Nursing Management for Fever

Nursing Management for FeverHyperthermia occurs when the body absorbs heat more than it can release. Excessively elevated body temperatures are considered medical emergency as it may life-threatening that can cause permanent disability and even death.

Hyperthermia is elevated body temperature due to failed thermoregulation that occurs when a body produces or absorbs more heat than it dissipates.

Hyperthermia can also be deliberately induced using drugs or medical devices and may be used in the treatment of some kinds of cancer and other conditions, most commonly in conjunction with radiotherapy.

Fever is one of the most common medical signs and is characterized by an elevation of body temperature above the normal range of 36.5–37.5 °C (97.7–99.5 °F) due to an increase in the temperature regulatory set-point. This increase in set-point triggers increased muscle tone and chills.

A fever is usually accompanied by sickness behavior, which consists of lethargy, depression, anorexia, sleepiness, hyperalgesia, and the inability to concentrate.

Other causes of fever infection can also be caused by a condition of toxemia, violence or reaction to drug use, also disturbances in central temperature regulation center (eg hemorrhage, coma). Basically to achieve the diagnosis of other causes of fever required: taking care of patients the disease history, physical examination, observation course of the disease, and evaluation of laboratory examinations and other support in a timely and holistic.

Some specific things to look for in a fever is way arising fever, long fever, daily nature fever, high fever and other symptoms of a complaint and join fever.

Have not been diagnosed with fever is a condition in which a patient developed fever continuously for 3 weeks with a body temperature above 38.3 ° C and still have not found the cause despite a week of intensive scrutiny by using laboratory and other supporting facilities.

Before rising to the current inspections, which are readily available for use such as ultrasonography, endoscopy or scanning, can still be checked several blood tests, breeding germs from body fluids / lesion surface or penetrating beam routine.

In the next stage can be thoughtful to make a more definite diagnosis through biopsy in suspicious places. Screening can also be done as angiography, aortography, or lymphangiography.

Hyperthermia related to the Infection Process

Defining characteristic :

  • rise in body temperature above the normal range
  • seizures or convulsions
  • skin redness
  • increase in RR
  • tachycardia
  • hands feel warm when touched.

Goal and outcome criteria:

  • Patients suffering from balance thermoregulation:

Outcome criteria:

  • Body temperature in the normal range.
  • Pulse and respiration in the normal range
  • No color change
  • No turning

Nursing Management of Hyperthermia

Fever Control

  • Monitor temperature at least every 2 hours.
  • Monitors in continuous basal temperature.
  • Monitor blood pressure, pulse, and respiration.
  • Monitor skin color and temperature.
  • Monitor level of consciousness.
  • Monitor WBC, Hb, Hct.
  • Monitor intake and output.
  • Give antipyretic.
  • Provide treatment to overcome the cause of fever.
  • Provide intra-venous fluids.
  • Compress the patient, on the thigh fold, axila and neck.
  • Increase air circulation.
  • Provide treatment to prevent shivering.

Temperature Regulation

  • Monitor signs of hyperthermia
  • Increase fluid intake and nutrition
  • Teach the patient how to prevent fatigue due to heat
  • Discuss and clarify the importance of temperature regulation and possible negative effects of cold
  • Provide appropriate antipyretic medication as needed
  • Use the mattress cool and warm water bath to overcome the interference fit the needs of the body temperature
  • Release of excess clothing and covered the patient with only a piece of clothing.

Vital Sign Monitoring

  • Monitor blood pressure, pulse, temperature, and respiration
  • Record the blood pressure fluctuates
  • Monitor the patient’s vital signs while standing, sitting and lying
  • Auscultation of blood pressure in both arms and compare
  • Monitor blood pressure, pulse, and respiration before, during, and after activity
  • Monitor the quality of the pulse
  • Monitor breathing frequency and cadence
  • Monitor the voice of the lungs
  • Monitor abnormal breathing patterns
  • Monitors temperature, humidity and skin color
  • Monitor peripheral cyanosis
  • Monitor the availability of a widened pulse pressure, bradycardia, increase in systolic (Chusing Triad)
  • Identify the cause of the change in vital signs.

Acute Pain related to Postoperative Thyroidectomy

Thyroidectomy is the surgical removal of the thyroid gland. The surgical procedure of thyroidectomy involves a partial or a complete removal of the thyroid (a gland, which is located in front of the lower neck, just above the trachea). The gland is formed by two cone-like lobes or wings (lobus dexter (right lobe) and lobus sinister (left lobe), and attached by a middle part (isthmus).

The surgery may be recommended for a variety of conditions including:

An overactive thyroid gland that produces extremely high levels of thyroid hormones A growth (nodule or cyst) associated with the thyroid gland Cancer of the thyroid A small thyroid growth Malignant (cancerous) thyroid tumors Benign (noncancerous) tumors of the thyroid that are causing symptoms An enlarged thyroid gland (nontoxic goiter) that makes it hard for you to breathe or swallow.

