List of Nursing Diagnosis

Hyperthyroidism is a condition in which an overactive thyroid gland produces an excessive amount of thyroid hormones that circulate in the blood . Thyrotoxicosis is a toxic condition caused by an excess of thyroid hormones from any cause. Thyrotoxicosis can be caused by an excessive intake of thyroid hormones or by the production of thyroid hormones excess by the thyroid gland.

Thyroiditis is the inflammation of the thyroid gland which is usually followed by symptoms of hyperthyroidism. The disease is more common in women after childbirth, a few months later the symptoms of hypothyroidism. Most will recover back to normal thyroid.

The thyroid is regulated by another gland located in the brain, called the pituitary. In turn, the pituitary is regulated in part by thyroid hormone that is circulating in the blood (a feedback effect of thyroid hormones on the pituitary gland) and partly by another gland called the hypothalamus, is also a part of the brain.

The hypothalamus releases a hormone called thyrotropin releasing hormone (TRH), which sends a signal to the pituitary to release thyroid stimulating hormone (TSH). In turn, TSH sends a signal to the thyroid to release thyroid hormones. If the excessive activity of whichever of these three glands occurs, an amount of thyroid hormones excess can be generated, thus resulting in hyperthyroidism.

Number or rate of thyroid hormone production is controlled by the pituitary gland. If there is no sufficient amount of thyroid hormone circulating in the body to allow for normal functioning, the release of TSH, enhanced by the pituitary in an attempt to stimulate the thyroid to produce more thyroid hormone. Conversely, when there is an excessive amount of circulating thyroid hormone, the pituitary release of TSH reduced when trying to reduce the production of thyroid hormones.


Some diseases that cause hyperthyroidism are:

a) Graves' Disease
The disease is caused by an overactive thyroid gland and is the most frequent cause of hyperthyroidism encountered. The disease is usually derived. Women 5 times more often than men. Suspected cause is an autoimmune disease, in which antibodies are found in the blood circulation, namely thyroid stimulating.
Immunoglobulin (TSI antibodies), thyroid peroxidase antibodies (TPO) and thyrotropin receptor antibody (TRAb). The originators of this disorder is stress, smoking, radiation, eye and skin disorders, blurred vision, sensitive to light, feels like there is sand in the eyes, the eyes may protrude up to double vision. This eye disease often runs itself and does not depend on the high / low thyroid hormone. Skin disorders cause the skin to be red, loss of pain, and sweating a lot.

b) Toxic Nodular Goiter
Lump in the neck due to enlargement of the thyroid in the form of solid grains, can be one or many. The word "toxic" means hyperthyroidism, whereas nodules or seeds that are not controlled by TSH, thus producing excessive thyroid hormone.

c) Drinking excessive thyroid hormone medication.
Drinking thyroid hormone with the aim of lowering the body until the side effects.

d) Production of abnormal TSH.
Pituitary TSH production can produce excessive TSH, which stimulates the thyroid issue that a lot of T3 and T4.

e) Thyroiditis (inflammation of thyroid gland).
Thyroiditis often occurs in women after childbirth, postpartum thyroiditis is called, where a complaint arises in the initial phase of hyperthyroidism, 2-3 months then quit hpotiroid symptoms.

f) Excessive iodine consumption.
When excessive consumption can cause hyperthyroidism, this disorder usually occurs when the patient previously had been no abnormalities of the thyroid gland.


In the mild stage often without complaint. Similarly, in older people, more than 70 years, the typical symptoms are often not apparent. Depending on the severity of hyperthyroidism, then a complaint can be mild to severe.

Complaints that often arise include:

• Anxiety, insomnia, and a fine tremor.
• Weight loss despite a good appetite.
• Heat intolerance and a lot of sweat.
• Palpitations, tachycardia, cardiac arrhythmias, and heart failure, which may occur as a result of the effects of thyroxine on myocardial cells.
• Amenorrhoea and infertility.
• Muscle weakness, especially in limb circumference (proximal myopathy).
• Osteoporosis with bone pain.

Nursing Diagnosis for Hyperthyroidism

1. Hyperthermia related to inflammatory processes.
2. Imbalanced nutrition : less than body requirements related to the inability to absorb nutrients.
3. Activity intolerance related to imbalance between oxygen supply and demand.
4. Ineffective Breathing Pattern related to respiratory muscle fatigue.

Anemia Definition

Anemia is characterized by levels of hemoglobin (Hb) and red blood cells (erythrocytes) is lower than normal. If the hemoglobin level is less than 14 g / dl and erythrocyte less than 41 % in men, then a man is said to be anemic. Similarly in women, women with hemoglobin levels less than 12 g / dl and erythrocyte less than 37 %, then the woman was said to be anemic. Anemia is not a disease, but rather a reflection of the state of a disease or disorder caused by the body's functions. Physiologically anemia occurs when there is a shortage of hemoglobin to carry oxygen to the tissues.

