Basic Concepts of Nursing Process for Typhoid Fever

According Doenges, et al (2000) in providing nursing care to clients with Typhoid Fever using the five stages of the nursing process, which includes: assessment, nursing diagnosis, planning, implementation and evaluation.

1. Assessment for Typhoid Fever
The initial steps of the nursing process is a systematic assessment, continuous, valid, and client data obtained from interviews and observations (Carol Taylor, 1997)

As for the things that need to be assessed on the client with typhoid Fever by Doenges, et al (2000: 481) is as follows:

a. Activity / rest
Symptoms:

  • weakness
  • fatigue malaise
  • tired
  • restrictions on activities / work until the effects of the disease process.

b. Circulation
Signs :

  • tachycardia (in response to fever, dehydration, inflammation)
  • blood pressure hypotension
  • skin or mucous membranes: poor turgor, dry skin, dirty tongue, lips chapped.

c. Ego integrity
Symptoms:

  • anxiety, fear, emotional upset.
  • stress factors

Signs:

  • rejected, narrowed attention, depression

d. Elimination
Symptoms:

  • stool texture varies from hard to soft shape, even watery.
  • bloody defecation
  • rectal bleeding.

Signs:

  • if constipation then decreased bowel sounds do not even exist, but the bowel diarrhea will increase.
  • oliguria.

e. Food / fluid
Symptoms:

  • anorexia, nausea / vomiting
  • weight loss
  • dirty tongue

Signs :

  • decrease in subcutaneous fat / muscle mass
  • weakness, muscle tone and poor skin turgor

f. Hygiene
Signs :

  • inability to maintain self-care
  • body odor

g. Pain / Leisure
Symptoms:

  • pain / tenderness in the lower left quadrant.
  • pain point moves, tenderness (arthritis).
  • eye pain.

Signs :

  • abdominal tenderness / distension.

h. Security
Symptoms:

  • arthritis.
  • increased body temperature 39 – 40oC.
  • blurred vision.
  • allergies to food or dairy products (histamine release into the gut and has the effect of inflammation).

i. Sexuality
Symptoms:

  • decreased frequency / avoid sexual activity.

j. Social interaction
Symptoms:

  • relationship problems / roles with respect to the condition.
  • active in social incompetence.
  • counseling / learning.

 

2. Nursing Diagnosis for Typhoid Fever

Nursing diagnosis is a statement that describes the human response (health status or risk of change in the pattern) of an individual or group in which nurses are able to identify and provide accountability for certain interventions to maintain health status, reduce, limit, prevent and change. (Nursalam, 2001: 52) quoted from (Carpenito, 2000)

Nursing diagnoses that often appears on the client with typhoid Fever is as follows:
a. Hyperthermia related to the process of infection
b. Constipation / Diarrhea related ton changes the planning process, decreased physical activity.
c. Imbalanced Nutrition: less than body requirements related to no appetite and nausea.
d. Risk for Deficient Fluid Volume related to loss through the normal route (diarrhea and vomiting).
e. Deficient Knowledge : about the condition, prognosis, and treatment needs related to misinterpretation of information, lack of recall.
(Doenges, et al, 2000; 471)

 

3. Nursing Interventions for Typhoid Fever

After formulating the nursing diagnosis, the next step is to determine the planning of nursing. Planning involves developing design strategies for preventing, reducing, and correcting the problems identified in the nursing diagnoses. This stage begins after determining nursing diagnoses and concluded the plan documentation.
(Nursalam, 2001: 51 quoted from the layer, taptich, and Bernocchi-Losey, 1996)

In the planning stages include: Determining priorities, determine outcomes, determine a plan of action and documentation. (Nursalam, 2001: 52)

The plan is based on each nursing diagnosis by Doenges, et al (2000) are:

A. Hyperthermia related to infectious process

Goal: Hyperthermia is reduced or lost

Expected Outcomes :

  • body temperature within the normal range (36 – 370C).
  • free from the cold

Plan of action:

Independent
1) Monitor the client’s temperature (degrees and patterns), note the chills / diaphoresis.
R: temperature 37.9 ° C or more indicates the infection process. Fever pattern may help in the diagnosis, such as typhoid, fever remittances (varies).

2) Monitor the temperature of the environment
R: The ambient temperature / number of blankets to be changed to maintain near-normal temperatures.

3) Provide warm compresses bath, avoid the use of alcohol.
R: Can help reduce fever. The use of alcohol may cause chills, increased temperature and can actually dry out the skin.

