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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Nursing care in patients with Anemia aplastic

Anemia aplastic

A. UNDERSTANDING
Aplastic anemia is a disorder in bone disumsum stem cells that can cause death if the amount of blood cells produced are not adequate.

B. ETIOLOGY

• Certain antibiotics such as chloramphenicol
• Viral infections such as hepatitis
• Benzene
• Radiation Therapy
• Antineoplastic agents or cytotoxic

C. Pathophysiology
The existence of an anemia reflect the existence of a marrow failure or excessive loss of red blood cells or both. Marrow failure (eg reduced eritropoesis) can occur due to nutritional deficiencies, toxic exposure, invasion of tumor or other cause not yet known. Red blood cells can be lost through bleeding or hemolysis (destruction).

Red blood cell lysis (dissolution) occurs mainly in phagocytic cells or the reticuloendothelial system primarily in the liver and spleen. As a result of this process is bilirubin that form in the phagocyte will enter the bloodstream. Any increase in red blood cell destruction (hemolysis) immediately reflected by increased plasma bilirubin. (Normal concentration of 1 mg / dl or less; levels above 1.5 mg / dl result in jaundice in the sclera).
If experiencing the destruction of red blood cells in circulation, the hemoglobin will appear in the plasma (hemoglobinemia). If the plasma concentration exceeds the capacity of plasma haptoglobin (hemoglobin-binding proteins for free) to bind it all (eg if there are more than about 100 mg / dl), hemoglobin will be diffused in the kidney glomerulus and into the urine (hemoglobinuria).
Conclusions about whether an anemia in certain patients is caused by destruction of red blood cells or red blood cell production is not sufficient in a way that is:

1. Calculate reticulocyte in blood circulation.
2. The degree of proliferation of young red blood cells in bone marrow and how pematangannya.
3. Presence or absence of hyperbilirubinemia and hemoglobinemia.

Aplastic anemia is caused by a decrease in precursor cells in bone marrow with fat that can occur in congenital or acquired and idiopathic (no cause is not clear). Various kinds of infections during pregnancy can be as originators, or can be caused by drugs, chemicals, or damage radiation. Substances that often cause bone marrow aplasia is benzene and benzene derivatives (eg, airplane glue); anti-tumor drugs such as nitrogen mustard,; antimetabolik, including metotrexate and 6-merkaptopurin; and berabagai other toxic substances such as arsenic.

Various materials which sometimes causes aplasia or hypoplasia include various antimicrobial, anti-convulsive, anti-thyroid drugs, oral hypoglycemic drugs, anti histamine, analgesic, sedativ, phenothiasine, insecticides, and heavy metals. In various circumstances, aplasia anemia occurs when the drugs or substances included in the amount of toxic chemicals. If exposure is stopped immediately (in this case at the first occurrence of retikulositopenia, anemia, granulositopenia, thrombocytopenia) can be expected soon and perfect healing. In a young man who experienced puberty during hepatitis have a high risk of experiencing severe aplasia anemia with mortality rates of 90% in the first year with a mean survival of six months; marrow transplantation is a treatment option.

D. CLINICAL MANIFESTATIONS

• Pale as a result of reduced blood volume and decreased hemoglobin.
• Dyspnea, shortness of breath and tired quickly when berktivitas.
• Loss of appetite, nausea and stomatitis.
• Tachycardia and cardiac noise as a picture of the workload and bulk Increased heart.
• Headache, dizziness and weakness as a result of reduced supply of oxygen carried by red blood cells into the central nervous system.

