NURSING CARE OF CLIENTS

An acute myocardial infarction (MI), necrotis (death) of cell in an area of cardiac muscle.
If circulation to the affected cardiac muscle is not restored in a timely manner, loss of functional myocardium affects the heart’s ability to maintain an effetive cardiac output and may ultimately result in cardiogenic shock and death.
MI usually follows the sudden occlusion of a coronary flow to the heart muscle.

Because the heart muscle must function continuously, blockage of blood to the muscle and the development of necrotic areas within the myocardium represent a serious event

Angina as a result of ischemia causes reversible cellular injury, and infarction is the result of sustained ischemia, causing irreversible cellular death.

Risk factors and incidence :
US : Every year approximately 1.500.000 fall victom to heart attacks.. MI is the leading cause of deaths each year. Most deaths occur within the first 2 hours after the onset of symptom. Approximately 45 per cent of all heart attack clients are under the age of 65 years, and 5 per cent are under the age of 40 years(Polaski & Tatro, 1996).

The most common cause of MI is complete or nearly complete occlusion of a coronary artery due to ongoing atherosclerosis.

The vessel lumen slowly occludes and is often blocked with a thrombus.

Risk factor for MI : Age, gender, heredity, race, smoking, obesity, hyperlipidemia, hypertension, diabetes, stress, sedentary life-style, and personality type.

Phatophysiology
MI occur when a coronary artery becomes critically occluded, blocking blood flow to a portion of cardiac muscle for a prolonged period of time.
Usually caused by a thrombus (clot) developing at a site of arterial narrowing.
May also by ulceration and rupture of atherosclerotic plaquestimulates platelet aggregationplatelet-thrombus formationclot formthe vessel becomes occluded.

Cellular injury  inadequate oxygen and nutrients.
More than 20 to 45 minutes irreversible hypoxemic damage-cellular death and tissue necrosis-intracellular enzymes are released through damaged cell membranes into interstitial spaces  serum enzimes is elevated (CK-MB, LDH).

Infarctions are described by the area of occurrence as anterior, inferior, lateral, or posterior wall infartions. Common combinations of are the anterolateral or anteroseptal MI. An inferior MI is also called a diaphragmatic MI
Clinical Manifestations
•Cardinal symptom of MI is chest pain.
•The pain may radiate to the neck, jaw, shoulder, back, or left arm. Also, the pain may present near the epigastrium.
•Nausea anmd vomiting :Nausea and vomiting can result from reflex stimulation of the vomiting centre by the serve pain.
•Sympathetic nervous system stimulation :Inreased catecholamines are released. Increased symphatetic nervous system stimulation results in diaphoresis and vasoconstriction of peripheral blood vessels.
•Fever :The temperature may increase within the first 24 hours up to 38C  systemic manifesttion of the imflamatory process caused by cell death in the infarcted myocardium.
•BP and HR : BP and HR mey be elevated. Later BP may drop because of decreased CO.
•Urine output may be decreased.
•Cracles may be noted in the lungpersisting for several hours to several days.
Complications :
1.ArrhythmiasMost common complications.
Arrhythmias are caused by any condotion that affects the myocardial cell sensitivity to nerve impulses, such a ischemia, electrolyte imbalances, an sympathetic nervous system stimulation.
2.Congestive heart failure : when the pumping power of the heart has diminished.
AMIcommon of LV dysfungction in the first 24 hours
3.Cardiogenic shock  when inadequate oxygen and nutriens are supplied to the tissues because of severe LV failure.
4.Ventricular aneurysm : Result when the infarcted myocardial wall becomes thinned and bulges out during contraction.
5.Pericarditis : Inflammation of the visceral or parietal pericardium, or both cardiac compressiondecreased ventricular filling and emptyingcardiac failure.

tiar@2007

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CLIENT BIOGRAPHICAL INFORMATION

A. Full name
B. Address and telephone numbers telephone Number
1. Client's permanent
2. Contact of Client
C. Birthdate
D. Sex
E. Race
F. Religion
G. Marital Status
H. Occupation
I. Birthplace
J. Source of referral
K. Usual Source of Health Care
L. Source and and reliability of information
M. Date of Interview

