Benefits of Early Mobilization for Postoperative Appendectomy

Benefits of Early Mobilization for Postoperative Appendectomy

Health Articles   October 27, 2013

Appendicitis is an inflammation of the appendix are relatively common which can arise without apparent cause or arise after obstruction of the appendix by feces or due to twisting of the appendix or blood vessels. Appendix inflammation causes swelling and pain that can lead to gangrene due to impaired blood supply (Corwin, 2001).

Appendicitis is the most common cause of acute inflammation in the lower right quadrant of the abdominal cavity, as well as the most common causes of emergency abdominal surgery. Approximately 7% of the population will have appendicitis at the same time in their lives, men are more frequently affected than women, and adolescents are more frequent in adults. Although it can occur at any age, appendicitis occurs most often between the ages of 10 and 30 years (Smeltzer and Bare, 2002).

According to Smeltzer and Bare (2002), appendicitis treatment is indicated when the diagnosis of appendicitis has been upheld. Antibiotics and intravenous fluids are given until surgery is performed. Analgesics can be given after the diagnosis is established. Appendectomy (surgery to remove the appendix) as soon as possible to reduce the risk of perforation. Appendectomy can be performed with general or spinal anesthesia with a lower abdominal incision or with a laparoscope, which is the latest method is very effective.

Surgery is a treatment that uses all measures invasive way to unlock or show body parts to be handled. The opening part of the body is generally done by making an incision, after which the part to be handled displayed, performed remedial action that ended with the closure and suturing wounds. The next treatment will be included in the post- surgical care. Surgery or surgery can cause a variety of complaints and symptoms. Complaints and symptoms that often is painful (Sjamsuhidajat, 2002).

Surgery leads to changes in the continuity of body tissues. To maintain homeostasis, the body is a mechanism for immediate recovery of the tissue injury experience. In the recovery process is a chemical reaction occurs in the body so that the pain felt by the patient ( Fields, in Ani, 2010). In the operation process used anesthesia so that the patient does not feel pain during surgery. But after the operation is completed and the patient regained consciousness, he will feel the pain in the body that had surgery ( Wall & Jones, in Ani, 2010).

To prevent postoperative appendectomy complications in patients appendix, the patient must be done in accordance with the stages of early mobilization. Therefore, after having an appendectomy, patients are advised not to lazy to move after surgery, the patient should fast mobilization. The faster it moves, the better, but the mobilization must be performed carefully.

Early mobilization for Postoperative Appendectomy is an important aspect of the physiological function because it is essential to maintain independence (Carpenito, in Fitriyahsari, 2009). Patients feel healthier and stronger with early ambulation. With the move, the muscles of the abdomen and pelvis will be back to normal so that the stomach muscles become strong again and can relieve pain so the patient feel healthier and help gain strength and speed healing (Mochtar, in Fitriyahsari, 2009).

Pain by The International Association for the Study of Pain is a sensory and emotional experience that is not enjoyable, accompanied by tissue damage potential and actual. Pain is a condition that is more than just a single sensation caused by a particular stimulus (Potter & Perry, 2006). Pain is felt in the appendix postoperative patients can worsen the patient's condition and even cause many complications in the appendix.

The main complication of appendicitis is perforation of the appendix, which can develop into peritonitis or abscess. The incidence of perforation was 10 % to 32 %. Incidence is higher in young children and the elderly. Perforation generally occurs 24 hours after the onset of pain. Symptoms include a fever with a temperature of 37.7 ° C or higher, toxic appearance, and abdominal pain or tenderness of the continuous (Smeltzer and Bare, 2002).

Nursing Assessment - Physical Examination for Appendicitis

Risk for Deficient Fluid Volume - Nursing Interventions for Appendicitis

Appendicitis Pre- and Post-Operative Care Plan

Appendicitis Pre- and Post-Operative Care Plan

Surgical Nursing   October 27, 2013

Appendicitis Pre Operative Care:

• Sonde installation to decompress the stomach.
• Catheters to control urine production.
• Rehydration.
• Antibiotic with broad spectrum and is given intravenously.
• Fever-reducing medicines.
• If fever, should be reduced before anesthesia.

Appendicitis Operative Care :

• Appendectomy
• Appendix removed, if the appendix is perforated freely, then the abdomen was washed with physiological saline and antibiotics.
• Appendix abscess treated with IV antibiotics, its mass may shrink, or abscess may require drainage within a few days.
• Appendectomy done if the abscess performed elective surgery after 6 weeks to 3 months.