Collaboration
4) Collaboration with physicians for the provision of antipyretic
R: Used to reduce fever with central action on the hypothalamus.

 

B. Constipation / Diarrhea related to changes in the digestive process, decreased physical activity.

Goal: The pattern of bowel movements back to normal

Expected Outcomes:

  • Clients can defecate / frequency in the normal range (1 x / day).
  • Soft stool consistency
  • Back to normal intestinal peristalsis (5-15 x / min)

Plan of action:

Independent
1) Auscultation of bowel sounds
R: The sound of the gut in general increased in diarrhea and decreased in constipation.

2) Encourage fluid intake is 2500-3000 cc / day.
R: To assist in improving the consistency of the stool when constipated. Will help maintain hydration status on diarrhea.

3) Encourage gradual mobilization.
R: Loss of muscular tone will reduce intestinal peristalsis or can damage the rectal sphincter control.

4) Encourage foods with high fiber content, such as fruits (papaya) and pudding.
R: Improving stool consistency and stool spending.

Collaboration
5) Collaboration with physicians for drug delivery stool softeners: Suppositories moment when anticholinergic constipation and diarrhea.

 

C. Imbalanced Nutrition: less than body requirements related to no appetite and nausea.

Goal: Nutrition met.

Outcomes:

  •  Experiencing weight gain or stable.
  •  There were no signs of malnutrition.

Plan of action:

Independent
1) Measure body weight every day when conditions allow.
R: Providing information about dietary needs / effectiveness of therapy.

2) Give the food a little and often.
R: Maximizing nutrient intake, to prevent nausea and reduce irritation of the stomach wall.

3) Avoid stimulating foods, such as spicy and sour and cold.
R: stimulating and cold food can cause nausea.

4) Perform oral hygiene
R: a clean mouth can increase the sense of eating

5) Explain the importance of nutrition for healing.
R: Knowledge increased so motivated to eat

6) Assess diet (diet clients in the home, food likes and dislikes)
R: Identify patterns that require change and as a basis for evaluating the diet program.

7) Encourage clients fibrous foods such as papaya, pudding and others.
R: Fiber resist digestive enzymes and absorbing water in the stream along the intestinal tract and thus can lead to bulk, which works as a stimulus for defecation.

Collaboration
8) Collaboration with physicians for antiemetic medication.
R: Antiemetika to prevent nausea and vomiting.

 

D. Risk for Deficient Fluid Volume related to loss through the normal route (diarrhea and vomiting).

Goal: lack of fluid volume did not happen

Expected Outcomes:
– Vital signs are within normal limits
– Intake and output balanced
– Consistency normal urine (1 cc / kg body weight / hour)
– Good skin turgor

Plan of action:
Independent
1) Assess vital signs
R: Hypotension, tachycardia and fever may indicate a response to fluid loss.

2) Observation of skin turgor
R: Indicates excessive fluid loss / dehydration.

3) Measure intake and output
R: Provide information as a guide for fluid replacement.

Collaboration
4) Collaboration with physicians for parenteral fluid administration.
R: To replace lost fluids.

 

E.  Knowledge Deficit : about the condition, prognosis, and treatment needs related to misinterpretation of information, lack of recall.

Goal: Expressing its understanding of the conditions / processes and treatment of the disease.

Expected Outcomes:
Identifying the relationship between the signs / symptoms of the disease process and relationship with symptoms factor.
Pinpoint the necessary procedures and explain the reason for an action.
Initiate the necessary lifestyle changes and participate in treatment rules.

Plan of action:

Independent:
1) Determine the patient’s perception challenge panyakit process.
R: Creating awareness and provide basic pengatahuan individual learning needs

2) Review the disease process, the cause or effect relationship factors that cause symptoms and identify ways to reduce the factors supporting
R: Knowledge of accurate base gives patients the opportunity to make an informed decision or choice about the future and control of chronic diseases.

3) Review the drug, purpose, frequency, dosage, and possible side effects
R: Improving understanding and to increase cooperation in the program

4) Emphasize the importance of skin care, such as good hand washing techniques and good perineal care.
R: Reduce the spread of bacteria and the risk of skin irritation or damage, infection.

Brain Cancer – 7 Nursing Diagnosis and Interventions

I. Anxiety related to diagnosis, poor prognosis, chemotherapy and possible side effects.

Goal: The client said anxiously down, to fear that can be overcome.

Intervention:
1. Use a calm and convincing approach.
Rational: to prevent anxiety.