E. EXAMINATION SUPPORT
Laboratory (Hb, HCT, Platelets, Granulocytes)

F. MANAGEMENT
There are two methods of treatment are now often implemented are:

1. Transplantation of bone marrow Bone marrow transplantation was undertaken to provide a network inventory hematopoesti that still works. For transplantation is required ability to adapt behasil donor and recipient cells and to prevent complications during healing. With the use of the immunosuppressant cyclosporin, the incidence of rejection for grafts less than 10%.
2. Immunosuppressive therapy with antitimosit globin (ATG). Immunosuppressive therapy with ATG given to stop the immunological function that extends the bone marrow aplasia allowing experienced healing. ATG was given every day through a central venous catheter for 7-10 days. Patients who respond usually recovers within a few weeks to 3 months, but if it responds slowly to 6 months after treatment. Patients who experience severe anemia and treated early during the history of the disease have the best chance of responding to the ATG. Supportive therapy plays an important role in the management of aplastic anemia. Patients supported with transfusions of red blood cells and platelets are sufficient to overcome the symptoms.

G. NURSING DIAGNOSIS ARISING

• Imbalance nutrition less than the needs associated with nausea, vomiting, anorexia.
• Activity intolerance related to reduced oxygen supply to the central nervous system.
• PK: Thrombocytopenia
• PK: Bleeding
• Risk of infection associated with invasive measures: a reduction in immunological

H. LITERATURE

1. Arif Mansjoer, 2000, Capita Selekta Medicine, Publisher Media Aeusculapius FK-UI, Jakarta
2. Doenges M.E. at al., 1992, Nursing Care Plans, F.A. Davis Company, Philadelphia
3. Renowned, HY, et al, 2002, Textbook Medical-Surgical Nursing Brunner & Suddarth, EGC, Jakarta
4. Joane C. Mc. Closkey, Gloria M. Bulechek, 1996, Nursing Interventions Classification (NIC), Mosby-Year Book, St. Louis
5. Marion Johnson, et al, 2000, the Nursing Outcome Classifications (NOC), Mosby-Year Book, St. Louis
6. Marjory Gordon, et al, 2001, Nursing Diagnoses: Definition & Classification 2001-2002, NANDA
7. Soeparman. (1987). Medicine, Faculty of medicine Publishing Center, Jakarta.

I. NURSING DIAGNOSIS

Imbalance nutrition less than the needs associated with nausea, vomiting, anorexia.

Purpose:
Once the action has been nursing for 3x24 hours clients nutritional needs are met with the criteria results:

• Adequate nutrient intake.
• Nausea, vomiting, loss anoreksi
• Free from signs of malnutrition.
• There was no decline Weight Loss

Intervention:

• Monitor nutritional intake and output
• Monitor weight gain corporate clients Explain to klie about the importance of nutrition for the body and the diet prescribed and ask again what has been described
• Help clients and families identify and select foods that contain calories and protein in accordance with a programmed diet.
• Serve food in warm and attractive
• Collaboration with a dietitian to determine the proper diet as well as physicians in the provision of vitamins.

Activity intolerance related to reduced oxygen supply to the central nervous system.

Purpose:
Once the action has been nursing for 3x24 hours clients can increase activity tolerance criteria:

• Freedom from exhaustion after activity
• A balance needs activity and rest
• There is an increasing activity tolerance

Intervention:

• Monitor vital signs
• Review the causes of intolerance client activity
• Train ROM when circumstances allow clients
• Teach client techniques energy savings for activity
• Increase client activity according to ability

PK: Thrombocytopenia

Purpose:

• Nurses are expected to minimize complications from the presence of thrombocytopenia with the criteria:
• Trombosit in normal circumstances (350-450 rb / MMK).

Intervention:

• Observation of general condition Clients
• Monitor laboratory results (number of platelets)
• Observation of signs of bleeding
• Collaborative provision platelet transfusion

PK: Bleeding

Purpose:
Nurses are expected to minimize complications from the bleeding with criteria:

• Hb levels within limit Normal
• There are no signs hypovolemic shock

Intervention:

• Observation of general condition Clients
• Monitor laboratory results (figure hemoglobin)
• Observation of signs of bleeding

Resiko infeksi berhubungan dengan tindakan invasif; penurunan imunologis

Purpose:After nursing for a 3x24 hour action does not occur with infection criteria:

• There are no signs of infection.
• Vital signs within limit Normal
• Number of leucocytes and differential within normal limits.