Appendicitis Post Operative Care:

• Observation of vital signs.
• Lift the stomach sonde when patients have realized that aspiration of gastric fluid can be prevented.
• Put the patient in a semi-Fowler position.
• Patients are said to be good when it is in 12 hours without any disturbance, during fasting.
• When the action is bigger operation, for example the perforation, fasting continued until bowel function returned to normal.
• Give drink from 15 ml / hour, for 4-5 hours, then raised it to 30 ml / hour. The next day give food strain, and the next day be given soft foods.
• One day after surgery the patient is advised to sit upright in bed for 2 × 30 min.
• On the second day the patient can stand and sit outside the room.
• Day 7 stitches can be removed and the patient allowed to go home.

In the appendix to the state of the masses who are still active inflammatory process that is characterized by:

• General state of the client it still looks sick, the body temperature is still high.
• Local examination of the right lower quadrant of the abdomen are still clear signs of peritonitis.
• Laboratory there are leukocytosis and the counts are shifting to the left.

Surgery should be performed as soon as the client is prepared, because it feared would happen appendix abscess and generalized peritonitis. Preparation and surgery should be done as well as possible given the complications of wound infection is higher than surgery in simple appendicitis without perforation.

On the state of the appendix mass with inflammatory process has subsided characterized by:

• General condition has improved with no visible pain, body temperature is not high anymore.
• Local inspection abdomen there are no signs of peritonitis and only clear and palpable mass with mild tenderness.
• Laboratory leukocyte count and differential count normal.

Actions taken should be conservative with antibiotics and bed rest. Surgery if the bleeding was more difficult and more, especially when mass appendix has formed more than a week since the attacks of abdominal pain. Surgery is carried out immediately if the treatment occurs abscess with or without generalized peritonitis.

Impaired Skin Integrity related to Cellulitis Care Plan

Impaired Skin Integrity related to Cellulitis Care Plan

Nursing Care Plan   October 27, 2013

Cellulitis is a skin infection that is caused by bacteria. The bacteria called Staphylococcus aureus and Group A Streptococcus are usually responsible for this kind of infection. Streptococci and Staphylococci can enter the skin to cause cellulitis infection through scrapes, cuts, wounds, blisters, insect bites and ulcers and find their way into the dermal and subcutaneous layers of the skin. Different cellulitis infections are facial cellulitis, breast cellulitis, orbital (eye) cellulitis, periorbital (eyelid) cellulitis, hand or arm cellulitis, perianal cellulitis and lower leg or foot cellulitis.

The main symptoms are skin redness or inflammation that spreads in size as the infection spreads , tight, glossy, stretched occurrence of the skin , tenderness of the area , skin injury or rash, sudden onset ,warmth over the redskin,fever .there are some other signs of infection includes chills, shaking, fatigue, warm skin, sweating, muscle aches, myalgias. Some of the additional symptoms that may be related with this disease are nausea, vomiting and hair loss at the site of infection.


Nursing Diagnosis and Interventions for Cellulitis

Impaired Skin Integrity related to changes in turgor

Goal: Demonstrate tissue regeneration.

Outcomes:

• Lesions began to recover and the free area of the infection,
• Clean skin,
• Dry and surrounding area free from edema,
• Normal temperature.

Nursing Intervention:

1. Assess the damage, size, color depth of the liquid.
R /: proper assessment of the wound and the healing process will assist in determining further action.

2. Maintain bed rest with an increase in limb and mobilization.
R /: Circulation that can smoothly accelerate the wound healing process.

3. Maintain aseptic technique.
R /: to accelerate the wound healing process.

4. Use the compress and bandage.
R /: Compress and dressing could reduce contamination from outside.

5. Monitor the temperature of the report, report your doctor if there is improvement.
R /: Early indications for infectious complications.