 

Indications for Thyroidectomy:

  • A large goiter that is unlikely to react anti-thyroid drugs, may require surgery of the thyroid gland, to avoid pressure on the trachea and esophagus, which then can cause difficulty breathing and swallowing, respectively.
  • Side effects of drug therapy or adherence to taking medication Persistent poor or non-response to radioactive iodine therapy, up to repeated episodes of hyperthyroidism require excision of the thyroid gland.
  • Thyroidectomy used to negate the need for radioactive iodine therapy, especially in children.
    In pregnant women, when drug therapy fails to control hyperthyroidism, thyroid operation organized
  • Violence and tumors of the thyroid gland require surgical excision.
  • It is also advisable in the case of clinical manifestations such as the rapid growth of the thyroid gland, severe pain, and cervical lymphadenopathy, or when there have been prior to irradiation of the neck. A fine needle aspiration cytology (FNAC) need to preformed to confirm the diagnosis and determine the type of operation.
  • Functionally or anatomically benign goiter, causing much anxiety among patients and is preferred to cut surgery for cosmetic reasons.

 

Common occurrence after Thyroidectomy

  • There will be episodes of pain, swelling, and bruising around the wound area.
  • Voice may be hoarse. But, this is usually temporary and tone of voice to get back to normal after a few days.
  • During the first few days, eating and drinking can be associated with some discomfort and pain.
  • You will feel a bit sluggish and tired after the surgery.
  • Area can be washed after 7 to 10 days.
  • Light jobs can be done after a period of 2 weeks.

 

Action to reduce the Acute Pain related to postoperative thyroidectomy

1. Study the presence of pain symptoms, both verbal or nonverbal, note the location, intensity (scale of 0-10), and duration.
Rationale: useful in evaluating pain, determine the choice of interventions to determine effectiveness of therapy.

2. Give patients in semi-fowler’s position and support the head / neck with a small pillow.
Rationale: prevent hyper-extension neck and protect the integrity of the suture line.

3. Suggest patients use relaxation techniques, such as imagination, soft music, progressive relaxation.
Rationale: help to refocus attention and help patients to cope with pain / discomfort more effectively.

4. Give & evaluation prescribed analgesic effectiveness.
Rationale: Analgesics should be at great pains to block pain.

Clinical Symptoms of Benign Prostatic Hyperplasia

Conversations with medical professionals concerning prostate health, symptoms and remedies are typically packaged at some point with medical vocabulary for example, benign prostatic hyperplasia (BPH), prostate cancer surgery and laparoscopic prostatectomy. Medical issues in general often start with a first stage, which is for sufferers to get the counsel of doctors. A comprehensive knowledge of symptoms and likely treatment plans help to comfort sufferers with prostate issues.

Prostate gland enlargement (BPH) rarely leads to problems before the age of forty. Statistics show that more than fifty percent of men in their sixties and as many as ninety percent in their seventies and eighties experience the signs of BPH. Roughly thirty percent of men with BPH may at some time call for treatment for the condition. Initial treatment for an enlarged prostate might be addressed with medicines that reduce the size of the prostate or improve urine flow by relaxing the tissues in the region.

It is very important to see your doctor should you have signs or symptoms which are continuing and also signs and symptoms which are causing you dread. At this time specialists are not certain what brings about prostate cancer.

Clinical symptoms may include:

  • Increased frequency of urination
  • Nocturia
  • Difficulty in starting (hesitency) and end urination
  • Interrupted micturition (hermittency)
  • Urine still dripping after urination (terminal dribbling)
  • Micturition emission becomes weak (poor stream)
  • Pain during urination (dysuria)
  • Sense not satisfied after micturition

Clinically the symptoms can be divided into 4 grades as follows:

1. Grade I (congestive)

  • At first patients for months or years, difficulty urinating and started pushing.
  • If micturition was not satisfied.
  • Urine drips out and weak.
  • Nocturia.
  • Erection longer than normal, and more than a normal libido.
  • At Cystoscopy, visible hyperemia and urether orifreum internal and varicose veins occur gradually, eventually bleeding can occur.

2. Grade 2 (residual)

  • When micturition is hot.
  • Nocturia increased.
  • Can not urinate (pee is not satisfied).
  • Infection can occur because of residual urine.
  • Occurs high heat and can die.
  • Pain in the lumbar region and spreading to the kidneys.

3. Grade 3 (urinary retention)

  • Ischuria paradorsal
  • Incontinential paradorsal

4. Grade 4

  • Full bladder.
  • Patients feel pain.
  • Periodically dripping urine (overflow incontinential).
  • On physical examination, palpation of the lower abdomen.
  • With the infection, the patient may die and high body temperature around 40-41 C.
  • Awareness can be decreased.Then the patient could commas.

The Different Types of Brain Cancer

Cancer of the brain is usually called a brain tumor. Cancers of the brain are the consequence of abnormal growths of cells in the brain. Brain cancer can arise from many different types of brain cells (primary brain cancer) or occur when cancer cells from another part of the body spread (metastasize) to the brain. Brain cancers can arise from primary brain cells, the cells that form other brain components (for example, membranes, blood vessels), or from the growth of cancer cells that develop in other organs and that have spread to the brain by the bloodstream (metastatic brain cancer).

