Nursing Key outcomes, Nursing interventions, and patient teaching Nursing Care Plans for Chronic Renal Failure

Nursing Key outcomes, Nursing interventions, and patient teaching Nursing Care Plans for Chronic Renal Failure
Key outcome for patients with CRF, patients will:

• Report increased comfort.
• Maintain hemodynamic status.
• Remain oriented to person, place, time, and situation.
• Maintain fluid balance.
• Verbalize appropriate food choices according to his prescribed diet.
• Maintain adequate ventilation and oxygenation.
• Demonstrate skill in managing the urinary elimination problem.
• Use support resources and exhibit adaptive coping behaviors.
• Resume sexual activity to the fullest extent possible.
• Maintain adequate urine output.
• Verbalize having feelings of control over condition and own well-being.
• Remain free from signs or symptoms of infection.
• Avoid or minimize complications.
• Family members will demonstrate adaptive coping behaviors.
• The patient's oral mucous membrane will remain intact.
• Family members will verbalize the effects of the patient's condition on the family unit.

Nursing interventions Nursing Care Plans for Chronic Renal Failure (CRF)
The widespread clinical effects of chronic renal failure require meticulous and carefully coordinated supportive care.

• Provide good skin care.
• Provide good oral hygiene
• Offer small, palatable, nutritious meals
• Monitor the patient for hyperkalemia. Watch for cramping of the legs and abdomen and for diarrhea.
• Carefully assess the patient's hydration status.
• Carefully measure daily intake and output.
• Monitor for complications.
• Encourage the patient to perform deep-breathing and coughing exercises to prevent pulmonary congestion
• Maintain aseptic technique.
• Carefully observe and document seizure activity. Periodically assess neurologic status.
• Observe for signs of bleeding.
• Report signs of pericarditis, such as a pericardial friction rub and chest pain.
• Schedule medication administration carefully.
• If the patient requires dialysis, check the vascular access site for patency and the arm used for adequate blood supply and intact nerve function.
• After dialysis, check for disequilibrium syndrome, a result of sudden correction of blood chemistry abnormalities.

Patient teaching Nursing Care Plans for Chronic Renal Failure (CRF)

CRF and ESRD are disorders that affect the patient’s total lifestyle and the whole family. Patient teaching is essential and should be understood by the patient. All teaching should be reinforced at intervals during the patient’s lifetime. Include: Care of peritoneal catheter for dialysis, care of external arteriovenous dialysis access (shunt), care of the arteriovenous fistula, post-transplantation teaching.

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Nursing Outcomes Nursing interventions and Patient teaching Nursing care plans for Conduct Disorder

Nursing outcomes Nursing care plans for Conduct Disorder

• Patients Anxiety is maintained at a level at which client feels no need for aggression and will not harm self or others physically or emotionally.
• Client will seeks out staff to discuss true feelings.
• Client recognizes, verbalizes, and accepts possible consequences of own maladaptive behaviors.
• The patient and parents will attend counseling to discuss the patient's illness and learn how to handle his behavior.
• Patient will develop effective coping skills to help him process stressors.
• Patient will develop effective social interaction and problem solving skills.
• Patient will utilize constructive channels to release anger.
• Patient will express awareness of how his actions affect others.

Nursing interventions Nursing care plans for Conduct Disorder

Work to establish a trusting relationship with the child. Provide clear behavioral guidelines, including consequences for disruptive and manipulative behavior. Help the child accept responsibility for behavior rather than blaming others, becoming defensive, and wanting revenge.

Nursing Diagnosis and Interventions for Conduct Disorder


Patient teaching Nursing care plans for Conduct Disorder

• Teach the child effective coping skills, social skills, and problem-solving skills, and have him demonstrate them in return.
• Teach the child to express anger appropriately through constructive methods to release negative feelings and frustrations.
• Use role playing to help the child practice handling stress and gain skill and confidence in managing difficult situations.

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Nursing Care Plans for Epilepsy

Epilepsy is a paroxysmal neurological disorder; epilepsy is a condition of the brain characterized by a susceptibility to recurrent seizures. It's also known as seizure disorder. Seizures are paroxysmal events associated with abnormal electrical discharges of neurons in the brain. In most patients, this condition doesn't affect intelligence. Epilepsy characterized by recurrent episodes of convulsive movements or other motor activity, loss of consciousness, sensory disturbances, and other behavioral abnormalities. Epilepsy often considered a syndrome rather than a disease, because epilepsy occurs in more than 50 diseases. Epilepsy usually occurs in patients younger than age 20, patients with Epilepsy achieve good seizure control with strict adherence to prescribed treatment.

Causes for Epilepsy

About half the cases of epilepsy are idiopathic. Nonidiopathic epilepsy may be caused by:

• Primary central nervous system CNS disorders include any potential mass effect (tumor, abscess, atrioventricular malformation AVM, aneurysm, or hematoma)
• Stroke (especially those that are embolic.).
• Genetic abnormalities (E.g. Tuberous sclerosis and phenylketonuria PKU)
• Prenatal injuries
• Metabolic abnormalities, such as hypocalcemia, hypoglycemia, and pyridoxine deficiency
• Brain tumors
• Infections, such as meningitis, encephalitis, or brain abscess
• Developmental disorders. Epilepsy can be associated with other developmental disorders, such as autism and Down syndrome
• Traumatic injury, especially if the dura mater was penetrated
• Toxins, such as mercury, lead, or carbon monoxide

Epilepsy occurs in all races and ethnicities, Researchers have also detected hereditary EEG abnormalities in some families, and certain seizure disorders appear to have a familial incidence. Different age groups have distinct associated causes. newborns up until 6 months of age, seizures are generally caused by birth trauma or metabolic disturbances. In children from 6 months to 5 years of age, etiology is related to febrile episodes or metabolic disturbances (hyponatremia, hypernatremia, hypoglycemia, hypocalcemia). In the 5- to 20-year-old group, seizures are primarily idiopathic (50%). In adults from 20 to 50 years of age, a new onset of seizures is almost exclusively caused by trauma or tumors. In older adults, seizures are generally caused by vascular disease cardiac dysrhythmias and Dementia.

Complications for Epilepsy
Associated complications can occur during a seizure:

• Anoxia from airway occlusion by the tongue or vomitus and
• Traumatic injury could result from a fall while the patient is confused or has an altered level of consciousness.
• Drowning

 Other life threatening complications

• Sudden unexplained death
• Status epilepticus

Nursing Assessment Nursing Care Plans for Epilepsy

Signs and symptoms vary Depending on the type and cause of the seizure. Physical findings may be normal if the assessment is performed when the patient isn't having a seizure. If the seizure is associated by a brain tumor, which may reveal signs and symptoms of that problem

Patient’s history of seizure occurrence

Diagnostic tests for Epilepsy

• Electroencephalogram EEG
• Computed tomography scanning
• magnetic resonance imaging (MRI)
• Positron emission tomography (PET)
• Other helpful tests include serum glucose and calcium studies, skull X-rays, lumbar puncture, brain scan, and cerebral angiography, Neuropsychological tests.

Treatment for Epilepsy
Specific to the type of seizure.

• commonly prescribed drugs include phenytoin, carbamazepine, phenobarbital, valproic acid, and primidone administered individually for generalized tonic-clonic seizures and complex partial seizures. Valproic acid, clonazepam, and ethosuximide are commonly prescribed for absence (petit mal) seizures. Lamotrigine is also prescribed as adjunct therapy for partial seizures. Fosphenytoin is an I.V. preparation that's effective in treatment.
• Surgical removal of a demonstrated focal lesion to attempt to end seizures
• Vagal nerve stimulation
• Transcranial magnetic stimulators

Nursing diagnosis Nursing Care Plans for Epilepsy

• Ineffective airway clearance related to clonic tonic motor activity and tongue obstruction
• Anxiety
• Deficient knowledge (diagnosis and treatment)
• Fear
• Ineffective coping
• Risk for injury
• Social isolation

Nursing Key outcomes, nursing interventions and Patient teaching Nursing Care Plans for Epilepsy

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Nursing care plans for patient’s with Delusional disorders

Psychiatric nursing care plans for Delusional disorders. Delusional disorders are characterized by false beliefs with a plausible basis in reality. Formerly referred to as paranoid disorders, delusional disorders are known to involve erotomanic, grandiose, jealous, or somatic themes as well as persecutory delusions. Some patients experience several types of delusions; other patients experience unspecified delusions that have no dominant theme. Delusional disorders typically chronic, these disorders often interfere with social and marital relationships but seldom impair intellectual or occupational functioning significantly. (DSM-IV-TR)

Delusional disorder is characterized by the presence of one or more no bizarre delusions that last for at least 1 month. Hallucinatory activity is not prominent. Apart from the delusions, behavior and functioning are not impaired. The following types are based on the predominant delusional theme (AMA, 2000):

• Persecutory
• Jealous
• Erotomanic
• Somatic
• Grandiose

Causes for Delusional disorders

Hereditary predisposition. Some researchers suggest that delusional disorders are the product of specific early childhood experiences with an authoritarian family structure. sensitive personality is particularly vulnerable to developing a delusional disorder. At least one study has linked the development of delusional disorders to inferiority feelings in the family. Certain medical conditions exaggerate the risks of delusional disorders: head injury, chronic alcoholism, deafness, and aging.