2. Perform the action that makes it convenient.
Rational: increase relaxation.

3. Listen attentively to the client’s expression of feelings and concerns.
Rational: create an atmosphere of mutual trust.

4. Give real information you know about the disease, treatment and prognosis.
Rational: knowledge about what I expected to decrease anxiety.

 

II. Deficient Knowledge related to the disease process and treatment.

Goal: the client has the proper knowledge, about the disease process and
describe the disease course.

Intervention:

1. Assess the client’s current level of knowledge about cancer.
Rational: the data will provide a basis for counseling.

2. Describe the disease process as needed.
Rational: assist clients in understanding the disease process.

3. Give info about therapies and treatment options and the benefits of each option.
Rational: to assist clients in making treatment decisions.

 

III. Risk for Injury related to seizures

Goal: seizures resolved without physical Injury.

Intervention:

1. Point the limbs and head movements.
Rational: to prevent trauma.

2. Loosen the client clothing.
Rational: to prevent damage or abrasion on the skin.

3. Maintain airway.
Rational: to prevent airway obstruction.

4. Remain with the client during a seizure.
Rational: to provide comfort and a sense of security for the client.

5. Collaboration anticonvulsants medications.
Rational: improving control of seizures.

 

IV. Imbalanced Nutrition: less than body requirements related to nausea, vomiting, and anorexia

Intervention:

1. Assess food intake and food provided.
Raional: provide daily information for planning

2. Encourage eating in small portions but often.
Rational: to prevent nausea and vomiting.

3. Encourage clients to try different foods if there is a change in taste.
Rational: chemotherapy can cause changes in taste.

 

V. Activity intolerance related to weakness

Goal: clients maintain optimal levels of activity, and maximize
energy to break.

Intervention:

1. Examine the patterns of rest / fatigue on the client.
Rational: establish a baseline to assist patients with fatigue.

2. Encourage clients to express feelings of limitations.
Rational: assist clients in coping with fatigue.

3. Encourage clients to plan rest periods as needed throughout the day.
Rational: improving adequate rest.

4. Encourage light exercise.
Rational: to improve the pattern breaks.

 

VI. Risk for Infection related to immunosuppression

Goal: decrease the potential for infection.

Intervention:

1. Sign of the vital-signs monitor.
Rational: fever may identify an infection.

2. Assess the possibility of damage to the skin and mucous membranes.
Rational: skin and mucous membranes gave way thd first entry of microorganisms into the body.

3. Collaboration antibiotic, antifungal and antimicrobial as needed.
Rational: to prevent and deal with the sources of infection.

 

VII. Disturbed Body Image related to alopecia (a side effect of chemotherapy)

Goal: understanding client revealed to the effects of chemotherapy and discuss measures to minimize the impact on lifestyle.

Intervention:

1. Assess the impact of alopecia on client lifestyle.
Rationale: provide information to formulate care.

2. Encourage clients to shave hair.
Rational: to minimize the shock to alopecia.

3. Identify measures to minimize the impact of such usage alopecia wigs or hats and so on.
Rational: improving control against loss.

4. Encourage clients to use fake hair to grow back before the original hair.
Rational: increase client confidence in dealing with the social environment.

Physical Examination : Head to Toe

Physical examination is a review from head to toe on every body system, which provides information on clients and allows nurses to make clinical judgments. The accuracy of the physical examination affect selection of treatment received by the client and the determination of response to therapy. (Potter and Perry, 2005)

Physical examination techniques used are:

1. Inspection

Inspection is the examination by using the senses of sight, hearing and smell. General inspection done when you first met the patient. An overview or general impression about the state of health in shape. Examination then forward it to a local inspection that focuses on a single system or parts and typically use special equipment such as an ophthalmoscope, otoscope, speculum and others. (Laura A.Talbot and Mary Meyers, 1997)

2. Palpation

Palpation is an examination by using the sense of touch by laying hands on the body that can be reached by hand. (Laura A.Talbot and Mary Meyers, 1997)

It is detected are: temperature, moisture, texture, motion, vibration, growth or mass, edema, crackles and sensation.

3. Percussion

Percussion is the examination that includes; tapping the surface of the body to produce a sound that would be helpful in assisting the determination of density, location, and position of the structure underneath. (A.Talbot Laura and Mary Meyers, 1997)

4. Auscultation

Auscultation is the act of listening to sounds generated by a variety of organs and tissues. (A.Talbot Laura and Mary Meyers, 1997)

In the physical examination, there are principles that need to be noticed, which is as follows:

1. Infection control
Includes washing your hands, put sterile gloves, masks, and help clients check the wear.

2. Environmental control
Make sure the room in a state that is comfortable, warm, and light enough to carry out a physical examination of both the client and for the inspectors themselves. For example, closing the door / window to maintain client privacy.