First, Record the client's name. Since persons who live in an ethnically homogenous geographical area of¬ten have similar names, it is important that this key information be exact. Precise identification, including firs, middle, and last names, assists in ensuring accurate information retrieval and coordination. If additional identifying information is needed, record the parents' name, including the mother's maiden name.
Next, record the client's full mailing address and tele¬phone numbers. Also include the name, address, and telephone number of one of the client's friends or rel¬atives. This person should be someone with whom tile client is in frequent contact and who would be willing anti able to relay a message to the client in all emergency or if the client cannot be located.
The birthdate sex, race, religion, marital status, and birthplace entries are self-explanatory. Many health problems and needs are related to age, sex, race, or social situation. This information provides initial insight into the client as a unique person and can be correlated with the client's needs and problems discovered later in the history.
Justifiable reasons for recording the client's Social Security number include the precise identification of each client and potential access to a large pool of health related information. The potential for violation of client confidentiality is a disadvantage.
A significant difference may exist between the client's current and usual occupations. The nature of the dif¬ference may indicate the severity of the client's health problems and the level of disability resulting from them
in addition, knowledge of past occupations might pro¬vide clues to past or present environmental hazards contributing to the present illness. A mine worker with a respiratory system complaint is an example.
Knowledge of the client's birthplace provides geo¬graphical information associated with the origin of problems and cultural implications for therapy and health maintenance.
If the current caregivcr is not tile usual anti primary source of the client's care, record the name and address of tile individual or institution so identified by the client. In addition, document tile reason that tile client is en¬tering a new health care system. The client may be in crisis, may be dissatisfied with past care, or may be .shopping. If the past source of care possesses signif¬icant data about the client's health and if the client intends to continue in tile current health care system, ask the client to sign a permission for the transfer of information. Later in the health history, you will have the opportunity to record, in sonic detail, past patterns of health care
The source of client payment for care is usually included on administrative record. However, nothing this information in the health history might be useful in guiding choice of interventions, next , make a statement about the source of the information to follow. In most instances the source is the client, but do not assume that this is so unless the source is specifically identified. If the information is given by some one other then the client, describe the nature of the informant's contact with the client. For example. In the case of the child, a history given by grandmother who resides with child should be viewed differently from one given by a grandmother who visit the child the child once a week Readmore...

DIARRHEA

DEFINITION

Diarrhea is generally unpleasent condition in which the sufferer has frequent watery, loose bowel movement, watery stools occuring more than tree times in a day.

Cause of diarrhea
1. Bacterial infection
Several types of bacteria, consumed through contaminated food or water such as ; salmonella, shingella, E. Coli
2. Parasites
Example : Gardia lamblia, entamoeba histolyca
3. Viral infetion
4. Food intolerances
Any kind of food for some people are unable to digest, such as lactose
5. Dissorders of bowel function

SYMTOM OF DIARRHEA
- Bloating
- Abdominal Pain
- Irritable Bowel Syndrom
- Celiac Desease

COMPLICATION

Diarrhea can be dangerous specially in infant, the general sign of dehidration are :
- Thirst
- less of urinal frequent
- fatique
- Dry skin
- Dry mouth and Tonque
- Fever ect.

DIAGNOSTIK TEST

- Medical history and physical assesment
- Stool Culture
- Blood test
- Fasting Test
- Colonoscopy
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USING NURSING CARE PLANS

Nursing Diagnosis And Intervention
The nursing care plan is best thought of as a written re­flection of the nursing process: What does the assessment reveal? What should be done? How, when, and where should these planned interventions be carried out? What is the desired outcome? That is, Will the delivery of planned interventions result in the desired goal? The nurse's ability to carry out this process in a systematic fashion, using all available information and resources, is the fundamental basis for nursing practice. This process includes correctly identifying existing needs, as well as recognizing potential needs and/or risks. Planning and de­livering care in an individualized fashion to address these actual or potential needs, as well as evaluating the effec­tiveness of that care, is the basis for excellence in nursing practice. Forming a partnership with the patient and/or caregiver in this process and humanizing the experience of being a care recipient is the essence of nursing.
The Assessment

