List of Nursing Diagnosis

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.

Hypertension Nursing Diagnosis List

Definition

Hypertension is defined as persistent blood pressure where the systolic pressure above 140 mmHg and diastolic above 90 mmHg. In the elderly population, hypertension is defined as systolic pressure of 160 mmHg and a diastolic pressure of 90 mmHg. (Smeltzer, 2001).


Etiology

In general, hypertension has no specific cause (idiopathic). Hypertension occurs in response to increased cardiac output or increased peripheral pressure. However, there are several factors that influence the occurrence of hypertension :

1. Genetic response to stress or neurological disorders or transport of Na excretion.
2. Obesity : associated with high insulin levels that result in increased blood pressure.
3. Environmental Stress.
4. The loss of tissue elasticity and atherosclerosis in the elderly as well as dilation of blood vessels.

Based on the etiology hypertension were divided into 2 groups, namely :

a. Essential Hypertension (Primary)
The cause is unknown but many factors that influence such as genetics, environment, hyperactivity, sympathetic nervous system, renin-angiotensin system, the effect of Na excretion, obesity, smoking and stress.

Although primary hypertension is not known with certainty the cause, research data have found several factors that often lead to hypertension. These factors are as follows :

Heredity.

• From the statistical data it is evident that a person will have a greater chance to get hypertension if their parents are hypertensive.

Individual characteristics :

• Individual characteristics that affect the incidence of hypertension is :
• Age (if age increases, blood pressure increases).
• Men is higher than women.
• Race (blacks more than whites).
• Living habits.

Habits often cause hypertension are :

• High salt consumption (in excess of 30 g).
• Obesity or overeating.
• Stress.
• Smoking.
• Drinking alcohol.
• Taking certain medications that increase blood pressure.

b. Secondary Hypertension
Could be due to renal parenchymal disease / renal vascular.
The use of oral contraceptive pills. Endocrine disorders etc..

While the causes of secondary hypertension are :

• Kidney
• Glomerulonephritis
• Pyelonephritis
• Acute tubular necrosis
• Tumors
• Vascular
• Atherosclerosis
• Hyperplasia
• Thrombosis
• Aneurysms
• Cholesterol embolism
• Vasculitis
• Endocrine disorders
• Diabetes Mellitus
• Hyperthyroidism
• Hypothyroidism
• Nerves
• Stroke
• Encephalitis
• Guillain - Barré Syndrome
• Drugs
• Oral contraceptives
• Corticosteroids

The cause of hypertension in the elderly is the occurrence of changes in :

• Decreased elasticity of the aortic wall.
• Valvular heart to thicken and become stiffer.
• Heart's ability to pump blood decreases 1 % every year after the age of 20 years decreases the heart's ability to pump blood causes decreased contraction and volume.
• Loss of elasticity of the blood vessels .

This happens due to lack of efficacy for peripheral vascular oxygenation Increased peripheral vascular resistance.

Risk factors

• Family history of heart disease and hypertension.
• Men aged 35-55 years and women over 50 years of age or after menopause.
• Most consume salt / sodium.
• The blockage of the blood vessels (atherosclerosis) caused by several things such as smoking, lipid levels, and increased serum cholesterol, caffeine, diabetes, etc..
• Emotional factors and stress levels.
• Monotonous lifestyle.
• Sensitive to angiotensin.
• Obesity.
• The use of oral contraceptives, such as estrogen.

Nursing Diagnosis for Hypertension

1. Risk for decreased cardiac output related to :
increased afterload,
vasoconstriction,
hypertrophy / ventricular rigidity,
myocardial ischemia.

2. Activity intolerance related to :
weakness,
imbalance between supply and demand of oxygen.

3. Acute pain related to :
increase in cerebral vascular pressure.

4. Anxiety related to :
situational crisis ; secondary hypertension suffered.

5. Knowledge Deficit related to :
lack of information about the disease process.

Nursing Care Plan for Bronchitis 


Nursing Diagnosis : Ineffective Airway Clearance

Definition : Inability to clear secretions or obstruction of the respiratory tract to maintain the cleanliness of the airway.

Defining characteristics :

• Dyspnea , decreased breath sounds.
• Orthopnoea.
• Cyanosis.
• Abnormalities of breath sounds (rales, wheezing)
• Difficulty speaking.
• Cough, ineffective or non-existent.
• Eyes widened.
• Sputum production.
• Restless.
• Changes in the frequency and rhythm of the breath.

Related factors :

• Environment : smoking, inhaling cigarette smoke, secondhand smoke, infection.
• Physiological : neuromuscular dysfunction, hyperplasia of the bronchial wall, airway allergies, asthma.
• Airway obstruction : airway spasm, retained secretions, much mucus, the presence of artificial airway, bronchial secretions, presence of exudate in the alveoli, the presence of foreign bodies in the airway.