Intervention:

• Monitor vital sign andsigns of infection
• Monitor laboratory results (number of leucocytes and differential)
• Perform aseptic techniques and Septic each perform action on the client.
• Observations on the region where the stabbing infusion,catheter
• Teach the client and families about how infection prevention and signs of infection
• Collaborative provision antibiotic

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Anemia

ANEMIA

UNDERSTANDING
Anemia is a reduction in red blood cell count, hemoglobin quantity and volume of red blood cells (hematocrit per 100 ml of blood).
Anemia can be classified according to:

1. The morphology of red blood cells and index-index
2. Etiology

Classification of Anemia According to Micro and Macro morphology showed red blood cell size while kromik show warnanya.Ada three major classifications are:

• Anemia Normositik Normokrom is size and shape of red blood cells of normal and contained normal amounts of hemoglobin (MCV and MCHC normal or low.
• Anemia Makrositik normokrom is size of red blood cells are larger than normal but normal hemoglobin concentration (MCV increased, normal MCHC).
• Microcytic hypochromic anemia is the size of red blood cells contain hemoglobin small amounts of less than normal (MCV and MCHC less).

Included in the category of microcytic hypochromic anemia is deficiency anemia can occur due to iron deficiency, pirodoksin or copper.Iron Deficiency Anemia is a condition in which total body iron content falls below normal levels that occur due to lack of sufficient iron to synthesize hemoglobin.

Pathophysiology

Iron-deficiency anemia is anemia most often affects children. Babies born to builan enough nonanemik and well-nourished mothers, have adequate supplies of iron until the birth weight doubling time is generally 4-6 months old. After that iron must be available in the diet to meet the needs of children. If iron intake from food is insufficient iron deficiency anemia.
This most often occurs due to the introduction of solid foods too early (before age 4-6 months) discontinuation of infant formula containing iron or breast milk before age 1 year and excessive drinking cow's milk without the addition of solid foods rich in iron. Babies are not enough months, infants with perinatal excessive bleeding or infants of mothers who are malnourished and lack of iron also do not have adequate iron stores. These babies are at higher risk of iron deficiency anemia before the age of 6 months.
Iron-deficiency anemia can also occur due to chronic blood loss. At Baby this happens because of chronic intestinal bleeding caused by a protein in cow's milk is not heat resistant. At any age children as much as 1-7 ml of blood loss from the gastrointestinal tract every day can cause iron deficiency anemia. In young women iron deficiency anemia can also occur due to excessive menstrual.

CLINICAL Pathway

Lack of Iron Intake >>>>Insufficient iron reserves >>>>Anemia Def. Iron
>>>>Weak >>>>Pale >>>>Fever

SIGNS AND SYMPTOMS

* Conjunctiva was pale (hemoglobin (Hb) 6 sampai10 g / dl).
* Palms pale (Hb below 8 g / dl)
* Irritability and anorexia (Hb 5 g / dl or lower)
* Tachycardia, systolic murmur
* Pika
* Lethargy, increased sleep needs
* Losing interest in toys or play activities.

COMPLICATIONS

* Poor muscle development (long term
* Decreased concentration of power
* The test results decreased development
* The ability to process information decreases heard

SPECIAL INSPECTION AND SUPPORT

• Free erythrocyte porphyrin levels increased
• Decreased serum iron concentration
• Transferrin saturation decreased
• Serum ferritin concentration declined
• Hemoglobin decreased
• The ratio of erythrocyte hemoglobin porphyrin ---- more than 2.8 ug / g is diagnostic for iron deficiency
• Cospuscle Mean volume (MCV) and mean cospuscle hemoglobin concentration (MCHC) ---- decline causes hypochromic microcytic anemia or red blood cells that are small and pale.
• During treatment ---- reticulocyte count increased within 3 to 5 days sesuadh commencement of iron therapy indicates a positive therapeutic response.
• With treatment, hemoglobin ------- back to normal in 4 to 8 weeks indicate additional iron and adequate nutrition.
• Therapy Effort aimed at the prevention and treatment interventions. Prevention includes: Encourage moms to give milk, Eat iron-rich foods and taking prenatal vitamins that contain iron.

