Theories about the cause of benign prostatic hypertrophy

Theories about the cause of benign prostatic hypertrophy

There are 3 theories put forward about the causes of benign prostatic hypertrophy, are:
1. Stem cell theory
In normal circumstances periuretral gland balanced between growth and the dead (SteadyState). New cells are usually grown from stem cells, because of some reason like the factor of age, hormonal disorders or other factors then trigger the stem cells proliferate faster so happens hiperplasi periuretral gland.

2. Theory Reawakening
Re-grow tissues such as stem cell growth during embriologik level, so that periuretral network can grow faster than the surrounding tissue.

3. The theory de Hidrotestoteron
This theory says that hiperplasi caused by the change in the balance between testosterone and estrogen. Testosterone produced by Leydig cells located in the two testes by 90% while 10% in the adrenal gland. However, there were 20% in a state of free testosterone that can cause prostate enlargement. Testosterone that is free to enter into the prostate to penetrate the cell membrane into the cytoplasm of prostate cells to form DHT heseplar acid complex which will affect the RNA that resulted in the synthesis of proteins that can cause cell proliferation.

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Nursing care in patients with benign prostatic hyperplasia

Nursing care in patients with benign prostatic hyperplasia

DEFINITIONS
Benign prostatic hyperplasia is an urgent periuretral gland hyperplasia prostate tissue native to the peripheral and the surgical capsule.

ETIOLOGY
The cause of benign prostatic hypertrophy is less clear but there are 3 indications that the hormone causes tissue hyperplasia and stromal buffer glandural elements of the prostate. As we get older there will be changes in the balance of testosterone and estrogen, decreased testosterone production and testosterone is converted to estrogen in peripheral adipose tissue. Lobes that have an enlarged neck can clog vesika or prostatic urethra. Thing that happens is that delays the emptying of urine (urinary retention). The result is dilatation of the ureter (hidroureter) and kidneys (hydronephrosis) in stages. Urinary tract infections can occur due to stasis of urine, because most of urine inside the bladder is settled will be where the growth of the organism.

There are several theories about the balance of hormones that cause benign prostate hiperplasi.
1. stem cell theory (Isaacs)
2. Reawekening Theory (Mc Neal)
3. theory de hydro testosterone (DHT)
 
Predisposing factors :

• Age
• Hormonal
• Precipitation factor
• Too much sitting
• Too much sex
• Many masturbate
• Stress

PATOFISIOLOGY
Areas often affected are the lateral lobe regions of central and medial lobes. Prostate weight is about 60 -100 grams. Enlarged prostate cause narrowing of the lumen of the prostatic urethra pars and will inhibit the flow of urine, causing pressure intervasikal this situation. To remove the urine, bladder must contract more strongly for resistance against it. The contractions which continue to cause anatomic changes of bladder muscle hypertrophy destrusor form, trabekulasi, trbentuknya selula, sakula and divertikel vesika urinaria. At this stage destrusor muscle thickening called phase compensation.
With the increase in urinary retention, detrusor muscle into the phase of decompensation and eventually no longer mapu to contract. Resulting in urinary retention. The pressure of the higher intra vesikal, will be forwarded to all parts of vesika urinaria up in the two estuaries ureter. The pressure on these two estuaries ureter can cause backflow of urine from the bladder into the ureter or bladder occurs fesiko-ureteric reflux. if this situation continues to cause hidroureter, hydronephrosis can occur even kidney failure.

CLINICAL MANIFESTATIONS
Obstructive and irritating symptoms of the syndrome is also called prostatismus the mark with:

• Increased urinary frequency
• Nocturia
• The urge to urinate constantly
• Abdomen tense
• Decreased urine volume and must be straining during micturition
• Urine flow is not smooth
• Feeling like the bladder does not empty properly.
• Dribbling (urine continues to drip after urination)
• Acute urinary retention
• Recurrence of urinary tract infection

Clinically the degree of symptoms prostatismus divided into:
1. Grade I: symptoms prostatismus + residual urine <50 ml
2. Grade II: symptoms prostatismus + residual urine> 50ml
3. Grade III: urinary retention with upper urinary tract disorders + residual urine> 150 ml

In benign prostatic hypertrophy symptoms of symptoms known as the lower urinity symtoms tract (LUTS), which are divided into obstructive and irritating symptoms.
1. Irritating symptoms

• Frequent urination
• Waking at night to urinate
• Urgency
• Dysuria

2. Obstructive symptoms

• Flow / poor stream when urinating
• Not satisfied in micturition
• Long wait (hesitancy)
• Must straining
• Piss off break
• long time urinating and urinary incontinence due to overflow.

On the other references are divided into:
1. Grade I (congestive)

• Increased urination frequency
• nocturia
• Difficulty in starting and ending piss
• Piss off
• Dribbling
• poor stream
• Pain when urinating
• Pain has not been satisfied after urination

2. Grade II (Residual)

• Within a few months or years later the patient difficult urination or straining while urinating
• Urine is not satisfied
• Urine drips
• Nocturia
• Can not urinate
• Urinary tract infection due to residual urine in vesika
• High body temperature and potential death
• Pain in the kidney and spread to the hips

3. Grade III (Urine Retention)

• Ischuria paradorsal
• Incontinential paradorsal

4. Grade IV

• Full bladder
• Patients in pain
• Periodic urine dripping (overflow incontinensia)
• With this infection the patient may die with high heat up to 40-41 degrees Celsius
• Decreased consciousness
• Coma

If the fourth grade is not handled properly, it will eventually happen azotamia (accumulation of nitrogen waste products) and renal failure with urinary retention and a large residual volume.