NOC :

• Respiratory Status: Ventilation
• Respiratory status : Airway patency
• Aspiration Control

Outcomes :

• Demonstrate effective cough and breath sounds were clean, no cyanosis and dyspnea (able to produce a sputum sample, is able to breathe easy, no pursed lips).
• Showed a patent airway (the client does not feel suffocated, the rhythm of breath, respiratory frequency in the normal range, no abnormal breath sounds).
• Being able to identify and avoid factors that can inhibit airway.

NIC :
Airway Suctioning

• Ensure the needs of oral / tracheal suctioning.
• Auscultation of breath sounds before and after suctioning.
• Inform the client and family about suctioning.
• Ask the client a deep breath before suction is done.
• Give O2 by using a nasal, to facilitate nasotracheal suction.
• Use sterile equipment every action.
• Instruct the patient to rest and breath in after catheter removed from nasotracheal.
• Monitor the patient's oxygen status.
• Teach the family how to do suction .
• Stop suction and administer oxygen if the patient showed bradycardia, an increase in O2 saturation, etc..

Airway Management

• Open the airway , use techniques jaw thrust or chin lift if necessary.
• Position the patient to maximize ventilation.
• Identification of patients , the need for installation of an artificial airway.
• Attach mayo if necessary.
• Perform chest physiotherapy if necessary.
• Remove secretions by coughing or suctioning.
• Auscultation of breath sounds, note the presence of additional noise.
• Perform suction on the mayo.
• Give bronchodilators if necessary.
• Give Kassa humidifier moist wet NaCl.
• Set intake to optimize fluid balance.
• Monitor respiration and O2 status.

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.

NCP for Dissociative Disorders
Definition

In general, dissociative disorders can be defined as a loss of (some or all) of the normal integration (under conscious control) includes memories of the past, awareness of identity and immediate sensations, and control of body movement.

In diagnosis, dissociative disorders should be a disorder that causes failure of coordinating identity, perception or consciousness of memory, and cause a significant disruption in social functioning, work and take advantage of free time.

There are several penggolonga in dissociative disorders, including dissociative amnesia is, dissociative fugue, dissociative stupor, trance disorder, dissociative motor disorder, dissociative convulsions and anesthesia, and dissociative sensory loss.


Causes

Dissociative Disorders exact cause is not yet known, but it usually occurs as a result of severe trauma of the past, but no organic disturbance experienced. This disorder occurs when the first children but not distinctive and can not be identified, dissociative disorders in the course of the disease can occur at any time and trauma of the past never happen again, and again and again so that the symptoms of dissociative disorders.

Dissociative Disorders refers to a mechanism, dissociation, which is suspected to be the cause. The basic idea is the unity of consciousness is usually an experience, including cognition, emotion and motivation. However, under conditions of stress, trauma memory can be stored in a way so that in the future can not be accessed by normal consciousness back in line with the conditions in question, so the result is the possibility of amnesia or fugue.

Behavioral view of the dissociative disorders is somewhat similar to the initial speculation. In general, behavioral theorists assume full dissociation in response to stress and memory of the incident.
In some references say that the trauma that occurs in the form of:

• Unstable personality.
• Harassment.
• Physical abuse.
• Domestic violence (father and mother divorced).
• Social environment that often show violence.

Personal identity is formed during childhood, and during even then, the children more easily step out of himself and observe trauma although it happens to someone else.


Classification

Dissociative Disorders differentiated or classified into several classifications, namely:

Dissociative Amnesia

In dissociative amnesia usually found specific memory impairment only and is not general. The information is usually forgotten about stressful or traumatic events, in one's life. The general form of amnesia dissociative amnesia for personal identity involves a person, but general information memory is intact.

Dissociative Fugue

Person's behavior patients with dissociative fugue is more integrated with the aims and amnesia than patients with dissociative amnesia. Patients with dissociative fugue has physically walk way from home and work situation and unable to remember important aspects of their previous identity (name, family, work). These patients are often, but not always, take the identity and job completely new, although the new identity is usually less complete than that seen in multiple personality dissociative identity disorder.

Dissociative Stupor

Dissociative stupor can be defined as a significant reduction or loss of voulunter movements and a normal response to external stimuli, such as light, sound, and tactile (while consciousness is not lost in the physiological sense).

Trans Disorder or Trance

Trance Trans disorder or a disorder that showed a temporary loss of identity aspects appreciation and awareness of the environment; in some instances, individuals behave as if controlled by another personality, magical powers, angels or "other forces".

Dissociative Motor Disorders

Dissociative motor disorder in the form of the most common is the inability to move all or part of the limbs (arms and legs).