Brain cancers are relatively rare, but they are often deadly. The most common malignant types are called gliomas, where cells called glia (cells which help support the nerve cells) become cancerous. Glioblastoma multiforme is the most common of the gliomas. Glioblastoma multiforme and anaplastic astrocytoma are fast-growing gliomas. Oligodendroglioma, another type of glioma, is also rare, but is most often found in adults. Gliomas make up between 50% to 60% of all brain tumours (malignant and benign) in both children and adults combined.

The exact cause of cancer is unknown. Brain cancer that originates in the brain is called a primary brain tumour. It can spread and destroy nearby parts of the brain. Cancers of the breast, lung, skin, or blood cells (leukemia or lymphoma) can also spread (metastasize) to the brain, causing metastatic brain cancer. These groups of cancer cells can then grow in a single area or in different parts of the brain.

The following factors have been proposed as possible risk factors for primary brain tumors, but whether these factors actually increase an individual’s risk of a brain tumor is not known for sure.

  • Radiation to the head
  • An inherited (genetic) risk
  • HIV infection
  • Cigarette smoking
  • Environmental toxins (for example, chemicals used in oil refineries, embalming chemicals, rubber industry chemicals)

Symptoms of brain cancer vary but often include weakness, difficulty walking, seizures, and headaches. Other common symptoms are nausea, vomiting, blurry vision, or a change in a person’s alertness, mental capacity, memory, speech, or personality.

There are two essential brain cancer types that can be treated; these are benign and malignant types. Some types of cancer begin in the brain and are called as primary tumors and those that are metastatic tumors are a result of some cancerous or disease causing cells spread from other parts of the body to the brain. brain cancer types vary even in the symptoms, some tumors are detected with visible symptoms while other show up only in an imaging scan or an autopsy.

Glioma brain cancer: The glial cells are the place from where this tumor originates in the brain or spine.

Meningioma brain cancer: Arising from meninges or the membranes encompassing the central nervous system, this brain cancer comes out in diverse forms. It is one of the most common primary tumors affecting individuals.

Pituitary adenoma brain cancer: Arising from the pituitary gland which is one of the significant parts of the cranium of the brain, this type of cancer can range from the smallest to as large at 10 mm in size. They are often detected only through brain scans or autopsies.

Nerve sheath brain cancer: Originating in the nervous system, this tumor is one of those types of cancer that are primarily made up of myelin around the nerves of the nervous system.

Nursing Care Plan for Colostomy

Colostomy is a surgical procedure that brings one end of the large intestine out through the abdominal wall. Stools moving through the intestine drain into a bag attached to the abdomen.

The colostomy may be short-term or permanent.

Colostomy is done while you are under general anesthesia (asleep and pain-free). It may either be done with a large surgical cut in the abdomen, or with a small camera and several small cuts (laparoscopy).

The type of approach used depends on what other procedure done needs to be done. In general, the surgical cut is made in the middle of the abdomen. The bowel resection or repair is done as needed.

 

Nursing Assessment for Colostomy

Stoma circumstances:

  • Stoma color (normal reddish color)
  • Signs of bleeding (bleeding wound)
  • Signs of inflammation (Dolor – Latin term for “pain”, Calor – Latin term for “heat”, Rubor – roomates in Latin means “Redness”, Tumor – a Latin term for “swelling”, Functio laesa – roomates in Latin means “injured function”, roomates can also mean loss of function)
  • Position of stoma

Is there changes in fecal elimination:

  • Consistency, odor, color stool
  • Is there constipation / diarrhea
  • Is stool properly accommodated.
  • Is the patient able to take care of their own feces

Is there pain disorders:

  • No pain / no
  • The things that cause pain
  • Quality of pain
  • When pain arises (continuous / repetitive)
  • Is the patient agitated or not

Is rest and sleep needs are met

  • Sleep well / not
  • Is stoma disrupt sleep / no
  • Is there environmental factors make it difficult to sleep
  • Is there psychological factors complicate sleep

How does the concept of patient self

  • How patients’ perception of: identity, self-esteem, ideal self, self-image and role

Is there any nutritional deficiencies:

  • How appetite client
  • Normal weight or not
  • How the eating habits of patients
  • Foods that cause diarhe
  • Foods that cause constipation

Is a patient’s open?

  • Will patients express the problem
  • Can the patient adapt to the environment after learning his body parts removed

Assess client needs sexual needs:

  • Ask about the sexual needs of the client
  • Wife / husband to understand the state of the client

 

Nursing Diagnosis for Colostomy

1. Risk for Impaired Bowel Elimination (konstipasi atau diare) related to related to the possibility of an unbalanced diet.

2. Acute Pain related to the mechanism of skin disorder caused by surgery.

3. Disturbed Sleep Pattern related to the fear of the state of the stoma.

4. Risk for Americans through imbalanced Nutrition Less Than Body Requirements related to ignorance against the needs of food.

