Nanda Books

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.

Referene :
http://www.umm.edu
http://en.wikipedia.org

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

Reference :
http://www.ncbi.nlm.nih.gov

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

Defining characteristics:

• Sleep disorders
• Chemical abuse
• Decline in the use of social support
• Poor concentration
• Fatigue
• Complained about the inability of coping
• Destructive behavior toward self / others
• The inability to meet the expectations of the role

Related factors:

• Gender differences in coping strategies
• Confidence level is inadequate
• Uncertainty
• Ineffective social support
• Situational crisis / maturasional
• The degree of high-level treatment

NOC Labels: Coping

Expected outcomes:

• Shows the flexibility of the role
• Shows the flexibility of the role of family members
• Conflict issues
• Can set the value of family issues
• Manage the problem
• Involving family members in making decisions
• Express feelings and emotional freedom
• Shows a strategy to manage the problem
• Using stress reduction strategies
• Care for the needs of family members
• Determine priorities
• Determine the timetable for the routine, and family activities
• Schedule for respite care
• Have a plan on the condition of gravity
• Maintain financial stability
• Seeking help when needed
• Using social support

NOC assessment information:

1 = not done at all

2 = rarely done

3 = sometimes done

4 = often

5 = always done


NIC: Improved coping

• Respect the patient's understanding of the disease process and self-concept
• Appreciate and discuss the substitute response to the situation
• Respect the client's attitude toward the changing roles and relationships
• Support the use of spiritual resources upon request
• Use a calm approach and provide assurance
• Provide information about the actual diagnosis, and prognosis handlers
• Provide a realistic option at this aspect of care
• Support the use of appropriate defensive mechanism
• Encourage family involvement in an appropriate manner
• Help patients to identify positive strategies to overcome these limitations and to manage lifestyle and role changes
• Help clients to adapt and anticipate changes in client
• Help clients identify the possibilities that can occur.

A space occupying lesion is any abnormal tissue found on or in an organism, usually damaged by disease or trauma.

A space occupying lesion of the brain is usually due to malignancy but it can be caused by other pathology such as an abscess or a haematoma. Almost half of intracerebral tumours are primary but the rest have originated outside the CNS and are metastases.

The symptoms are also dependent on the area of the brain affected:

• Temporal lobe – dysphasia, contralateral homonymous hemianopia, amnesia
• Frontal lobe – Hemiparaesis, personality change, executive dysfunction
• Parietal lobe – Hemisensory loss, astereogenesis (can’t recognise objects by touch alone), reduced 2-point discrimination
• Occipital lobe – contralateral visual field defects, palinopsia (see things again once stimulus has left field of vision)
• Cerebellum – DASHING: Dysdiadochokinesis, Ataxia, Slurred speech, Hypotonia, Intention tremor, Nystagmus, Gait abnormalities
• Personality change – irritability, lack of concentration, socially inappropriate behaviour.

Pathophysiology of Space Occupying Lesion (SOL)

Brain tumors cause neurological disorders. Symptoms occur sequentially. This emphasizes the importance of history in the examination of the client. The symptoms should be addressed in a time perspective.

Neurologic symptoms in brain tumors typically considered to be caused by two factors focal disorder, caused by the tumor and intracranial pressure. Focal disruption occurs when an emphasis on brain tissue and infiltration / invasion of the brain parenchyma by direct tissue damage neurons. Of course the greatest dysfunction occurs in tumors that grew most rapidly.

Changes in blood supply due to the pressure caused by the growing tumor causing brain tissue necrosis. Impaired arterial blood supply is generally manifest as an acute loss of function and may be confused with primary cerebrovascular disorders. Seizures as a manifestation of neuro sensitivity changes associated with compression of the invasion and changes in blood supply to the brain tissue. Some tumors form cysts that also suppress the surrounding brain parenchyma so that aggravate focal neurological disorders.

Increased intra-cranial pressure can be caused by several factors: the increase of the mass in the skull, the formation of edema around the tumor and cerebrospinal circulation changes. Tumor growth causes increasing mass, because the tumor will take a relatively from the rigid skull. Malignant tumors cause edema in brain tissue. The mechanisms are not entirely understood, but due to the difference in osmotic allegedly causing bleeding. Venous obstruction and edema caused by damage to the blood brain barrier, all lead to an increase in intracranial volume. Observation of the circulation of cerebrospinal fluid from the ventricle into the sub-arachnoid laseral cause hidrocepalus.

Increased intracranial pressure would endanger the life, when it occurs rapidly due to a cause that has been discussed previously. Compensation mechanism takes many days / months to be effective and therefore not useful when intracranial pressure arise quickly. This compensation mechanism among other works lowering intra-cranial blood volume, cerebrospinal fluid volume, intracellular fluid content and reduce parenchymal cells. The increase in pressure resulting in untreated ulcer or serebulum herniation. Herniation occurs when the medial lobe gyrus temporals shifted to inferior through territorial notch by the masses in the cerebral hemispheres. Herniation pressing metencephalon cause loss of consciousness and hit the third nerve. In the cerebellar herniation, tonsillar before shifting down through the foramen magnum by a posterior mass. Compression of the medulla oblongata and stop breathing occur quickly. Intracranial fast is progressive bradycardia, systemic hypertension (widening pulse pressure and respiratory problems).

Atelectasis is the collapse of part or (much less commonly) all of a lung.

The primary cause of atelectasis is obstruction of the bronchus serving the affected area. This condition may be caused by obstruction of the major airways and bronchioles, by pressure on the lung from fluid or air in the pleural space, or by pressure from a tumor outside of the lung.

