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Nursing Care Plan for Mesothelioma

Mesothelioma

Mesothelioma is a form of cancer that is almost always caused by exposure to asbestos. In this disease, malignant cells develop in the mesothelium, a protective lining that covers most of the organs. The most common site is the pleura (the outer layer of the lungs and internal chest wall), but may also occur in the peritoneum (the lining of the abdominal cavity), heart, pericardium (the sac that surrounds the heart) or tunica vaginalis.

Mesothelioma Signs and Symptoms

These symptoms may be Caused by mesothelioma or by other, less serious conditions.

That Mesothelioma affects the pleura can cause these signs and symptoms:
  • Chest wall pain
  • Pleural effusion, or fluid Surrounding the lung
  • Shortness of breath
  • Fatigue or anemia
  • Wheezing, hoarseness, or cough
  • Blood in the sputum (fluid) coughed up (hemoptysis)

In severe cases, the person may have many tumor masses. The individual may develop a pneumothorax, or collapse of the lung. The disease may metastasize, or spread, to other parts of the body.

That tumors affect the abdominal cavity Often do not cause symptoms until They are at a late stage. Symptoms include:
  • Abdominal pain
  • Ascites, or an abnormal buildup of fluid in the abdomen
  • A mass in the abdomen
  • Problems with bowel function
  • Weight loss
In severe cases of the disease, the following signs and symptoms may be present:
  • Blood clots in the veins, the which may cause thrombophlebitis
  • Disseminated intravascular coagulation, a disorder Causing severe bleeding in many body organs
  • Jaundice, or yellowing of the eyes and skin
  • Low blood sugar levels
  • Pleural effusion
  • Pulmonary emboli, or blood clots in the arteries of the lungs
  • Severe ascites
A mesothelioma does not usually spread to the bone, brain, or adrenal glands. Pleural tumors are usually found only on one side of the lungs.
Source : wikipedia.org

Mesothelioma Diagnostic Test
  • Pleural biopsy
  • Then histologic study of the specimen ..
  • Chest x-rays
  • Computed tomography scans of the chest
Nursing Assessment Nursing Care Plan for Mesothelioma

Assessment is the main base of the nursing process. Assessment is the first step in one of the nursing process (Gaffar, 1999). Activities undertaken in the assessment is gathering data and formulating priority issues. In the assessment - a careful collection of data about clients, Their families, the data obtained through interviews, observation and examination.
  1. Patient Identity
    The identity of the client: name, age, sex, marital status, religion, tribe / nation, education, occupation, income, address and registration number.

  2. Main complaint: chest pain and dyspnea, hoarseness cough, anorexia, weight loss, weakness and fatigue.

  3. Previous medical history: exposure to asbestos

  4. Physical examination:
    • Inspection: shortness of breath and, finger clubbing.
    • Auscultation: diminished chest sounds
    • Percussion: dullness over lung fields

Nursing Care Plan for Mesothelioma

Nursing Diagnosis and Nursing Interventions for Mesothelioma

Source : http://nanda-nursing.blogspot.com/2011/08/nursing-care-plan-for-mesothelioma.html
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Nursing Diagnosis and Nursing Interventions for Mesothelioma

Nursing Diagnosis for Mesothelioma
  • Ineffective airway clearance
  • Ineffective breathing pattern
  • Pain
  • Impaired gas exchange
  • Impaired physical mobility
  • Anxiety
  • Excess fluid volume
  • Fatigue
  • Hopelessness
  • Impaired skin integrity
  • Risk for infection

Nursing Interventions for Mesothelioma
  • Monitor respiratory status, Provide oxygen as ordered.
  • Assist the patient to a comfortable position (Fowler's position, for example)
  • Provide action for patient comfort: Such as repositioning and relaxation techniques.
  • Provide treatment to reduce pain, according to therapy programs. Monitor and document the medication's effectiveness.
  • If mobility decreases, turn the patient frequently. Provide skin care, particularly over bony prominences. Encourage him to be as active as possible.
  • Monitor I.V. fluid intake to avoid circulatory overload and pulmonary congestion.
  • Monitor vital signs: blood pressure, respiration, pulse, body temperature.
  • Teach relaxation techniques.
  • Teach breathing and positioning variations to ease the dyspnea associated with progressive disease

Nursing Diagnosis, Nursing Interventions NCP for Mesothelioma
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Nursing Care Plan for Hepatocellular Carcinoma - Hepatoma

Hepatocellular carcinoma

Hepatocellular carcinoma (HCC, also called malignant hepatoma) is the most common type of liver cancer. Most cases of HCC are secondary to either a viral hepatitide infection (hepatitis B or C) or cirrhosis (alcoholism being the most common cause of hepatic cirrhosis).

Signs and symptoms

HCC may present with jaundice, bloating from ascites, easy bruising from blood clotting abnormalities or as loss of appetite, unintentional weight loss, abdominal pain,especially in the upper -right part, nausea, emesis, or fatigue.
wikipedia


Nursing Assessment Nursing Care Plan for Hepatocellular Carcinoma - Hepatoma

Biodata

The assessment is important to know the background, socioeconomic status, customs / culture, and spiritual beliefs, so easy in the communications and determine appropriate nursing actions.