Clinical Manifestation and Pathophysiology of Migraine

Clinical Manifestation and Pathophysiology of Migraine

Migraine   October 25, 2013

Clinical Manifestation of Migraine

Migraine is a chronic condition. Most of the migraine attacks are also accompanied with another headache. Migraine headache is often described as a severe headache, throbbing and attacking head on one side. Some pain is felt in the forehead, around the eyes and behind the head so obscure symptoms with another headache. Although most of the migraine attack on one side of the head, but often also found symptoms of migraine headaches on both sides of the head. Side of the head migraines too often turns on every time attack. Be careful when the affected side of the head is always the same, another possibility is the occurrence of a brain tumor. Patients with migraine often tormented in performing daily activities, especially when the attack occurred. Other accompanying symptoms of migraine include, nausea, vomiting, diarrhea, facial pallor, cold hands feet, and the patient will be sensitive to light and sound. Due to an increased sensitivity to light and sound then migraine sufferers had to lie in a quiet and dark room. Migraine attacks usually subside within 4 to 72 hours.

Nearly 70% had a family history of migraine. Most of the women. The first attack in the migraine usually starts during adolescence and young adulthood, and then tended to decrease at the age of 5 and 6 decades. Usually there is a triggering factor. Patients generally have a perfectionist personality, rigid, and impulsive.
The clinical features of migraine is usually a throbbing headache but unilateral and bilateral or switched sides. Migraine attacks typically 2-8 times per month, once the attack duration between 4-24 hours or longer isa, moderate-severe pain intensity, accompanying symptoms, among others,: nausea, vomiting, photophobia and / or phonophobia, pale face, vertigo , tinnitus, irritable. On migraine with aura, the symptoms prodromalnya is skotomata.teikopsia (fortification spectra), photophobia (light flashes) paresthesias and visual hallucinations exhausted, feeling tired, very hungry and feeling nervous / anxious.
Headaches often appear at the wake, but it can happen at any time.


Pathophysiology of Migraine

Signs and symptoms of migraine on the result of cerebral cortical ischemia varying degrees. Typical attack starts with a scalp artery vasoconstriction and retinal blood vessels and cerebral. Extracranial and intracranial blood vessels dilated, which causes pain and discomfort. Studies suggest that arterial dilatation hyperpermeable and cause local inflammation that sterilize, which causes pain in surrounding areas and arterial dilatation. The state aims to enable existing substances in the blood vessels (histamine, serotonin, plasmokinin) who participated in cleaning the inflammatory reaction.

Migraine attacks commonly activate the sympathetic nervous going. The meaning of the sympathetic nerve is the nerve that is part of the human nervous system is responsible for controlling the body's response to stress and pain. Increased sympathetic nervous activity in the intestine causes nausea , vomiting and diarrhea. Sympathetic activity will also lead to slow gastric emptying resulting in drug delivery to the small intestine to be absorbed will also be hampered. Barriers to drug absorption that is the problem for people with migraine when administered orally administered drug. Increased sympathetic activity also decreases the flow of blood so that the skin will appear pale and cold. Increased neural activity will also lead to increased sensitivity to light and sound.

There are various theories that explain the occurrence of migraine.

Vascular theory, disruptions vasospasm causing cerebral blood vessels constrict, causing brain hypoperfusion which began in the visual cortex and spread forward. Continued deployment of frontal headache and cause phase begins.

Theory of cortical spread depression, which in the migraine threshold value decreases neuronal excitation of neurons so easily happen, then apply shortlasting depolarization wave, by potassium - liberating depression ( decreased release of potassium ) that results in a prolonged period of depressed neurons. Furthermore, there will be deployment of depression that would suppress the activity of neurons as it passes through the cerebral cortex.

Theory of neovascular (trigeminovascular), the vasodilatory effect NOS activity and NO production would stimulate the trigeminal nerve endings in blood vessels, releasing CGRP (calcitonin gene related). CGRP binds to its receptor on mast cells and will stimulate spending meningens inflammatory mediators that lead to inflammation of neurons. CGRP is also working on the cerebral arteries and the smooth muscle that will lead to increased blood flow. In addition, CGRP will work on post junctional second order neurons site that acts as the transmission of pain impulses.

5 Types of Migraine

5 Types of Migraine

Migraine   October 25, 2013

Migraine is a recurrent headache is idiopathic, with pain attacks lasting 4-27 hours, usually one-sided, throbbing nature, moderate-severe pain intensity, the more intense by regular physical activity, can be accompanied by nausea, photophobia and phonophobia. Migraines can occur in children with pain more often bifrontal location.

1. Classic Migraine

Preceded by a visual aura, a scotoma, flash of light, vision fireflies or black and white stripes, or blurred vision for 10-20 minutes. Then comes the headache, throbbing, unilateral, which is more severe, lasts between 1-6 hours. Will usually subside within 6-24 hours but sometimes longer. Accompanying symptoms are often encountered are nausea, vomiting, photophobia, phonophobia, irritable and malaise.

