Tuesday, October 25, 2011

Treatment and Prevention of Hepatitis B

hepar 

Hepatitis B
  
Key facts
  • Hepatitis B is a viral infection that attacks the liver and can cause both acute and chronic disease.
  • The virus is transmitted through contact with the blood or other body fluids of an infected person - not through casual contact.
  • About 2 billion people worldwide have been infected with the virus and about 350 million live with chronic infection. An estimated 600 000 persons die each year due to the acute or chronic consequences of hepatitis B.
  • About 25% of adults who become chronically infected during childhood later die from liver cancer or cirrhosis (scarring of the liver) caused by the chronic infection.
  • The hepatitis B virus is 50 to 100 times more infectious than HIV.
  • Hepatitis B virus is an important occupational hazard for health workers.
  • Hepatitis B is preventable with a safe and effective vaccine.

Hepatitis B is a potentially life-threatening liver infection caused by the hepatitis B virus. It is a major global health problem and the most serious type of viral hepatitis. It can cause chronic liver disease and puts people at high risk of death from cirrhosis of the liver and liver cancer.
Worldwide, an estimated two billion people have been infected with the hepatitis B virus (HBV), and more than 350 million have chronic (long-term) liver infections.
A vaccine against hepatitis B has been available since 1982. Hepatitis B vaccine is 95% effective in preventing HBV infection and its chronic consequences, and is the first vaccine against a major human cancer.

Treatment

There is no specific treatment for acute hepatitis B. Care is aimed at maintaining comfort and adequate nutritional balance, including replacement of fluids that are lost from vomiting and diarrhoea.
Chronic hepatitis B can be treated with drugs, including interferon and anti-viral agents, which can help some patients. Treatment can cost thousands of dollars per year and is not available to most patients in developing countries.
Liver cancer is almost always fatal, and often develops in people at an age when they are most productive and have family responsibilities. In developing countries, most people with liver cancer die within months of diagnosis. In higher income countries, surgery and chemotherapy can prolong life for up to a few years in some patients.
Patients with cirrhosis are sometimes given liver transplants, with varying success.

Prevention

All infants should receive the hepatitis B vaccine: this is the mainstay of hepatitis B prevention.
The vaccine can be given as either three or four separate doses, as part of existing routine immunization schedules. In areas where mother-to-infant spread of HBV is common, the first dose of vaccine should be given as soon as possible after birth (i.e. within 24 hours).
The complete vaccine series induces protective antibody levels in more than 95% of infants, children and young adults. After age 40, protection following the primary vaccination series drops below 90%. At 60 years old, protective antibody levels are achieved in only 65 to 75% of those vaccinated. Protection lasts at least 20 years and should be lifelong.
All children and adolescents younger than 18 years old and not previously vaccinated should receive the vaccine. People in high risk groups should also be vaccinated, including:
  • persons with high-risk sexual behaviour;
  • partners and household contacts of HBV infected persons;
  • injecting drug users;
  • persons who frequently require blood or blood products;
  • recipients of solid organ transplantation;
  • those at occupational risk of HBV infection, including health care workers; and
  • international travellers to countries with high rates of HBV.
The vaccine has an outstanding record of safety and effectiveness. Since 1982, over one billion doses of hepatitis B vaccine have been used worldwide. In many countries where 8% to 15% of children used to become chronically infected with HBV, vaccination has reduced the rate of chronic infection to less than 1% among immunized children.
As of December 2006, 164 countries vaccinate infants against hepatitis B during national immunization programmes - a major increase compared with 31 countries in 1992, the year that the World Health Assembly passed a resolution to recommend global vaccination against hepatitis B.

http://www.who.int/mediacentre/factsheets/fs204/en/

Nursing Care Plan Disturbed Sleep Pattern

Sleep Disorder

A sleep disorder, or somnipathy, is a medical disorder of the sleep patterns of a person or animal. Some sleep disorders are serious enough to interfere with normal physical, mental and emotional functioning. A test commonly ordered for some sleep disorders is the polysomnography.