EXAMINATION SUPPORT

1. Urinalysis
2. Urodinamis examination (assessing obstruction of urine flow pattern)
3. Complete blood examination
4. Assessment of cardiac and respiratory function
5. Radiological examinations plain to see an enlarged prostate
6. Ultrasonography (TRUS-transrectal ultrasonography)
7. Sistografi

MANAGEMENT

1. Catheterization (with a metal catheter)
2. Prostatekmi
3. Watch ful waiting (prostate incision intrasuretral / TUIP)
4. Balloon dilatation
5. Gap alfaInhibitor 5 - @-reductase

ASSESSMENT
1. Circulation
Blood pressure rises as the effects of kidney enlargement
2. Elimination
Decrease in strength or encouragement of urine, difficult start, urination, not satisfied in urination, nocturia, Dysuria, Hematuria, recurrent urinary tract infections, urinary tract stone disease history, Constipation
3. Enter the food / beverage
Anorexia, nausea, vomiting, weight loss.
4. Comfort
Suprapubis pain and back pain / hip
5. Security
Fever
6. Sexuality
Decrease in ejaculation

NURSING DIAGNOSIS
1. acute pain associated with muscle spasm spincter
2. changes in the pattern of elimination: urinary retention associated with secondary obstruction
3. Sexual dysfunction associated with loss of body function
4. Risk of infection associated with port de enter microorganisms through a catheter

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Nursing care in patients with diarrhea

DIARRHEA

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UNDERSTANDING
Diarrhea is the number of bowel movements with stools more than normal (normal 100-200 ml per hour) with the form of liquid or semi-liquid feces, can also be accompanied by an increased frequency defecation.
According to WHO diarrhea is watery bowel movements and more than 3 times a day.
Acute diarrhea is a sudden diarrhea and short duration, within a few hours to 7 days or until 14 days.
Chronic diarrhea is diarrhea that lasts more than 3 weeks.

ETIOLOGY
The cause is a bacterial diarrhea, parasites, or viruses (E.colli, V. cholerae, Aeromonas.SP.)
Another cause is a toxin, drug, food, chemotherapy, fecal impaction and other conditions.

CLINICAL MANIFESTATIONS
Patients with infections often experience diarrhea nausea, vomiting, abdominal pain to stomach cramps, fever and defecation increases with increasing fluid content in feces. spasmodic contraction of the pain and stretching is not effective in anal (tenesmus) can happen every defecation. lack of fluid causes the patient to feel thirsty, tongue dry, and decreased skin elasticity.
hypovolemic cause rapid pulse, decreased blood pressure, nervous, pale, cyanosis, in certain circumstances cause hypokalemia which which will lead to cardiac arrhythmia.

PATHOPHYSIOLOGY
Infectious diarrhea is usually transmitted through the fecal oral because of contaminated food or beverages feces excretion bad plus, the food is not cooked or undercooked. Transmission is person to person via aerosolization or contaminated hands.
Non-invasive bacteria produce a toxin that bound to the intestinal mucosa and increase levels of cyclic AMP in the cell causes active secretion of chloride anions into the intestinal lumen at follow water, carbonate ions, sodium and potassium cations.
Entero-invasive bacteria cause damage to the intestinal wall in the form of necrosis and ulceration, are secretory eksudatif. The liquid can be mixed with mucus and diarrhea with blood.

EXAMINATION SUPPORT

• Laboratory tests are complete
• Examination of blood gas analysis
• Examination of urine and feces

MANAGEMENT

• Rehydration as a priority treatment. on acute diarrhea can be given ORS, RL fluid or an isotonic Nacl plus 1 ampoule of 7.5% Sodium bicarbonate 50 ml.
• Identify causes of diarrhea
• Symptomatic therapy. anti-intestinal motility and secretion (loperamide / Imodium), anti-emetic (metokloperamide).
• Definitive therapy. cotrimoxazol, cloramphenicol, metronidazole, Ampisillin.

NURSING MANAGEMENT

1. Measures to control diarrhea by resting in bed, eating and drinking low-fiber to reduce the acute period, limit drinking caffeine and carbonates which stimulates intestinal motility.
2. Maintaining fluid balance and encourage oral rehydration such as water, juice and broth.
3. Reduce anxiety by supporting individual coping.
4. perianal skin care to maintain cleanliness and humidity.
5. Prevent infections that may occur and prevent the spread of disease through the hands, clothing, bed sheets and other objects.
6. Monitoring and management of potential complications with the examination of serum electrolyte levels, vital signs and general condition.

COMPLICATIONS

• Metabolic acidosis
• Hypovolemic shock
• Cardiac arrhythmias
• Acute renal tubular necrosis

NURSING

1. Physical examination: Patient's general condition: the objective data: body weakness, nausea, vomiting, abdominal pain. Subjective Data: decreased skin elasticity, cyanosis, pale, cold ektrimitas, anuria.
2. Abdomen: abdominal cramps, hyper peristalsis.
3. Skin: cold sweat, moisture, changes in skin elasticity.
4. Neurological: decreased consciousness, seizures.
5. Psychological: anxiety.
6. Cardiovascular: Tachicardi, cardiac arrhythmia, shock.

