Nursing Care Plan for Nausea and Vomiting

Nausea

Nausea is a sensation of unease and discomfort in the upper stomach with an involuntary urge to vomit. It often, but not always, preceded vomiting. A person can suffer nausea without vomiting. Some common causes of nausea are motion sickness, gastroenteritis (stomach infection) or food poisoning, side effects of many medications including cancer chemotherapy, or morning sickness in early pregnancy. Medications taken to prevent nausea are called antiemetics and include diphenhydramine, metoclopramide and ondansetron. Nausea may also be caused by stress and depression.


Vomiting

Vomiting (known medically as emesis and informally as throwing up and a number of other terms) is the forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose. Vomiting may result from many causes, ranging from gastritis or poisoning to brain tumors, or elevated intracranial pressure. The feeling that one is about to vomit is called nausea, which usually precedes, but does not always lead to, vomiting. Antiemetics are sometimes necessary to suppress nausea and vomiting, and, in severe cases where dehydration develops, intravenous fluid may need to be administered to replace fluid volume.

Vomiting is different from regurgitation, although the two terms are often used interchangeably. Regurgitation is the return of undigested food back up the esophagus to the mouth, without the force and displeasure associated with vomiting. The causes of vomiting and regurgitation are generally different.
en.wikipedia

How is nausea or vomiting treated?

Symptomatic treatment may occur while the underlying illness is being investigated because ideally, nausea and vomiting should resolve when the cause of the symptoms resolves.

Nausea and vomiting are often made worse when the patient is dehydrated, resulting in a vicious cycle. The nausea makes it difficult to drink fluid, making the dehydration worse, which then increases the nausea. Intravenous fluids may be provided to correct this issue.

There are a variety of anti-nausea medications (antiemetics) that may be prescribed. They can be administered in different ways depending upon the patient's ability to take them. Medications are available by pill, liquid, or tablets that dissolve on or under the tongue, by intravenous or intramuscular injection, or by rectal suppository.

Common medications used to control nausea and vomiting include promethazine (Phenergan), prochlorperazine (Compazine), droperidol (Inapsine) metoclopramide (Reglan), and ondansetron (Zofran). The decision as to which medication to use will depend on the specific situation.
www.medicinenet.com

Nursing Diagnosis and Intervention Nursing Care Plan for Nausea and Vomiting

Nursing Diagnosis: Fluid and electrolyte deficit related to excessive fluid output.

Purpose: devisit fluid and electrolyte resolved

Expected outcomes: The signs of dehydration do not exist, the mucosa of the mouth and lips moist, fluid balance.

Nursing Intervention:

• Observation of vital signs.
• Observation for signs of dehydration.
• Measure infut and output of fluid (fluid balance).
• Provide and encourage families to provide drinking a lot of approximately 2000 - 2500 cc per day.
• Collaboration with physicians in the provision of therafi fluid, electrolyte laboratory tests.
• Collaboration with a team of nutrition in low-sodium fluids.

Nursing Diagnosis: Risk for Fluid Volume Deficit related to a sense of nausea and vomiting

Purpose: Maintaining the balance of fluid volume.

Expected outcomes: The client does not nausea and vomiting.

Nursing Intervention:

• Monitor vital signs.
• Rational: This is an early indicator of hypovolemia.
• Monitor intake and urine output and concentration.
• Rationale: Decreased urine output and concentration will improve the sensitivity / sediment as one suggestive of dehydration and require increased fluids.
• Give fluid little by little but often.
• Rationale: To minimize loss of fluid.
• The risk of infection associated with an inadequate defense of the body, characterized by: body temperature above normal. Respiratory frequency increased.