Anemia was defined as a decrease in the volume of red blood cells or hemoglobin level to below the range of accepted values ​​for healthy people. Anemia is a symptom of an underlying condition, such as loss of blood components, elements inadequate or lack of nutrients needed for the formation of blood cells, resulting in decreased oxygen-carrying capacity of the blood, and there are many types of anemia with different causes.

Etiology

1. Hemolysis (erythrocytes easily broken).
2. Bleeding.
3. Bone marrow suppression (eg by cancer).
4. Nutrient deficiency (nutritional anemia), including iron deficiency, folic acid, pyridoxine, vitamin C and copper.

According to various sources the causes of anemia include:

1. Less consumption of foods containing iron, vitamin B12, folic acid, vitamin C, and the elements necessary for the formation of red blood cells.
2. Excessive menstrual blood. Women who are menstruating prone to iron deficiency anemia when much menstrual blood and not enough iron stores.
3. Pregnancy. Pregnant women are prone to anemia because the fetus to absorb iron and vitamins for growth.
4. Certain diseases. Diseases that cause continuous bleeding in the digestive tract such as gastritis and appendicitis can lead to anemia.
5. Certain drugs. Several types of medications can cause stomach bleeding (aspirin, anti- inflammatory, etc.). Other drugs can cause problems in the absorption of iron and vitamins (antacids, birth control pills, antiarthritis, etc.).
6. Retrieval operation of part or all of the stomach (gastrectomy). It can cause anemia because the body absorbs less iron and vitamin B12.
7. Chronic inflammatory diseases such as lupus, rheumatoid arthritis, kidney disease, thyroid gland problems, some types of cancer and other diseases can cause anemia because they affect the process of the formation of red blood cells.
8. In children, anemia can occur due to hookworm infection, malaria, or dysentery that caused a severe shortage of blood.

Pathophysiology

The presence of an anemia marrow reflects the existence of a failure or loss of red blood cells or both. Marrow failure (for example, reduced erythropoiesis) can occur as a result of nutritional deficiencies, toxic exposure , tumor invasion or other unknown causes.

Red blood cells can be lost through bleeding or hemolysis (destruction).
Red blood cell lysis (dissolution) occurs primarily in phagocytic cells or in the reticuloendothelial system, mainly in the liver and spleen. Byproducts of this process is bilirubin that would enter the bloodstream. Any increase in red blood cell destruction (hemolysis) immediately reflected by an increase in plasma bilirubin (normal concentration of ≤ 1 mg / dl, levels above 1.5 mg / dl result in jaundice in the sclera).

If the destruction of red blood cells in the circulation experience, (in hemolytic disorders) then it will appear in the plasma hemoglobin (hemoglobinemia). If the plasma concentration exceeds the capacity of plasma haptoglobin ( protein binding to free hemoglobin ) to bind everything, hemoglobin diffuses in the renal glomerulus and into the urine (hemoglobinuria).

Conclusions about whether an anemia in patients caused by destruction of red blood cells or red blood cell production is not sufficient usually be obtained on the basis of : 1 . reticulocyte count in the blood circulation ; 2 degree of the proliferation of young red blood cells in the bone marrow and maturation ways, as seen in the biopsy ; and presence or absence of hyperbilirubinemia and hemoglobinemia.


Signs and Symptoms

1. Weak, tired, lethargic and tired.
2. Often complain of headache and dizziness.
3. Further symptoms such as eyelids, lips, tongue, skin and palms became pale. Pale because of lack of blood volume and hemoglobin, vasoconstriction.
4. Tachycardia and heart murmur (an increase in blood flow velocity) Angina (chest pain).
5. Dyspnea, shortness of breath, tired quickly when activity (reduced O2 delivery).
6. Headache, weakness, tinnitus (ringing in the ears) illustrates the reduced oxygenation of the CNS
7. Severe anemia GI disorders, and CHF (anorexia, nausea, constipation or diarrhea).

Complication 

• Heart failure.
• Seizures.
• Poor muscle development (long-term).
• Concentration decreases.
• The ability to process information that is heard decrease.

Test

• Hemoglobin concentration, hematocrit, red blood cell indices, white blood cell studies, the levels of Fe, iron binding capacity measurement, folate, vitamin B12, platelet count, bleeding time, prothrombin time, and partial thromboplastin time.
• Bone marrow aspiration and biopsy. Unsaturated iron - binding capacity of serum.
• Diagnostic assay to determine the presence of acute and chronic diseases as well as the source of chronic blood loss.