Disruptions in sleep can be caused by a variety of issues, from teeth grinding (bruxism) to night terrors. When a person suffers from difficulty in sleeping with no obvious cause, it is referred to as insomnia.[1] In addition, sleep disorders may also cause sufferers to sleep excessively, a condition known as hypersomnia. Management of sleep disturbances that are secondary to mental, medical, or substance abuse disorders should focus on the underlying conditions.wikipedia.org

Nursing Care Plan Disturbed Sleep Pattern


Nursing Care Plan Disturbed Sleep Pattern

 Disturbed Sleep Pattern

Related factors:

Pathophysiology
Associated frequent awakening:
(Damage to transport oxygen)
Angina
Arteriosclerosis
Respiratory disorders
Impaired circulation
(Damage to bowel and urinary elimination)
Diarrhea
Constipation
Retention of Urine
Dysuria
Frequency
(Damage metabolism)
Hyperthyroidism
Gastric ulcer
Hepatic disorders
Action
Difficulties associated with undergoing the usual position
Splints, traction
Painful
IV Therapy
Associated with excessive daytime sleep:
(Drugs)
Tranquilizers
Sedatives
Hypnotic
Antidepressants
Antihypertensive
Amphetamines
Corticosteroids
Soporifik
Barbiturates
Situational (Personal, Environment)
Associated with excessive hyperactivity
Anxiety panic
Associated with excessive daytime sleep
Associated with ketidakadekuatan activity during the day.
Dealing with depression
Responses associated with anxiety
Associated with discomfort
Lifestyle-related disorders
Emotional
Social
Associated with changes in circadian rhythms
Dealing with fear
Maturisional
(Children)
Dealing with fear of the dark
(Adult Women)
Associated with hormonal changes (eg, premenopausal)

Major Data :

Difficulty falling asleep and staying asleep

Minor Data :

Fatigue when awake or during the day
Or nap during the day
Agitation
Changes in mood

Results Criteria

Individuals will:
1. Describe the factors that prevent or inhibit sleep.
2. Identify techniques to induce sleep.
3. reported an optimum balance of rest and activity.

Intervention:

1. Reduce noise.
2. Organization procedure to provide the smallest amount of disturbance during sleep periods (eg, when individuals get up to the treatment also provide handling and measurement of vital signs)
3. If urination during the night interrupt, limit your fluid intake at night and urinate before lying down.
4. Assign an individual with a schedule for program activities over time (path, physical therapy)
5. Limit the number and length of time if excessive sleep (eg, more than 1 hour)
6. Assess with individuals, families, or parents of bedtime routine - time hygiene practices, rituals (reading, toys) - and stick as close as possible whenever possible.
7. Limit drinks that contain caffeine input
8. For the children:
a. Explain to children the night (moon, stars)
b. Discuss how some people (nurses, factory workers) to work at night.
c. Compare the opposite that when night came in their place, it will happen during the day for people in other places.
d. If there is a nightmare, encourage the children to talk about it if possible. Reassure the child that this is a dream even though it seems very real. Sharing feelings with your child that you also never dreamed.
e. Give your child the night lights and / or flashlight to be used, so that children can control the darkness.
f. Reassure your child that you will be nearby sepenjang night.
9. Explain to individuals and other people closest to cause disturbance to sleep / rest and possible ways to avoid it.

Nursing Care Plan for Hyperthermia

Ineffective Breathing Pattern Care Plan

Friday, October 7, 2011

Neonatal Jaundice Discharge Planning Applications

Neonatal Jaundice Discharge Planning Applications

Growth and development and the changing needs of infants with hyper-bilirubin (such as stimulation, exercise, and social contacts) has always been the responsibility of parents in fulfilling it by following the rules and the description given during hospitalization and follow-up care at home.

Factors that must be delivered to the mother can do the best in baby care hyper-bilirubinemia (warley & Wong, 1994):
1. Instruct the mother revealed / reported when the infant suffered disturbances of consciousness such as seizures, anxiety, apathy, appetite decreased breastfeeding.