5. Self-concept disturbance related to not be able to adapt to the stoma and anatomical changes.

6. Risk for Impaired Skin Integrity related to skin contamination with feces.

7. Sexual dysfunction related to changes in body structure.

8. Risk for Infection related to the contamination of the wound with feces.

9. Anxiety related to fear of isolation from others.

10. Activity Intolerance related to clients feel scared to do the activity because of the stoma.

 

Nursing Interventions for Colostomy

1. Patients can defecate regularly:

Avoid eating foods laxative effect.
Avoid eating foods that cause constipation (hard food).
Collaboration with nutrition experts with regard to the food menu.
Control food brought from home.
Give drink enough (2-3 liters / day).
Regular diet (3 times daily).

2. The pain can be reduced by:

Record the medication administration during intra operative.
Evaluation of pain and its characteristics.
Give the client’s understanding that pain is accepted as a reasonable to a certain extent.
Give analgesics as an act of collaboration.

3. Clients can sleep / rest enough:

Explain, stoma will not open during sleep.
Observe environmental factors that make it difficult to sleep.
Observe the psychological factors that make it difficult to sleep.

4. Nutritional needs are met:

Working closely with a nutritionist for a food menu.
Provide adequate nutrition as needed.
Give motivation to not be afraid to spend their food.

5. No disruption of self-concept:

Give the spirit of encouragement.
Avoid foreign stance on the state of the patient’s illness.
Point your clients to care for themselves.
Give an explanation so that the client can accept the situation and adapt to the stoma.
Avoid behaviors that make patients offense (anger, disgust, etc.).

6. Sexuality needs can be met:

Give an explanation that the client may have sexual intercourse with the fair.

7. No disruption of skin integrity:

Perform better treatment techniques (net).
Protect your skin with a protective skin (vaseline / skin barrier) around the stoma.
Put the pad (gauze) which can absorb the flow of feces.

8. To avoid secondary infection:

Perform aseptic and antiseptic action on stoma
Teach clients about personal hygiene and stoma care

9. To avoid anxiety:

Give the belief that the client is able to adapt to the environment (society).

10. Clients are not afraid to do the activity

Provide a description of the problem should not be performed activities (sports soccer, ran).
When the stoma bag will do the activities given buffer (belts).

Nursing Care Plan BPH with Diagnosis and Interventions

Nursing Care Plan BPH with Diagnosis and InterventionsBenign prostatic hyperplasia (BPH) is a histologic diagnosis characterized by proliferation of the cellular elements of the prostate. Cellular accumulation and gland enlargement may result from epithelial and stromal proliferation, impaired preprogrammed cell death (apoptosis), or both.

BPH is considered a normal part of the aging process in men and is hormonally dependent on testosterone and dihydrotestosterone (DHT) production. An estimated 50% of men demonstrate histopathologic BPH by age 60 years. This number increases to 90% by age 85 years.

Assessment

1. Circulation:

  • increased blood pressure (the effect of kidney enlargement)

2. Elimination:

  • decrease the power / boost the flow of urine.
  • urinary hesitancy early.
  • inability to empty the bladder
  • nocturia, dysuria and hematuria.
  • recurrent UTI, (stetis urine)
  • constipation
  • mass in the abdomen below.
  • tenderness of the bladder
  • hernia ingiunalis

3. Food and fluid :

  • anorexia
  • nausea
  • vomiting
  • weight loss.

4. Pain :

  • supra pubic pain
  • pelvic pain
  • lower back.

5. Anxiety :

  • Fever

6. Sexuality :

  • fear incontunesia or drip during intercourse
    decline in construction ejaculation.
    enlargement, tenderness in the prostate.

Nursing Diagnosis for Benign Prostatic Hyperplasia (BPH)

1. Impaired Urinary Elimination: Urinary Retention related to mechanical obstruction of prostate enlargement, muscle decompensation destrusor, inability to empty the bladder, bladder distension.

2. Acute Pain related to mucosal irritation, distention of the bladder, renal colic, urinary infection.

3. Risk for Fluid Volume Deficit related to loss of body fluids is not normal, such as bleeding through the catheter, vomiting.

4. Anxiety related to change in health status, the possibility of surgical procedures.

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

 

Nursing Diagnosis and Interventions :

 

1. Impaired Urinary Elimination: Urinary Retention related to mechanical obstruction of prostate enlargement, muscle decompensation destrusor, inability to empty the bladder, bladder distension.

Goal:
Urination by a considerable amount.
Shows post-voiding residual of less than 50 ml in the absence of droplets / excess flow.

Intervention:

1. Encourage clients to urinate every 2 to 4 hours.
Rational : minimizing excessive retention of urine in the bladder.

2. Observation of the flow of urine. Note the size of the force.
Rational : useful for evaluating obstruction and intervention options.

3. Supervise and record time, the number of each micturition. Note the decrease in spending and changes in urine specific gravity.
Rational: urinary retention increases the pressure in the upper urinary tract that can affect the kidneys.