Nursing Care Plan for Anemia

Nursing Diagnosis for Anemia

1. Ineffective Cerebral Tissue Perfusion related to changes in the oxygen bond with hemoglobin, decrease in hemoglobin concentration in the blood.
2. Imbalance nutrition less than body requirements related to inadequate food intake .
3. Self-care deficit related to weakness
4. Risk for infection related to inadequate secondary defenses (decreased hemoglobin )
5. Activity intolerance related to imbalance between supply and demand of oxygen .
6. Impaired gas exchange related to ventilation perfusion .
7. Ineffectivene breathing pattern related to fatigue .
8. Fatigue related to anemia .

Nursing Care Plan for Lower Back Pain

Nursing Diagnosis for Lower Back Pain : Acute pain related to the agent of injury (physical, musculo skeletal disorders and vascular nervous system).

Defining characteristics :
Verbal

• Took a deep breath, moaning.
• Complained of pain.

Motor

• Grinning face.
• Step struggling.
• Rigid posture / unstable.
• Movement is very slow or forced.

Autonomic response

• Changes in vital signs.

Goal :
Pain is reduced / lost

Outcome :

Levels of pain

• Reported pain reduced / lost.
• Frequency of pain reduced / lost.
• Long of pain pain reduced / lost.
• Oral expression is reduced / lost.
• Muscle tension is reduced / lost.
• Can rest.
• Pain scale decreased.

Control of pain

• Know the factors that cause.
• Know the onset of pain.
• Rarely / never done action / relief with non- analgesic.
• Rarely / never use of analgesics.
• Rarely / never reported pain to the healthcare team.
• Pain controlled.

Level of comfort

• Report needs a break - sleeping fulfilled.
• Reported good physical condition.
• Reported good psychological condition.

Interventions :


Pain Management

• Perform a comprehensive pain assessment (location, characteristics, duration, frequency, quality, and precipitation factors).
• Observation of non-verbal reactions of discomfort.
• Use therapeutic communication techniques to determine the client's experience of pain.
• Assess the culture that affects pain response.
• Evaluation of past painful experiences.
• Evaluation with clients and other health team about the ineffectiveness of pain control past.
• Help clients and families to seek and find support.
• Control environment that may affect pain (room temperature, lighting, and noise).
• Reduce pain precipitation factor.
• Choose and pain management (pharmacological, non-pharmacological and interpersonal).
• Assess the type and source of pain to determine the intervention.
• Teach about non-pharmacological techniques.
• Give analgesics to reduce pain.
• Evaluation of the effectiveness of pain control.
• Increase the break.
• Collaboration with doctors, if there is a complaint and the action of pain that did not work.
• Monitor client acceptance of pain management.

Analgesic Andministrasi

• Determine the location, quality characteristics, and the degree of pain as drug delivery.
• Check the doctor's instructions about the type of medication, dosage and frequency.
• Check history of allergy.
• Select the required analgesics or combination of analgesics when giving more than one.
• Determine analgesic choice , depending on the type and severity of pain.
• Determine the route of administration of analgesic options, and the optimal dose.
• Select the route of administration of intravenous / intramuscular, for the treatment of pain on a regular basis.
• Monitor vital signs before and after the administration of first analgesic.
• Give analgesic especially timely when severe pain.
• Evaluation of the analgesic effectiveness of signs and symptoms (side effects).

Nursing Diagnosis : Anxiety

Uterine Fibroids (Myoma) is a benign, well-circumscribed, not encapsulated, which is derived from smooth muscle and fibrous connective tissue. Also called fibromyoma, leiomyomas. This benign tumor is a benign neoplasm that is most commonly found in the genital tract of women, especially women of childbearing age. Although not frequent, reproductive dysfunction associated with myomas include infertility, spontaneous abortion, premature delivery, and malpresentation (Crum, 2003).


Myoma (fibroids) are generally classified by the location and the direction in which they grow. Classification as follows :

1. Intramural fibroids (myoma) : myomas are most commonly found. Most of the lining of the uterus grows in between the thickest and most central, the myometrium.
2. Subserous myoma : myoma which grew out of the outermost layer of the uterus, which is serous and grow toward the peritoneal cavity. This type of myomas pedunculated or have a wide base. When detached from the parent and a walk or can be attached to the peritoneal cavity is called wandering / parasitic fibroids, the second most points were found.
3. Submucosal myoma : myoma grows from the uterine wall in that protrude into the uterus. This type can also be stemmed or based on width. Sessile polyps can grow into, then born through the cervical canal, called myomas Geburt. (Chelmow, 2005)

Definite etiology is unknown.

1. Increased estrogen - progesterone receptors in uterine myoma tissue affects tumor growth.
2. Predisposing factors are hereditary, has identified 145 chromosomes that carry genes, estimated to affect fibroid growth. Some experts say that uterine fibroids inherited from the paternal genes.
3. Myomas usually enlarges during pregnancy and shrink after menopause is rare before menarche. (Crum, 2005)

Risk factor for uterine fibroids (myoma), namely :
1. Age of patients
Uterine fibroids are found approximately 20 % in women of reproductive age and about 40 % -50 % in women aged over 40 years (Suhatno, 2007). Uterine fibroids are rare before menarche (before menstruation). While uterine fibroids in postmenopausal women was found to be 10 % (Joedosaputro, 2005).