Therapies
to treat iron deficiency anemia treatment program consists of the following:

• Iron is given orally in doses of 2-3 mg / kg of iron element of all forms of iron is as effective (ferrous sulfate, ferrous fumarate, ferrous succinate, ferrous gluconate.
• Vitamin C should be given together with iron (Vitamin C increases iron absorption).

Iron therapy should be given at least 6 weeks after the anemia is corrected to replenish iron reserves. Injected iron is rarely used anymore unless there is malabsorption of small bowel disease.

NURSING PROBLEMS

1. Activity Intolerance related to oxygen transport damage secondary to the decrease of red blood cells
2. Changes in nutrition: less than body requirements
3. Fatigue
4. Risk of infection associated with a decrease in resistance secondary to tissue hypoxia and / or white blood cells are abnormal (neutropenia, leukopenia)
5. Risk of injury: The tendency of bleeding associated with thrombocytopenia and splenomegaly
6. High risk of changes in growth and development.

COLLABORATION ISSUES

* PK: Bleeding
* PK: Heart Failure
* PK: Excess iron (repeated transfusions).

PLANNING NURSING

* Goal
Main Objectives include tolerance of activity, achievement and maintenance of adequate nutrition and lack of complications.

* Criteria Results
1. Improve a child's skin color
2. Pattern tumbuih children improved (as shown on the map the growth)
3. Activity levels of children according to age
4. The old man showed his understanding of the rules of treatment at home (For example: The drug, iron-rich foods that fit).

* Intervention
a. Monitor therapheutik effects and unwanted effects of iron therapy in children:

• Side effects of oral therapy (eg, tooth discoloration)
• Teach about ways to prevent tooth discoloration:
• Drink iron preparations with water, preferably with orange juice
• Gargling after taking the drug.
• Encourage to increase fiber and water to reduce the effects of iron constipation
• To overcome the severe constipation due to iron try to lower doses of iron but prolong duration of treatment.

b. Teach the parents about the intake of adequate nutrition.

* Reduce the intake of milk in children
* ncrease your intake of meat and substitute the corresponding protein
* Add whole grains and green vegetables in your diet.

c. Get information about the history of diet and feeding behavior

• Assess the factors that cause nutritional deficiencies,-psychosocial, behavioral and nutritional
• Create a plan with their parents about the eating habits of approaches that can be accepted
• Refer to the nutrition expert for evaluation and intensive therapy.
• Encourage mother to breastfeed her baby because of iron from breast milk is easily absorbed.

Rational

• By monitoring therapheutik effects can be known advantages and disadvantages of granting therapheutik they will be making it easier for i for further action.
• By teaches parents about adequate nutrition intake for iron for children can be met in accordance with age beside their parents better understand the importance of the need for iron for children.
• By providing information about the history of dieting and eating behaviors can be known habits that benefit / harm to the health of the client.
• With Mother to breastfeed their infants suggest iron deficiency in infants and children can be prevented because the milk contains iron that is easily absorbed by the body.

REFERENCES

1. Cecily L. Betz, et al, 2002, Pocket Book of Pediatric Nursing, EGC Jakarta.
2. Suriadi, et al, 2001, Child Nursing, prints I, publisher CV Great Seto, Jakarta
3. Faculty of medicine, 1998, Child Health Sciences, Printing infomedika, Jakarta.
4. Richard, R., et al, 1992, Health Sciences Children Part II.
5. Sylvia A. Price, et al, 1995, Pathophysiology Clinical Concepts of disease processes, Issue 4, EGC, Jakarta.
6. Sell ​​Lynda Carpenito, 2001, Handbook of Nursing Diagnosis, Issue 8, EGC, Jakarta.