Source : Nursing Care Plan for Nausea and Vomiting - Nursing Care Plan (free-nursingcareplan.blogspot.com)

Nursing Care Plan for Anorexia Nervosa and Bulimia Nervosa

 Anorexia Nervosa and Bulimia Nervosa

Anorexia Nervosa

Definition

Anorexia Nervosa is a psychological disease in the form of deliberate starvation due to body image disturbances, excessive fear and irrational about weight gain. (Kimberly, 2011)

Anorexia Nervosa is a food disorder characterized by voluntary hunger and stress from doing exercises that involve psychological, sociological, physiological. (Arif Muttaqin, 2010)

According to the National Eating Disorders Association (NEDA, 2012), anorexia nervosa is a serious and potentially life-threatening disease in which eating disorders are characterized by hunger and excessive weight loss.


Etiology

The exact cause of anorexia nervosa is not known with certainty, but there are several factors as follows;

1. Biological Factors
   
   • Hunger or starvation will cause changes in neuropeptide activity and contribute to neuroendocrine disorders in anorexia nervosa patients.
   • There is a research on the function of the hypothalamic-pituitary-adrenal (HPA) axis in patients with anorexia nervosa in principle found hypercortisolism in which HPA plays a role in releasing the hormone corticotropin which affects patients to anorexia. (Licino, 1996)
   • The central pathway of serotonin eating regulates eating patterns and also participates in regulation of behavior and mood. Disorders of regulatory regulation and mood. Impaired regulation of serotonin regulation has implications for general depressive conditions that clearly will cause eating disorders. In the study of impaired serotonin regulation there is an increased risk of anorexia nervosa. (Jimerson, 1990)
   • Determination of ghrelin, glucose-dependent insulinotropic polypeptide (GIP) provides an increased response to anorexia. A decrease in GIP occurs in objects, although a small intake of calories prevents rapid insulin response in patients with anorexia. (Stock, 2005)
   • In conditions of depressed thyroid function, this abnormality can only be corrected by elimination. Hunger also causes amenorrhea that shows hormone levels (Luitenizing Hormone FSH, Gonadotropin, Realisine Hormone). Even so, some patients with anorexia nervosa suffer from amenorrhea before significant weight loss.
2. Sociocultural factors, anorexia nervosa patients have a family history of depression, alcohol dependence or eating disorders.
   
3. Psychological factors, fear of being fat, pressure to excel, social behavior that equates leanness with beauty.

Pathophysiology

In chronic conditions it provides a decrease in essential fatty acid content (Holman, 1995) which provides manifestations of decreased prostagladin synthesis as a constituent and protective mucous membrane which causes the patient to have a high risk of mucous membrane injury. Lack of fat intake and activities that are always carried out with the aim of losing weight so that patients tend to be weak and provide manifestations of disruption of daily activities, as well as the risk of secondary infection from decreased immunity.

The condition of chronic anorexia nervosa also has an impact on increasing the risk of osteoporosis as a result of shrinkage of bone mass or bone mineral density decreases thus providing a risk of pathological fracture. (Ringgoti, 1995)

Decreased calorie intake reduces fat reserves to be synthesized and protein in the body, endocrine disruption involving the hypothalamic-pituitary-gonadal axis occurs, resulting in estrogen deficiency which causes amenorrea. Whereas in men fluctuating testosterone levels that cause decreased erectile function and sperm count. (Kimberly, 2011)

In addition, a lack of calorie intake will have an impact on decreasing gastrointestinal motility, causing slowing of gastric emptying and constipation. (Wals, 2008)

The most serious risk of anorexia is the deterioration of intolerable physical conditions which increases the risk of death in some anorexia nervosa individuals.


Clinical Manifestations

According to the National Eating Disorders Association (NEDA, 2012), anorexia nervosa has four main symptoms as follows;

1. Resistance maintains weight at or above the minimum body weight that is normal for age and height.
2. Fear of being fat, even though body weight is below normal.
3. Dissatisfaction with certain aspects of physical appearance or serious self-rejection of low body weight.
4. Loss of menstrual periods in girls and post-puberty women.