4. Encourage drinking water to 3000 ml / day
Rational : the increased flow of fluid to maintain renal perfusion and kidney cleanse, bladder from bacterial growth.

5. Perform catheterization and perianal care.
Rational : reduce the risk of ascending infection.

6. Collaboration of anti-spasmodic drugs, rectal suppositories, antibiotics
Rational: eliminating bladder spasm, while antibiotics to fight infection.

 

2. Acute Pain related to mucosal irritation, distention of the bladder, renal colic, urinary infection.

Goal:
Pain reported lost / controlled.
Looks relaxed.
Able to sleep / rest appropriately.

Intervention:

1. Assess the level of pain
Rational : provide information on the effectiveness of interventions.

2. Plaster drainage hose on the verge of defeat in the thigh and abdomen.
Rational : to prevent the withdrawal of the bladder, and penis skrotal erosion.

3. Maintain bed rest.
Rational : may be required at the beginning of acute retention but early ambulation can improve normal voiding pattern.

 

3. Risk for Fluid Volume Deficit related to loss of body fluids is not normal, such as bleeding through the catheter, vomiting.

Goals:
Maintain adequate hydration

Evidenced by:
vitat signs stable,
palpable peripheral pulse,
good capillary refill mucous membranes moist.

Intervention:

1. Monitor fluid output per hour and record of urine.
Rational: rapid diuresis can result in the total volume of fluid deficiency due to insufficient amount of sodium absorption in the kidney tubules.

2. Encourage oral intake based on individual needs.
Rational: hemostatic and increased risk of hypovolemic dehydration.

3. Monitor blood pressure and pulse observation of the capillary and oral mucous membranes.
Rational: early detection of hypovolemic system.

4. Collaboration in the delivery of IV fluids (hypertonic saline physiology), as needed.
Rational: giving IV fluids that replace lost fluids and sodium to prevent / fix hipopolemik.

 

4. Anxiety related to change in health status, the possibility of surgical procedures.

Goals:
Looks relaxed.
Reported anxiety decreased to the level can be handled.
Declare an accurate knowledge of the situation.

Intervention:
1. Create a trusting relationship with the patient or the patient’s family is always around the patient.
Rational : showing concern and desire to help.

2. Provide information about procedures and special tests and what will happen samples; bloody urine catheter.
Rational : helping patients understand the purpose of what they do and reduce health problems including fear due to ignorance of cancer.

3. Encourage the patient / person closest to stating the problem.
Rational : define the problem provides an opportunity to answer questions, clarify misconceptions and problem-solving solutions.

 

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

Goals:
Expressed understanding of the disease process.
Participate in the treatment process.

Intervention:

1. Review the patient experiences the disease process.
Rational : provides the knowledge base in which the patient can make an informed choice of therapy.

2. Encourage states fear / feeling and attention.
Rational : helping patients may experience a feeling of vital rehabilitation.

Disturbed Sensory Perception: Auditory related to Chronic Otitis Media

Chronic Otitis Media (COM) is the term used to describe a variety of signs, symptoms, and physical findings that result from the long-term damage to the middle ear by infection an inflammation. This includes the following:

  • Severe retraction or perforation of the eardrum (a hole in the eardrum)
  • Scarring or erosion of the small, sound conducting bones of the middle ear
  • Chronic or recurring drainage from the ear
  • Inflammation causing erosion of the bony cover or the facial nerve, balance canals, or cochlea (hearing organ)
  • Erosion of the bony borders of the middle ear or mastoid, resulting in infection spreading to the meninges (the coverings of the brain) or brain
  • Presence of cholesteatoma
  • Persistence of fluid behind an intact eardrum

Signs of chronic otitis media include:

  • Persistent blockage of fullness of the ear
  • Hearing loss
  • Chronic ear drainage
  • Development of balance problems
  • Facial weakness
  • Persistent deep ear pain or headache
  • Fever
  • Confusion or sleepiness
  • Drainage or swelling behind the ear

 

Nursing Diagnosis for Chronic Otitis Media : Disturbed Sensory Perception: Auditory related to interference of sound in the auditory organ.

Expected outcomes:

  • Patients will participate in a treatment program
  • Patients will maintain hearing ability
  • The absence of headache

Nursing Interventions for Chronic Otitis Media :

1. Improved Communication: Hearing deficits

Activities:

  • Promised to facilitate the examination of hearing as it should.
  • Facilitating the use of assistive devices appropriately.
  • Tell the patient that the voice will sound different due to tool wear.
  • Keep your tools.

2. Formation of cognition

Activities:

  • Help the patient to accept the fact that the statement itself was in the midst of the emergence of emotions.
  • Help patients understand about the inability to achieve the desired behavior is often caused by a self-statements that make no sense.
  • Show me other forms of thinking dysfunction (eg, thoughts to the contrary, too much generalization, reinforcement, and personalization).
  • Help the patient recognize the painful emotions that are felt
  • Help the patient to know the trigger is received (eg, situations, events, and interactions with others) that create stress.
  • Help the patient to know that any personal interpretation of the triggering factors are acceptable.
  • Help the patient to replace the incorrect interpretation with a more realistic based on stressful situations, events, and interactions.