Dissociative Convulsions

Dissociative convulsions or also called pseudo seizures may be very similar to epileptic seizures in terms of movement, but very rarely accompanied by tongue biting, serious injuries from falls when the attack took place and incontinent. Also not found to lose consciousness.



Signs and Symptoms

In dissociative disorders, the ability of control under the selective control of consciousness and impaired to the extent that can last from a day to day or even hour to hour.

Symptoms common to all types of dissociative disorders, including:

• Loss of memory (amnesia) of the specified time period, events and people,
• The problem of mental disorders, including depression and anxiety,
• Perceptions of people and objects around them are not real (derealization)
• The identity of the opaque
• Depersonalization.

Therapy

Psychotherapy is the primary treatment against this dissociative disorder. Forms of treatment such as talk therapy, counseling or psychosocial therapy, including talking about the disorder suffered by the patient's soul. Therapy will help you understand the causes of the conditions experienced.

Psychotherapy for dissociative disorders often involve techniques such as hypnosis which helps us to remember the trauma that causes dissociative symptoms.

Handling other dissociative disorders include:

• Creative arts therapy. In some references say that this type of therapy uses the creative process to help patients who are difficult to express their thoughts and feelings. Creative arts can help improve self-awareness. Creative arts therapies include art, dance, drama and poetry.
• Cognitive therapy. Cognitive therapy can help to identify negative behaviors and unhealthy and replace it with a positive and healthy, and it all depends on the idea in mind for determining what the examiner behavior.
• Drug therapy. This therapy is very good to be used as initial handler, although there is no specific medicine in dealing with this dissociative disorder. Usually the patient is given a prescription anti-depressant and anti-anxiety drugs to help control the symptoms of dissociative disorder is mental.

Nursing diagnosis for Gastritis : Ineffective Management of Therapeutic Regimen

Gastritis is an inflammation of the gastric mucosa is happening area, which is caused by germs, which can occur in acute and chronic.

Food / drinks that can damage the gastric mucosa, consuming alcohol, using drugs. Bacterial infections especially sreptococcus, stapylococcus, as well as chemicals and beverages which are corrosive like concentrated acid. Food and beverages that are too acidic, spicy, hot, fatty, can also cause gastritis. Too much thinking or stress can increase stomach acid.

Clinical manifestations

a. Acute gastritis.
Epigastric pain that may plus nausea. Pain can arise again when the stomach is empty. When pain, sweating, restlessness, abdominal pain and may be accompanied by an increase in body temperature, takicardia, cyanosis, such as a burning feeling in the epigastric, seizures and weakness.

b. Chronic gastritis.
signs and symptoms of acute gastritis is almost the same as, only accompanied by weight loss, chest pain, anemia pain, such as peptic ulcer, high serum gastrin levels.


Nursing Diagnosis for Gastritis : Risk for Ineffective Management of Therapeutic Regimen related to lack of knowledge about the disease process, contra indications, signs and symptoms, complications, and treatment programs.

Interventions :

1. Describe the pathophysiology of gastritis, using appropriate terminology and media to the level of knowledge of the client and family.

2. Describe the behavior that can be changed or eliminated to reduce the risk of recurrence :

• tobacco use,
• excessive alcohol input,
• foods and beverages that contain caffeine,
• large number of products containing milk.

3. Discuss about further treatment even when there are no symptoms.

4. Instruct client and family to notice and report these symptoms :

• stool red / black
• bloody vomit / black
• epigastric pain settled
• severe abdominal pain and a sudden
• constipation
• nausea and vomiting settled
• weight loss is not clear why

5. Refer to community resources, when indicated ( eg, smoking cessation programs, drink alcohol, stress management).

The author suggests the use of this diagnosis only if there is one among the following signs :

• Weight less than 20 % or more below ideal weight for height and body frame.
• Food intake is less than the metabolic needs, both total calories and certain nutrients.
• Losing weight baan with adequate food intake.
• Reported inadequate food intake less than RDA.

Subjective :
Abdominal cramps.

• Abdominal pain.
• Refusing to eat.
• Perception inability to digest a meal.
• Reported changes in taste sensation.
• Reported a lack of food.
• Feeling full quickly after eating.

Objective :

• Fragile capillaries.
• Diarrhea or steatorrhea.
• Evidence of lack of food.
• Excessive hair loss.
• Hyperactive bowel sounds.
• Lack of information / misinformation.
• Lack of interest in food.
• Oral cavity hurt.
• Muscle weakness which serves to swallow or chew.

Imbalanced Nutrition Less Than Body Requirements - Diabetes Mellitus

Imbalance Nutrition Less than Body Requirements related to psychological factors