Wednesday, October 28, 2009

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

. Wednesday, October 28, 2009

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.


Monday, October 26, 2009

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

. Monday, October 26, 2009

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.


Tuesday, October 20, 2009

Nursing Care Plans for Epilepsy

. Tuesday, October 20, 2009

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


Tuesday, October 13, 2009

Nursing care plans for patient’s with Delusional disorders

. Tuesday, October 13, 2009

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


Friday, October 9, 2009

Nursing care plans for Conduct Disorder

. Friday, October 9, 2009

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


Wednesday, October 7, 2009

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

. Wednesday, October 7, 2009

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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