Anorexia nervosa patients can be treated well on an outpatient basis. However, if the patient shows any of the following signs, the patient must be hospitalized;

1. Rapid weight loss is equivalent to 15% or more of normal body mass.
2. Persistent bradycardia (50 times / minute or less)
3. Systolic hypotension is less than or equal to 90 mmHg
4. Hypothermia (core body temperature less than or equal to 36.1ºC)
5. Medical complications found, suicidal thoughts
6. Persistent sabotage or obstacles to outpatient therapy due to rejection of the condition and the need for therapy

Bulimia Nervosa

Definition

Bulimia nervosa is a behavioral disorder characterized by fond of eating followed by guilt, contempt and self-deprecation where vomiting is induced alone, use of laxatives or diuretics, or restricting diet or fasting to overcome the effects of overeating. (Kimberly, 2011)

Bulimia nervosa is a recurring episode of binge eating and then with compensatory treatment (vomiting, fasting, serving, or a combination thereof). Overeating is accompanied by the subjective feeling of losing control when eating. Vomiting that is intentional or exaggerated, and abuse of laxatives, diuretics, amphetamines and thyroxine can also occur. (Chavez and Insel, 2007).

According to the National Eating Disorders Association (NEDA), bulimia nervosa is an eating disorder characterized by excessive eating cycles and compensatory behaviors such as self-induced (vomiting) are designed to cancel or compensate for the effects of large meals outside normal eating portions.


Etiology

The cause of bulimia nervosa can not be known with certainty, but there are factors as follows;

1. Biological factors, mental disorders are also caused by chemical processes in the brain, namely the presence of neurotransmitter abnormalities in the brain, primarily the neurotransmitter serotonin is a trigger for bulimia nervosa.
2. Psychological factors, appearance problems, lack of confidence in the weight they have, family conflicts.
3. Cultural factors, excessive emphasis on physical appearance due to cultural influences.

Pathophysiology

Decreasing calorie intake will reduce fat and protein stores in the body. Estrogen deficiency occurs in women due to lack of pleated substrates for synthesis, causing amenorrea. Whereas in men, there is also a decrease in erectile function and sperm count as a result of fluctuating testosterone levels. (Kimberly, 2011)

Caused by repeated vomiting, a person suffering from bulimia nervosa will experience an electrolyte imbalance and nutrients are not fulfilled properly (malnutrition). Vomiting also causes erosion of tooth enamel, especially the surface of the tongue, the back of the tongue (because it is often affected by finger friction to induce vomiting).

 Unlike anorexia nervosa, bumilia nervosa does not interfere with bone mineral density, this can occur depending on age, body weight (the thinner the more at risk). Most patients with bulimia nervosa experience depression which results in suicide attempts.


Clinical Manifestations

According to the National Eating Disorders Association (NEDA, 2012) bulimia nervosa has three main symptoms as follows;

1. Regular intake of large amounts of food is accompanied by a sense of loss of control when eating.
2. Usually use inappropriate self-induced compensation behaviors such as vomiting, laxative or diuretic abuse, fasting, or exercise.
3. Extreme attention to body weight and body shape.

Nursing Care Plan

Assessment


The identity examined includes name, age, gender, place of residence as a description of environmental and family conditions, and other information about the patient's identity.

1. Psychological and lifestyle assessments are usually found in adolescents and consider themselves unattractive, unhealthy and undesirable.
2. Psychosocococcal assessment and environmental conditions in the family.

The main complaint, the desire to be thin because they feel overweight.

