Nursing Diagnosis for Disseminated Intravascular Coagulation (DIC)

Disseminated Intravascular Coagulation (DIC) can occur in virtually all persons without distinction of race, sex, and age. The symptoms of DIC, generally strongly associated with the underlying disease, plus additional symptoms due to thrombosis, embolism, organ dysfunction, and bleeding. Disseminated Intravascular Coagulation (DIC) is a complex diagnosis that involves a component of blood clots as a result of other diseases that precede.



Definition of Disseminated Intravascular Coagulation

Disseminated Intravascular Coagulation is a syndrome characterized by bleeding / clotting disorders are caused by the formation of plasmin which is a specific plasma protein that is active as a fibrinolytic in getting the circulation (Healthy Cau's)

In general, disseminated intravascular coagulation (DIC) is defined as a complex disorder or blood clotting disorder due to excessive stimulation of procoagulant and anticoagulant mechanisms in response to injury (Yan Euphrates Sembiring, Paul Tahalele)


Etiology of Disseminated Intravascular Coagulation

Bleeding occurs due to the following matters:

• Hypofibrinogenemia.
• Thrombocytopenia (a common cause of abnormal bleeding, can occur due to insufficient production of platelets by the bone marrow, or due to increased destruction of platelets).
• Circulating anticoagulant in blood circulation.
• Excessive fibrinolysis.

Diseases that predispose to DIC is as follows:

• Infections (dengue hemorrhagic fever, sepsis, meningitis, severe pneumonia, tropical malaria, rickettsial infection by some types). Where bacteria release endotoxins (a substance that causes clotting activation).
• Pregnancy complications (placental abruption, intrauterine fetal death, amniotic fluid embolism).
• After surgery (lung surgery, bypass cardiopulmonal, lobectomy, gastrectomy, splenectomy).
• malignancies (prostate carcinoma, lung carcinoma, acute leukemia).
• Acute liver disease (acute liver failure, obstructive jaundice).
• Palepasan severe trauma occurs to the network with a large number of blood vessels. The release coincides with hemolysis and endothelial damage that would release blood clotting factors in large numbers then activates blood coagulation systemically.

Clinical Manifestations of Disseminated Intravascular Coagulation

1. Bleeding from puncture area, wounds and mucous membranes in patients with shock, obstetric complications, sepsis (widespread infection), or cancer. If bleeding occurs under the skin, vascular lesions will appear.
2. Changes in the level of consciousness.
3. Cyanosis and tachypnea (increased respiratory rate) due to poor tissue perfusion and oxygenation are common. Splotches on the skin indicates tissue ischemia.
4. Hematuria (blood in the urine) due to bleeding or oliguria (decreased urine output) due to poor perfusion.

Complication

• Clot which formed much will cause obstruction or hindrance of blood flow in all organs of the body. Organ failure can occur at large. The mortality rate of more than 50%.
• Shock.
• Acute tubular necrosis.
• Pulmonary edema.
• Chronic renal failure.
• Convoluted.
• Coma.

Assessment for Disseminated Intravascular Coagulation (DIC)

1. Predisposing factors:

• Septicemia (most common cause).
• Obstetric complications.
• Severe and extensive burns.
• Neoplasia.
• Liver disease.
• Trauma.

2. Patterns of health functions
a. Health Perception and Management

• nausea, vomiting
• minus liquid
• Ht (if that exit the plasma, hematocrit rise; wrote out all that blood, Ht down)

b. Nutritional metabolic

• Impaired elimination patterns, both bladder and bowel movements. In bowel constipation or diarrhea occurs. Melena
• Hematuri
• Hematemesis

c. Activity exercise

• Changes in vital signs, SaO2 (descending)
• The need for assistance to meet their daily needs.
• Weak muscle contraction.

d. Sleep rest

• Changes meet the needs sleep (quality and quantity).

e. Cognitive-perceptual

• abdominal pain; pain, coldness in the fingers accompanied by numbness and tigling.

f. Role relationship

• With the long treatment, there will be obstacles in carrying out its role as before.

g. Sexuality reproductive

• Decreased sexual function
• Changes in menstrual patterns

h. Value-Belief Pattern

• Religious or cultural beliefs influence the selection of treatment.