2. Encourage mothers to pump milk using a tool for a few days to maintain a smooth milk.

3. Provide an explanation of procedures to lower the replacement fototherapi baby's bilirubin levels.

4. Advised the mother to consider dismissal of the ASI in terms of preventing an increase in bilirubin.

5. Taught about skin care:
  • Bathing with mild soap and warm water.
  • Prepare the tools to clean the eyes, mouth, perineal area and the area around the damaged skin.
  • Use a moisturizer after cleansing skin to retain moisture.
  • Avoid using baby clothes on the skin adhesive.
  • Avoid the use of talc in the groin and body because it can lead to blisters due to friction
  • Looking at risk factors that can cause skin damage such as pressing a long, scratching.
  • Exempt from the skin like a wet loom: a wet diaper for the chapter and tub.
  • Conduct a rigorous assessment of the nutritional status of infants such as: skin turgor, capilari reffil.

Another thing to note is:
1. How to bathe a baby with warm water (37 -38  C)
2. Umbilical cord care / umbilicus
3. Changing diapers and baby clothes
4. Crying is a communication if the baby is uncomfortable, bored, in contact with something new
5. Temperature
6. Respiratory
7. How to breastfeed
8. Elimination
9. Circumcision care
10. Immunization
11. The signs and symptoms of disease, for example:
  • lethargy (difficult infant awakened)
  • fever (temperature over 37 celsius)
  • vomiting (most or all of the food as much as 2 x)
  • diarrhea (more than 3 x)
  • no appetite.
12. Security
  • Prevent baby from trauma such as falling sharp objects (knives, scissors) are easily accessible by the infant / toddler.
  • Prevent hot objects, electricity, and other
  • Maintain the security of the baby during the journey by car or other means.
  • Strict supervision of the infant by his brothers.

Wednesday, October 5, 2011

Nursing Care Plan for Pain

Pain is the most common reason a person seeking medical assistance. Pain occurs with the disease process, diagnostic examination and treatment process. Pain is very disturbing and difficult for many people. The nurse could not see and feel the pain experienced by the client, because pain is subjective (between one individual to another individual is different in addressing the pain). Nurses provide nursing care to clients in various situations and circumstances, which provide interventions to improve comfort. According to some theories of nursing, comfort is the basic requirement that the client is the goal of providing nursing care. The statement was supported by Kolcaba who said that comfort is a state has fulfilled basic human needs.

DEFINITION
According to the International Association for the Study of Pain (IASP), pain is a subjective sensory and emotional unpleasant obtained related to actual or potential tissue damage, or described the condition of the damage.

Specificity theory "suggest" states that pain is a sensory-specific that arise because of the injury and the information is obtained through peripheral and central nervous system through the pain receptors in the peripheral nerves and specific pain in the spinal cord.
In general, nursing defines pain as anything that hurts the body of individuals who experience it who said, whenever there is an individual who said it.

QUALITIES OF PAIN
Pain is tiring and requires a lot of energy
Pain is subjective and individualized
Pain can not be objectively assessed as X-rays or lab blood
Nurses can assess patients' pain just by looking at behavioral and physiological changes of client statements
Only the client knows when the pain arises and what it's like
Pain is a physiological defense mechanism
Pain is a warning sign of tissue damage
Pain started the inability
The false perception that pain causes pain management so it is not optimal

In summary, pain Mahon suggested the following attributes:
Pain relief is an individual
Pain is not fun
Is a strength that dominate
Are endless

Sunday, October 2, 2011

Nursing Care Plan for Hyperthermia

Nursing Care Plan for Hyperthermia

Hyperthermia

Definition:

Circumstances where an individual experiencing or at risk of increased body temperature continuously above 37.8 by 38.8 ยบ C orally or rectally as an increased susceptibility to external factors.

