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.

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