NURSING DIAGNOSIS

1. Diarrhea associated with the infection process
2. Imbalance nutrition: less than the needs of biological factors associated with nausea and vomiting
3. Fluid deficit associated with loss of fluid volume excess
4. Anxiety associated with changes in health status
5. Acute pain related to biological factors increasing intestinal motility

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Body care in AIDS patients

Body care in AIDS patients

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A. Actions in treatment room

• Align the patient's body, close your eyes, ears and mouth.
• Remove the medical equipment that is still attached.
• Each wound must be in plaster and covered well.
• Close all holes of the body with waterproof plasters.
• Clean bodies carefully.
• Give family and friends to view the corpse.
• Enter the corpse into a special plastic bag and attach the label "INFECTIOUS / HIV".
• After all the neat corpse may be sent to the morgue.

B. Actions in the morgue

• The body was bathed by a morgue worker who has been trained, then is wrapped with a cloth shroud or other packaging in accordance with the belief / religion, and then inserted into a special plastic bag labeled "infectious / HIV".
• Bodies that have been in special plastic bags should not be opened.
• The body should not be preserved in any manner or autopsy.
• In certain circumstances, an autopsy can only be done after obtaining approval from the head of the hospital.

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AIDS Patient Care

AIDS Patient Care

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The principles of Treatment:

ISOLATION
Basically, AIDS patients can be treated in the usual space infection. Sometimes AIDS patients need care in one special room for consideration:

• Protect AIDS patients from other infections both endogenous and exogenous.
• Facilitate the provision of nursing care.

REGULATION OF OFFICERS
a. Nursing team who suffered from infections, skin disorders and pregnant women should not be treating AIDS.
b. Wearing Barakshort (long underwear), masks and eye coverings and gloves for taking action:

• Bathing.
• Helping defecation and urination.
• Preparing laboratory materials.
• Changing clothes and loom.
• Expenditure measure urine, faeces or vomit.
• Doing huknah / klisma and catheterization.
• Perform procedures medical / invasive: infusion set, clearing the airway, injection and others.
• Caring for the body.

c. Wash hands before and after treatment measures despite wearing gloves and using a disinfectant under running water.
d. Reporting to the special team handling AIDS in the hospital when exposed to needle puncture scars in use in people with AIDS or splashing liquids when exposed to AIDS sufferers in the eyes, mouth or injured body part.
e. Giving plastic coating on the pillow and mattress as a shield so easy to wash.
f. Replacing the label reads "MATERIALS TRANSMITTED / HIV" in all specimen bottles that will be sent to the laboratory.
g. Cleaning the bathroom and treatment room regularly.
h. uphold the official secret.

PREVENTION OF CONTAMINATION AND CLEANING EQUIPMENT
a. All equipment used by people with AIDS should be set apart.
b. Use disposable tools in the tools such as syringes, infusion set, catheter, endotracheal(ET) tube and others.
c. Loom such as mattresses and pillows were given a plastic coating before it is used to prevent the attachment of blood or body fluids. The loom is already in use fed into a special plastic bag, labeled "INFECTIOUS MATERIAL / HIV", then tied and sent to the place of washing.
d. Gloves are used every action, straightening the bed and holding a tool that has been contaminated.
e. Tool is not the kind of disposable, should be sterilized immediately after use.
f. Masks, oxygen hose, and other breathing aids must be sterilized after use.
g. Instruments wound care or medical equipment, once used soaked with disinfectant solution and then sterilized according to the rules of sterilization.

CONTAMINATED MATERIALS
a. All remaining tissue, blood, body fluids, bandages, needles and abbocath(venous catheter) used during the action placed in hard plastic bag, double-layered, puncture resistant, waterproof and special color, and then given the label "MATERIALS TRANSMITTED / HIV" and then burned.
b. Give the guards with plastic alt on the operating table, operating coat, the base of the hands or head if done action intubation / cannulation / extubasi trachea.

PATIENT RIGHTS
a. patients may visit the facilities available in hospitals such as the television room, canteen and others.
b. Patients can receive guests at the time of visit and may be accompanied during the treatment, except in conditions of infection.
c. Patients with severe diarrhea may only use the special toilet.

COUNSELING
a. Counseling is an important aspect that aims to:

• Provides information on all matters relating to HIV infection which include, among other causes, clinical symptoms, patterns of transmission, prevention and others.
• Providing psychological and social encouragement to patients and families in dealing with problems of physical and psychological, so the patient can overcome the problems independently.
• Providing encouragement to the patient to adjust to new conditions, among others by holding a sexual behavior change, to reduce the spread of the HIV virus to others.

b. Counseling done by doctors and or nurses who have been specially trained.
c. Counseling target not only patients and families but all health workers including nurses, physicians, laboratory workers, laundry officers and others.

MAINTENANCE OFFICER ATTITUDES
a. Understand, understand and have skills in providing nursing care.
b. Be calm, fair, and not excessive but remain vigilant in helping patients.
c. Understanding the state of the patient, show empathy.
d. Be protected.

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Nursing care in patients with AIDS

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A I D S

UNDERSTANDING

• HIV (human immunodeficiency virus): The virus that causes one's immune system weaknesses.
• AIDS (Acquired immunodeficiency syndrome): an infection that can cause severe damage to the immune system and can not be cured, so people are very open or vulnerable to infection or certain cancers.
• Patients with HIV: is someone who is infected with human immunodeficiency virus, which infects mainly T lymphocyte cells and disrupt cell immunity.
• Patients with HIV-AIDS is someone who has been infected with HIV and are at the last stage of infection with signs of the emergence of various bacterial infectious diseases, fungi, parasites and viruses that are opportunistic or malignancy.