2. Endogenous hormonal
The concentration of estrogen in uterine fibroids tissue, higher than normal myometrium tissue. (Djuwantono, 2005)

3. Family history
Women with a first -level lineages with uterine fibroids sufferer has 2.5 times more likely to suffer myomas compared with women without uterine fibroids sufferer lineage. (Parker, 2007)

4. Body Mass Index (BMI)
Obesity also plays a role in the occurrence of uterine fibroids. (Parker, 2007)

5. Food
Reported that beef, undercooked meat (red meat), and pork increased incidence of uterine fibroids, however greens lowering the incidence of uterine fibroids. (Parker, 2007)

6. Pregnancy
Pregnancy can affect uterine fibroids due to high estrogen levels in pregnancy and increased vascularity to the uterus. This speeds enlargement uterine fibroids. (Manuaba, 2003).

7. Parity
Uterine fibroids are more common in multiparous women compared with women who have a history of giving birth frequency of 1 (one) or 2 (two) times (Khashaeva, 1992).



Nursing Care Plan for Uterine Fibroids (Myoma)

Nursing Diagnosis for Uterine Fibroids (Myoma) : Anxiety related to situational crisis (hysterectomy or chemotherapy), threats to self-concept, changes in health status, stress

NOC :

Anxiety Control

Can be expected to control anxiety

Outcomes :

• The nurse monitors the patient's level of anxiety.
• Clients are able to lower the causes of anxiety.
• Nurses and families can lower the environmental stimulus when the patient is anxiety.
• Clients are able to search for information about things to do to reduce anxiety.
• Clients are able to use effective coping strategies.
• Clients report to the nurse decreased anxiety.
• Clients are able to use relaxation techniques to reduce anxiety.
• Clients are able to maintain social relationships, and concentration.
• Clients report to nurse enough sleep, no physical complaints due to anxiety, and no behavior indicating anxiety.

NIC

Lowering Anxiety

• Reassure the patient and assess the patient's level of anxiety .
• Explain to the patient throughout the procedure actions and feelings that might arise during the action .
• Trying to understand the patient's condition ( empathy ) .
• Provide information about the diagnosis , prognosis and act with good communication .
• Accompanying patients to reduce anxiety and increase comfort .
• Encourage the patient to express feelings .
• Create a trusting relationship .
• Help the patient to explain the circumstances that can lead to anxiety .
• Help the patient to reveal things that provoke anxiety and listen attentively .
• Teach the patient relaxation techniques .
• Instruct the patient to enhance the worship and prayer .
• Collaboration with physicians for the provision of drugs that relieve anxiety.

Nursing Care Plan for Atrial Septal Defect

Atrial Septal Defect (ASD) is a congenital heart disease in the form of a hole (defect) in the interatrial septum (septum between the porch) that occurs due to malfunction during fetal interatrial septum. Atrial septal defect (ASD) is a hole in the wall (septum) that separates the upper heart (left atrium and right atrium). Cardiac abnormalities such as VSD is similar, but the location of the leak in the septum between the left atrium and right. These abnormalities lead to complaints that are lighter than the VSD. Atrial Septal Defect is an association (holes) on the abnormal septum that separates the right atrium and left atrium. Congenital heart defects requiring open heart surgery is the atrial septum defect.

The cause is not yet known with certainty, but there are several factors suspected to have an influence on the increase in the incidence of ASD. These factors include:
1. Prenatal Factors

• Mother suffered from rubella infection.
• Mother's alcoholism.
• Maternal age over 40 years.
• Mother suffered from IDDM.
• Mothers taking sedative drugs.

2. Genetic factors

• Children born before suffering from congenital heart disease.
• Father or mother suffering from congenital heart disease.
• Chromosomal abnormalities such as Down syndrome.
• Born with other congenital abnormalities.

Nursing Diagnosis for Atrial Septal Defect :
Altered Growth and Development related to the inadequate oxygen and nutrients to the tissues, social isolation.

Purpose:

• Children follow the growth curve of body weight and height.
• Children have the opportunity to participate in age-appropriate activities.

Outcomes Criteria :

• Children achieve adequate growth.
• Children perform age-appropriate activities
• Children do not experience social isolation.

Nursing Interventions

• Give a balanced diet high in nutrients to achieve adequate growth.
• Monitor height and weight; draw on a growth chart to determine the trend of growth.
• Can provide iron supplements to treat anemia, if recommended.
• Encourage age-appropriate activities.
• Emphasize that the child has the same needs as other children socialization.
• Allow the child to organize his own space and limitation of activity because the child will rest when tired.