Nursing History


The main complaint: The enlargement of the liver is felt more and more annoying so that it can lead to complaints of shortness of breath is felt more heavily in addition accompanied by abdominal pain.
  1. History of present illness
    Disease history can now be obtained through other people or by the client itself.

  2. Disease history of the past
    Disease history of the past studied to obtain data on disease ever suffered by the client.

  3. Family Disease History
    Family history of disease studied to find out data about the disease that had experienced ol er family members.

Physical Examination

Clinical symptoms

Early Phase: Asymptomatic.
Further Phase: No known symptoms are pathognomonic.

Complaints of abdominal pain, weakness and weight loss, anorexia, feeling of fullness after a meal is sometimes accompanied by vomiting and nausea. If there is metastasis to bone sufferers complain of bone pain.

On physical examination can be obtained:
  • Ascites
  • Jaundice
  • Splenomegaly, spider nevi, palmar erythema, edema.

In general, nursing assessment on the client with a case of hepatoma, include:
  • Metabolic disorders
  • Bleeding
  • Ascites
  • Edema
  • Hypoalbuminemia
  • Jaundice / icterus
  • Endocrine Complications
  • Activities were disrupted by treatment

Nursing Diagnosis for Hepatocellular Carcinoma

Nursing Interventions for Hepatoma - Hepatocellular Carcinoma


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Nursing Diagnosis for Hepatocellular Carcinoma

Nursing Diagnosis for Hepatocellular Carcinoma
  1. Imbalanced Nutrition: Less Than Body Requirements related to anorexia, nausea, impaired absorption, metabolism of vitamins.

  2. Ineffective Breathing Pattern related to the presence of ascites and emphasis diapragma.

  3. Acute pain related to tension in the abdominal wall.

  4. Activity intolerance related to imbalance between supply oxygenation to the needs.

  5. Risk for deficient fluid volume related to excessive ascites, bleeding, and edema.

  6. Risk for infection related to deficiency of white blood cells.

  7. Impaired Skin Integrity related to pruritus, edema, and ascites.

  8. Altered Sexuality and Sexual Dysfunction related to hormonal dysfunction and decreased libido.

  9. Anxiety related to hospitalization.

  10. Knowledge deficient: the disease process and its causes.

  11. Social isolation related to the risk of spreading infection.

Nursing Diagnosis for Hepatocellular Carcinoma

Nursing Intervention for Hepatoma - Hepatocellular Carcinoma

Source : http://nandanursingdiagnosis.blogspot.com
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Nursing Interventions for Hepatoma - Hepatocellular Carcinoma

Nursing Intervention for Hepatoma - Hepatocellular Carcinoma


Nursing Diagnosis for Hepatoma - Hepatocellular Carcinoma

Acute pain related to tension in the wall of the abdomen (ascites)

Goal :
Demonstrate the use of relaxation skills and entertainment activities as indicated pain.
Reported the maximum pain relief.

Nursing Intervention :
  • Determine the history of pain such as location, frequency, duration and intensity (0-10) and measures of pain relievers for example provide a comfortable position.
  • Provide basic comfort measures such as repositioning, rubbing his back.
  • Assess pain level / control value
Rational :
  • Provide basic data to evaluate the need / effectiveness of interventions such as: pain is the individual who combined both physical and emotional responses.
  • Increase relaxation and help refocus attention.
  • Maximum pain control.

Nursing Diagnosis for Hepatoma - Hepatocellular Carcinoma

Activity intolerance related to imbalance between supply oxygenation to the needs

Goal :
Can perform activities according to the ability of the body.

Nursing Intervention :
  • Encourage the patient to do anything if possible, such as bathing, getting up from a chair / bed, walk.
  • Increase activity according to ability.
  • Monitor the physiological response to such activities; changes in blood pressure, heart rate and breathing.
  • Give oxygen as indicated
Rational :
  • Increasing the strength / stamina and enables patients to become more active without significant fatigue.
  • Tolerance depends on the stage of the disease process, nutritional status, fluid balance and reactions to therapeutic rules.
  • The presence of hypoxia, lowering oxygen availability for cellular uptake and aggravate fatigue.

Nursing Diagnosis for Hepatoma - Hepatocellular Carcinoma

Imbalanced Nutrition : Less Than Body Requirements
related to anorexia, nausea, impaired absorption

Goal :
  • Demonstrated stable weight, weight gain progressively towards the goal, with normalization of laboratory values ​​and limit signs of malnutrition.
  • Countermeasures understanding of individual influences on adequate input.
Nursing Intervention :
  • Monitor the input of food every day, give pasein diary about the food as indicated.
  • Encourage patients to eat a diet high in calories and rich in protein with adequate fluid intake.
  • Encourage the use of supplements and foods often / less that divided during the day.
  • Give antiemetics on a regular schedule before / during and after the administration of antineoplastic agents as appropriate.
Rational :
  • The effectiveness of individual dietary assessment in the disappearance of nausea, post-therapy.
  • Patients should try to find a solution / the best combination.
  • Increased metabolic needs as well as the fluid (to remove residual production).
  • Supplements can play an important role within to maintain adequate caloric intake and protein.
  • Nausea / vomiting at least reduce the ability and psychological side effects of chemotherapy that causes stess.