CAUSE
AIDS is caused by human immunodeficiency virus. This type of retrovirus that is easy to die outside the body. The period between infected with HIV until the onset of symptoms (incubation period) is 6 months in children and 60 months in adults.

SYMPTOMS AND SIGNS
Clinical stage I:

• Without symptoms (asymptomatic)
• Generalized lymphadenopathy which persistent

Clinical Stage II:

• Weight loss <10% - Preview minor mucocutaneous - herpes zoster - Upper respiratory tract infections recurring Clinical Stage III: - weight loss> 10%
• Prolonged fever that can not be explained (intermittent or constant), more than a month
• Oral candidiasis
• Pulmonary Tuberculosis
• Severe bacterial infection

Clinical Stage IV:

• HIV wasting syndrome
• Pneumonia carini
• Toxoplasmosis of brain
• CMW in organs other than liver, spleen, or lymph nodes
• Infection with Herpes simplex virus (HSV) mucocutaneous more than 1 month
• Candidiasis esophagus, trachea, bronchus, or lung
• Micobakteriosis
• Septicemia
• Extra pulmonary tuberculosis
• Lymphoma
• Kaposi's sarcoma
• HIV encephalopathy

LABORATORY EXAMINATION
1. Tests to determine the presence of antibodies and HIV antigen:

• Detection of HIV antigen by ELISA (enzyme linked immunosorbent assay).
• Immunoblot western blot (WB)

2. The tests showed a decrease in body immunity
Decrease the body's immunity:
Simple laboratory tests: Hb, Smear of peripheral blood, leucocytes, lymphocytes and platelets, the AIDS found existence of anemia ,leukopenia ,and thrombocytopenia limfopenia .

3. Testing for the presence of malignancy or opportunistic infection

• Serology or culture against herpes simplex, CMV, Epstein Barr
• Staining culture or histopathology of pneumonia carinii, cryptosporidium, toxoplasmosis, candidiasis, or aspergilus.
• Histopathologic of Kaposi's sarcoma or lymphoma.

NURSING ASSESSMENT IN AIDS PATIENTS
A. Diagnose
History of free sex, homosexuality, history of drug abuse via intravenous blood transfusion recipient, a parent suffering from HIV - AIDS, chronic diarrhea, decreased appetite, weight loss, fever.
B. Psychological
knowledge and acceptance of disease, function and role in family, community, and employment.
acceptance of the patient's family.
C. Social
Support systems are available and affordable with the ability financially.
The Group of HIV-AIDS sufferers.
D. Clinical manifestations
clinical manifestations that spread throughout the body that can of whole organs, infections, malignancies.
E. Neurologic (malignancy)
HIV encephalopathy, Cryptococcus neofarmans, progressive multifocal lauciensefalopaty (PML).

NURSING DIAGNOSIS

1. PK: Opportunistic Infections
2. PK: Sepsis
3. PK: malignancies
4. Ineffective airway clearance
5. Diarrhea
6. Changes in family process
7. Risk of infection
8. The risk of transmission of infection
9. Fatigue
10. Social isolation
11. The risk of ineffective management of therapeutic regimen
12. Powerlessness
13. Anxiety

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Nursing care in patients with Lung Cancer

LUNG TUMOR (CARCINOMABRONCHOGENIC)

DEFINITION
Bronchogenic carcinoma is a malignant tumor originating from primary lung airways.
Most of the primary lung tumor is a carcinoma bronchi (John E. Stark, 1990).

PHYSICAL SYMTOMS
Hemopthisis, Cough, Chest pain, Shortness of breath, this is due to enlargement of the tumor and due to collapse of the lung, Wheezing / stridor, this sounds arising from the trachea or bronchus obstruction, Hoarse, this happens due to his stricken recurents left laryngeal nerve, Pneumonia Recurents, Dysfagia, this may occur due to the spread of tumors via lymphatic vessels to the area mediatinum or to the esophagus, Obstruction of superior vena cava, Systemic symptoms: such as weight loss, no appetite, which is the initial symptom in 50% of patients with lung cancer, Symptoms of metastasis, the most common of the organs of the brain, liver, bone and adrenal gland, Non-metastatic effects: such as peripheral neuropathy, dermatomiositis or syndrome whose symptoms such as secretion of hormones (eg ADH, ACTH, PTH).

ETIOPATOGENSIS
Such as cancer in general, the exact etiology of carcinoma bronkogenik still unknown, but it is expected that the long-term inhalation of carcinogenic materials is a major factor, without prejudice to possible predisposing role of family relations or ethnic / racial and immunologis status. Inhalation of carcinogenic materials is highlighted that many cigarettes.

HIGH RISK GROUPS:
- Smokers.
- Workers at asbestos factories.
- History fibrosis suffer from chronic lung diffus.

EFFECT OF CIGARETTE:
The materials are carcinogens in tobacco smoke include: polomium 210 and 3.4 benzypyrene. The use of a filter is said to reduce her risk of carcinoma broncogenik, but still remained higher than non-smokers.
In the long term ie, 10-20 years, smoking:
1-10 cigarettes / day increases the risk 15 times
20-30 cigarettes / day increases the risk 40-50 times
40-50 cigarettes / day increases the risk 70-80 times.

Industry Influence
The most widely associated with the carcinogen is asbestos, which otherwise increases the risk of cancer is 60-10 times. Following the industrial radioactive materials, miners uramium 4 times the population at risk in general. Exposure to this industry only visible effect after the 15-20 years.