Classic migraine attack can be divided into three phases, namely:

1). Aura phase

When migraine with aura is connected, the aura can be more than 30 minutes and can give sufficient time for the patient to determine which drugs would be used to prevent attacks in the. This period is the manifestation of the characteristics of sensory, particularly visual disturbances (glare).

Other symptoms may occur in the presence of:

1. Pins and needles
2. Itchy feeling on the face and hands
3. Confusion being
4. A little weak on the extremities
5. Dizziness

Period aura, is associated with vasoconstriction without pain that begins with early physiologic changes characteristic of classic migraine. Cerebral blood flow studies conducted during the headache phase of migraine attacks showed that all reduced cerebral blood flow throughout the brain, with a further loss of autoregulation and CO2 responsiveness damage.

2). Headache phase

At the time of initial symptoms began to diminish, these symptoms followed by unilateral headache (two-thirds of patients) and pulsed. Severe headache and was not able to make and is often associated with photophobia, nausea, and vomiting. Duration of this state varies, with the distance of a few hours in a day or all day.

3). Recovery phase

Is the period of muscle contraction neck and scalp are associated with local muscle pain and tension. Fatigue and exhaustion are common physical cause back pain headaches. During the post-headache phase, the patient may sleep for a long time.

2. Common Migraine

Headache arise without any prior prodromal visual aura as the classic migraine and usually lasts longer.

3. Association Migraine

At this migraine, headache accompanied by transient neurological deficits, for example in oftalmoplegik migraine, hemiplegic migraine, and migraine with aphasia. Deficit neurogis This usually occurs prior to or after the headache (migraine association) or in the absence of headache (migraine dissociation).

4. Complicated Migraine

At this migraine, neurological deficit arising will settle due to cerebral infarction. Therefore, the constrictor phase should not be given so as not to aggravate the infarction.

5. Status Migraine

Is a migraine attack that lasts more than 24 hours due to sterile inflammation around the blood vessels are dilated.

Non- Pharmacological Therapies for Constipation

Non- Pharmacological Therapies for Constipation

Constipation   October 22, 2013

Constipation is a condition in which a person's bowel movement difficulty with normal daily pattern. At each state of constipation, causes of constipation should be correctly identified in order to determine the therapeutic approach. Causes of constipation can be as diverse as a low fiber diet or due to the consumption of drugs hypothyroidism.

Constipation is generally regarded as the usual health problems, experienced by many people, and generally they do the treatment themselves. Problems many people experience constipation problems are usually associated with a low fiber diet. Constipation is also often wrongly understood by the general public. Society generally considers that a bowel movement every day is important for health. And assume that the bowel is not routine every day will contribute to the accumulation of toxins and lead to somatic complaints varied. This misunderstanding resulted in the use of laxatives are less rational society.

To assess the condition of constipation, required an assessment of the following variables:

1. Frequency of bowel movements. Someone would otherwise be constipated if bowel frequency magnitude less than 3 times a week in women and 5 times per week in men.
2. The size and consistency of stools. A person with constipation requires 25% more time than usual for the number of defecation and fecal or fewer.
3. Symptoms as the sensation of defecation incomplete.

The following are some factors or conditions can cause constipation:

1. Diseases of the gastrointestinal tract; irritable bowel syndrome, diverticulitis, gastrointestinal disease above the anal and rectal disease, hemorrhoids, tumors, hernia, intestinal volvulus, syphilis, tuberculosis, worm infections, limphogranuloma, hirscprung's Disease
2. Metabolic and endocrine disorders; diabetes mellitus with neuropathy, hypothyroidism, pheochromocytoma, hypercalcemia, enteric glucagon excess.
3. Pregnancy; Emphasis intestinal motility, increased fluid absorption from the large intestine, decreased physical activity, dietary changes, lack of fluid intake, low fiber diet, the use of iron salts.
4. Neurogenic; central nervous system disease, brain trauma, spinal injuries kordata, central nervous system tumors, cerebrovascular accident, Parkinson's disease
5. Psychogenic; Psychogenic to ignore / postpone the urge to defecate, psychiatric disease.
6. Use of certain drugs

Signs and Symptoms

1. Signs and symptoms that need to be considered in knowing whether a person is constipated or not:
2. Keep in mind the condition whether the patient complained of a lack of volume conditions stool during bowel movements, stomach feeling full, pain during bowel movements.
3. Signs and symptoms such as hard stools, small or dry. Abdominal discomfort, pain, cramps, nausea and vomiting, headache, and fatigue.