Complications for Delusional disorders

Patient’s irrational beliefs may pose a threat to him or others. Greater patient's rage, the greater the risk of violent behavior or suicide.

Treatment for Delusional disorders

• Combination of drug therapy and psychotherapy.
• Drug with antipsychotic agents is similar other psychiatric drugs, such as antidepressants and anxiolytics.

Nursing diagnoses Nursing care plans for Delusional disorders

• Risk for other-directed violence
• Risk for self-directed violence
• Social isolation
• Anxiety
• Disabled family coping
• Disturbed personal identity
• Disturbed sensory perception (visual, auditory)
• Disturbed thought processes
• Fear
• Imbalanced nutrition: Less than body requirements
• Impaired home maintenance
• Impaired social interaction
• Ineffective coping
• Powerlessness
• Risk for injury

Nursing Key outcomes nursing care plans for patient’s with Delusional disorders

• The patient will consider alternative interpretations of a situation without becoming hostile or anxious. Anxiety is maintained at a level at which client feels no need for aggression.
• Client demonstrates trust of others in his or her environment.
• Client maintains reality orientation.
• Client causes no harm to self or others.
• Client demonstrates willingness and desire to socialize with others, voluntarily attends group activities.
• Client approaches others in appropriate manner for one-to-one interaction.
• The patient and his family will participate in care and prescribed therapies.
• The patient will identify internal and external factors that trigger delusional episodes.
• The patient will maintain functioning to the fullest extent possible within the limitations of his visual or auditory impairment.
• The patient will express all fears and concerns.
• Client is able to recognize that hallucinations occur at times of extreme anxiety.
• Client is able to recognize signs of increasing anxiety and employ techniques to interrupt the response.
• The patient will demonstrate effective social interaction skills in both one-on-one and group settings.
• The patient will demonstrate adaptive coping behaviors.
• The patient will identify and perform activities that decrease delusions.
• The patient will remain free from injury.
• The patient will maintain family and peer relationships.

Nursing interventions nursing care plans for patient’s with Delusional disorders

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Nursing care plans for Conduct Disorder

Aggressive behavior is the hallmark of conduct disorder. The conduct is more serious than the ordinary mischief and pranks of children and adolescents. The disorder is more common in boys than in girls, and the behaviors may continue into adulthood, often meeting the criteria for antisocial personality disorder a child with this disorder fights, bullies, intimidates, and assaults others physically or sexually, and is truant from school at an early age. Typically, the patient has poor relationships with peers and adults and violates others' rights and society's rules. Conduct disorder evolves slowly over time until a consistent pattern of behavior is established.

Causes for Conduct Disorder

Studies have suggested that conduct disorder has both biological (including genetic) and psychosocial components. Roughly 30% to 50% of patients with conduct disorder also have attention deficit hyperactivity disorder (ADHD).

Predisposing Factors for Conduct Disorder

Physiological: Birth Temperament, Genetics
Psychosocial: Peer Relationships, Theory of Family Dynamics

• Parental rejection
• Inconsistent management with harsh discipline
• Early institutional living
• Frequent shifting of parental figures
• Large family size
• Absent father
• Parents with antisocial personality disorder and/or alcohol dependence
• Association with a delinquent subgroup
• Marital conflict and divorce
• Inadequate communication patterns
• Parental permissiveness

Complications for Conduct Disorder
The prognosis is worse in children with earlier onset; these children are more likely to develop antisocial personality disorder as adults. Social complications may include poor performance in school and substance abuse, and the child may suffer physical injury from fights or accidents due to risk-taking behaviors. Patients with conduct disorder also tend to have higher incidences of other psychological disorders, including ADHD, oppositional-defiance disorder, mood disorders, anxiety disorders, depression, and learning difficulties

Nursing Assessment Nursing care plans for Conduct Disorder
Signs and symptoms of conduct disorder include: abusing others sexually, cheating in school, cruelty to animals, engaging in precocious sexual activity, fighting with family members and peers, skipping classes, smoking cigarettes, speaking to others in a hostile manner, stealing or shoplifting, using drugs or alcohol, vandalizing or destroying property.

• Uses physical aggression in the violation of the rights of others.
• The behavior pattern manifests itself it virtually all areas of the child’s life (home, school, with peers, and in the community).
• Stealing, fighting, lying, and truancy are common problems.
• There is an absence of feelings of guilt or remorse.
• The use of tobacco, liquor, or no prescribed drugs, as well as the participation in sexual activities, occurs earlier than the peer group’s expected age.
• Projection is a common defense mechanism.
• Low self-esteem is manifested by a “tough guy” image. Often threatens and intimidates others.
• Characteristics include poor frustration tolerance, irritability, and frequent temper outbursts.
• Symptoms of anxiety and depression are not uncommon.
• Level of academic achievement may be low in relation to age and IQ.
• Manifestations associated with ADHD (e.g., attention difficulties, impulsiveness, and hyperactivity) are very common in children with conduct disorder.

Treatment for Conduct Disorder
Treatment focuses on coordinating the child's psychological, physiologic, and educational needs. A structured living environment with consistent rules and consequences can help reduce a variety of symptoms. Parents need to be taught how to deal with the child's demands. Juvenile justice interventions may also be used. Medication can be useful as an adjunct to treatment. Overt aggression responds to many medications, such as antipsychotics, lithium, clonidine, and selective serotonin reuptake inhibitors. ADHD, if present, must also be addressed.

Nursing diagnosis nursing care plans for Conduct Disorder

• Risk for self-directed or other-directed violence
• Defensive coping
• Impaired social interaction
• Ineffective coping
• Low self esteem
• Nursing Diagnosis Anxiety
• Disabled family coping
• Noncompliance
• Impaired adjustment
• Interrupted family processes

Nursing Key outcomes, Nursing interventions, and patient teaching nursing care plans for Conduct Disorder

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Nursing Key outcomes, Nursing interventions and Patient teaching Nursing Care Plans for Bulimia Nervosa

Nursing Key outcomes Nursing Care Plans for Bulimia Nervosa, The patient will:

• State strategies to reduce levels of anxiety.
• Express positive feelings about self.
• Have regular bowel elimination patterns.
• Acknowledge change in body image.
• Verbalize feeling well rested.
• Display appropriate eating patterns, including regular, nutritious meals.
• Participate in decision-making about case.
• Interact with family or friends.
• Fluid balance will remain stable, with intake equal to or greater than output.

Nursing interventions Nursing Care Plans for Bulimia Nervosa

• Supervise the patient during mealtimes and for a specified period after meals, usually 1 hour. Set a time limit for each meal. Provide a pleasant, relaxed environment for eating.
• Using behavior modification techniques, reward the patient for satisfactory weight gain.
• Establish a contract with the patient, specifying the amount and type of food to be eaten at each meal.
• Encourage the patient to recognize and verbalize her feelings about her eating behavior. Provide an accepting and nonjudgmental atmosphere, controlling your reactions to her behavior and feelings.
• Encourage the patient to talk about stressful issues, such as achievement, independence, socialization, sexuality, family problems, and control.
• Identify the patient's elimination patterns.
• Assess the patient's suicide potential.
• Refer the patient and her family to the National Eating Disorders Association and the National Association of Anorexia Nervosa and Associated Disorders as sources of additional information and support.