Effect of Other Diseases
Pulmonary tuberculosis is associated as much bronchogenik carcinoma predisposing factors, through mechanisms hyperplasi - metaplasi - carcinoma in situ-carcinoma - bronkogenik as a result of scar tissue tuberculosis.

Effect of Genetic and immunological status
In 1954, Tokuhotu can prove that despite the influence of heredity rather than factors of environmental exposure, this provides an opinion that can be derived bronkogenik carcinoma. Research recently skewed that the factors involved with Aryl Hydrocarbon hydroxylase enzymes (AHH). Status immonologis patients are monitored from cellular mediated showed a correlation between the degree of cell differentiation, stage of disease, response to treatment and prognosis.

Classification by histopathology using ordinary light microscope (WHO, 1977).
1. Epidermois carcinoma (squamous cell carcinoma).
2. Adeno carcinoma
3. Undiferentiated small cell carcinoma (oat cell)
4. Large cell carcinoma undeferentiated.

INVESTIGATIONS
Radiological
Radiopaque mass in the lung, Airway obstruction with resultant atelectasis, Pneumonia, Enlarged hilar glands, Cavitation.

Sputum cytology:
In sputum cytologic examination to help establish the case up to 70%. Sputum for cytologic sample should be received by the laboratory within 2 hours after ekspectorasi / expenditure. Sample dawn is not required.

Bronchoscopy:
In the biopsy is used to determine the type of tumor cells. Bronkografi
The picture is considered bronkografi patognomonik irregular stenosis is obstruction, stenosis rats and indented thumb.

Pleural aspiration and biopsy:
Aspiration is an action that must be done if patients with lung tumors have effusi pleura. Effusi not always result from the spread of tumors to the pleura, but may result from pneumonia reaction to the tumor or lymphatic obstruction.

Biopsy needle percutan:
This examination is useful for diagnosing tumors that are difficult peripheral transbronchial biopsied denag techniques.

Mediatinoscopy:
This technique is used to take samples of lymph gland enlargement mediatinum experiencing, this is done if no visible pulmonary tumor.

Endoscopy
Includes examining laryngoscopy and bronchoscopy and bronchial washings, scrapings / sweep and biopsy. The objective examination of Bronchoscopy (fiber optics) are:
a. Knowing the changes in the bronchus of lung cancer.
b. Retrieving material for cytological examination.
c. Noting the changes on the surface of tumor / mucosa to predict the type of malignancy.
d. Assessing the success of therapy.
e. Determining overbilitas lung cancer.

Immunology
The existence of a negative correlation between cancer and immunological reactions have been generally known. Immunological disorders mainly seen in cell mediated immunity that can be given through a delayed hypersensitivity reaction is clearly, tolerance to skin graft, total circulatory low T cell, and lymphocyte transformation in vitro is low. At this time more immunological examination serve as prognostic factors than diagnostic factor. Conclusion Correlation of skin test and response to cytostatic:
a. Less than 1.0 cm. : Prognosis is poor, widespread disease.
b. Less than 2.5 m. ; Better prognosis, limited disease, good response to chemotherapy.

PHASING CLASSIFICATION CLINIC (Clinical Staging)
Based on TNM
T = Tumor: N. : Nodules, namely the lymph nodes of M. : Metastases
1. T: T-0: No visible primary tumor

• T-1: tumor diameter of less than 3 cm. Without the invasion of bronchus
• T-2: tumor diameter more than 3 cm. Can be accompanied by atelectasis or pneumonitis, but is more than 2 cm. From Karina, and there is no pleural effusion.
• T-3: Tumor size with an invasion into the surrounding (thoracic wall, diaphragm or mediastinum) or have been near Karina accompanied by pleural effusion.

2. N: N-0: There was no propagation to regional lymph nodes.

• N-1: There is a propagation to the ip silateral hilar lymph nodes.
• N-2: There is a spreading to the lymph limfemediastinum or contralateral
• N-3: There extratoracal spreading to lymph nodes.

3. M. M-0: There is no distant metastases.
M-1: Already there are distant metastasis to other organs.
Based on TNM. Compiled phasing following clinics.
a. Carcinoma in situ: T-0, N-0, M-0, but positive sputum cytology for malignant cells.
b. Phase I. T-1, N-0, M-0, or T-2, N-0, M-0
c. Phase II. T-2, N-1, M-0.
d. Stage III: when there are already T-3, N-2, or M-1.


MANAGEMENT
Treatment of lung tumors depend on tumor cell types.
1. Surgical resection.
2. Palliative therapy.

ASSASSMENT:
Activity / rest : Weakness, inability, to maintain regular habits, dyspnea because the activity, lethargy usually advanced stage.

Cardiovaskuler and circulation :
Pallor, cyanosis, diaphoresis, hypotension, bradycardi, tachycardi, arrytmia in atrial or ventricular, decreased cardiac output, shock. Increased jugular vein, heart sound: friction pericardial (addressing effusion) Dysrhythmias, finger percussion.

Ego Integrity : Anxiety, fear of death, resist harsh conditions, anxiety, insomnia, the question is repeated. lack of rest.

Elimination :
Diarrhea that intermittent (hormonal imbalance) Increased frequency / amount of urine (Hormonal Imbalance).

Food / liquids :
Weight loss, poor appetite, decreased food input, difficulty swallowing, thirst / increase fluid intake, Thin, wiry, less weight or appearance (stage 0, edema face, periorbital (hormonal imbalance), Glucose in the urine.