1. Previous medical history, often obtained by the use of appetite suppressant drugs, diuretics, laxatives (laxatives) or alchohol.
2. Family health history, assesses whether or not a family has experienced bulimia or anorexia nervosa.
3. Physical examination.Physical examination is carried out to assess any changes or disturbances to the vital function of anthropometry: Body weight and anthropometric examination is carried out to assess nutritional status. Widespread endocrine disruption involves the hypotalamus pituytary-gonadal axis, with manifestations in women as amenorrhoea and in men ie loss of interest and seyual potential.
4. Supporting investigation
5. Laboratory

Nursing diagnoses that may appear

1. Imbalanced Nutrition: Less Than Body Requirements
2. Risk for Electrolyte Imbalance
3. Activity Intolerance
4. Disturbed Body Image

Nursing Interventions

1. Imbalanced Nutrition: Less Than Body Requirements

NOC: After nursing actions are fulfilled, the patient's nutritional needs are fulfilled.

Outcomes :

• There is an increase in body weight according to the purpose
• No signs of malnutrition
• No significant weight loss occurred

NIC:

1. Assess for food allergies
2. Monitor for weight loss
3. Give sugar substance
4. Instruct the patient to increase protein and vitamin C
5. Provide information about nutritional needs
6. Collaboration with a nutritionist to determine the number of calories and nutrients a patient needs.

2. Risk for Electrolyte Imbalance

NOC: After nursing, electrolyte balance occurs

Outcomes:

• No signs of dehydration
• Good skin turgor elasticity
• There is no excessive thirst
• Maintain urine output according to age and body weight

NIC:

1. Assess vital signs
2. Monitor hydration status (mucous membrane moisture, adequate pulse, orthostatic blood pressure)
3. Monitor fluid status including fluid intake and output
4. Maintain accurate intake and output records
5. Give IV fluids
6. Push oral input
7. Encourage the family to help patients eat
8. Doctor's collaboration if signs of excess fluid appear to worsen

3. Activity Intolerance

NOC: After nursing actions the client's condition is stable when performing activities

Outcomes :

• Able to do daily activities (ADLs) independently
• Good circulation status
• Vital signs are normal

NIC:

Monitor physical, emotional, social and spiritual responses

1. Monitor adequate nutrition intake as a source of energy
2. Help to choose activities that are consistent with physical, psychological and social abilities
3. Help clients to identify activities that can be done
4. Collaborate with medical rehabilitation personnel in planning appropriate therapeutic programs

4. Disturbed Body Image

NOC: After nursing actions

Outcomes:

• Positive body image
• Being able to identify personal strengths
• Factually describing changes in bodily functions
• Maintaining social interaction

NIC:

1. Assess verbally and non-verbally the client's response to his body
2. Monitor the frequency of self-criticism
3. Explain treatment, treatment of disease
4. Encourage clients to express their feelings
5. Facilitate contact with other individuals in small groups

Bibliography

(Kimberly, 2011) 
(Arif Muttaqin, 2010)
(NEDA, 2012)
(Licino, 1996)
(Jimerson, 1990)
(Stock, 2005)
(Holman, 1995)
(Ringgoti, 1995)
(Kimberly, 2011)
(Wals, 2008)
(Chavez and Insel, 2007) 

Source : https://nandacareplan.blogspot.com/2020/04/nursing-care-plan-for-bulimia-nervosa.html

Appendectomy - Nursing Care Plan for Preoperative and Postoperative

Definition of Appendicitis

Appendicitis is an inflammation that often occurs in the appendix which is a serious case of abdominal surgery are the most common.


Appendectomy

An appendectomy is the surgical removal of the vermiform appendix. This procedure is normally performed as an emergency procedure, when the patient is suffering from acute appendicitis. In the absence of surgical facilities, intravenous antibiotics are used to delay or avoid the onset of sepsis; it is now recognized that many cases will resolve when treated perioperatively. In some cases the appendicitis resolves completely; more often, an inflammatory mass forms around the appendix, causing transruptural flotation. This is a relative contraindication to surgery.


Etiology of Appendicitis

Appendicitis is a bacterial infection caused by obstruction or blockage due to:

1. Hyperplasia of lymphoid follicles
2. Fecalith presence in the lumen of the appendix
3. Appendix tumor
4. The presence of foreign objects such as ascariasis worm.
5. Appendix mucosal erosion due to parasites such as: E. Histilitica.