Nursing interventions for bulimia nervosa base on its nursing diagnosis:

Nursing Diagnosis Imbalanced nutrition: Less than body requirements

• If client is unable or unwilling to maintain adequate oral intake, physician may order a liquid diet to be administered via nasogastric tube.
• Nursing care of the individual receiving tube feedings should be administered.
• In collaboration with dietitian, to provide realistic (according to body structure and height) weight gain, determine number of calories required to provide adequate nutrition.
• Explain to patient’s behavior modification program as outlined by physician.
• Explain benefits of compliance with prandial routine and consequences for noncompliance.
• Sit with client during mealtimes for support and to observe amount ingested. Give to the patient a time limit for meals.
• Client should be observed for at least 1 hour following meals.
• Client may need to be accompanied to bathroom.
• Weigh client daily; use same scale, if possible.
• Do not discuss food or eating with client.

Nursing Diagnosis Deficient fluid volume

• Teach client importance of daily fluid intake of 2000 to 3000 ml. This information is required to promote client safety and plan nursing care. Keep strict record of intake and output.
• Weigh client daily; use same scale, if possible.
• Assess and document condition of skin turgor and any changes in skin integrity.
• Hot water and soap are drying to the skin, .Discourage client from bathing every day if skin is very dry.
• Monitor laboratory serum values, and notify physician of significant alterations.
• Client should be observed for at least 1 hour after meals and may need to be accompanied to the bathroom if self-induced vomiting is suspected.
• Assess and document moistness and color of oral mucous membranes.
• To minimizing risk of tissue infection. Encourage frequent oral care to moisten mucous membranes, reducing discomfort from dry mouth, and to decrease bacterial count.
• Help client identify true feelings and fears that contribute to maladaptive eating behaviors.

Nursing Diagnosis Ineffective coping

• Establish a trusting relationship with.
• When nutritional status has improved, begin to explore with client the feelings associated with his or her extreme fear of gaining weight,
• Explore family dynamics. Help client to identify his or her role contributions and their appropriateness within the family system
• Initially, allow client to maintain dependent role. To deprive the individual of this role at this time could cause his or her anxiety to rise to an unmanageable level.
• Give Positive reinforcement to increases self-esteem and encourages the client to use behaviors that are more acceptable.
• Explore with client ways in which he or she may feel in control within the environment, without resorting to maladaptive eating behaviors.

Patient teaching Nursing Care Plans for Bulimia Nervosa

• To monitor the treatment progress Teach the patient how to keep a food journal.
• Teach about risks abuse of laxative, emetic, and diuretic to the patient.
• To help the patient gain control over her behavior and achieve a realistic and positive self-image provide assertiveness training.
• If the patient is taking a prescribed tricyclic antidepressant, instruct her to take the drug with food. Warn her to avoid consuming alcoholic beverages; exposing herself to sunlight, heat lamps, or tanning beds; and discontinuing the medication unless she has notified the physician.

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Nursing Key outcomes, interventions, and Patient teaching Nursing Care Plans for Abruptio Placentae (placenta abruption)

Nursing Key outcomes, interventions, and Patient teaching Nursing Care Plans for Abruptio Placentae (placenta abruption)

Key outcomes Nursing Care Plans for Abruptio Placentae (placenta abruption) the patient will:

•  Express feelings of comfort.
•  Express feelings of reduced anxiety.
•  Communicate feelings about the situation.
• Discuss fears and concerns.
• Use available support systems, such as family and friends, to aid in coping.
• Remain hemodynamically stable.
• Patient's fluid volume will remain within normal parameters.

Nursing interventions Nursing Care Plans for Abruptio Placentae (placenta abruption)

• Monitor Vital sign; blood pressure, pulse rate, respirations, central venous pressure, intake and output, and amount of vaginal bleeding.
• Monitor fetal heart rate electronically.
• If vaginal delivery is elected, provide emotional support during labor.
• Because of the neonate's prematurity, the mother may not receive an analgesic during labor and may experience intense pain. Reassure the patient of her progress through labor, and keep her informed of the fetus's condition.
• Encourage the patient and her family to verbalize their feelings. Help them to develop effective coping strategies. Refer them for counseling, if necessary.

Patient teaching Nursing Care Plans for Abruptio Placentae (placenta abruption)

• Teach the patient to identify and report signs of placental abruption, such as bleeding and cramping.
• Explain procedures and treatments to allay patient's anxiety.
• Teach the patient to notify the doctor and come to the hospital immediately if she experiences any bleeding or contractions.
• Prepare the patient and her family for the possibility of an emergency cesarean delivery, the delivery of a premature neonate, and the changes to expect in the postpartum period. Offer emotional support and an honest assessment of the situation.
• Tactfully discuss the possibility of neonatal death. Inform the patient that the neonate's survival depends primarily on gestational age, the amount of blood lost, and associated hypertensive disorders.
• Inform the patient that frequent monitoring and prompt management greatly reduce the risk of death.
• Inform the patient that she is at much higher risk of developing abruptio placentae in subsequent pregnancies.

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Nursing Care Plans for Bulimia Nervosa

Bulimia nervosa the binge and purge syndrome is an eating disorder, the essential features of bulimia nervosa include eating binges followed by feelings of guilt, humiliation, and self deprecation guilt, and anxiety over fear of weight gain. Characterized by extreme overeating, followed by self induced vomiting and abuse of laxatives, diuretics, strict dieting or fasting to overcome the effects of the binges. Unless the patient devotes an excessive amount of time to binging and purging, bulimia nervosa seldom is incapacitating.

Bulimia nervosa usually begins in adolescence or early adulthood and can occur simultaneously with anorexia nervosa. The disorder occurs predominantly in females and begins in adolescence or early adult life. Between 1% and 3% of adolescent and young females meet the diagnostic criteria for bulimia nervosa; 5% to 15% have some symptoms of the disorder.

Causes for Bulimia Nervosa

The exact cause of bulimia is unknown, but bulimia is generally attributed to a combination of psychological, genetic, and physiological causes. Such factors include family disturbance or conflict, sexual abuse, maladaptive learned behavior, struggle for control or self-identity, cultural overemphasis on physical appearance, and parental obesity. Bulimia nervosa is strongly associated with depression. Predisposing Factors to Anorexia Nervosa and Bulimia Nervosa

Complications for Bulimia Nervosa

• Dental caries result from repetitive vomiting in bulimia nervosa.
• Erosion of tooth enamel.
• Parotitis
• Gum infections.
• Arrhythmias and even sudden death result from electrolyte imbalances.
• Ipecac syrup intoxication can cause cardiac failure in patients who rely on this drug to induce vomiting.
• Esophageal tears and gastric ruptures rare complications.
• Mucosal damage can occur if patient with bulimia nervosa use laxatives and enemas.
• Potential psychiatric complication of bulimia nervosa is suicide.
• Bulimia nervosa patients are more prone to psychoactive substance use disorders.

Nursing Assessment Nursing Care Plans for Bulimia Nervosa

Patient history of bulimia nervosa is characterized by episodic binge eating several times per day. Commonly reports a binge eating episode during which she continues eating until abdominal pain. The Bulimia Nervosa patient usually preferred food that sweet, soft, and high in calories and carbohydrate. Unlike the anorexic nervosa patient bulimic patient usually can keep her eating disorder hidden, because patient's weight frequently fluctuates, but usually stays within the normal range through the use of diuretics, laxatives, vomiting, and exercise. The patient may complain of abdominal and epigastric, Amenorrhea, Painless swelling of the salivary glands, hoarseness, throat irritation or lacerations, and dental erosion. A Bulimia Nervosa patient commonly is perceived by others as a perfect person’s, However, the patient's psychosocial history may reveal an exaggerated sense of guilt, symptoms of depression, childhood trauma (especially sexual abuse), parental obesity, or a history of unsatisfactory sexual relationships.