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Drug abuse in adolescents

Drug abuse in adolescents

Drug???

Drugs???....

Drugs: narcotics, psychotropic substances and dangerous drugs.
Drugs: narcotics, psychotropic and other addictive substances.


Drug abuse: drug use outside of medical purposes without the supervision of a physician and a violation of law. (Act no 5 and 22 in 1997).

why are abused?
Drugs provide a soothing effect, the relief of pain, sleep, create euphoria, fly, get high.

Dangers of drug abuse

• Drugs cause addiksi and tolerance
• Damage the brain that can not be restored
• Facilitate transmission of HIV /AIDS, Hepatitis B and C
• Psychiatric disorders
• Facilitate the fall in criminality

How drug abuse

• Ingested
• Through cigarette
• Injected
• smoked

Type of drug

• Marijuana (canabis sativa) or marijuana,
• Heroin / putauw
• Amphetamin, ecstasy
• Alcohol
• Sedative-hipnotika Substance (Benzodiazepam) BK, Lexo, MG, Rohyp
• Solvent / Inhalasia

Early detection
Efforts to identify those factors that can trigger someone experiencing drug abuse problems, and recognize the early signs of those affected by drug abuse disorders.

Factors that may encourage a person to engage in drug abuse

• the substance
• the individual
• the environment

Potential USER
That is, those who have not become users or engage in drug abuse but has the risk to be involved in these things without ~ CANDIDATES FOR USERS.

This high-risk groups can be distinguished on several levels:

• Individuals at high - risk
• High-risk families
• High-risk environment

high-risk individuals:

• Negative self-concept,inferior,not confident
• Is easily frustrated / desperate,impatientin doing something and run to the drug
• Too dare to take risks / oppose rules of antisocial behavior
• History of hyperactivity in childhood, borderline IQ
• Smoking at an early age

High-risk families :

• Ineffective communication
• Attitude is very authoritarian or permissive
• The attitude is not consistent between the two parents
• Less harmonious family
• One / both parents become abusers / drug dependence

High-risk environment

• The existence of a peer group that uses drugs
• The existence of youth leaders / youth who use drugs
• Lack of consistent law enforcement

Teenagers use drugs, because

• Feeling troubled
• Pressure comrades
• Rebellion / protest
• Want to know
• Adventurous spirit
• Imitating adults
• The belief that one

Early Symptoms of Drug abuse
Symptoms can be observed according to the stages abuse.

experimental phase (USE)
Dependence has not been visible physical / psychological, but can occur due to intoxication or panic reaction
ignorance.

Phase addiction (abuse)
Symptoms are easily recognized according to the type DRUGS

Changes in attitudes and behavior

• Truant,
• Declining achievement,
• Lie,
• Do not make the task,
• often emotional,
• Angry easily offended, often suspicious,
• Changes in sleep patterns,
• Changes in choosing friends,
• Avoid meeting with family members

Physical changes
Depending on the type of drugs, generally:

when using:
stagger, tough talk, apathy, looking sleepy and aggressive

Long-term effects:
hygiene / unkempt personal hygiene, former injection in the arm / other body parts, symptoms of other diseases (complications)

overdose:
shortness of breath, heart / pulse is slow, the skin felt cold, slow breaths ïƒ stopped / killed

withdrawal :
Eyes and runny nose, yawning continue, diarrhea, muscle aches / bone pain throughout the body, lazy bath (opiates), depression (amfetamine), seizures (alcohol / sedative)


Drug abuse prevention for teens

• Loving and grateful for life as a gift the Almighty
• Every person has its advantages and disadvantages of self respectively, Intersection identify the strengths and weaknesses, develop and realize the positive things and leave the negatives to yourself
• Everyone has problems in his life, face and solve, not be avoided especially with the run to the drug abuse
• Drug abuse is not settle the problem but aggravate the problem.

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