:

1. Monitor general condition
Rationale: Establish baseline data to determine the patient's deviation from normal condition.

2. Observations of vital signs
Rationale: It is a reference to determine the patient's general condition.

3. Assess fluid intake and output
Rationale: To determine the body's fluid balance.

4. Collaboration in the provision of intravenous fluids
Rationale: To meet the water balance.


Nursing Diagnosis for Paralytic Ileus : Impaired Bowel Elimination
related to: constipation

Goal: Impaired elimination pattern does not occur

Expected outcomes: Patterns of normal bowel elimination

Interventions:

1. Assess and record the frequency, color and consistency of stool
Rationale: To determine the presence or absence of abnormalities that occur in fecal elimination.

2. Auscultation of bowel sounds
Rationale: To determine whether or not normal bowel movements.

3. Encourage clients to drink plenty
Rationale: To stimulate spending feces.

4. Collaboration in the provision of laxative therapy
Rationale: To provide ease of elimination needs.

Definition: the body temperature rises above the normal range

Limitation Characteristics:

• The increase in body temperature above the normal range
• Offensive or convulsions (seizures)
• Skin redness
• Addition of RR
• Tachycardia
• Hand feels warm to the touch

Related Factors:

• disease / trauma
• increased metabolism
• excessive activity
• the influence of medication / anesthesia
• inability / reduced ability to sweat
• exposure to hot environment
• dehydration
• improper attire

NOC: Thermoregulation

Expected outcomes:

• Body temperature within normal range
• Pulse and RR in the normal range
• No skin discoloration and no dizziness, feeling comfortable

NIC:

Fever Treatment

• Monitor the temperature as much as possible
• Monitor IWL
• Monitor skin color and temperature
• Monitor blood pressure, pulse and RR
• Monitor decreased level of consciousness
• Monitor WBC, Hb, and Hct
• Monitor intake and output
• Give anti-pyretic
• Provide treatment to address the cause of the fever
• Cover the patient
• Perform tapid sponge
• Give intravenous fluids
• Compress patients in the groin and axilla
• Increase air circulation
• Provide treatment to prevent shivering

Temperature regulation

• Monitor the temperature at least every 2 hours
• Plan for continuous temperature monitoring
• Monitor blood pressure, pulse, and RR
• Monitor skin color and temperature
• Monitor signs of hyperthermia and hypothermia
• Increase fluid intake and nutrition
• Cover the patient to prevent the loss of body warmth
• Teach the patient how to prevent fatigue due to heat
• Discuss the importance of temperature regulation and the possible negative effects of the cold
• Tell about the indications of fatigue and needed emergency treatment
• Teach indication of hypothermia and handling required
• Give anti pyretic if necessary

Vital sign monitoring

• Monitor blood pressure, pulse, temperature, and RR
• Note the fluctuations in blood pressure
• Monitor vital signs while the patient is lying down, sitting or standing
• Auscultation of blood pressure in both arms and compare
• Monitor blood pressure, pulse, RR, before, during, and after activity
• Monitor the quality of the pulse
• Monitor respiratory rate and rhythm
• Monitor lung sounds
• Monitor abnormal breathing patterns
• Monitor temperature, color, and moisture
• Monitor peripheral cyanosis
• Monitor the Cushing's triad (widening pulse pressure, bradycardia, increased systolic)
• Identify the causes of changes in vital sign