Symptomatology for Bulimia Nervosa

• Patients with Bulimia Nervosa usually solitary and secret and patients with Bulimia Nervosa able to consume thousands of calories in one binge episode.
• Loss of control to stop eating After the binge has begun
• After binge eats, the individual engages in inappropriate compensatory measures to avoid gaining weight, like self-induced vomiting, excessive use of laxatives, diuretics, or enemas, and extreme exercising.
• Eating binges may be viewed as pleasurable but are followed by intense self criticism and depressed mood.
• Patient with Bulimia Nervosa usually within normal weight range, some a few pounds underweight, and some a few pounds overweight.
• Obsession with body image and appearance is a predominant feature of this disorder.
• Binges usually alternate with periods of normal eating and fasting.
• Excessive vomiting may lead to problems with dehydration and electrolyte imbalance.
• Gastric acid in the vomitus may contribute to the erosion of tooth enamel.

Treatment for Bulimia Nervosa
Treatment of bulimia nervosa may continue for several years. Interrelated physical and psychological symptoms must be treated simultaneously.

Nursing diagnosis Nursing Care Plans for Bulimia Nervosa

• Anxiety
• Chronic low self-esteem
• Constipation
• Deficient fluid volume
• Disturbed body image
• Disturbed sleep pattern
• Imbalanced nutrition: Less than body requirements
• Ineffective coping
• Social isolation

Nursing Key outcomes, interventions, Patient teaching Nursing Care Plans for Bulimia Nervosa

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Nursing Care Plans for Abruptio Placentae (placenta abruption)

Abruptio placentae also called placental abruption occur when the placenta prematurely separates from the uterine wall, usually after the 20th week of gestation, producing hemorrhage. This disorder may be classified according to the degree of placental separation and the severity of maternal and fetal symptoms. It is characterized by a triad of symptoms: vaginal bleeding, uterine hypertonus, and fetal distress. It can occur during the prenatal or intrapartum period

Abruptio placentae is most common in multigravidas usually in women older than age 35 and is a common cause of bleeding during the second half of pregnancy. On heavy maternal bleeding generally necessitates termination of the pregnancy. The fetal prognosis depends on the gestational age and amount of blood lost. The maternal prognosis is good if hemorrhage can be controlled.

Grading System for Abruptio Placentae (placenta abruption)

Grade 0 Less than 10% of the total placental surface has detached; the patient has no symptoms; however, a small retroplacental clot is noted at birth.

Grade I approximately 10%–20% of the total placental surface has detached; vaginal bleeding and mild uterine tenderness are noted; however, the mother and fetus are in no distress.

Grade II Approximately 20%–50% of the total placental surface has detached; the patient has uterine tenderness and tetany; bleeding can be concealed or is obvious; signs of fetal distress are noted; the mother is not in hypovolemic shock.

Grade III More than 50% of the placental surface has detached; uterine tetany is severe; bleeding can be concealed or is obvious; the mother is in shock and often experiencing coagulopathy; fetal death occurs.

Central abruption, the separation occurs in the middle, and bleeding is trapped

Between the detached placenta and the uterus, concealing the hemorrhage.

Marginal abruption, separation begins at the periphery and bleeding accumulates between

The membranes and the uterus and eventually passes through the cervix, becoming an external hemorrhage.

Causes for Abruptio Placentae (placenta abruption)

The cause of abruptio placentae is unknown; however, any condition that causes vascular changes at the placental level may contribute to premature separation of the placenta. Predisposing factors include:

• Traumatic injury.
• Placental site bleeding from a needle puncture during amniocentesis,
• Chronic or pregnancy induced hypertension.
• Multiparity
• Short umbilical cord
• Dietary deficiency
• Smoking
• Advanced maternal age
• Pressure on the vena cava from an enlarged uterus.

The spontaneous rupture of blood vessels at the placental bed may result from a lack of resiliency or to abnormal changes in the uterine vasculature. The condition may be complicated by hypertension or by an enlarged uterus that can't contract sufficiently to seal off the torn vessels. Consequently, bleeding continues unchecked, possibly shearing off the placenta partially or completely.

Complications for Abruptio Placentae (placenta abruption)

• Hemorrhage and shock.
• Renal failure,
• Disseminated intravascular coagulation.
• Maternal and fetal death.

Nursing Assessment Nursing Care Plans for Abruptio Placentae (placenta abruption)

Abruptio placentae produces a wide range of clinical effects, depending on the extent of placental separation and the amount of blood lost from maternal circulation.

Obtain patient history obstetric history. Determine the date of the last menstrual period to calculate the estimated day of delivery and gestational age of the infant. Inquire about alcohol abuse, tobacco, and drug usage, and any trauma or abuse situations during pregnancy

• Mild abruptio placentae with marginal separation usually report mild to moderate vaginal bleeding, vague lower abdominal discomfort, and mild to moderate abdominal tenderness.
• Moderate abruptio placentae are about 50% placental separation usually report continuous abdominal pain and moderate, dark red vaginal bleeding. Onset of symptoms may be gradual or abrupt. Vital signs may indicate impending shock. Palpation reveals a tender uterus that remains firm between contractions.
• Severe abruptio placentae about 70% placental separations patient usually report abrupt onset of agonizing, unremitting uterine pain (described as tearing or knifelike) and moderate vaginal bleeding. Vital signs indicate rapidly progressive shock. Palpation reveals a tender uterus with boardlike rigidity. Uterine size may increase in severe concealed abruptions.

Psychosocial Assessment to understanding patient’s situation and also the significant other’s degree of anxiety, coping ability, and willingness to support the patient

Diagnostic tests for Abruptio Placentae (placenta abruption)

• Pelvic examination under double setup
• Ultrasonography
• Decreased hemoglobin level
• Decreased platelet count.
• Periodic assays for fibrin split products aid in monitoring the progression of abruptio placentae and in detecting DIC.

Treatment for Abruptio Placentae (placenta abruption)

Medical Treatment management goals of abruptio placentae are to assess, control, and restore the amount of blood lost and to deliver a viable infant and prevent coagulation disorders.

Nursing diagnoses Nursing Care Plans for Abruptio Placentae (placenta abruption)

Primary nursing diagnosis nursing care plans for abruptio placentae (placenta abruption) fluid volume deficit related to blood loss

Common nursing diagnosis fond in Nursing Care Plans for Abruptio Placentae (placenta abruption):

• Acute pain
• Anxiety
• Deficient fluid volume
• Dysfunctional grieving
• Fear
• Ineffective coping
• Ineffective tissue perfusion: Cardiopulmonary

Nursing Key outcomes, interventions, and Patient teaching Nursing Care Plans for Abruptio Placentae (placenta abruption)

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Nursing outcomes, interventions, Patient teaching, Nursing Care Plans for Preeclampsia Pregnancy Induced Hypertension

Nursing outcomes, interventions, Patient teaching, Nursing Care Plans for Preeclampsia Pregnancy Induced Hypertension

Nursing Key outcomes Nursing Care Plans for Preeclampsia, The patient will:

• Be able to perform activities of daily living without excessive fatigue.
• Identify strategies to reduce anxiety.
• Maintain optimal functioning within the confines of the visual impairment.
• Maintain orientation to environment.
• Verbalize fears and concerns
• Demonstrate adaptive coping behaviors.
• Exhibit signs of adequate cerebral and peripheral perfusion.
• Avoid complications.
• Fluid volume will remain within normal parameters.
• The patient's urine output will remain within normal limits.

Nursing interventions Nursing Care Plans for Preeclampsia

• Monitor the patient vital sign regularly for changes in blood pressure, pulse rate, respiratory rate, fetal heart rate, vision, level of consciousness, and deep tendon reflexes and for headache unrelieved by medication.
• Immediately report changes.
• Assess these signs before administering medications.
• Monitor the extent and location of edema.
• Elevate affected extremities to promote venous return.
• Assess fluid balance by measuring intake and output and by checking daily weight.
• Provide a quiet, darkened room until the patient's condition stabilizes.
• Enforce strict bed rest.
• Provide emotional support for the patient and family.
• Explain to patients and family if the patient's condition necessitates premature delivery.

Patient teaching Nursing Care Plans for Preeclampsia

• Teach the patient and her family how to identify and report signs and symptoms of preeclampsia and eclampsia.
• Instruct the patient to maintain bed rest as ordered.
• Advice her to lie in a left lateral position to increase venous return, Elevate affected extremities, cardiac output, and renal blood flow.
• Stress the importance of adequate nutrition in the prenatal period.
• Advise the patient to avoid foods high in sodium.
• Explain the importance of scheduling and keeping prenatal visits.