  • Communication (explanation of the procedure).
  • Privacy and comfort of clients.
  • Systematic and consistent (head to toe, from external to internal, from normal to abnormal).
  • Being on the right side of the client.
  • Efficiency.
  • Documentation.

Physical examination purposes
In general, a physical examination performed aims:

  1. To gather baseline data the client’s health.
  2. To add, confirm, or deny the data obtained in the history of nursing.
  3. To confirm and identify the nursing diagnoses.
  4. To make a clinical judgment about the client’s health status changes and management.
  5. To evaluate the physiological outcomes of care.

Each examination also has a specific purpose that will be described later in every part of the body that will do a physical examination.

Benefits of Physical Examination

Physical examination has many benefits, both for the nurses themselves, as well as for other health professionals, including:

  1. As data to assist nurses in nursing diagnosis.
  2. Knowing the health problems experienced by clients.
  3. As a basis for selecting appropriate nursing interventions.
  4. As the data to evaluate outcomes of nursing care.

Indication
To be conducted on every client, especially on:

  1. Clients who had entered into the place for in-patient health care.
  2. Routinely to clients who are in care.
  3. At any time as per client requirements.

Nursing Care Plan of Patients with Parotitis

Nursing Care Plan of Patients with ParotitisParotitis is an infectious disease in 30-40% of cases are asymptomatic infection. Spread of the virus occurs by direct contact, splashing saliva, raw materials possible with urine. Now the disease is common in young adults, causing epidemics in general. Generally, epidemic parotitis is considered less contagious if compared with morbilli or varicella, because, many infectious epidemic parotitis likely not clinically apparent. Complications that can occur include: meningoencephalitis, arthritis, pancreatitis, myocarditis, oophoritis, orchitis, mastitis, and deafness.

Parotitis is not handled properly and promptly can lead to serious complications that will increase the risk of death. So due to this, through this paper we provide a solution to provide knowledge and prevention of disease ordinance parotitis, so the scale can decrease the incidence of the disease and also be useful for nurses that is able to carry out the nursing care of patients with parotitis appropriately and correctly.

 

Salivary Gland (anatomy)

Based on the size of salivary glands consist of two types, namely the major salivary glands and minor salivary glands. The major salivary glands consist of the parotid glands, submandibular glands, and sublingual glands (Dawes, 2008; Roth and Calmes, 1981).

Parotid gland is the largest salivary glands, located in front of the ear on a bilateral basis, between the mandibular ramus and mastoid process with the part that extends into the face below the zygomatic arch. Parotid gland, parotid encased in a sheath. Parotid duct, passes horizontally from the edge of the gland. On the anterior edge of the masseter muscle, parotid duct turn toward the medial, penetrates buccinator muscle, and enters oral cavity opposite 2nd molar permanent maxillary (Leeson et al., 1990; Moore and Agur, 1995).

Submandibular gland which is the second largest after the salivary glands the parotid, located on the floor of the mouth below the mandibular corpus. Submandibular duct empties through one to three holes were found in a small papil beside the lingual frenulum. The estuary can be easily seen, even, it can often seem saliva coming out. (Rensburg, Moore and Agur, 1995).

Sublingualis gland is the major salivary glands located smallest and most deeply. Each gland, shaped like almond (almond shape), located, on the floor of the mouth between the mandible and Genioglossus muscle. Each gland sublingualis left and right unite to form a mass of horseshoe-shaped gland, around the lingual frenulum (Moore and Agur, 1995).

Minor salivary gland composed of glands lingual, buccal glands, labial gland, palatine glands, and glossopalatine glands. Lingual glands are bilateral and are divided into several groups. Anterior lingual gland located in the inferior surface of the tongue, near the tip, and is divided into anterior mucous glands and posterior glands mix. Glands associated with posterior lingual tonsil tongue, and the lateral margin of the tongue. This is pure mucous glands (Rensburg, 1995).