Nursing Interventions Nursing Care Plan for Hepatocellular Carcinoma - Hepatoma
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Sepsis and Septic Shock Emergency Nursing Care Plan

Definition of Sepsis

Sepsis is a systemic response to bacteremia. At the time of bacteremia caused changes in the circulation, leading to decreased tissue perfusion and Septic Shock occurs. Approximately 40% of patients with sepsis caused by gram-positive microorganisms and 60% due to gram-negative microorganisms. The most common organisms causing sepsis are Staphylococcus aureus and Pseudomonas sp.

Signs and Symptoms of Sepsis

Patients with sepsis and septic shock is an acute illness. Assessment and treatment is needed. Patients can die from sepsis. Common symptoms are:
  • fever
  • sweat
  • headache
  • muscle aches

Find out the source of primary infection. Consider the source of infection the following:
  • urinary infection
  • respiratory tract infections
  • dermatitis
  • meningitis
  • endocarditis
  • intra-abdominal infections
  • osteomyelitis
  • pelvic inflammatory disease
  • sexually transmitted diseases

Nursing Assessment - Sepsis and Septic Shock Emergency Nursing Care Plan

Always use the ABCDE approach.

Airway
  • Make sure the airway clearance
  • Give the tool a respirator if necessary (nasopharyngeal)
  • If a decline in respiratory function immediately contact the anesthesiologist and the patient may be brought immediately to the ICU

Breathing
  • Assess the amount of breathing, more than 24 times / minute is a significant symptom
  • Assess oxygen saturation
  • Check arterial blood gases to assess the oxygenation status and the possibility of acidosis
  • Give 100% oxygen via non re-breath mask
  • Chest auscultation, to determine the presence of chest infection
  • Photo thoracic radiograph

Circulation
  • Assess heart rate, more than 100 times / minute is a significant sign
  • Monitoring blood pressure
  • Check the capillary refill time
  • Attach infusion using a large canul
  • Replace catheter
  • Perform a complete blood
  • Record the temperature
  • Prepare the urine and sputum examination

Disability
  • Confused is one of the first signs of sepsis patients, whereas previously there were no problems (healthy and good).
  • Assess level of consciousness

Exposure
  • If the source of infection is unknown, look for the existence of injuries, cuts and the injection site and the source of other infections.

Sign of the threat to life

Severe sepsis defined as sepsis that caused the failure of organ functions. If it is causing a threat to the life of the patient should be taken to the ICU, while the indications are as follows:
  • decline in kidney function
  • decline in cardiac function
  • hypoksia
  • acidosis
  • clotting disorders
  • acute respiratory distress syndrome (ARDS)


Sepsis and Septic Shock Emergency Nursing Care Plan
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Meningitis Emergency Nursing Care Plan

Meningitis Emergency Nursing Care Plan

Meningitis

Meningitis is a bacterial infection of the membranes covering the brain and spinal cord (meninges).

Signs of meningitis as follows:
  • fever
  • headache
  • stiff neck
  • photophobia and vomiting
  • confused (possible)

Assessment - Emergency Nursing Care Plan Meningitis

Always use the ABCDE approach to assessment

Airway
  • Make sure the airway clearance
  • Prepare tools to facilitate the airway if necessary
  • If there is a decrease in respiratory function immediately contact an anesthesiologist and treated in the ICU

Breathing
  • Assess respiratory rate - less than 8 or over 30 is a significant sign.
  • Assess oxygen saturation
  • Perform blood gas
  • Give oxygen via non re-breath mask
  • Chest auscultation
  • Make checks thoracic photo

Circulation
  • Assess heart rate - more than 100 or less than 40 x / min is a significant sign
  • Monitoring blood pressure
  • Check the capillary refill time
  • Attach infusion using a large cannula
  • Attach Catheterization
  • Check the lab for complete blood, urine, electrolyte
  • Perform blood cultures
  • Perform a throat swab for culture and sensitivity
  • Record the temperature

Disability
  • Assess level of consciousness
  • Observations of focal neurological signs

Exposure
  • Assess the ptechie


Sign of the threat to life:

If the patient shows signs of distress, showing patients should be brought immediately to the ICU as for the sign as follows :
  • Redness more
  • CRT more than 4 seconds
  • Oliguria
  • Breathing is less than 8, more than 30 per minute
  • Heart rate less than 40, more dari140 times per minute
  • Signs of impairment of consciousness
  • Focal neurology
  • Convulsions
  • Bradycardia and hypertension
  • Papiloedema

Emergency Nursing Care Plan - Meningitis
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