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Nursing Care Plans for Preeclampsia Pregnancy Induced Hypertension

Pregnancy Induced Hypertension PIH is a potentially life-threatening disorder that usually develops after the 20th week of pregnancy. It typically occurs in nulliparous women and may be nonconvulsive or convulsive.

The cause of Preeclampsia is unknown it is often called the “disease of theories” because many causes have been proposed, yet none has been well established. occure approximately 7% of all pregnant women. Almost preeclampsia case occurs before the fetus is term. primary goals in nursing care plan for preeclampsia is prevent seizures, intracranial hemorrhage, and serious organ damage in the mother and to deliver a healthy term infant. Preeclampsia, the nonconvulsive form of the disorder, is marked by the onset of hypertension after 20 weeks of gestation. It develops in about 7% of pregnancies and may be mild or severe. The incidence is significantly higher in low socioeconomic groups. Eclampsia, the convulsive form, occurs between 24 weeks' gestation and the end of the first postpartum week. The incidence increases among women who are pregnant for the first time, have multiple fetuses, and have a history of vascular disease.

About 5% of women with preeclampsia develop eclampsia; of these, about 15% die of eclampsia or its complications. Fetal mortality is high because of the increased incidence of premature delivery Pregnancy Induced Hypertension PIH and its complications are the most common cause of maternal death in developed countries.

Causes for Preeclampsia

The cause of PIH is unknown. Geographic, ethnic, racial, nutritional, immunologic, and familial factors may contribute to preexisting vascular disease, which, in turn, may contribute to its occurrence. Age is also a factor. Adolescents and primiparas older than age 35 are at higher risk for preeclampsia. Other theories include a long list of potential toxic sources, such as autolysis of placental infarcts, autointoxication, uremia, maternal sensitization to total proteins, and pyelonephritis.

Complications for Preeclampsia

• Intrauterine growth retardation (or restriction),
• Placental infarcts, and
• abruptio placentae.
• Other possible complications include stillbirth of the neonate, seizures, coma, premature labor, renal failure, and hepatic damage in the mother.

Nursing Assessment Nursing Care Plans for Preeclampsia

• A patient with mild preeclampsia typically reports a sudden weight gain,
• The patient's history reveals hypertension
• Inspection reveals generalized edema, especially of the face. Palpation may reveal pitting edema of the legs and feet.
• Deep tendon reflexes may indicate hyperreflexia.
• Oliguria
• Blurred vision caused by retinal arteriolar spasms,
• Epigastric pain or heartburn, irritability, and emotional tension.
• Patient may complain of a severe frontal headache.

In a patient with severe preeclampsia:
Blood pressure readings increase to 160/110 mm Hg or higher on two occasions, 6 hours apart, during bed rest. Also,
Ophthalmoscopic examination may reveal vascular spasm, papilledema, retinal edema or detachment, and arteriovenous nicking or hemorrhage.

Diagnostic Highlights Nursing Care Plan For Preeclampsia
Hemolysis, elevated liver enzyme levels, and a low platelet count (HELLP syndrome) characterize severe eclampsia. A unique form of coagulopathy is also associated with this disorder.

• Urine for protein and creatinine
• Uric acid
• Blood urea nitrogen (BUN)
• Liver enzymes: AST, ALT, LDH,Bilirubin
• Platelets
• Coagulation studies
• RBC (red blood cell)
• Hgb (hemoglobin)
• Hct (hematocrit)

Preeclampsia Treatment
Therapy for patients with preeclampsia is intended to halt the progress of the disorder specifically, the early effects of eclampsia, such as seizures, residual hypertension, and renal shutdown and to ensure fetal survival. Some physicians advocate the prompt inducement of labor, especially if the patient is near term; others follow a more conservative approach. Therapy may include:

• complete bed rest in the preferred left lateral lying position to enhance venous return
• an antihypertensive, such as methyldopa or hydralazine
• magnesium sulfate to promote diuresis, reduce blood pressure, and prevent seizures if the patient's blood pressure fails to respond to bed rest and the antihypertensive and persistently rises above 160/100 mm Hg, or if central nervous system irritability increases.
• If fetal life is endangered cesarean section or oxytocin inducement may be required to terminate the pregnancy.

Nursing diagnoses Nursing Care Plans for Preeclampsia

• Activity intolerance
• Anxiety
• Disturbed sensory perception (visual)
• Disturbed thought processes
• Excess fluid volume
• Fear
• Impaired urinary elimination
• Ineffective coping
• Ineffective tissue perfusion: Cerebral, peripheral
• Risk for injury

Key outcomes, Nursing interventions , Patient teaching , Nursing Care Plans for Preeclampsia Pregnancy Induced Hypertension

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Nursing Care Plans for Endometriosis

Nursing Care Plans for Endometriosis. Endometriosis is a hormonal and immune system disease characterized by a benign growth of endometrial tissue that occurs atypically outside of the uterine cavity. When endometrial tissue appears outside the lining of the uterine cavity, endometriosis results. Such ectopic tissue is generally confined to the pelvic area, most commonly around the ovaries, uterovesical peritoneum, uterosacral ligaments, and the cul-de-sac, but it can appear anywhere in the body.

This ectopic endometrial tissue responds to normal stimulation in the same way that the endometrium does. During menstruation, the ectopic tissue bleeds, which causes inflammation of the surrounding tissues. This inflammation causes fibrosis, leading to adhesions, which produce pain and infertility.  Active endometriosis usually occurs between ages 30 and 40. Severe symptoms of endometriosis may have an abrupt onset or may develop over many years. This disorder usually becomes progressively more severe during the menstrual years but tends to subside after menopause.

Causes for Endometriosis

The direct cause is unknown, but the most predominant theory is the retrograde menstruation theory, research focuses on the following possible causes:

• Transportation (retrograde menstruation). During menstruation, the fallopian tubes expel endometrial fragments that implant outside the uterus.
• Formation in situ. Inflammamsstion or a hormonal change triggers coelomic metaplasia.
• Induction. The endometrium chemically induces undifferentiated mesenchyma to form endometrial epithelium. (This is the most likely cause.)
• Immune system defects. Endometriosis may result from a specific defect in cell mediated immunity.

Complications for Endometriosis
Primary complication

• Infertility.

Other complications

• Spontaneous abortion,
• Anemia due to excessive bleeding.
• Emotional problems resulting from infertility.

Nursing Assessment Nursing Care Plans for Endometriosis

• Patient History Elicit a complete history of the woman’s menstrual, obstetric, sexual, and contraceptive practices
• The patient may complain of cyclic pelvic pain, infertility and, the classic symptom, acquired dysmenorrhea.
• The patient typically reports pain in the lower abdomen, vagina, posterior pelvis, and back. This pain usually begins from 5 to 7 days before menses, reaches a peak, and lasts for 2 to 3 days.
• Patient may complain of deep-thrust dyspareunia (ovaries and cul-de-sac);
• suprapubic pain, dysuria, and hematuria
• painful defecation, rectal bleeding with menses, and pain in the coccyx or sacrum
• nausea and vomiting that worsen before menses and abdominal cramps
• Palpation may disclose multiple tender nodules on uterosacral ligaments or in the rectovaginal septum.
• Palpation may also uncover ovarian enlargement in the presence of endometrial cysts on the ovaries or thickened, nodular adnexa.

Diagnostic tests for Endometriosis
Laparoscopy
Scoring and staging system created by the American Society for Reproductive Medicine quantifies endometrial implants according to size, character, and location.

• Stage I is minimal disease (0 to 5 points);
• Stage II signifies mild disease (6 to 15 points);
• Stage III, moderate disease (16 to 40 points); and
• Stage IV, severe disease (more than 40 points).

Treatment for Endometriosis
The stage of the disease and the patient's age and desire to have children are considered in determining the course of treatment.

• Conservative therapy for young women who want to bear children with androgens, which produce a temporary remission in Stages I and II.
• Progestins and hormonal contraceptives also relieve symptoms.
• Gonadotropin releasing analogues, such as leuprolide, suppress estrogen production.
• Laparoscopy, used for diagnostic purposes, can also be used therapeutically to lyse adhesions, remove small implants, and cauterize implants. The goal is to remove as much of the ectopic endometrial tissue as possible
• Laparoscopy also permits laser vaporization of implants. This surgery is usually followed with hormonal therapy to suppress the return of endometrial implants.
• Surgery may be needed to rule out cancer.
• Conservative surgery is possible, but the treatment of choice for women who don't want to bear children or for those who have extensive disease (Stages III and IV) is a total abdominal hysterectomy with bilateral salpingo-oophorectomy.
• Minor gynecologic procedures are contraindicated immediately before and during menstruation.