Nursing Diagnosis for for Disseminated Intravascular Coagulation (DIC)

1) Ineffective Tissue Perfusion r / t disruption of blood circulation.

2) Risk for fluid volume deficit r / t bleeding.

3) Acute pain r / t tissue trauma.

4) Anxiety r / t threat of death from chronic diseases suffered...

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Self-care deficit related to Stroke

Nursing Care Plan for Stroke : Self-care deficit


Definition of Stroke

Stroke is an acute neurological dysfunction caused by impaired blood flow that occur suddenly (within seconds) or raised quickly (within hours) with symptoms and signs corresponding to the focal area disturbed.

Cerebrovascular accident (CVA) also called Stroke is a condition in which the occurrence of neurological deficits caused by decreased blood flow to certain areas of the brain tissue.
Neurological deficits caused by ischemia caused necrotising cells in brain tissue in various areas of the brain.

In the U.S., stroke is the third leading cause of death after heart disease and cancer. This disease can be prevented or minimized by efforts: blood pressure under control, increase awareness of the necessary diet and avoid smoking.


Etiology of Stroke

The occurrence of stroke is caused by the presence of thrombi and emboli that cause the narrowing or occlusion of one of the perfect blood vessels that supply blood to the brain, also if there is bleeding (hemorrhagic). Stroke due to pressure on the walls of blood vessels and arteries spasm, rarely encountered.

1. Thrombosis:

Is the formation of blood clots in blood vessels that can lead to narrowing of the lumen of a blood vessel blockage even happen. Thrombosis is a major cause of cerebral infarction. Two-thirds of strokes are caused by thrombosis due to hypertension and diabetes mellitus both of which can lead to atherosclerosis.

Another factor that can be at risk of thrombosis is an oral contraceptive, coagulation disorders, polycithemia, arteritis, chronic hypoxia, and dehydration. Thrombosis occurs as a result of the formation of atheroma thus narrowing the lumen of blood vessels. Thrombus causing hypoperfusion, infarction and ischemia.

At first occurred paresis (decrease / reduction in force and limb movement), aphasia (language function disorder), paralysis, impaired consciousness, visual disturbances.

2. Embolism:

Blockage / cerebral artery occlusion by an embolus, which resulted in necrosis and edema in the area supplied by the blood vessel blockage.

Embolism is the second leading cause of stroke. Generally derived from the inner lining of the heart (endothelial) where plaque is formed which is then separated and flowed in the blood circulation. If embolism is walking / running on the smaller blood vessels then place it will clog embolism or vascular branching.
Embolism associated with disease / heart problems, namely atrial fibrillation, cardiac infarction, infective endocarditis, rheumatic heart disease, and atrial septal defect. Another cause is not often that air embolism, fat embolism due to fracture femor, amniotic fluid after delivery, and the presence of a tumor.

The attack is sudden. The patient is fully conscious, although patients also feel headache. Prognosis depends location of the blood vessel blockage.

3. Intracerebral hemorrhage:

Bleeding in the brain caused by the rupture of a blood vessel. Intracerebral hemorrhage is usually caused by the presence of hypertension. Another cause is a brain tumor, trauma, thrombolytic treatment, and aneurysm rupture.
Hypertension and atherosclerosis cause degenerative change in the artery walls, causing rupture and hemorrhage. Blood mass will suppress brain tissue. This pressure causes the brain tissue of urgency and decreased blood flow to the brain due to ischemia and infarction.