Nursing Care Plan for Brain Tumor (Intracranial Tumor)

Brain Tumor

A brain tumor, or tumour, is an intracranial solid neoplasm, a tumor (defined as an abnormal growth of cells) within the brain or the central spinal canal.

A brain tumor begins when normal cells in the brain change and grow uncontrollably, forming a mass. A tumor can be benign (noncancerous) or malignant (cancerous). In general, primary CNS tumors do not spread outside of the CNS. Malignant brain tumors are further classified using a grade: low, intermediate, or high.

Brain tumors can occur at any age. The exact cause of brain tumors is not clear.
There most common type of primary brain tumors among adults are astrocytoma, meningioma, and oligodendroglioma.
The most common type of primary brain tumors in children are medulloblastoma, grade I or II astrocytoma, ependymoma, and brain stem glioma.

The most common symptoms of brain tumors include headaches; numbness or tingling in the arms or legs; seizures, memory problems; mood and personality changes; balance and walking problems; nausea and vomiting; changes in speech, vision, or hearing.

 

Assessment for Brain Tumor (Intracranial Tumor)

  1. Focal neurological disorders. In the frontal lobe, occurred personality disorders, affective disorders, the motor system dysfunction, seizures, aphasia. Precentral gyrus can be found on Jacksonian seizures. In the occipital lobe, visual disturbances, and headache. Temporal lobe can occur auditory hallucinations, visual or gustatory and psychomotor seizures, aphasia. In the parietal lobe can be found the inability to distinguish left – right, sensory deficit (contralateral).
  2. Increased ICT: lethargy, decreased HR, decreased level of consciousness, papilledema, projectile vomiting, seizures, changes in breathing patterns, changes in vital signs.
  3. Mental. Personality changes, depression, decreased memory and ability to make decisions.
  4. Pituitary dysfunction. Cushing’s syndrome, acromegaly, giantisme, hypopituitarism.
  5. Pain. Persistent headache.
  6. Seizure activity.
  7. Fluid status. Nausea and vomiting, decreased urine output, dry mucous membranes, decreased skin turgor, decreased serum sodium, BUN, Hb, Hct, hypotension, tachycardia, weight decreased.
  8. Psychosocial. Anger, fear, mourning and hostility.

 

Nursing Diagnosis for Brain Tumor (Intracranial Tumor)

1. Disturbed Body Image related to hair loss, and changes in the structure and function of the body.

2. Impaired Skin Integrity related to the effects of chemotherapy and radiation therapy.

3. Acute Pain related to severe headaches and side effects of treatment.

4. Risk for Fluid Volume Deficit related to the side effects of chemotherapy and radiation therapy.

 

Nursing Interventions for Brain Tumor (Intracranial Tumor)

1. Disturbed Body Image related to hair loss, and changes in the structure and function of the body.

Goal:
Patients express a positive self-image

Expected outcomes:
Patients received a change in body image.

Interventions:

1. Assess the patient’s reaction to body changes.
2. Observation of patient social interaction.
3. Maintain a therapeutic relationship with the patient.
4. Instruct the patient to open communication with health care or other important person.
5. Help patients find effective coping about body image.

Rational:

1. Determine the patient’s reaction to changes in body image.
2. Social withdrawal may occur due to rejection.
3. Facilitate a therapeutic relationship.
4. Expression of fears openly to reduce anxiety.
5. Help patients find coping strategies that can reduce anxiety and fear.

 

2. Impaired Skin Integrity related to the effects of chemotherapy and radiation therapy.

Goal:
Patient’s skin integrity is maintained

Expected outcomes:
Intact skin,
There is no redness or damage.

Interventions:

1. Assess skin integrity every 4 hours.
2. Keep skin clean and dry, use soap and water to bathe the patient.
3. Repositioning the patient every 2 hours.
4. Advise for fluid intake and adequate nutrition.

Rational:

1. Red, dry, and injuries can occur in the area of radiation, chemotherapy can cause rash, hyperpigmentation and hair loss.
2. Prevent skin damage.
3. Improve circulation and prevent pressure sores.
4. Dehydration and malnutrition may increase the risk of developing pressure sores.

 

3. Acute Pain related to severe headaches and side effects of treatment.

Goal:
The patient does not feel pain

Expected outcomes:
Reported no discomfort,
Not grimace, cry,
Vital signs within normal limits,
Participate in activities appropriately.

Interventions:

1. Assess the location, and duration of headache and pain in the incision every 2 hours.
2. Set giving analgesics / narcotics.
3. Give comfort to the patient.

Rational:

1. Sudden changes or severe pain may indicate increased ICT and should be reported to the doctor.
2. Giving narcotic, sedative effect.
3. Eliminating discomfort and anxiety.
4. Risk for Fluid Volume Deficit related to the side effects of chemotherapy and radiation therapy.