Nursing diagnosis nursing care plans for endometriosis
Primary nursing diagnosis nursing care plans for endometriosis
Pain, chronic, related to cramping, internal bleeding, swelling, and inflammation during the menstrual cycle
Common nursing diagnosis found on nursing care plans for endometriosis:

• Anxiety
• Chronic pain
• Deficient knowledge (diagnosis and treatment)
• Disturbed body image
• Fear
• Ineffective coping
• Risk for infection
• Sexual dysfunction

Key outcomes Nursing Care Plans for Endometriosis

• Comfort level, Pain control, Depression control, Pain: Disruptive effects, Pain: Psychological response
• Patient will identify strategies to reduce anxiety.
• Patient will express feelings of comfort.
• Patient and her family will express understanding of the disorder and its treatment.
• Patient will express feelings about self.
• Patient will discuss fears and concerns.
• Patient will develop adequate coping behaviors.
• Patient will remain free from signs and symptoms of infection.
• Patient will verbalize feelings regarding sexual impairment.

Patient teaching Nursing Care Plans for Endometriosis

• Ensure that the patient understands the dosage, route, action, and side effects before going home.
• Explain all procedures and treatment options. Clarify misconceptions about the disorder, associated complications, and fertility.
• Advise adolescents to use sanitary napkins instead of tampons. This can help prevent retrograde flow in girls with a narrow vagina or small vaginal meatus.
• Because infertility is a possible complication, counsel the patient who wants children not to postpone childbearing.
• Advise the patient to have an annual pelvic examination and a Pap test.

Encourage the patient to be alert to her emotions, behavior, physical symptoms, diet, and rest and exercise. Encourage the patient to maintain open communication with her significant other and her family to discuss concerns she may have about the disease process.

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Nursing interventions, Key outcomes nursing care plans for Autistic disorder

Nursing Key Outcomes Nursing Care Plans For Autistic Disorder

• The patient and his family will express reduced levels of anxiety.
• Anxiety is maintained at a level at which client feels no need for self mutilation
• Client initiates interactions between self and others, and use eye contact, facial responsiveness, and other nonverbal behavior
• The patient's family will openly share feelings about the present situation.
• As much as possible, the patient will demonstrate age-appropriate skills and behaviors.
• The patient will perform self care activities independently.
• The patient will develop peer relationships.
• The patient’s family will identify and contact available resources as needed.
• The patient and his family will practice safety measures and take safety precautions in the home.
• The patient won't engage in self-destructive behaviors.
• The patient will interact with family or friends.

Nursing interventions nursing care plans for Autistic disorder

• Reduce self destructive behaviors.
• Physically stop the child from harming himself.
• Give verbal or physical reinforcement.
• Foster appropriate use of language.
• Provide positive reinforcement when the child indicates his needs correctly.
• Encourage development of self esteem.
• Encourage self care.
• Encourage acceptance of minor environmental changes.
• Provide emotional support to the parents.
• Refer them to the Autism Society.

Nursing interventions nursing care plans for Autistic disorder based on nursing diagnosis

Nursing Diagnosis Risk for self mutilation

• Intervene to protect child when self mutilate behaviors, Safety tools like helmet may be used to protect against head banging, hand mitts to prevent hair pulling, and appropriate padding to protect extremities from injury during hysterical movements.
• Try to determine if self mutilate behaviors occur in response to increasing anxiety, and if so, to what the anxiety may be attributed.
• To establish trust, Work on one to one basis with child.

Nursing Diagnosis Impaired social interaction

• Build trust relationship with the child.
• Provide child with familiar objects such as favorite toys, or favorite blanket.
• Convey a manner of warmth, acceptance, and availability as client attempts to fulfill basic needs.
• Do not force interactions.
• Give positive reinforcement for eye contact. Gradually introduce use eye contact, facial responsiveness, and other nonverbal behavior
• Support client with nurse presence as he or she endeavors to relate to others in the environment.

Nursing Diagnosis Impaired verbal communication

• Maintain consistency in assignment of caregivers. Consistency facilitates trust and enhances the caregiver’s ability to understand the child’s attempts to communicate.
• Anticipate and fulfill client’s needs until satisfactory communication patterns are established. Anticipating needs helps to minimize frustration while the child is learning communication skills.
• Use the techniques of consensual validation and seeking clarification to decode communication patterns.
• Use face to face approach.

Nursing Diagnosis Disturbed personal identity

• Function in a one to one relationship with the child to establishment of trust.
• Assist child to recognize separateness during self-care activities, such as dressing and feeding.
• Point out, and assist child in naming, own body parts.
• Gradually increase amount of physical contact, using touch to point out differences between client and nurse. 
• Cautious in using touch until trust is established, client may be interpreted as threatening.
• Use mirrors and drawings or pictures of the child to reinforce the child’s learning of body parts and boundaries.

Nursing Diagnosis Anxiety
Nursing Diagnosis Compromised family coping
Nursing Diagnosis Delayed growth and development
Nursing Diagnosis Dressing or grooming self-care deficit
Nursing Diagnosis Interrupted family processes
Nursing Diagnosis Risk for injury
Nursing Diagnosis Risk for self-directed violence
Nursing Diagnosis Social isolation

Patient teaching and home health guidance for Autistic disorder

• Give knowledge to the parents about Autistic disorder to Help parent understand that the cause of this condition is unknown.
• Teach the parents how to physically care for the child's needs.
• Teach the parents how to identify signs of excessive stress and coping skills to use under these circumstances.
• Emphasize that they'll be ineffective caregivers if they don't take the time to meet their own needs in addition to those of their child.

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Nursing care plans for Autistic disorder

Autistic disorder is a severe, pervasive developmental disorder marked by unresponsiveness to social contact, gross deficits in intelligence and language development, ritualistic and compulsive behaviors, restricted capacity for developmentally appropriate activities and interests, Autistic disorder is characterized by a withdrawal of the child into the self and into a fantasy world of his or her own creation. Activities and interests are restricted and may be considered somewhat bizarre. The disorder is rare, but occurs 4 to 5 times more often in males than in females. Onset of symptoms is prior to age 3. The course is chronic and often persists into adulthood.

Causes for Autistic disorder

The causes of autistic disorder remain unclear but are thought to include psychological, physiologic, and sociologic factors. Previously, it was thought that most parents of autistic children were intelligent, educated people of high socioeconomic status; recent studies suggest that this may not be true. The parents of an autistic child may appear distant and unaffectionate toward the child. However, because autistic children are clearly different from birth, and because they are unresponsive or respond with rigid, screaming resistance to touch and attention, parental remoteness may be merely a frustrated, helpless reaction to this disorder, not its cause.

Some theorists consider autistic disorder related to:

• Genetics. An increased risk of autistic disorder exists among siblings of individuals with the disorder (APA, 2000). Studies with both monozygotic and dizygotic twins have also provided evidence of a genetic involvement.
• Neurological Factors. Abnormalities in brain structures or functions have been correlated with autistic disorder (National Institute of Mental Health [NIMH], 2002). Certain developmental problems, such as postnatal neurological infections, congenital rubella, phenylketonuria, and fragile X syndrome, also have been implicated.

Complications for Autistic disorder

• Autistic disorder may be complicated by epileptic seizures
• Depression is common in adolescence and early adulthood
• During periods of stress, catatonic phenomena, such as excitement or posturing, or an undifferentiated psychotic state with delusions and hallucinations may occur.

Nursing Assessment nursing care plans for Autistic disorder

Primary characteristic of autistic disorder is unresponsiveness to people. Patient with this disorder won't cuddle, avoid eye contact and facial expression, and are indifferent to affection and physical contact. Parents may report that the child becomes rigid or flaccid when held, cries when touched, and shows little or no interest in human contact.  As the patient grows older, his smiling response is delayed or absent. He doesn't lift his arms in anticipation of being picked up or form an attachment to a specific caregiver.