According to research, epidemiology suggests eating foods low in fiber will cause constipation which can cause appendicitis. This will increase intra-caecal pressure, causing a functional obstruction appendix and increase the growth of germs in the colon flora.


Pathophysiology of Appendicitis

Signs and Symptoms of Appendicitis

Pain, felt in the lower abdominal quadrant and is usually accompanied by mild fever, nausea, vomiting and loss of appetite. Local tenderness at the point Mc. Burney, when done pressure. Tenderness may be found out.

The degree of tenderness, muscle spasm, and whether there is constipation or diarrhea does not depend on the severity of infection and location of the appendix. If the appendix at the back of the cecum circular, pain and tenderness can be felt in the lumbar region; when one end was in the pelvis, these signs can only be known on rectal examination. Pain on defecation shows that the tip of the appendix is close to the bladder or ureter. The existence of muscle stiffness in the bottom right of the rectum may occur.

Rovsing sign can arise with left lower quadrant palpation, which causes pain felt in the lower right quadrant. If the appendix has ruptured, the pain can be more spread out; abdominal distension due to paralytic ileus and the client's condition worsened.


Complications of Appendicitis

The main complication of appendicitis is perforation of the appendix, which can lead to peritonitis or abscess. The incidence of perforation is 105 to 32%. The incidence is higher in young children and the elderly. Perforation generally occurs 24 hours after the onset of pain. Symptoms include a fever with a temperature of 37.7 ° C or higher, continuous abdominal tenderness.


Management of Appendicitis

In acute appendicitis, the best treatment is surgery the appendix. Within 48 hours must be performed. Patients in the observation, rest in Fowler's position, given antibiotics and given food that does not stimulate peristalsis, if there is perforated drain given the lower right stomach.

1. Preoperative Appendectomy, including patients in hospital, given antibiotics and compress, to reduce the temperature of the patient, the patient is asked to bed rest and fasted.
2. Operative action; Appendectomy
   
3. Postoperative Appendectomy, one day post surgery clients are encouraged to sit upright in bed for 2 x 30 minutes, the next day soft food and stand upright outside the room, the seventh day stitches removed, the client's home.

Nursing Care Plan Appendicitis

Nursing Assessment

1. The identity of the client
2. History of Nursing
   
   • Current medical history; complaints of pain in postoperative wound appendectomy, nausea, vomiting, increased body temperature, increased leukocytes.
   • Past medical history
3. Physical Examination
   
   • Cardiovascular System: To determine vital signs, presence or absence of jugular venous distension, pallor, edema, and abnormal heart sounds.
   • Hematologic System: To determine whether there is an increase in leukocytes is a sign of infection and bleeding, nosebleeds splenomegaly.
   • Urogenital System: Whether or not the tension of the bladder and lower back pain complaints.
   • Musculoskeletal System: To determine whether there is difficulty in movement, pain in bones, joints and there is a fracture or not.
   • The immune system: To determine whether there is lymph node enlargement.
4. Investigations
   
   •   Routine blood tests: to determine an increase in leukocytes is a sign of infection.
   •   Abdominal examination photo: to know the existence of post-surgical complications.

Nursing Diagnosis Preoperative and Postoperative Appendectomy

Preoperative Appendectomy

1. Risk for deficient fluid volume related to preoperative vomiting.

2. Acute pain related to distention of the intestinal tissue by inflammation.

3. Anxiety related to change in health status.

Postoperative Appendectomy

1. Acute pain related to the presence of postoperative wound appendectomy.

2. Impaired nutrition less than body requirements related to reduced anorexia, nausea.

3. Risk for infection related to surgical incision.

4. Deficient knowledge: about the care and diseases related to lack of information.


Nursing Interventions


1. Preparation of general surgery

This can be done by the nurse when the client entered the operating room nurse before surgery:

• Introducing the client and close relatives of hospital facilities to reduce the anxiety of clients and their relatives (the orientation of the environment).
• Measuring vital signs.
• Measure weight and height.
• Collaboration is an important laboratory tests (hematocrit, serum glucose, Urinalisa).
• The interview.