The area that is often experienced intracerebral hemorrhage putamen and the internal capsule (50%), thalamus, brain hemisper, and pons. Clients will experience a severe headache, nausea and vomiting, loss of ability to walk, dysphagia, eye movement disorders. Bleeding in the post is very dangerous because it is part of the basic life functions. Pons can lead to bleeding in hemiplegia, coma, hyperthermia, and subsequently died.

The prognosis is very bad intracerebral hemorrhage: 70% of patients died due to intracerebral hemorrhage.

4. Subarachnoid hemorrhage:

Caused by the aneurysm, vascular abnormalities, trauma, and hypertension. Aneurysms often occur in patients with atherosclerosis, trauma, hypertension, or vascular abnormalities that are usually congenital bleeding can also be caused by anticoagulant treatment, treatment trhrombolitik, and symphatomimetic.

Bleeding that occurs suppress arachnoid space and cause headache, dizziness, loss of consciousness, nausea, vomiting, fever, pain in the neck and back, paralysis, coma, and later died.


Prevention of Stroke

Primary prevention is to avoid the risk of public health education. Maintain body weight and cholesterol within normal limits, and avoid smoking or using oral contraceptives. Treatment / control diabetes, hypertension and heart disease.

Provide information to clients in connection with the illness with strokes. If already had a stroke, in this situation the goal is to prevent the occurrence of complications with respect to stroke and myocardial wider in the future. In the event of immobility will increase the risk of injury in connection with paralysis and aspiration of the airway. Further Prevention is monitoring the risk factors that can be identified.


Nursing Diagnosis for Stroke : Self-care deficit related to decrease in strength and endurance.

Goal:

Patients can help themselves according to their needs, and be able to express their needs.

Intervention:

1. Assess the capability and level of deficiency to perform day-to-day needs.
2. Maintain support, with a strong attitude.
3. Give positive feedback for any thing done or success.
4. Avoid doing something for patients to do their own patients, but provide assistance as needed

Rational:

1. Assist in anticipating / planning meeting individual needs.
2. Patients will require empathy, care giver to know that will help patients consistently.
3. Increase feelings of self meaning.
4. The patient may be very frightened and very dependent.

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Management and Nursing Care Plan for Dementia

Definition of Dementia

Dementia can be defined as cognitive and memory disorders that can affect daily activities. People with dementia often show some disturbances and changes in daily behavior (behavioral symptoms) that interfere with (disruptive) or do not disturb (non-disruptive) (Volicer, L., Hurley, AC, Mahoney, E. 1998). Grayson (2004) states that dementia is not just ordinary disease, but rather a collection of symptoms caused by multiple diseases or conditions resulting in changes in personality and behavior.


Causes of Dementia


Causes of dementia according to Nugroho (2008) can be classified into 3 major categories:

1. Syndrome dementia with disease essentially unknown etiology, often not found in this class of cerebral atrophy, abnormalities may be present in sub-cellular or biochemical level on enzyme systems, or on the metabolism such as those found in Alzheimer's disease and senile dementia.

2. Syndrome dementia with known etiology but can not be treated,
The main cause in this class include:

• Spinocerebellar degeneration disease.
• Subacute sclerosing leukoencephalitis (van Bogaert).
• Huntington's chorea.
• Creutzfeldt-Jakob disease, etc.

3. Syndrome dementia by etiology of the disease that can be treated, in this class include:
Cerebrovascular disease.

• Metabolic diseases.
• Nutrition disorder.
• Due to chronic intoxication.
• Communicating hydrocephalus.

Dementia (senility) is a severe cognitive decline such that it interferes with activities of daily living and social activities. Cognitive decline in dementia usually begins with the deterioration of memory or memory (forgetful). Dementia mainly caused by Alzheimer's disease is closely related to old age. Alzheimer's disease causes 60% of senility or dementia and is expected to continue.

The classic symptoms of Alzheimer's disease dementia is memory loss happens gradually, including difficulty finding the right word or mention, is not able to recognize the object, forgetting how to use plain and simple objects, such as pencils, forgot to turn off the stove, close the window or close the door, the mood and personality may change, agitation, trouble with memory, and made ​​a bad decision can lead to unusual behavior.