Discomfort / pain :
Chest pain, which does not / can be affected by the change of position. Painful shoulder / hand, bone pain / joint, cartilage erosion secondary to the increase of growth hormone. Abdominal pain is gone / arise.

Respiratory :
Cough mild cough or a change from the usual pattern, increased sputum production, shortness of breath, workers exposed to carcinogenic substances, hoarse, vocal cord paralysis, and smoking history. dyspnea, increased employment, increased tactile fremitus, wheezing on inspiration or expiration (air flow interruption). persistent wheezing tracheal deviation (the area that suffered lesions) hemoptysis.
Blood gas analysis (obtained hypoksemia, acidosis, an increase or decrease in CO2). Respiratory function (VC reduction, increased tidal volume). ECG (may show a arrytmia).

Security : Fever, maybe there is / are not, reddish, pale skin.

Sexuality :
Gynecomastia, amenorrhea, or impotence.
family risk factors: a history of lung cancer, tuberculosis.

NURSING DIAGNOSIS

• Ineffective breathing pattern related to decreased lung expansion.
• Ineffective airway clearance related to airway obstruction.
• Damage to gas exchange associated with chronic hypoxia in lung tissue.
• Anxiety associated with an inability to breathe.
• Acute pain b / d of cancer invasion into the pleura, chest wall.
• Nutrition less than body requirements b / Inadequate nutrition, increased metabolism, the process of malignancy.
• Impaired body image b / d of changes in body structure.

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Nursing care in patients with Congestive Heart Failure

Inception Report

NURSING IN PATIENTS WITH CONGESTIVE HEART FAILURE

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UNDERSTANDING
Congestive heart failure is a condition where the heart can no longer pump enough blood to meet body needs circulation for tissue metabolism in certain circumstances, whereas in cardiac filling pressure is still high.

CAUSES OF HEART FAILURE

1. Causes of heart failure are classified as follows:
2. Myocardial dysfunction (myocardial failure).
3. Expenses excessive pressure - systolic loading (systolic overload).
4. Excessive volume load - loading diastolic (diastolic overload).
5. Impaired filling (input resistance).
6. Increased metabolic needs - increasing need for excess

LEFT HEART FAILURE SYMPTOMS:
Complaints of body feeling weak, tired, palpitations, shortness of breath, cough, anorexia, and sweating cold, cough and / or coughing up blood, decreased kidney function.

RIGHT HEART FAILURE SYMPTOMS:
Edema, anorexia, nausea, ascites, abdominal pain.

FUSE
Hypertension, myocardial, pulmonary embolism, infection, arrhythmia, anemia, febrile, emotional stress, pregnancy / delivery, infusion / transfusion.

PATHOPHYSIOLOGY
Each obstacle in the flow direction (forward flow) in the circulation will cause the dam to flow in reverse direction (backward congestion). Barriers flux (forward failure) will cause the symptoms of failure in the system backward flow of blood circulation. Cardiac compensatory mechanisms in heart failure is the way the body to maintain blood circulation to meet tissue metabolic needs. Compensatory mechanisms that occur in heart failure are: ventricular dilation, ventricular hypertrophy, increased sympathetic stimulation in the form of tachycardia and peripheral vasoconstriction, elevation of plasma catecholamine levels, retention of salt and fluid loss and increase oxygen ekstraksi by the network.
When the heart of the right and the left together in a state of failure due to interruption of blood flow and the presence of dams, it would appear the signs and symptoms of heart failure on systemic circulation and pulmonary circulation. This is called Congestive Heart Failure (CHF).

LABORATORY EXAMINATION:
There is no specific test that can diagnose heart failure (T. Santoso, heart failure 1989). Laboratory tests are needed to determine the extent to which heart failure has been disturbing the functions of other organs such as liver, kidney and others.

EXAMINATION OF OTHER SUPPORT:
A. Radiology:

• The image of the lung hili thick and wide, getting to the edge density decreases.
• Field lung spots because of pulmonary edema.
• Pulmonary venous distension.
• Hidrothorak.
• Enlargement of the heart, Cardio-thoragic ratio increased.

B. ECG:
Can be found in the primary abnormality of the heart (ischemia, ventricular hypertrophy, rhythm disturbances) and signs of acute trigger factors (myocardial infarction, pulmonary embolism).

C. Echocardiography:
For detection of functional and anatomical disorders that cause heart failure.

D. Cardiac Catheterization:
In left heart failure is obtained (VEDP) 10 mmHg or pulmonary arterial wedge pressure> 12 mmHg in the resting state. Cardiac output is lower than 2.7 lt/mnt/m2 body surface area.

MANAGEMENT
According to the priority is divided into 4 categories:

1. Improving myocardial contraction / perfusion systemic.
2. Lowering the volume of excess fluid.
3. Post Op prevent complications.
4. Surgical treatment (Komisurotomi).
5. Health education regarding disease, prognosis, medications and prevention of recurrence.

ad. 1 Improving myocardial contraction / perfusion systemic:

• Bed rest / bed rest in semi-Fowler position
• Provide oxygen therapy as needed
• Provide medical therapy: digitalis to strengthen heart muscle contraction

ad.2 Lose excess fluid volume

• Provide medical therapy: diuretics to reduce fluid in the tissues
• Record intake and output
• Considering weight
• Restriction of salt / low salt diet

ad.3 Preventing complications

• Schedule a gradual mobilization according to client circumstances
• Prevent the occurrence of immobilization due to bed rest
• Changing sleeping positions
• Noting the adverse effects of Medica mentosa; digitalis poisoning
• Checking or monitoring ECG

ad.4 Surgical Treatment Komisurotomi
Only in the aorta due to infection of aortic regurgitation, aortic valve repair can be considered. While in aortic regurgitation due to other diseases should generally be replaced with artificial valves. Indications on the complaint shortness of breath that can not be overcome by treatment symptomatik. When ekhokardiografi showed left ventricular systole 55 mm, or 25% fractional shortning considered for surgery before heart failure arise.