All the information that the nurse collects regarding a particular patient makes up the assessment. This assess­ment allows a nursing diagnosis, or summary judgment, to be made. This, in turn, drives the identification of ex­pected outcomes ( what is desired by and for this par­ticular patient in relation to this identified need) and the plan of care. Without a comprehensive assessment, all else is a "shot in the dark."
Nurses have always carried out the task of assess­ment. As science progresses, technology develops, infor­mation is more abundant than at any other time in his­tory, and length of contact with each patient becomes shorter, astute assessment skills are essential in a nurse's ability to plan and deliver effective nursing care.
Assessment data are abundant in any clinical setting. What the nurse observes; what a history (written or ver­bal) reveals; what the patient and/or caregiver reports (or fails to report) about a situation, problem, or con­cern; and what laboratory and other diagnostic infor­mation is available are all valid and important data. Readmore...

NURSING CARE PLANS

COMPONENTS OF NURSING CARE PLANS

regarding the incidence or prevalence of the problem or diagnosis, a brief overview of the typical management and/or the focus of nursing care, and a description of the setting in which care for the particular problem or diag¬nosis can be expected to occur.
Each problem or diagnosis is accompanied by one or several cross-references, some of which may be synonyms. These cross-references assist the user in locating other in¬formation that may be helpful and also in deciding whether this particular care plan is indeed the one the user needs.
Nursing care plan in this article begins with an expanded definition of the title problem or diagnosis. These definitions made enough information to guide the user what the problem or diagnosis is, information
For each care plan, appropriate nursing diagnoses are developed, each with the following components :
 Related or risk factors (depending on wether the nursing diagnosis is actually a problem or one for which the individual is at risk)
 Defining characteristic
 Ongoing assessment
 Therapeutic intervention, both independent and collaborative
 Expected outcomes
Wherever possible, expanded rationales assist the user in understanding the information presented, this allows for use of Nursing Care Plans: Nursing Diagnosis and Intervention as a singular reference tool. The interven¬tions and supporting rationales for each care plan repre¬sent current research-based knowledge and evidence ¬based clinical practice guidelines for nursing and other health care professionals. Many care plans also refer the user to additional diagnoses that may be pertinent and would assist the user in further developing a plan of care. Each diagnosis developed in these care plans also identi¬fies the Iowa Nursing Interventions Classification (NIC) interventions and the Iowa Nursing Outcomes Classi¬fication(NOC) Readmore...

NURSING DIAGNOSIS AND NURSING INTERVENTION

As Nursing Care Plans
Nursing Diagnosis and Inter­vention continues to mature and reflect the changing times and needs of its readers, as well as the needs of those for whom care is provided, nursing diagnoses continue to evolve. The body of research to support diagnoses, their definitions, related and risk factors, and defining characteristics is ever increasing and gaining momen­tum; nurses continue to study both independent and collaborative interventions for effectiveness and desir­able outcomes.
The taxonomy as a whole continues to be refined, its use as an international tool for practice, education, and research is testament to its importance as an organizing framework for the body of knowledge that is uniquely nursing. As a taxonomy, nursing diagnosis and all its components are standardized. Nurses must remember that plans of care developed for each diagnosis or cluster of diagnoses for particular patients must be individual­ized. The tailoring of the plan of care is the hallmark of nursing practice.
Nursing Interventions Classification (NIC) presents an additional opportunity for clarifying and organizing what nurses do. With NIC, nursing interventions have been systematically organized to help nurses identify and select interventions. NIC informa­tion continues to be presented along with each nursing diagnosis within each care plan, giving the user added ability to use NIC taxonomy in planning for individual­ized patient care. According to the deyelopers of NIC, nursing interventions are "any treatment, based on clin­ical judgment and knowledge, that a nurse performs to enhance patient/client outcomes" (McCloskey, Bulechek, 2000). These interventions may include direct or indirect care and may be initiated by a nurse, a physi­cian, or another care provider. Student nurses, practic­ing nurses, advanced-practice nurses, and nurse execu­tives can use nursing diagnoses and NIC as tools for learning, organizing, and delivering care; managing care within the framework of redesigned health care and within financial constraints through the development of critical paths; identifying res6atch questions; and moni­toring the outcomes of nursing care both at an individual level and at the level of service provision to large popu­lations of patients.
Nurse investigators at the University of Iowa have de­veloped Nursing Outcomes Classification (NOC), a tax­onomy of patient outcomes that are sensitive to nursing interventions. The authors of this outcomes taxonomy state, "For nurses to work effectively with managed care organizations to improve quality and reduce costs, nurses must be able to measure and document patient outcomes influenced by nursing care (Johnson, Maas, & Moorhead, 2000,). Readmore...