• Failure to form interpersonal relationships.
• Impairment in communication verbal and nonverbal, nonverbal expressions may be inappropriate or absent.
• Bizarre responses to the environment.
• Extreme fascination for objects that move.
• Unreasonable insistence on following routines in precise detail.
• Marked distress over changes in trivial aspects of environment.
• Stereotyped body movements.

Common Nursing Diagnoses Found On Nursing Care Plans For Autistic Disorder

• Risk for self mutilation
• Impaired social interaction
• Impaired verbal communication
• Disturbed personal identity
• Anxiety
• Compromised family coping
• Delayed growth and development
• Dressing or grooming self-care deficit
• Interrupted family processes
• Risk for injury
• Risk for self-directed violence
• Social isolation

Nursing interventions, Key outcomes nursing care plans for Autistic disorder

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Nursing diagnosis Nursing Care Plans Attention Deficit Hyperactivity Disorder (ADHD)

Common Nursing Diagnosis and Interventions found on Nursing Care Plans Attention Deficit Hyperactivity Disorder (ADHD)

• Risk for self directed or other directed violence
• Defensive coping
• Impaired social interaction
• Ineffective coping
• Low self esteem
• Noncompliance
• Anxiety (moderate to severe)
• Compromised family coping
• Imbalanced nutrition: Less than body requirements
• Ineffective family therapeutic regimen management
• Interrupted family processes
• Risk for impaired parenting

Key outcomes nursing diagnosis Nursing Care Plans Attention Deficit Hyperactivity Disorder (ADHD)

• Patient and his family will report concern about difficulties in social interactions.
• Patient and his family will communicate understanding of special dietary needs.
• Patient will demonstrate effective social interaction skills.
• Patient and his family will comply with the prescribed treatment regimen.
• Patient's family will discuss the impact of the patient's illness and feelings about it with a health care professional.
• Parents will utilize support groups and other community resources.
• Patient will acknowledge and respond to efforts by others to establish communication.

Nursing interventions for ADHD

• Set realistic expectations and limits because the patient with attention deficit hyperactivity disorder is easily frustrated
• Always remain calm and consistent with the child.
• Keep all your instructions to the child short and simple.
• Provide praise and rewards whenever possible.
• Provide the patient with diversional activities suited to his short attention span.
• Help the parents and other family members develop planning and organizing systems to help them cope more effectively with the child's short attention span.

Nursing interventions for ADHD related to nursing diagnosis:
Nursing diagnosis Risk for self directed or other-directed violence

•  Observe client’s behavior frequently.
•  Observe for suicidal behaviors: Verbal statements, such as “ statement going to kill myself”
• Determine suicidal intent and available means. Ask how where and when you plan to kill yourself
• Obtain contract from client not to harm self and agreeing to seek out staff when ideation occurs.
• Help client to recognize when anger occurs and to accept those feelings
• Act as a role model for appropriate expression of angry feelings.
• Give positive reinforcement.

Nursing diagnosis Defensive coping

• Encourage client to recognize and verbalize feelings of inadequacy and need for acceptance from others and to recognize how these feelings provoke defensive behaviors
• Provide immediate, fact, nonthreatening feedback for unacceptable behaviors
• Help client identify situations that provoke defensiveness
• Practice with role play for appropriate responses
• Give positive feedback for acceptable behaviors
• Evaluate and discuss with client the effectiveness of the new behaviors and any modifications for improvement

Nursing diagnosis Impaired social interaction

• Develop trust relationship
• Give to the client’s constructive criticism and positive reinforcement for client’s efforts
• Give Positive feedback to client
• Provide group situations for client

Nursing diagnosis Ineffective coping

• Provide safe environment for continuous large muscle movement, If client is hyperactive
• Provide large motoric activities
• Do not debate, argue, rationalize, or bargain with the client.
• Explore with client and discus alternative ways of handling frustration that would be most suited for client

Nursing diagnosis Low self esteem

Nursing diagnosis Anxiety

• Establish a trusting relationship
• Maintain an atmosphere of calmness
• Offer support during times of elevated anxiety, Use of touch is comforting for some clients
• When anxiety diminishes, help client to recognize specific events that preceded onset of anxiety.
• Provide help to client to recognize signs of escalating anxiety
• On escalating anxiety provide tranquilizing medication, as ordered

Nursing diagnosis Compromised family coping
Nursing diagnosis Imbalanced nutrition: Less than body requirements
Nursing diagnosis Ineffective family therapeutic regimen management
Nursing diagnosis Interrupted family processes
Nursing diagnosis Risk for impaired parenting


Patient teaching Nursing Care Plans Attention Deficit Hyperactivity Disorder (ADHD)

• Make certain that the parents fully understand the child's prescribed medication regimen.
• Teach the patient and family about any adverse reactions that may occur, emphasizing those that may require immediate medical attention.
• Encourage the parents to provide the child with nutritious snacks such as fruit to supplement his dietary intake.
• Refer the parents to appropriate support groups.

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Predisposing Factors for Attention Deficit Hyperactivity Disorder (ADHD)

The patient with attention deficit hyperactivity disorder has difficulty focusing his attention, engaging in quiet passive activities, or both. Some patients have an attention deficit without hyperactivity; they're less likely to be diagnosed and receive treatment. Although attention deficit hyperactivity disorder is present at birth, diagnosis before age 4 or 5 is difficult unless the child exhibits severe symptoms. Some patients, however, aren't diagnosed until they reach adulthood. Attention deficit hyperactivity disorder is thought to be a physiologic brain disorder with a familial tendency. Some studies indicate that it may result from altered neurotransmitter levels in the brain. Scientists are not sure what causes ADHD, although many studies suggest that genes play a large role. Like many other illnesses, ADHD probably results from a combination of factors. In addition to genetics, researchers are looking at possible environmental factors, and are studying how brain injuries, nutrition, and the social environment might contribute to ADHD

Predisposing Factors for Attention Deficit Hyperactivity Disorder (ADHD)

Physiological

• Genetics. A number of studies have indicated that hereditary factors may be implicated in the predisposition to ADHD. Siblings of hyperactive children are more likely than normal children to have the disorder.
• Biochemical. Abnormal levels of the neurotransmitters dopamine, norepinephrine, and possibly serotonin have been suggested as a causative factor.
• Prenatal, Perinatal, and Postnatal Factors. Maternal smoking during pregnancy has been linked to ADHD . Premature birth, fetal distress, precipitated or prolonged labor, and perinatal asphyxia have also been implicated. Postnatal factors include cerebral palsy, epilepsy, and other central nervous system abnormalities resulting from trauma, infections, or other neurological disorders.

Psychosocial

• Environmental Influences Disorganized or chaotic environments or a disruption in family equilibrium may predispose some individuals to ADHD. A high degree of psychosocial stress, maternal mental disorder, paternal criminality, low socioeconomic status, and foster care have been implicated.

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Nursing Care Plans Attention Deficit Hyperactivity Disorder (ADHD)

Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common childhood disorders and can continue through adolescence and adulthood. Attention-deficit hyperactivity disorder (ADHD) is characterized by a persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequent and severe than is typically observed in individuals at a comparable level of development (APA, 2000). The patient with attention deficit hyperactivity disorder has difficulty focusing his attention, engaging in quiet passive activities, or both. Some patients have an attention deficit without hyperactivity; they're less likely to be diagnosed and receive treatment. Although attention deficit hyperactivity disorder is present at birth, diagnosis before age 4 or 5 is difficult unless the child exhibits severe symptoms. Some patients, however, aren't diagnosed until they reach adulthood. Males are three times more likely to be affected than females. The presence of other psychiatric disorders also needs to be determined, this disorder occurs in roughly 3% to 5% of school-age children.

Causes for Attention Deficit Hyperactivity Disorder (ADHD)

Attention deficit hyperactivity disorder is thought to be a physiologic brain disorder with a familial tendency. Some studies indicate that it may result from altered neurotransmitter levels in the brain. Scientists are not sure what causes ADHD, although many studies suggest that genes play a large role. Like many other illnesses, ADHD probably results from a combination of factors. In addition to genetics, researchers are looking at possible environmental factors, and are studying how brain injuries, nutrition, and the social environment might contribute to ADHD

Predisposing Factors Attention Deficit Hyperactivity Disorder (ADHD)

Complications for Attention Deficit Hyperactivity Disorder (ADHD)

Emotional and social complications can result from the child's impulsive behavior, inattentiveness, and disorganization in school. Hyperactivity can also lead to poor nutrition.