ad.5 health education, in terms of disease, prognosis, drug use and preventing relapse

• Explaining the course of the disease and prognosis.
• Explaining the use of medications that are used, as well as providing drug administration schedule.
• Changing lifestyles / habits that one: smoking, stress, heavy work, drinking alcohol, foods high in fat and cholesterol.
• Explain about the signs and symptoms that contribute to heart failure, particularly those associated with fatigue, soon tired, palpitations, shortness of breath, anorexia, cold sweat.
• Advise to all controls on a regular basis even if no symptoms.
• Providing mental support; client to accept his situation is real / reality will itself well.

ASSESSMENT OF DATA

1. Activity and rest

• The existence of fatigue / exhaustion, insomnia, lethargy, lack of rest.
• chest pain, dyspnea at rest or during activity.

2. Circulation

• History of hypertension, valve disorders, cardiac surgery, endocarditis, anemia, septic shock, swelling in the legs, ascites, tachycardia.
• Dysrhythmias, atrial fibrillation, premature ventricular contraction.
• Sound S3 Gallop, the sound of CA, the presence of systolic or diastolic, murmur, increased JVP.
• Presence of chest pain, cyanosis, pale, ronchi, hepatomegaly.

3. Mental Status

• Anxiety, fear, anxiety, anger, iritabel / sensitive.
• Stress related to illness, financial social

4. Elimination

• Decrease in urine volume, urine is concentrated
• Nocturia, diarrhea and constipation

5. Food and fluid

• Loss of appetite, nausea, and vomiting
• In the lower limb edema, ascites

6. Neurology

• Dizziness, fainting, pain
• Lethargi, confusion, disorientation, iritabel

7. Comfort
Chest pain, chronic / acute angina

8. Respiration

• Dispnoe at the time of activity, takipnoe
• Sleeping and sitting, history of lung disease

9. Sense of security

• Changes in mental status
• Disorders of the skin / dermatitis

10. Social interaction
Reduced social activity

PRIORITY TREATMENT

• Increase myocardial contractility / systemic tissue perfusion.
• Lose excess fluid volume.
• Preventing Post op complications.
• Provides information about the tailor, prognosis, therapy and prevention of recurrence of disease.

TREATMENT DIAGNOSIS FREQUENTLY ARISING:

1. Decrease in cardiac output in relation to the decrease in myocardial contractility, characterized by:Increased heart rate, changes in blood pressure, decreased urine output, the S3 and S4, chest pain.
2. Limitations of activity in relation to the imbalance between supply and demand of oxygen, characterized by: weakness, fatigue, changes in vital signs, dysrhythmias, dispnoe, diaporesis
3. Disorders of fluid balance, more of the needs in relation to the decline in GFR, marked by: heart sounds 3, orthopnoe, oliguria, edema, weight change, hypertension, respiratory distress, abnormal breath sounds.
4. High risk of failure of gas exchange in relation to changes in alveolar capillary membrane by accumulation of fluid in the lung cavity.
5. Risk of damage to skin integrity about its continuity due to edema, decreased perfusion to the skin.
6. Lack of knowledge about diseases, conditions and treatment in relation to the lack of information is marked with: the patient asked the patient the wrong statement.

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Dysphagia

Disfagi
 

Definition
Realize the difficulties in solid or liquid food flowing from the mouth through the esophagus.

Pathogenesis
1. Lumen of the esophagus or oropharynx obstruction due to intrinsic lesions on the wall, extrinsic compression or foreign objects of nature lumen.
Causes include :

• Malignancy (primary or secondary)
• Peptic stricture
• Chemical injury (eg corrosive)
• "oesophageal web"
• Esophageal diverticulum
• Infection of the esophagus (candidiasis)
• Foreign body (corpus alenum)
• Vascular (large left atrium)

2. Neuromuscular disorders that interfere with the coordination of the flow of normal food and fluid from the esophagus to the stomach.
causes include:

• Cerebro vascular accident
• Motor neuron disease
• Multiple sclerosis
• Myasthenia gravis
• Polimiositis, dermatomiositis, scleroderma
• Tiro toxic myopathy
• Akalasia

Clinical picture1. difficulty in cleaning the posterior pharynx, often accompanied by nasal regurgitation and pulmonary aspiration, almost always associated with neuro muscular disorders oropharynx. in such cases, solid and liquid foods can trigger symptoms.

2. Dysphagia for solid and liquid meal in patients who can cleanse the posterior pharynx leading to esophageal disorders such as diffuse esophageal spasm, or sklero akalasia charity. typical dysphagia are intermittent and not progressive.

3. Dysphagia a progressive slow, initially limited to solid foods, in patients with a history of gastro-esophageal reflux before, leading to peptic stricture.

4. Dysphagia rapid progressive, especially in elderly patients, typical for malignant lesions obstruction.

5. Chest pain accompanied by dysphagia have limited diagnostic value and occurs in both the esophageal spasm or obstructive lesions in each.

