Abdominal Aortic Aneurysm - Causes, Symptoms and Treatment

Definition of Abdominal Aortic Aneurysm

Aneurysm is a protrusion (dilation, dilatation) on the wall of an artery. Abdominal aortic aneurysm occurred on the part of the aorta that passes through the stomach. The disease tends to occur in a family (inherited). These aneurysms often occur in people with high blood pressure, larger than 7.5 cm and can rupture. (Normal diameter of the aorta is 1,8-2,5 cm).


Causes

The exact cause is unknown, but risk factors for abdominal aortic aneurysm are atherosclerosis and hypertension.

Abdominal aortic aneurysm may be caused by:

• Infection.
• Congenital abnormalities in connective tissue that forms the walls of the arteries.
• Trauma.

Abdominal aortic aneurysms can occur in anyone, but is most often found in men aged 40-70 years. In children, an aneurysm can occur as a result of blunt abdominal injury or as a result of Marfan syndrome. Frequent complication is rupture of the aneurysm can cause bleeding into the abdominal cavity. Ruptured aneurysm is more often found in patients with aneurysms greater than 5 cm.



Symptoms

Patients often feel a pulsation in the abdomen. Aneurysms can cause pain, especially in the form of a sharp pain in the back. Pain can be severe and usually permanent, but changes in body position can reduce this pain.

Early signs of aneurysm rupture is usually a tremendous pain in the lower abdomen and back and tenderness over the aneurysm. In severe bleeding, the patient may fall into a state of shock. Rupture of abdominal aneurysm is often fatal.



Diagnosis

Many patients who have no symptoms and are diagnosed on routine physical examination or on X-ray examinations performed for other reasons. On physical examination, the doctor may feel a pulsating mass in the midline of the abdomen. Aneurysms are expanding rapidly and nearly broke, often causing pain or tenderness when pressed. In obese patients, often lebarpun aneurysms that can not be found.

Several laboratory tests can help diagnose aneurysms:

• Abdominal X-rays may show an aneurysm that has calcium deposits on the wall.
• Ultrasound can show clearly the size of the aneurysm.
• CT scan performed after intravenous injection of dye, can accurately show the size and shape of the aneurysm.
• MRI scan is an accurate examination.

Treatment of Abdominal Aortic Aneurysm

Treatment depends on the size of the aneurysm. If the width is less than 5 cm, rarely broken; but if more than 6 cm wide, often broken. Because the aneurysm wider than 5 cm, surgery. In surgically inserted a synthetic graft to repair the aneurysm. The mortality rate for this surgery is 2%.

Ruptured aneurysm rupture or threatened, need to be addressed through emergency surgery. The risk of death during surgery ruptured aneurysm is 50%. If an aneurysm rupture, the kidneys are at risk for injury due to disruption of blood flow to the kidneys or from shock due to blood loss. If post-operative kidney failure, survival is very slim. Ruptured aneurysm and untreated, is always fatal.

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Arteriovenous Fistula Causes, Symptoms and Diagnosis

Definition of Arteriovenous Fistula

Arteriovenous fistula is an abnormal channel that sits between an artery and a vein. Under normal circumstances the blood flows from arteries to capillaries and then to veins. In an arteriovenous fistula, the blood flows directly from arteries to veins without passing through capillaries.


Causes of Arteriovenous Fistula

Arteriovenous fistula may be congenital abnormalities (congenital fistula) or can occur after birth (acquired fistula). Congenital arteriovenous fistula is rare. Acquired arteriovenous fistula can be caused by a variety of injuries that damage the arteries and veins that are close together, especially penetrating injuries due to knife or bullet. Fistulas can occur immediately or several hours later emerging. If blood seeps into the surrounding tissue, the injured area will experience immediate swelling.

Every time conducted several medical treatments (eg renal dialysis) required its way into the blood vessels (veins). This causes repeated stabbing veins become inflamed and can cause blood clots, and eventually the vein will be clogged by scar tissue. To avoid this, deliberately created arteriovenous fistula, usually between adjacent veins and arteries in the arm. This will widen the veins, facilitate the entry of the needle and reduce the chances of blood clots because blood flows faster. This small fistula does not cause heart defects and can be closed when not needed anymore.


Symptoms of Arteriovenous Fistula

If the congenital arteriovenous fistula located close to the skin surface, it would appear reddish blue swelling. In obvious places (eg faces), fistula will appear purplish. If a large arteriovenous fistula obtained untreated, a large amount of blood will flow under high pressure from the arteries to the veins. Vein wall is not strong enough to withstand this high pressure, so the walls are stretched and widened and prominent veins (varicose veins sometimes resemble).

Flow back to the heart through the abnormal arteriovenous shortcuts can make tense heart, causing heart failure. The larger the fistula, the faster heart failure.


Diagnosis of Arteriovenous Fistula

With a stethoscope placed over a large arteriovenous fistula obtained, could be heard the sound back and forth, such as moving machinery (machinery murmur). To confirm the diagnosis and to determine the extent of abnormality, angiography performed. At angiography injected a dye into the blood vessels and seen on x-rays; dye will show the pattern of blood flow.