Related factors:

Action
Associated with decreased ability to sweat:
(Special Treatment)

Situational
Related to exposure to heat (sun)
Related to clothing that does not fit with the climate
Related to a decrease in circulation:
Extreme weight
Dehydration
Insufficiency associated with hydration for strenuous activities
Maturisional
Related to temperature regulation ineffective:
Newborns
Premature Babies


Evidenced by

Temperature over 37.8° C (100° F) orally, or 38.8° C (101° F) rectally
Flushed skin
Malaise/weakness
Warm to touch
Increased respiratory rate
Tachycardia
Shivering/goose pimples
Dehydration
Loss of appetite

Expected outcomes:

Individuals will:
1. Identifying risk factors to hyperthermia.
2. Connecting method of prevention of hyperthermia.
3. Maintaining body temperature within normal limits.

Nursing Care Plan for Hyperthermia - Interventions :

1. Teach clients the importance of maintaining adequate fluid intake (at least 2000 ml / day unless there are contraindications to heart or kidney disease) to prevent dehydration
2. Monitor input and output.
3. Assess whether clothing or bedcovers too warm for the environment or the planned activities.
4. Teach the importance of increased fluid intake during hot weather and exercise
5. Explain why children and the elderly more at risk of hyperthermia.
6. Explain the need to avoid alcohol, caffeine, and eat a lot of weight and food during hot weather.
7. Explain the importance of wearing baggy clothes, thin and absorbs perspiration
8. Teach early signs of hyperthermia or heat stroke: Skin redness, fatigue, headache, loss of appetite.

Nursing Care Plan for Pain

Neonatal Jaundice Discharge Planning Applications

Saturday, October 1, 2011

Ineffective Breathing Pattern Care Plan

Ineffective Breathing Pattern as inspiration and/or expiration that does not provide adequate ventilation.

Ineffective Breathing Pattern related to :
  • Pain
  • Aspiration
  • Immobility
  • Decreased energy and fatigue
  • Neuromuscular impairment (e.g., Multiple Sclerosis, Guillain-Barre)
  • Anesthesia
  • History of smoking
  • Medications (narcotics, sedatives, analgesics)
  • Tracheobronchial Obstruction
  • COPD
  • Allergic response
  • Decreased lung compliance
  • Surgery of trauma
Evidenced by :
  • Dyspnea
  • Tachypnea
  • Respiratory depth changes
  • Use of accessory muscles
  • Bradypnea
  • Cyanosis
  • Hyperpnea
  • Nasal flaring
  • Increased anteroposterior chest diameter
  • Pursed-lip breathing or prolonged expiratory phase
  • Orthopnea
  • Cough
  • Grunting
  • Altered chest excursion
  • Abnormal arterial blood gas (ABG)
  • Irregular or paradoxical breathing
Objectives:

  • Effective breathing pattern

Expected Results:

  • There was no increased work of breathing
  • There is no use of accessory muscles / retractions and asymmetrical chest expansion
  • There was no dyspnea and cyanosis
  • Blood Gas Analysis within normal limits
  • Vital signs within normal limits
  • No additional breath sounds


Nursing Interventions - Ineffective Breathing Pattern Care Plan :

  • Review the causes of respiratory failure
  • Observations of breathing patterns
  • Auscultation of lung sounds periodically, note the quality of breath sounds, wheezing, expiratory lengthening and observation symmetry chest movement
  • Determine the location and extent of crackles in the sternum
  • Ensure breathing in harmony and there is no resistance (Fighting)
  • Have resuscitation equipment close to the client, perform manual ventilation if necessary

Health Education:

  • Teach the client and family relaxation techniques to increase effective breathing pattern
  • Teach how to cough effectively
  • Talk about home-care plan

Collaboration:

  • Ventilator settings and adjust the ventilator pattern with the client's condition
  • Observation konsintrasi oxygen (Fi O2) is given
  • Encourage deep breath through the abdomen during the period of respiratory distress
  • Record the pressure and the airway pressure waveform monitor
  • Ensure moisture and air temperature of inspiration and periodically checks
  • Set and check the ventilator alarm