Diagnosis
Observation of patients swallowing is an important diagnostic maneuvers and should be performed for all patients. When the oropharynx disorder is suspected, formal neurologic examination should be performed with direct visualization of the neuromuscular function of the pharynx and larynx.

Radiology
"Barium swallow" with contrast medium flow visualization carefully is the most important examination for verification for each obstructive lesions. This examination must show proof akalasia and maybe get other neuromuscular disorders, especially spasm of the esophagus.

Endoscopy
Fiber-optic endoscope may be needed to see firsthand and to biopsy lesions that are not entirely typical of the "barium swallow", especially to distinguish between benign and malignant strictures. If endoscopy performed before the "barium swallow" takes meticulous care to avoid trauma and possible perforation of the esophagus with high-lesion location. If the tests above failed to get the diagnosis or lead to motility disorders, esophageal manometri be done.

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Nursing care in patients with Acute tonsillitis

courtesy by E D U

Acute tonsillitis

(tonsillectomy) 

Definition
Tonsillitis is the presence of general inflammation and swelling of tonsil tissue with a collection of  leucocytes, el-dead epithelial cells and pathogenic bacteria in kripta (Adam Boeis, 1994: 330).

Tonsillectomy is an invasive measures being undertaken to take the tonsils with or without adenoid (Adam Boeis, 1994: 337).

Etiology
• Hemolitikus streptococcus group A.
• Pneumococcal.
• Staphylococcal.
• Haemofilus influezae.

Pathofisiologi
• The occurrence of inflammation in the area tonsila from the virus.
• Resulted in the formation of exudate.
• Cellulitis occurs tonsila and the surrounding area.
• Peritonsilar abscess formation.
• Tissue necrosis.

Symptoms
• Sore throat and dysphagia.
• Patients do not want to eat or drink.
• Malaise.
• Fever.
• Breath odor.
• Otitis media is one of the originators.

Management
• Bed rest.
• Provision of adequate fluids and light diet.
• Giving medications (analgesics and antibiotics).
• If no progress then the alternative measures that can be done is surgery.

Indications of surgery Indications of absolute
• incidence of pulmonary choir due to chronic airway obstruction.
• Hypertrophy of tonsils or adenoids with apnea syndrome during sleep.
• Excessive hypertrophy resulting in dysphagia and weight loss as a companion.
• Excision biopsy in suspected malignancy (lymphoma).
• Peritonsilaris recurrent abscess or abscess that spread to surrounding tissues.

Relative indication
All other indications for tonsillectomy action is considered as an indication of the relative.
Another indication that most can be received is:
• Recurrent tonsillitis attacks.
• Tonsil hyperplasia with functional disorders (dysphagia).
• Hyperplasia and obstruction which settled for 6 months.
• Not respond to treatment and therapy.

Contraindications
• Fever is not in the know the cause.
• Asthma.
• Systemic infection or chronic.
• Sinusitis.

Preparation of operations that may be done
• Laboratory tests (Hb, leko, bleeding time).
• Give an explanation to the client action and care after surgery.
• Fasting 6-8 hours before surgery.
• Give antibiotics as prophylaxis.
• Give premedication ½ hours prior to surgery. 

Assessment

• Medical history related to the factor supporting the occurrence of tonsillitis and the bio-psycho-socio-spiritual. Blood circulation : Palpitations, headache at the time of change of position, decreasing blood pressure, bradycardia, body felt cold, pale extremities.
• Elimination : Changes in the pattern of elimination (incontinence uri / alvi), abdominal distension, bowel sounds disappearance.
• Activity / rest : There is a decrease in activity because of weakness of body, loss of sensation or parese / plegia, tiredness, difficulty in recuperating from seizures or muscle spasms and pain.The reduced level of consciousness, decreased muscle strength, general body weakness.
• Nutrition and fluids : Anorexia, nausea, vomiting due to increased ICT (intra-cranial pressure), impaired swallowing, and loss of sensation on the tongue.
• Nerve supply : Dizziness / syncope, headache, decreased visual field area / blurred vision, decreased sensation of touch, especially in the area face and extremities.
• Mental status : coma, weakness in the extremities, muscle paralise face, aphasia, pupil dilation, decreased hearing.
• Comfort : Tense facial expressions, headache, anxiety.
• Breathing : Shortened breath, inability to breathe, sleep apnea, the occurrence period of apnea in breathing pattern.
• Security : Fluctuation of temperature in the room.
• Psikolgis : Denial, disbelief, profound sadness, fear, anxiety.

Nursing problem and action plan

Ineffective breathing pattern associated with tissue damage or trauma to the respiratory center

Objective:
Patients showed the ability to perform adequately with respiratory blood gas results showed a stable and good and the loss of signs of respiratory distress.

Plan of action:
• Exempt a patent airway (keep your head in a state parallel to the spine / as indicated).
• Perform suctioning if necessary.
• Assess the respiratory system function.
• Assess the patient's ability to do cough / business release secretions.
• Observation of vital signs before and after taking action.
• Observation for signs of respiratory distress (the skin becomes pale / cyanosis).
• Collaboration with the therapists in the provision of physiotherapy.

Impaired sense of comfort pain associated with physical trauma

Objective:
Patients express the pain is reduced and shows a state of relaxed and calm.

Plan of action:
• Assess the level or degree of pain felt by patients in using the scale.
• Help the patients in finding the factors the precipitation on pain in feel.
• Create a peaceful environment.
• Teach it to a patien and demonstration of several ways of doing relaxation techniques.
• Collaboration in the provision of appropriate indications

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