Non- Pharmacological Therapies for Constipation

High Fiber Diet
Nonpharmacologic therapy is first-line therapy in the treatment of constipation by making dietary modifications to increase the amount of fiber consumed. Fibers that are part of the vegetable that is not digested in the intestines will increase stool bulk, liquid stool retention, and increase stool transit in the gut. With fiber therapy is the increased frequency of bowel movements and decrease pressure on the colon and rectum.

Patients are advised to consume at least 10 grams per day of crude fiber. Fruit, vegetables and cereals are examples of food rich in fiber. Raw bran contains about 40% fiber. In addition there are also medicinal product which is the mass of fiber-forming agents such as hydrophilic colloids psylium, methylcellulose or polikarbofil which can produce effects similar to those of high-fiber foods are available in the preparation of tablets, powders or capsules.

Surgery
In some constipated patients required surgery. This is because the presence of colonic malignancy or gastrointestinal tract obstruction that required bowel resection. Besides surgery is also necessary in cases of constipation caused by pheokromositoma.

Biofeedback
Most of the patients of constipation due to pelvic floor dysfunction benefit from the electromyogram biofeedback therapy.

Nursing Care Plan for Acute Tonsillitis

Nursing Care Plan for Acute Tonsillitis

Nursing Care Plan   October 20, 2013

Tonsillitis is an inflammation of the tonsils. according to the stage, tonsillitis is divided into three stages, namely:

1. Acute tonsillitis
2. Membranous tonsillitis
3. Chronic tonsillitis

Acute Tonsillitis
Acute definition is an inflammation of the tonsils and sudden in onset.

Etiology

1. Group A Beta-Hemolytic Streptococcal.
2. Pneumococcus.
3. Staphylococcus.
4. Haemophilus influenzae.

Pathophysiology

1. Inflammation of the tonsils caused by a virus.
2. Resulted in the formation of exudate.
3. Cellulitis tonsils and surrounding areas.
4. Peritonsilar abscess formation.
5. Tissue necrosis.

Symptoms

1. Sore throat and dysphagia.
2. Patients do not want to eat or drink.
3. Malaise.
4. Fever.
5. Breath odor.
6. Otitis media is one of the originators.

Management

1. Bed rest.
2. Provision of adequate fluids and light diet.
3. Giving medications (analgesics and antibiotics).
4. If there is no progress then the alternative actions that can be done is surgery.

Preparation operations may be undertaken

1. Laboratory tests (hemoglobin, leukocytes, bleeding time).
2. Give an explanation to the client, treatment and care after surgery.
3. Fasting 6-8 hours before surgery.
4. Give antibiotics as prophylaxis.
5. Give premedication ½ hours before surgery.

Assessment

1. Medical history factors associated with the occurrence of tonsillitis supporters , as well as bio - psycho - socio - spiritual.

2. Circulatory
Palpitations, headache during position changes, decreased blood pressure, bradycardia, body felt cold, pale extremities appear.

3. Elimination
Changes in the pattern of elimination ( urinary incontinence ), abdominal distension, bowel sounds disappearance.

4. Activity / rest
There is a decrease in activity due to body weakness, loss of sensation or parese / plegia , tiredness, difficulty in recuperating from muscle cramps or spasms and pain. The reduced level of consciousness, decreased muscle strength, general body weakness.

5. Nutrition and fluids
Anorexia, nausea and vomiting due to increased ICP ( intracranial pressure ), impaired swallowing, and loss of sensation on the tongue.

6. Nervous system
Dizziness / syncope, headache, decreased visual field wider / blurred vision, decreased touch sensation, especially in the area of ​​the face and extremities. Comatose mental status, weakness in the extremities, muscle paralise face, aphasia, dilated pupils, decreased hearing.

7. Comfort
Tense facial expressions, headache, restlessness.

8. Breathing
Shortened breath, inability to breathe, apnea, apnea onset period in breathing patterns.

9. Security
Fluctuations of temperature in the room.

10. Psychological
Denial, disbelief, anguish, fear, anxiety.