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Nursing Diagnosis for Constipation : Acute Pain

Constipation is the inhibition of defecation (bowel movements) of a normal habit. Can be interpreted as a rare defecation, amount of stool (feces) less, or hard and dry stools. All people may experience constipation, especially in the elderly due to slower peristaltic movement and the possibility of other causes. Most occur if you eat less fiber, less drinking, and lack of exercise. This condition gets worse if it is more than three consecutive days.

Epidemiological studies show a rapid rise of constipation associated with age primarily based on patient complaints and not for clinical constipation. Many people think they are constipated if they do not defecate every day, so often there is a difference of view between physicians and patients about the meaning of constipation.

The frequency of bowel movements varies from 3 times per day to 3 times per week. In general, when 3 days have not defecation, fecal mass will harden and no trouble till pain during defecation. Constipation is often interpreted as a lack of frequency of bowel movements, usually fewer than three times per week with a small stool and hard, and sometimes with difficulty until the pain during bowel movements. Elderly people are often stuck with bowel habits.

A limitation of constipation proposed by Holson, including at least 2 of the complaint below and occurred within 3 months:

a. hard stool consistency;
b. with hard straining during bowel movements;
c. sense of incomplete bowel movements, covering 25% of the entire bowel movement;
d. defecation frequency 2 times a week or less.

Cases of constipation commonly affects approximately 4-30 percent of the general population in the age group 60 years and above. Apparently, women more often complain of constipation than men with a ratio of 3: 1 to 2: 1. The incidence of constipation increases with age, especially age 65 years and over. In a study at the age of 65 years old and over, there were people with constipation about 34 percent of women and 26 percent men.

Causes of constipation can be due to systemic factors, medication side effects, central nervous neurogenic factors, or peripheral nerves. It could also be due to abnormalities in organs such as the colon or organic obstruction of the colon muscles do not function normally or abnormalities in the rectum, pelvic floor and children and can be caused by chronic idiopathic factors.

Preventing constipation generally turns out it is not hard. Again, the key is to consume enough fiber. Fiber is most easily obtained in fruit and vegetables. If the patient is having trouble chewing constipation, for example because of a toothless, vegetables or fruit puree in a blender.



Nursing Diagnosis for Constipation : Acute Pain related to the accumulation of hard faeces in the abdomen.

Goal: show the pain has diminished.

Outcomes :
  • Shows relaxation techniques individually effective to achieve comfort.
  • Maintaining the level of pain on a small scale.
  • Reported physical and psychological health.
  • Recognizing the causes and using measures to prevent pain.
  • Using actions to reduce pain with analgesic and non-analgesic appropriately.

Nursing Interventions :

Independent
1. Help the patient to focus more on the activity of pain by doing of switching through television or radio.
R/: Clients can distract from pain.

2. Consider the possibility of drug interaction and drug disease in the elderly.
R/: Be careful in administering medications in the elderly.

Observation
3. Ask the patient to rate the pain on a scale or lack comfortable 0-10.
R/ : Knowing the client's level of perceived pain.

4. Use the pain flow sheet.
R/: Knowing the characteristics of pain.

5. Perform a comprehensive pain assessment.
R/: In order to know the specific pain.

Health education
6. Instruct the patient to the nurse if a deduction meminformasikan less pain reached.
R/: Nurses can take the appropriate action in dealing with client pain.

7. Provide knowledge about pain.
R/ : So that patients do not feel anxious.
READ MORE - Nursing Diagnosis for Constipation : Acute Pain

Pathophysiology of Constipation

Defecation as well on urination is a physiological process involving the working muscles smooth and striated, central and peripheral innervation, coordination of the reflex system, good awareness and physical ability to achieve a bowel movement. The difficulty of diagnosis and management of constipation is because of the many mechanisms involved in the normal process of defecation. Disruption of one of these mechanisms can result in constipation.

Defecation beginning of the large intestine peristalsis deliver feces into the rectum for expulsion. Feces go and stretch the ampulla of the rectum followed by relaxation of the internal anal sphincter. To avoid spontaneous stools, occurs reflex contraction of the external anal sphincter and pelvic floor muscle contractions are innervated by the pudendal nerve. The brain receives stimuli urge to defecate and the external anal sphincter was ordered for relaxation, thus removing the contents of the rectum with the help of the abdominal wall muscle contraction. This contraction will raise the pressure in the stomach, relaxation of the sphincter and the elevator ani muscle. Both sympathetic and parasympathetic innervation involved in the process of defecation.