Symptoms of Atelectasis : Breathing difficulty, Chest pain, Cough, Fever, low-grade, usually after surgery.

Atelectasis is diagnosed by clinical exam, close monitoring of a post-operative clinical course, and x-ray.

Prevention of Atelectasis

• Encourage movement and deep breathing in anyone who is bedridden for long periods.
• Keep small objects out of the reach of young children.
• Maintain deep breathing after anesthesia.

Treatment of Atelectasis

If atelectasis is due to obstruction of the airway, the first step in treatment is to remove the cause of the blockage. This may be done by coughing, suctioning, or bronchoscopy. If a tumor is the cause of atelectasis, surgery may be necessary to remove it. Antibiotics are commonly used to fight the infection that often accompanies atelectasis. In cases where recurrent or long-lasting infection is disabling or where significant bleeding occurs, the affected section of the lung may be surgically removed.

Pulmonary edema is an abnormal buildup of fluid in the air sacs of the lungs, which leads to shortness of breath.

Early symptoms of pulmonary edema include:

• shortness of breath upon exertion
• sudden respiratory distress after sleep
• difficulty breathing, except when sitting upright
• coughing

In cases of severe pulmonary edema, these symptoms will worsen to:

• labored and rapid breathing
• frothy, bloody fluid containing pus coughed from the lungs (sputum)
• a fast pulse and possibly serious disturbances in the heart's rhythm (atrial fibrillation, for example)
• cold, clammy, sweaty, and bluish skin
• a drop in blood pressure resulting in a thready pulse

The health care provider will perform a physical exam and use a stethoscope to listen to your lungs and heart. The following may be detected:

• Abnormal heart sounds
• Crackles in your lungs, called rales
• Increased heart rate (tachycardia)
• Pale or blue skin color (pallor or cyanosis)
• Rapid breathing (tachypnea)

Nursing Diagnosis : Anxiety related to Threat / Change in Health Status

Goal: Anxiety can be overcome

Expected outcomes:

• Reported fear / anxiety disappear or decrease to the level that can be handled, looks relaxed and resting / sleeping properly.

Nursing Intervention :

1) Record the degree of anxiety and fear. Inform the patient / person close to the patient, the normal feelings and push expressing feelings.
Rational:
Understanding that feelings (which are based plus oxygen imbalances that threaten) normal can help patients improve some sense of emotional control.

2) Explain the disease process and procedures in the level of the patient's ability to understand and handle information. Assess the current situation and the measures taken to address the problem.
Rational:
Eliminate anxiety as insecurity and reduce fear about personal safety. In the early phase of explanation needs to be repeated with frequent and short because the patient has decreased the scope of attention.

3) Provide comfort measures, ie, back massage, change of positions.
Rational:
Tool to reduce stress and indirect care to enhance relaxation and coping skills.

4) Help patients to identify behavioral help, eg a comfortable position, focus on breathing, relaxation techniques.
Rational:
Giving patients control measures to reduce anxiety and muscle tension.

5) Support the patient / significant other in accepting the reality of the situation, especially the plan for a long period of recuperation. Involve patients in planning and participation in care.
Rational:
Coping mechanisms and participation in treatment programs may improve learning patients to receive the expected result of the disease and improve some sense of control.

6) Watch out for out of control behavior or increased cardiopulmonary dysfunction, eg worsening dyspnea and tachycardia.
Rational:
Developing the capacity of anxiety requires further evaluation and possible intervention with anti-anxiety medication.

Hyperthyroidism is a condition in which the thyroid gland makes too much thyroid hormone. The condition is often referred to as an "overactive thyroid."

Causes of Hyperthyroidism

• Hyperthyroidism occurs when the thyroid releases too much of its hormones over a short (acute) or long (chronic) period of time. Many diseases and conditions can cause this problem, including:
• Getting too much iodine
• Graves disease (accounts for most cases of hyperthyroidism)
• Inflammation (thyroiditis) of the thyroid due to viral infections or other causes
• Noncancerous growths of the thyroid gland or pituitary gland
• Some tumors of the testes or ovaries
• Taking large amounts of thyroid hormone

Symptoms of Hyperthyroidism

• Palpitations
• Heat intolerance
• Nervousness
• Insomnia
• Breathlessness
• Increased bowel movements
• Light or absent menstrual periods
• Fatigue
• Fast heart rate
• Trembling hands
• Weight loss
• Muscle weakness
• Warm moist skin
• Hair loss
• Staring gaze

Assessment for Hyperthyroidism

1. Health Perceptions
Knowledge of the disease and the side effects of drugs.

2. Metabolic Nutrition
Changes in food intake, such as appetite and increases food intake, body weight decreased.

3. Elimination
Changes in fecal elimination, increased frequency of bowel movements or many times. Every meal tend to defecate, urine in large quantities.

4. Activity and Exercise
Experiencing chest pain / angina, tachycardia despite the break, dysrhythmias, and murmur, dyspnea experienced during the activity / rest muscle weakness, severe accidents, muscle atrophy.

5. Rest and Sleep
Insomnia.

6. Cognitive Sensory
Complained of impaired vision rapid eye fatigue, blurred vision, orbital pain, exophthalmos.

7. Coping Mechanisms
Emotional instability, experiencing severe stress both emotional and physical, psychological conditions.

8. Sexual Relations
Decreased libido, hipomenorea, amenorrhoea and impotence.

9. Self-Concept
Less confident because of physical changes such as the eye.


Nursing Diagnosis for Hyperthyroidism

1. Decreased Cardiac Output
2. Fatigue
3. Disturbed Thought Processes
4. Imbalanced Nutrition
5. Anxiety
6. Impaired Tissue Integrity
7. Knowledge Deficit