2. Preoperative Interventions

• Observation of vital signs
• Assess fluid intake and output
• Auscultation of bowel sounds
• Assess the status of pain: the scale, location, characteristics
• Teach relaxation techniques
• Give fluids intervena
• Examine the level of anxiety
• Give information about the disease process and actions

PostoperativeIinterventions

• Observation of vital signs
• Assess the scale of pain: characteristics, scale, location
• Assess the state of the wound
• Advise to change position as tilted to the right, left and sat down.
• Assess nutritional status
• Auscultation of bowel sounds
• Give wound care information and disease.

Evaluation

1. Impaired sense of comfort: pain is resolved
2. No infection
3. Overcome nutritional deficiencies
4. The client understands about care and illness
5. Weight loss does not occur
6. Vital signs within normal limits

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Nursing Care Plan for Chronic Obstructive Pulmonary Disease (COPD) with 10 Nursing Diagnosis

Chronic Obstructive Pulmonary Disease (COPD) is a chronic lung disease is progressive, meaning the disease lasts a lifetime and is slowly deteriorating from year to year. In the course of this disease there are phases of acute exacerbation. Various factors play a role in the course of the disease, among other risk factors are factors that cause or exacerbate illnesses such as smoking, air pollution, environmental pollution, infection, genetic and weather changes.

The degree of airway obtruksi happened, and identification of components that allow for reversibility. Stage of the disease outside the lung and other diseases such as chronic sinusitis and pharyngitis. That ultimately these factors make further deterioration occurs sooner. To perform the management of COPD should consider these factors, so that the treatment of COPD for the better.

Chronic obstructive pulmonary disease is a broad classification of disorders that includes chronic bronchitis, bronchiectasis, emphysema and asthma, which is an irreversible condition associated with dyspnea on exertion and decreased air flow in and out of the lungs.

Chronic obstructive pulmonary disease is a lung disorder characterized by impaired lung function in the form of prolonged expiratory period caused by the narrowing of the airways and not much changed in the period of observation for some time.

Signs and symptoms will lead to two basic types:

• Have a dominant direction of the clinical picture of chronic bronchitis (blue bloater).
• Have a clinical picture towards emphysema (pink puffers).

Signs and symptoms are as follows:

• body weakness
• cough
• shortness of breath
• Shortness of breath on exertion and breath sounds
• wheezing
• prolonged expiratory
• form the barrel chest (Barrel Chest) in advanced disease
• the use of accessory muscles
• decreased breath sounds
• sometimes found paradoxical breathing
• leg edema, ascites and clubbing

10 List of Nanda Nursing Diagnosis for COPD

1. Ineffective airway clearance related to: bronchoconstriction, increased sputum production, ineffective cough, fatigue / lack of energy, bronchopulmonary infection.
2. Ineffective breathing pattern related to: shortness of breath, mucus, bronchoconstriction, airway irritants.
3. Impaired gas exchange related to: ventilation perfusion inequality.

4. Activity intolerance related to: imbalance between oxygen supply with demand.
5. Imbalanced Nutrition: less than body requirements related to: anorexia.
6. Disturbed sleep pattern related to: discomfort, sleeping position.
7. Bathing / Hygiene Self-care deficit related to: fatigue secondary to increased respiratory effort and ventilation and oxygenation insufficiency.
8. Anxiety related to: threat to self-concept, threat of death, purposes that are not being met.
9. Ineffective individual coping related to: lack of socialization, anxiety, depression, low activity levels and an inability to work.
 10. Deficient Knowledge related to: lack of information, do not know the source of information.

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