 

4. Risk for Fluid Volume Deficit related to the side effects of chemotherapy and radiation therapy.

Goal:
Adequate fluid balance can be maintained

Expected outcomes:
Intake and output balance,
Skin turgor and moist mucous membranes,
Serum electrolytes, Hb, Hct, and vital signs within normal limits

Interventions:
1. Skin turgor, mucous membranes, thirst, blood pressure, HR, monitor serum electrolytes, albumin and CBC.
2. Monitor intake and output.
3. Encourage adequate intake. Set intravenous fluids, appropriate orders.
4. Set antiemtek administration, appropriate orders.

rational:
1. Determine dehydration status.
2. Vomiting may occur in patients with chemotherapy and radiation therapy.
3. Help maintain adequate hydration.
4. Reduce nausea and vomiting.

Nursing Diagnosis Interventions for Cancer and Chemotherapy

Cancer and Chemotherapy

1. Chronic Pain related to growth / metastatic tumor

Goal :

  • Clients are able to:
  • Lowering the level of pain
  • Controll of pain
  • Increase a sense of comfort

With the outcomes:

  • Measure the pain by using a pain scale, set goals for the reduction of pain, which is expected and make action plans to manage the pain.
  • Describing about pain management plan both pharmacological and non-pharmacological, including recognition of gains and losses in the management of pain medications and non-drug use.
  • Demonstrated ability to calm, relax.
  • Accept the situation being experienced and able to act with the minimum of pain.

Interventions:

1. Analgesic administration:

  • Assess the client’s experience when dealing with the pain for the first time, if possible, try to intervene to reduce pain.
  • Encourage clients to describe past experience about the pain and the methods used to deal with the pain, including the experience of side effects, the type of coping response, and how to express pain.
  • Describes the adverse effects of the pain was unbearable.
  • Encourage clients to report on the location, intensity and quality of pain when you’re in pain
  • Ask the client to manage the level of pain, time, originator, treatment and care, and other actions that can reduce the pain.
  • Determine the client’s use of the drug is needed.

Rational:

  • Intensity, character, time of occurrence, duration and factors that aggravate the reduction of pain, should be assessed and documented at the time after the initial evaluation.
  • Attention may give effect to the feelings of the client to report pain and use of analgesics.
  • The intensity of the pain and discomfort should be assessed and documented after the procedure that causes pain with a few new things about pain and pain interval.
  • To help plan the treatment of pain.

2. Acute Pain related to actual or potential tissue damage caused by metastatic tumor.

With the outcomes:

  • Decreased pain scale 1-3.
  • Client report reduced pain / lost.
  • Client looks relaxed.
  • Client are able to rest.

Interventions :

1. Pain management

  • Perform a comprehensive assessment of pain: location, characteristics, duration, frequency, quality and predisposing factors.
  • Observation of non-verbal reactions of discomfort.
  • Use therapeutic communication techniques to determine the client’s experience of pain.
  • Evaluation of past painful experiences.
  • Help clients and families to seek and find support.
  • Control of environmental factors that affect pain such as room temperature, lighting and noise.
  • Reduce pain precipitation factor.
  • Choose and pain management (pharmacological / non-pharmacological).
  • Teach relaxation techniques.
  • Give analgesics corresponding program.
  • Evaluate the effectiveness of pain control.
  • Increase rest-sleep.
  • Collaboration with the doctor if any pain complaints and the action does not work.
  • Monitor client acceptance of pain management.

2. Analgesic administration:

  • Determine the location, characteristics, quality and degree of pain before treatment.
  • Check the doctor’s instructions about the type of medication, dosage and frequency.
  • Check history of allergy.
  • Select the required analgesics.
  • Determine analgesic options depending on the type and severity of pain.
  • Determine the analgesic of choice, the optimal route of administration and dose.
  • Choose a route administration of drugs intravenously or intra-muscular, for the treatment of pain regularly.
  • Monitor vital signs before and after the administration of analgesics.
  • Give analgesics on time especially when severe pain.
  • Evaluation of analgesic efficacy and side effects.

Rational:

  • The intensity of the pain and discomfort should be assessed and documented after the procedure that causes pain with a few new things about the pain and the interval of pain.
  • Approaches to therapeutic communication techniques will increase client confidence.
  • Clients experience the pain of the past can be used as an initial evaluation for pain management.
  • Minimization of external influences capable of helping clients to overcome pain and prevent pain.
  • Can provide a sense of calm to the client and make the client more relaxed so that pain can be reduced.
  • Analgesic is needed on the conditions and severe pain was unbearable.
  • Client’s response to the evaluation procedure can be used as material for further pain management.
  • The intensity of pain, location and quality are the basis for determining which interventions will be carried out.
  • The accuracy and precision of providing analgesic administration program, is necessary in the treatment of pain.
  • Appropriate analgesic selection, and service that is able to minimize the pain at the time of delivery as well as the faster analgesic effect is felt by the client is needed in pain management.
  • Evaluation of the response to the administration of analgesics can be used to assess the effectiveness of analgesics given.