The pathogenesis of constipation varies, multiple causes, including several overlapping factors. Although constipation is a lot of complaints in the elderly, colonic motility was not affected by age. Normal aging process does not result in a slowing of gastrointestinal trip. Pathophysiological changes that cause constipation is not due to age but is particularly marked in those with constipation.

Research with radio-opaque markers ingested by healthy elderly people who do not get a change of the total time of bowel movements, including motor activity of the colon. About the time of bowel movements by following the radiopaque markers are swallowed, normally less than 3 days already incurred. In contrast, studies in older people who suffer from constipation bowel movements indicate an extension of time of 4-9 days. In those treated or bedridden, can be extended to 14 days. Radioactive markers were used primarily slow the course of the left colon and no later than when the expenditure of the sigmoid colon.

Electrophysiological examination to measure motor activity of the colon of patients with constipation showed reduced motor responses of the sigmoid due to reduced intrinsic innervation because myentericus plexus degeneration. Found also reduced nerve stimulation in circular smooth muscle that can lead to an increased time of bowel movements. Individuals over the age of 60 years was also found to have plasma levels of beta-endorphins are increased, accompanied by an increase in endogenous opiate binding to receptors in the gut. This is evidenced by the effect of dosage opiate constipation which can cause relaxation of colonic tone, reduced motility, and inhibits gastric-colonic reflex.

In addition, there is a tendency of decrease in sphincter tone and strength of smooth muscle associated with age, particularly in women. Patients with constipation have a greater difficulty to remove the small, hard stools that attempts to push harder and longer. This can result in pressure on the pudendal nerve, causing further weakness.
READ MORE - Pathophysiology of Constipation

Ineffective Airway Clearance and Activity Intolerance - NCP for Atelectasis

Nursing Diagnosis and Interventions for Atelectasis

Atelectasis is lung development is not perfect. Atelectasis is not actually a disease but is related to pulmonary parenchymal disease.

Clinical Manifestations
  • May not experience symptoms.
  • Mild shortness of breath: when is advanced in which up to half a lung inflammatory infiltration.
  • Cough: is due to the irritation of the bronchi, coughing is to throw / pull production inflammation, starting from a dry cough up purulent cough (produces sputum).
  • Chest pain: This is rare, occurs when the infiltration of inflammatory pain up to the pleura, giving rise to pleurisy.
  • Malaise: is found in the form of anorexia, decreased appetite, weight loss, headache, muscle aches, sweating at night time.
  • Tachycardia.
  • Cyanosis.
  • Heat or high temperature: subfebril, febrile (38-40 0C) intermittent.
  • Shock or loss of consciousness.
  • The location of the diaphragm will be elevated, reduced chest movement on the affected side.
  • May limit the heart and mediastinum will shift towards the sick.
  • Dullness or flat on the side that suffered atelectasis.
  • Additional breath sounds (crackles).
  • In broad atelectasis noisy breath weakened or no sound at all.
  • There are differences in the thoracic wall motion, the motion between the ribs and diaphragm. In the normal movement of the chest will tune during inspiration and expiration, but the client atelectasis chest movement on the affected side will be left of the chest movement on the healthy side.

Nursing Diagnosis for Atelectasis  : Ineffective Airway Clearance related to bronchial obstruction by mucus clot or foreign body

Characterized by:
  • Ineffective cough.
  • Secretions can not get out.
  • Additional breath sounds (eg crackles).
  • Increased RR, rapid and shallow breaths.

Goal:
Exhibit a client achieve airway clearance

Outcomes:
  • Clients can implement an effective cough.
  • Secretions can be removed.
  • Showed an increase in air exchange in the lungs.

Intervention:

1. Instruct clients to perform effective cough right:
  • Breath deeply and slowly as possible while sitting if able.
  • Use respiratory diaphragm.
  • Hold breath for 3-5 seconds and then exhale slowly through the mouth.
  • Take a second breath, hold it, and with a strong cough from the chest (use two short coughs really strong).
2. Maintain proper body position with.
3. Assist clients to dispense with the method of physiotherapy airway secretions (klepping, vibrating, or postural drainage).
4. Breaks Plan period (after coughing, before eating).
5. Guided and motivated clients to implement effective cough.
6. Collaboration with doctors for giving bronchodilators and suction (for spending secretions).
7. Record sputum characteristics (amount, color, odor).
8. Assess whether the client still feels pain.
9. Observation additional sound in the lungs, decreased chest wall expansion.