Assessment Nursing Care Plans Attention Deficit Hyperactivity Disorder (ADHD)

The patient is usually characterized as a fidgeted and a daydreamer. He may also be described as inattentive and lazy. The parents may state that their child is intelligent but that his school or work performance is sporadic. They may also report that he has a tendency to jump quickly from one partly completed project, thought, or task to another. If the child is younger, the parents may note that he has difficulty waiting in line, remaining in his seat, waiting his turn, or concentrating on one activity long enough to complete it.  An older child or an adult may be described as impulsive and easily distracted by irrelevant thoughts, sights, or sounds. He may also be characterized as emotionally labile, inattentive, or prone to daydreaming. His disorganization becomes apparent when, for example, he has difficulty meeting deadlines and keeping track of school or work tools and materials.

• Difficulties in performing age-appropriate tasks
• Highly distractible
• Extremely limited attention span
• Shifts from one uncompleted activity to another
• Impulsivity, or deficit in inhibitory control, is common
• Difficulty forming satisfactory interpersonal relationships
• Disruptive and intrusive behaviors inhibit acceptable social interaction
• Difficulty complying with social norms
• Some children with ADHD are very aggressive or oppositional. Others exhibit more regressive and immature behaviors.
• Low frustration tolerance and outbursts of temper are common.
• Boundless energy, exhibiting excessive levels of activity, restlessness, and fidgeting
• Often described as “perpetual motion machines,” continuously running, jumping, wiggling, or squirming
• They experience a greater than average number of accidents, from minor mishaps to more serious incidents that may lead to physical injury or the destruction of property.

Predisposing Factors Attention Deficit Hyperactivity Disorder (ADHD)
Common Nursing Diagnoses and Interventions for Attention Deficit Hyperactivity Disorder (ADHD)

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Nursing outcomes, interventions, and Patient teaching for Anorexia Nervosa

Anorexia nervosa is a clinical syndrome in which the person has a morbid fear of obesity. It is characterized by the individual’s gross distortion of body image, preoccupation with food, and refusal to eat. The disorder occurs predominantly in females

Goals/Objectives Nursing Care Plans for Anorexia Nervosa
Short-Term Goal
Client will gain weight (amount to be established by client, nurse, and dietitian) pounds per week
Long-Term Goal
By discharge from treatment, client will exhibit no signs or symptoms of malnutrition.

Key outcomes Nursing Care Plans for Anorexia Nervosa
The patient will:

• Engage in appropriate physical activities.
• Verbalize strategies to reduce anxiety.
• Express positive feelings about self.
• Resume a normal bowel elimination pattern.
• Demonstrate skills appropriate for age.
• Acknowledge change in body image.
• Maintain body temperature within the normal range.
• Achieve target weight.
• Demonstrate ability to practice two new coping behaviors.
• Participate in decision-making about care.
• Comply with the treatment regimen.
• Interact with family or friends.
• Fluid balance will remain stable, with intake equal to or greater than output.

Nursing interventions Nursing Care Plans for Anorexia Nervosa:

• If client is unable or unwilling to maintain adequate oral intake, physician may order a liquid diet to be administered via nasogastric tube. Nursing care of the individual receiving tube feedings should be administered according to established hospital procedures.
• Sit with client during mealtimes for support and to observe amount ingested, Client should be observed for at least 1 hour following meals. This time may be used by client to discard food stashed from tray or to engage in self- induced vomiting.
• During hospitalization, regularly monitor vital signs, nutritional status, and intake and output. Weigh the patient daily
• Negotiate an adequate food intake with the patient. Be sure that she understands that she'll need to comply with this contract or lose privileges.
• Frequently offer small portions of food or drinks if the patient wants them. itself.
• Anticipate a weight gain of about 1 lb/week.
• If edema or bloating occurs after the patient has returned to normal eating behavior, reassure her that this phenomenon is temporary
• Encourage the patient to recognize and assert her feelings freely.
• If a patient receiving outpatient treatment must be hospitalized, maintain contact with her treatment team to facilitate a smooth return to the outpatient setting.

Patient teaching Nursing Care Plans for Anorexia Nervosa

• Emphasize to the patient how improved nutrition can reverse the effects of starvation and prevent complications.
• Teach the patient how to keep a food journal, including the types of food eaten, eating frequency, and feelings associated with eating and exercise.
• Advise the pateint's family to avoid discussing food with him.

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Nursing Care Plans for Hypertension

Hypertension Description is a persistent or intermittent elevation of systolic arterial blood pressure above 140 mm Hg or diastolic pressure above 90 mm Hg. Hypertension is a chronic disease, primary goals in Hypertension Nursing Care Plan is to reduce the blood pressure to less than 140/90.

Hypertension classified:

• Primary (essential) accounts for over 90% of cases and is often referred to as idiopathic, since the underlying cause is not known.
• Secondary hypertension results from a number of conditions that impair blood pressure regulation, and accounts for only 5% to 8% of all cases of hypertension
• Malignant hypertension, results from either type and can cause blood pressures as high as 240/150 mm Hg, possibly leading to coma and death.

Cause of Hypertension:

• Cause of primary hypertension is not known; however, associated with risk factors such as genetic predisposition, stress, obesity, and a high-sodium diet.
• Secondary hypertension results from disorders that impair blood pressure regulation, particularly renal, endocrine, vascular, and neurological disorders, hypertensive disease of pregnancy (toxemia) and use of estrogen-containing oral contraceptive
• Malignant hypertension is also not known, but it may be associated with dilation of cerebral arteries and generalized arteriolar fibrinoid necrosis, which increases intracerebral blood flow

Ethnic/Racial African Americans and elderly people are most prone to hypertension and its complications.

Physical Examination Hypertension Nursing Care Plan:

• Appear symptom-free in early stages, although flushing of the face may be present
• Fundoscopic examination of the retina may reveal hemorrhage
• Measure blood pressure in both arms three times 3 to 5 minutes apart while the patient is at rest in the sitting, standing, and lying positions.
• Hypertension should not be diagnosed on
• The basis of one reading unless it is greater than 210/120 mm hg.

Diagnostic Highlights Hypertension Nursing Care Plan

• Blood urea nitrogen
• Serum creatinine
• Total cholesterol
• Triglycerides
• Electrocardiogram

Because Hypertension is chronic disease and a major cause of stroke, cardiac disease, and renal failure, Hypertension nursing diagnosis on nursing care plan for Hypertension many associated with the Knowledge deficit about Diet, Disease process, Health behaviors, Medication, prescribed activity, Treatment regime and lifestyle

Primary Hypertension nursing diagnosis is knowledge deficit related to chronic disease management,

Possible nursing diagnosis which is commonly found in nursing care plan for Hypertension

• Fatigue
• Ineffective coping
• Ineffective tissue perfusion: Cardiopulmonary
• Noncompliance: Therapeutic regimen
• Risk for injury

Nursing outcomes Hypertension nursing care plan, Patients will:

• Identify appropriate food choices.
• Express that he has more energy.
• Demonstrate adaptive coping behaviors.
• Maintain adequate cardiac output and hemodynamic stability.
• Comply with his therapy regimen.
• Remain free from complications

 Patient Teaching and Home Healthcare Guide on Hypertension nursing care plan

• Teach the patient to use a self-monitoring blood pressure cuff and to record the reading at least twice a week.
• Tell the patient to take his blood pressure at the same hour each time, with out more than usually activity preceding the measurement.
• Tell the patient and family to keep a record of drugs used in the past.
• To encourage compliance with antihypertensive therapy, suggest establishing a daily routine for taking medication. Warn the patient that uncontrolled hypertension may cause stroke and heart attack. Tell him to report any adverse reactions to prescribed drugs. Advise him to avoid high-sodium antacids and over-the-counter cold and sinus medications containing harmful vasoconstrictors.
• Help the patient examine and modify his lifestyle behavior.
• Suggest stress-reduction groups, dietary changes, and an exercise program.
• Encourage a change in dietary habits. Help the obese patient plan a reducing diet.
• Tell to the patients to avoid high-sodium foods, table salt, and foods high in cholesterol and saturated fat.

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