These symptoms are very varied and individual. Gradually the symptoms of Alzheimer's disease may occur in a different time, could be faster or slower. The symptoms are not always an Alzheimer's disease, but if the symptoms lasted more frequent and real, to consider the possibility of Alzheimer's disease (Nugroho, 2008).



Signs and Symptoms of Dementia

In general, signs and symptoms of dementia are as follows:

1. Decline in memory that continues to happen. In patients with dementia, "forget" become a part of daily life that can not be separated.
2. Impaired orientation of time and place, for example: forget the day, week, month, year, where people with dementia are.
3. The decline and inability to arrange words into correct sentences, using words that are not appropriate for a condition, repeat the word or the same story many times.
4. Excessive expression, for example, excessive crying when she saw a television drama, furious at small mistakes committed by others, fear and nervousness that is not grounded. People with dementia often do not understand why these feelings arise.
5. The change of behavior, such as: indifferent, withdrawn and anxious.
6. The whole range of cognitive function is damaged.
7. Originally impaired short-term memory.
8. Personality and behavioral disorders, mood swings.
9. Motors and focal neurologic deficits.
10. Irritability, hostility, agitation and seizures.
11. Psychotic Disorders: hallucinations, illusions, delusions and paranoia.
12. Aphasia, apraxia, agnosia and.
13. ADL (Activities of Daily Living) difficult.
14. Difficult to regulate the use of finances.
15. Not be able to go home when traveling.
16. Forgot to put the important stuff.

Patient Examination

1. Patients routine laboratory examination.
Laboratory tests are only done once a clinical diagnosis of dementia is made to help search the etiology of dementia, especially in reversible dementia, although 50% of people with dementia is Alzheimer's dementia with normal laboratory results, laboratory tests should be performed routinely. Laboratory tests are routinely done include: complete blood count, urinalysis, serum electrolytes, blood calcium, urea, liver function, thyroid hormone, folic acid levels.

2. Imaging
Computed Tomography (CT) scan and MRI (magnetic resonance imaging) has become a routine examination in the examination even if the results are still questionable dementia.

3. Examination of EEG
Electroencephalogram (EEG) does not provide specific features and in most EEG was normal. In the advanced stages of Alzheimer's can illustrate diffuse slowing, and periodic complexes.

4. Examination of cerebrospinal fluid
Lumbar puncture is indicated when clinically encountered acute onset dementia, persons with immunosuppressants, meninges and heat stimuli encountered, atypical presentations of dementia, normotensive hydrocephalus, syphilis test (+), meningeal stinger on CT scans.


Management for Dementia

Psychosocial therapy

Deterioration in mental status has a significant meaning in patients with dementia. The desire to continue living depends on the memory. Short-term memory is lost before the loss of long-term memory in most cases of dementia, and many patients typically experience distress as a result of thinking about how they use more memory function in addition to thinking about the disease being experienced. The identity of the patient has faded over the course of the disease, and they can only use a little bit and getting his memory. Emotional reactions ranging from severe depression to kecemasanyang and catastrophic terrorism is rooted in the realization that understanding itself (sense of self) disappeared.

Patients usually will benefit from supportive psychotherapy and educational so that they can understand the journey and the nature of the illness. They can also get support in her grief and acceptance of worsening disability and attention to the problems of self-esteem. Many functions are still intact can be maximized by helping patients identify activities that can still be doing. A psychodynamic approach to the defect in the function of the ego and the limitations of cognitive function can also be beneficial. The doctor can help the patient to find a way of "peace" with defects ego functions, such as saving a calendar for a patient with a problem orientation, create a schedule to help organize the structure of their activities, and make notes to memory problems.

Psychodynamic interventions involving the patient's family can be very helpful. It helps patients to fight feelings of guilt, sadness, anger, and despair as he slowly felt shunned by the family.

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