3. Anxiety related to change in health status

Goal:

  • Clients and families showed anxious

With the outcomes:

  • Adaptive coping
  • Able to control the anxiety

Interventions:

  • Assess the level of anxiety, the factors that influence the onset of anxiety.
  • Reassure the client that the nurse is ready to assist clients facing health problems and encourage clients to express their feelings, fears and perceptions.
  • Assess the client’s expectations to treatment and care.
  • Understand the client’s perception of stressful situations.
  • Accompany clients to provide security and reduce fear.
  • Provide factual information about diagnosis, action, and prognosis.
  • Encourage the family to accompany the client.
  • Help clients to identify situations that cause anxiety.
  • Teach relaxation techniques to reduce anxiety.

Rationals :

  • Preliminary data of anxiety is necessary to determine the client’s level of anxiety and the factors affecting it can be seen that the nurse can minimize / prevent clients from influential factor.
  • Presence and readiness of nurses in handling / accompany client during the period of anxiety can help clients to fulfill a sense of security so as to reduce anxiety.
  • The presence of the family, can provide mental suport to clients.
  • Relaxation techniques can reduce stress arising.

4. Nausea related to chemotherapy

Goal:

  • Nausea will be reduced

With the outcomes:

  • Clients feel more comfortable
  • Balanced fluid status
  • Adequate nutrient intake

Interventions:

  • Assess the client’s cause of nausea and vomiting.
  • Keep the client, after vomiting and put wipes in a convenient location accessible by the client.
    Provide oral care after vomiting.
  • Give / teaching methods of distraction from the sensation of nausea eg using music, etc..
  • Keep the environment clean, quiet and well ventilated.
  • Avoid sudden movements, let the client remain supine.
  • Collaboration of antiemetics.
  • Give antiemetics one hour before administration of chemotherapy.
  • Motivate clients to eat / drink a little but often.
  • Give diet favored in warm conditions and serve to draw.

Rationals :

  • With a known cause of the nurse can determine the appropriate action to deal with nausea / vomiting.
  • Hygiene and oral care can eliminate the smell and taste of vomit, and can reduce the stimulus for nausea / vomiting.
  • The smell from the kitchen, the bathroom can stimulate nausea / vomiting.
  • Movement of clients can further stimulate the onset of nausea / vomiting.
  • Giving antiemetic, is more effective in reducing / preventing nausea in clients with chemotherapy.
  • Eat / drink a little but often can reduce the sensation of vomiting due to a full stomach.
  • Diet interesting and liked by the client can be an appetite client so that the client’s nutritional needs are met.

Pathology and Pathogenesis of Benign Prostatic Hyperplasia (BPH)

Benign prostatic hyperplasia (BPH) is an enlarged prostate gland. As the prostate enlarges, it can squeeze down on the urethra. BPH occurs in almost all men as they age. BPH is not cancer. An enlarged prostate can be a nuisance. But it is usually not a serious problem.

Benign prostatic hyperplasia is probably a normal part of the aging process in men, caused by changes in hormone balance and in cell growth.

Risk factors for developing BPH include:

  • Obesity
  • Lack of physical activity
  • Erectile dysfunction
  • Increasing age
  • Family history of BPH

Symptoms include the following.

  • Hesitancy: difficulty starting the urine flow, even when the bladder feels full.
  • A weak or interrupted urinary stream.
  • Incomplete emptying: a feeling the bladder is not completely empty after passing urine.
  • Frequency: a need to urinate often during the day and during the night. Increased need to urinate in the night is usually a very early symptom.
  • Urgency: a need to urinate right away. Some men may experience involuntary discharge of urine (known as urge incontinence).
  • Dribbling of urine after urination. This is known as terminal dribbling.
  • Dysuria: a burning sensation or pain during urination.

Pathology and Pathogenesis of BPH

With increasing age, the prostate gland undergoes benign enlargement first around the prostatic urethra and later extends to involve the central zone. The weight of prostate gland in BPH is usually two to three times that of normal. Grossly, nodular enlargements are seen in the prostate gland usually with cystic spaces due to dilatation of the obstructed prostatic ducts.

Histologically, hyperplasia of both glandular and fibromuscular components are seen in BPH. It is also important to note that with advancing age, carcinoma of the prostate gland is also likely to occur and this commonly arise from the peripheral zone. Both conditions present with symptoms of bladder outlet obstruction and can sometimes coexist.

The pathogenesis of BPH is still largely unresolved. Several theories have been postulated to explain it s development. These include:

  1. Hormonal mechanism, an increase in the level of dihydro testosterone (DHT) in the cells leads to stimulation of cell growth. DHT is derived from testosterone by the enzymatic action of 5 alpha reeducates
  2. Stem cell theory, by reactivation of the stem cells and benign enlargement of the prostatic gland
  3. Stroma-epithelial interaction by growth factor which stimulates cell proliferation.

Both mechanical enlargement of the prostate gland as well as an increase in the tone of the prostatic urethra causes bladder outlet obstruction in BPH. The tone of the prostatic urethra is regulated by smooth muscle which is innervated buy the alpha adrenergic nerve fibres which are abundant in the prostate gland as well as in t he bladder neck.