INTERVIEWING SKILL AND TEHNIQUE

Purpose of the interviewing
Developing relationships
The major purpose of interviewing a client before performing the physical examination is obtain a health history . practitioner must be skillful in communication techniques to enable a client to fully share life experience relevant to his or his health status. When the initial interview is problem focused, the practitioner also ask about the signs and the symptoms associated with the client's problems or concerns.
understanding of the purpose of the interview, and ad­dress the client by his or her full name or surname.
Another way to promote trust and acknowledge the client as an active participant in the interview is to ask about the client's primary concerns and goals for the visit. Use communication skills that create a climate in which the client feels free to talk about his or her health condition. These strategies are necessary for obtaining the most reliable data about both the client's physical and mental status.
Contracting
The initial interview is the basis for establishing a client ­provider contract. Contracting is an agreement be­tween the provider and client that makes explicit the expectations of each party. For example, the provider might state that in order for the client to receive ap­propriate preventive care, the client will agree to make an appointment at least yearly. The client is then en­couraged to respond to this. It is not necessary to label this a "contract," but it is important for the client and provider to agree on the plan and modify it as needed.
Sometimes contracts are written, but must often they are verbal agreements. Written contracts are often use­ful when using behavior modification techniques for dealing with behavior changes such as smoking ces­sation or medication taking.
Timing is important when the examiner introduces discussion of a contract. Allow enough time so that you arid the client have exchanged introductions and you
have some awareness )f the client's needs and purpose of tile visit. However, it is, important not to wait until the very end of the visit to discuss, a plan of care or treatment. Adequate time ,should be available for negotiation any modification to the course of action or plan based on the client response.
Modifications in the Interview
The interview will be modified by the age of tile client, the reason for the visit, and the existing relationship between you and the client. A young child will be ac­companied by a parent or adult who will be the major Source of information. It is important to remember that although the adult may be providing the verbal infor­mation, the child needs to feel included in the interview. Introduce yourself to the child, ask the child questions, and let the child touch equipment. Adults may also prefer to have a family member or significant other with them during a health visit. Confirm with the client that he or she chooses to have another person present and acknowledge the presence and concerns of the family member or significant other.
On the first visit with a client who is being seen for a general health assessment, allocate a considerable amount of time for the interview and history. This allows you to obtain baseline data and develop a relationship with the client. When you see a client who has an acute problem, less time is focused on past history and greater emphasis is placed on understanding the immediate problem. An established practitioner who has known a client and/or tile family members over many years may be quite familiar with many aspects of the client's health status and may need a shorter amount of time for a visit. however, a Provider in this situation will need to periodically and systemat­ically update history information. Readmore...

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Rekan sejawat
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caranya mudah saja yang jelas anda mau belajar dan mau praktek...kalau ingin info lebih lanjut
rekan silahkan Klik disini dijelaskan secara detail bagaimana cara merancang sebuah web site sampai online dan memberikan penghasilan tambahan buat rekan -rekan sejawat. disini mungkin rekan perlu memberikan sedikit investasi, tapi nilai investasi yang diberikan jika dibandingkan dengan ilmu dan manfaatnya sangat kecil jadi tidak rugikan....soalnya banyak hal yang bisa kita dapatkan silahakn Teman coba deh.. Readmore...