Nursing Diagnosis for Atelectasis  : Activity Intolerance related to impaired O2 transport system secondary to atelectasis

Characterized by:
  • Malaise.
  • Clients say have a headache / dizziness.
  • Increased RR.
  • Increased pulse rate.
  • Cyanosis.
Goal:
Clients can perform the activity on the bed.

Outcomes:
  • After minimal activity (in bed), the client shows:
  • RR and pulse frequency are within normal limits.
  • Headache / dizziness that is felt to have diminished or disappeared.

Intervention:

1. Encourage clients to be aware and controlled breathing (diaphragmatic breath and breathing lips) during increased activity and time of emotional and physical stress.
  • Breath lips: the client should breathe in through your nose and then exhale slowly through the mouth slightly open.
  • Breath diaphragm: nurse lay hands on the abdomen below the ribs basis and remain in place while the client to breathe air. For inhalation, the client should relax your shoulders, inhale through the nose, stomach and push against the hand of a nurse, hold the breath for 1-2 seconds to keep the alveoli open, then exhale slowly through the mouth.
2. Motivate the client to keep the airway activities several times each hour.
3. Encourage an increase in the daily activities on the client gradually to prevent lung paralysis.
4. Monitor client's response to the activity:
Measure vital signs immediately after the activity (pulse and RR).
Rest client for 3 minutes and then re-measure the vital signs.
Reduce the intensity, frequency, or duration of activity if the breath frequency increases after excessive activity.
READ MORE - Ineffective Airway Clearance and Activity Intolerance - NCP for Atelectasis

Excess Fluid Volume, Activity Intolerance and Risk for Infection - NCP for Cushing's Syndrome


Nursing Care Plan for Cushing's Syndrome


Nursing Diagnosis : Excess Fluid Volume related to excessive secretion of cortisol due to sodium and fluid retention.

Goal: The client shows the volume of fluid balance.

Intervention:
1. Measure intake output.
2. Avoid excessive fluid intake when the patient's hypernatremia.
3. Measure vital signs (BP, pulse, RR) every 2 hours.
4. Measure weight.
5. Monitor ECG for abnormalities (electrolyte imbalance).
6. Collaboration lab results (electrolytes: Na, K, Cl).

Rationale :
1. Shows the status of the transfer fluid circulating volume and response to pain.
2. Provide some sense of control in the face of attempts restriction.
3. Increased blood pressure, increased pulse and respiratory rate decreases indicate excess fluid.
4. Changes in body weight showed impaired fluid balance.
5. Hypernatremia and hypokalemia showed indications of excess fluid.
6. Shows fluid retention and should be limited.


Nursing Diagnosis : Activity Intolerance related to muscle weakness and changes in protein metabolism.

Goal: The client showed activity returned to normal after the act of nursing

Nursing Intervention :
1. Assess client's ability to perform activities.
2. Increase bed rest / sit.
3. Note the response to activities such as tachycardia, dyspnea, fatigue.
4. Increase active involvement of the patient in accordance with his ability.
5. Provide assistance activities as needed.
6. Provide appropriate entertainment activities such as watching TV and listening to radio.

Rationale :
1. Knowing the client's level of development activity.
2. Periods of rest are energy saving techniques.
3. Response showed an increase in O2, fatigue and weakness.
4. Adding a level of confidence and self-esteem of patients both in abundance according to the level of activity is tolerated.
5. Meet the needs of client activity.
6. Increase relaxation and energy savings, refocus and improve coping.


Nursing Diagnosis : Risk for Infection related to a decrease in immune response, inflammatory response.

Goal: Infection does not occur after the intervention.

Nursing Intervention :
1. Assess for signs of infection.
2. Measure vital signs every 8 hours.
3. Wash hands before and after nursing action.
4. Restrict visitors as indicated.
5. Place the client in isolation as indicated.
6. Antibiotics as indicated.

Rationale :
1. Presence of signs of infection (tumor, rubor, dolor, calor, functionalist laesa) is an indicator of infection.
2. Temperature increased an indicator of infection.
3. Prevent cross infection.
4. Reducing Exposure to other infectious pathogens.
5. Isolation techniques may be needed to prevent the spread / protect other patients from infection process.
6. Antibiotic therapy to reduce the risk of nosocomial infection.
READ MORE - Excess Fluid Volume, Activity Intolerance and Risk for Infection - NCP for Cushing's Syndrome

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