Buccal glands and labial glands located on the cheeks and lips. These glands are mucus and serus. Palatine glands, are pure mucus, located, on the soft palate and uvula and the posterolateral region of the hard palate. Glossopalatinal glands, secretion properties, similar to the palatine glands, that is pure lies in folds of mucous and glossopalatinal (Rensburg, 1995)

 

Definition of Parotitis

Parotitis is an acute viral disease that usually attacks the salivary glands, especially the parotid glands (approximately 60% of cases). Typical symptoms are enlargement of the salivary glands, especially the parotid gland. In the salivary gland duct abnormalities such as swelling of the epithelial cells, dilation and obstruction. In adults, the infection can attack the testes (testicles), central nervous system, pancreas, prostate, breast and other organs. As for those who suffer from or are at great risk for contracting the disease are those who use or consume certain drugs to suppress their hormones and the thyroid gland Iodine deficiency in the body (Sumarmo, 2008)

Not all infected people have complaints, even about 30-40% of patients do not show signs (subclinical). They can be a source of infection as well as patients who appear ill parotitis. Parotitis shoots past about 14-24 days, with an average of 17-18 days.

 

Etiology of Parotitis

Epidemic parotitis causative agent is a member of the paramyxovirus group, which also includes parainfluenza virus, measles, and newcastle disease virus. Size of paramyxovirus particles of 90-300 mμ.

Virus has been isolated from saliva, cerebrospinal fluid, blood, urine, brain and other infected tissues. Mumps is a single stranded RNA virus genus Rubulavirus, subfamily Paramyxovirinae and family Paramyxoviridae.

Mumps virus, have 2 glycoprotein, the hemagglutinin-neuraminidase and fusion proteins. This virus also has two components capable of fixing, namely: S antigen or soluble, which is derived from the nucleocapsid and V antigens derived from the hemagglutinin surface.

The virus is active in a dry environment but this virus can only survive for 4 days at room temperature. Paramyxovirus can be destroyed at temperatures

Furthermore virus that location is the parotid gland, ovary, pancreas, thyroid, kidney, heart or brain. Virus entry into the central nervous system through the plexus choroideus through infection in mononuclear cells. The period of this virus is spread through 2-3 weeks of saliva, cerebrospinal fluid, blood, urine, brain and other infected tissues. Virus can be isolated from saliva 6-7 days before onset of illness and 9 days after the appearance of swelling of the salivary gland. Transmission occurs 24 hours before the swelling of the salivary gland and 3 days after the swelling disappeared (Sumarmo, 2008)

 

Classification of Parotitis

a. Recurrent parotitis

Children are susceptible to recurrent parotitis arising between the ages of 1 month until the end of childhood. Recurrent means that the child has been infected with the virus before then relapsed again.

b. Acute parotitis

Acute parotitis is characterized by sudden pain, redness and swelling of the parotid region. Can arise as a result of post-surgery performed on mentally retarded patients and elderly patients, particularly when the use of general anesthesia longer and dehydration disturbance.

 

Clinical Manifestations of Parotitis

Not everyone who is infected by the paramyxovirus have complaints, even about 30-40% of patients do not show signs of illness (subclinical). However, they are similar to other patients who have complaints, which can be a source of transmission of the disease. Mumps disease incubation period of about 12-24 days with an average of 17-18 days. The signs and symptoms of infection and the development of the shoot can be described as follows:

At the early stage (1-2 days), Mumps sufferers experience symptoms: fever (body temperature from 38.5 to 40 degrees Celsius), headache, muscle aches, loss of appetite, pain in the back of the jaw while chewing and sometimes accompanied by stiff jaw (difficult to open the mouth).
Further swelling of the glands under the ears (parotid) that begins with swelling of one side of the gland and then both have swollen glands.
Swelling usually lasts about 3 days and then gradually deflated.
Sometimes swelling of the glands under the jaw (submandibular) and glands under the tongue (sublingual). In adult men is swelling of the testicles (testes), due to the spread through the bloodstream.

 

Nursing Care Plan of Patients with Parotitis

 

Nursing Diagnosis and Interventions for Parotitis

Imbalanced nutrition less than body requirements related to inability to ingest adequate nutrients due to infectious conditions.

Goal: Demonstrate an increase in body weight reached the expected range.

Expected outcomes: body weight returned to normal ranges.

Interventions and Rational :

1. Give eat soft foods little by little and little extra, right. Avoid acidic foods.
Rational: The food is hard, is not able to be chewed by patients parotitis. Acidic foods, adding a sense of discomfort in patients with parotitis.

2. Give liquid diet or food tube / hyperalimentation when needed.
Rational: When caloric intake fails to meet the metabolic needs, nutritional support can be used to prevent malnutrition.

3. Give the drink a little by little but often.
Rational: Moisten the mucous membranes of the mouth are less wet because it is rarely used.