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Disturbed Body Image and Anxiety NCP for Endophthalmitis

Nursing Diagnosis and Interventions for Endophthalmitis

Endophthalmitis is a medical condition characterized by inflammation on the inside of the eyeball, typically caused by infection with bacteria, viruses or fungi. This condition usually occurs as a complication of surgery in the eye although it can also be caused by penetrating trauma to the eyeball. Regardless of the cause, the condition is dangerous and likely to lead to decreased vision or permanent loss of the eyeball itself. This condition typically arises accompanied by pain in the eye, decreased vision, and swelling of the eyelids. The prognosis of this condition varies depending on the cause, and how quickly acquire the handling and the presence of underlying disease; in general, the earlier the treatment is obtained and the smaller decrease in vision, the better the prognosis. Given the seriousness of the complications that can arise, it is recommended to a person with this condition to immediately consult with a doctor to get treatment.

Causes of endophthalmitis are:

• Eye injury.
• Bacterial infections.
• Fungal infections.
• Virus infection.

Signs and symptoms of endophthalmitis that may arise:

• Fever.
• Suffer from Headaches.
• Eye pain.
• Swelling of the eyes.
• The blood vessels are swollen or dilated on the white part of the eye, which causes the eyes to appear red (red eye).
• Blurred vision.
• Reduced vision.
• Sensitive to light.

Nursing Diagnosis for Endophthalmitis : Disturbed Body Image related to loss of vision.

Goal: body image disturbance does not occur.

Outcomes: Declare and indicate acceptance of the appearance of self-assessment.

Intervention:

1 Provide an understanding of the loss for the individual and those close, with respect to the invisibility of loss, loss of function, and the pent-up emotions.
Rationalization: With the loss of part or function of the body can cause the individual to the rejection, shocked, angry, and depressed.

2 Instruct individuals in response to the shortcomings are not the denial, shock, anger, and distress.
Rationalization: So that patients can receive shortcomings with more sincere.

3 Be aware of the influence of the reactions of other people on the shortcomings and push share that feeling with others.
Rationalization: When good family reactions can increase the confidence of individuals and can share that feeling with others.

4 Teach individuals to monitor their own progress.
Rationalization: Knowing how far the ability of individuals with its shortcomings.



Nursing Diagnosis for Endophthalmitis : Anxiety related to:

• Physiological factors, changes in health status: the possibility / reality of vision loss.
• Talk negatively about yourself.
• Eyelashes falling fast.

Possibility evidenced by:

• Fear.
• Expressed concerns about the changes in life events.

Outcomes:

• Looks relaxed and report anxiety levels decreased to be overcome.
• Demonstrate problem solving skills.

Intervention:

1 Assess the level of anxiety. Help the patient identify coping skills that have been done successfully in the past.
R /: Integrating therapeutic intervention and participation in self-care, coping skills in the past to reduce anxiety.

2 Instruct to express feelings. Give feedback.
R /: Creating a therapeutic relationship. Helping people closest in identifying problems that cause stress

3 Give accurate and real information about what actions are performed.
R /: patient involvement in care planning gives a sense of control and help reduce anxiety

4 Provide quiet environment and rest.
R /: Move the patient from external stress, improve relaxation, help reduce anxiety.

5. Encourage the patient / person closest to claim attention, attention behavior.
R /: The act of support can help patients feel stress is reduced, allowing for directed energy on healing.

6 Provide information about disease process and anticipation of action.
R /: Knowing what to expect can reduce anxiety.

7 Collaboration of sedative drugs.
R /: Can be used to reduce anxiety and facilitate rest.


Nursing Care Plan for Endophthalmitis

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Nursing Care Plan for Endophthalmitis

Endophthalmitis - Nursing Assessment and Diagnosis

Definition of endophthalmitis

Endophthalmitis is inflammation of the lining around the inner eye, the fluid in the eyeball (the vitreous humor) and the whites of the eyes (sclera).

Endophthalmitis is a purulent inflammation (suppurative) within the eyeball. Is a purulent inflammation of the entire intra-ocular tissues is accompanied by the formation of abscesses in the body of the glass. Cause of Sepsis, orbital cellulitis, penetrating trauma, ulcer.


Classification

Endophthalmitis can be classified according to:
1 How to enter

• Endogenous endophthalmitis caused by bacteria spread from elsewhere in the body through the bloodstream. The main fungi. Common predisposing factor is immunocompromised status, septicemia or IV drug abuse.
• Exogenous endophthalmitis can occur as a result of penetrating trauma or infection in the open surgery eyeball. Endogenous endophthalmitis is very rare, only 2-15% of all endophthalmitis. The main bacteria.

2. Types of agents causing

• bacteria
• fungi
• virus
• parasites

Etiology

The cause of endophthalmitis among others:

1. Surgery.
2. Wounds that penetrate the eye.
3. Bacteria. The cause of most is Staphylococcus epidermidis, Staphylococcus aureus, and Streptococcus species.
4. Fungi. The cause of most is Aspergillus, phycomycosis and Actinomyces.

Signs and Symptoms

Inflammation caused by bacteria will provide clinical manifestations of severe pain, red and swollen eyelids, difficult petals opened, chemotic and red conjunctiva, cornea cloudy, cloudy anterior chamber. In addition, there will be a decrease in visual acuity and photophobia (fear of light). Endophthalmitis due to surgery is common after 24 hours and eyesight would worsen with the passage of time. When already deteriorating, will be formed hypopyon, the white fluid-filled sac, in front of the iris.

The symptoms are often severe, which are:

1. eye pain
2. redness of the sclera
3. photophobia (sensitive to light)
4. visual impairment.

Signs often appear:

1. eyelids red,
2. swelling, and difficult to open,
3. cloudy cornea,
4. murky chamber of the eye.

Pathophysiology

Endophthalmitis or corpus vitreous abscess is severe inflammation within the eye, usually caused by trauma or surgery, or endogenous due to sepsis. Shaped suppurative inflammation within the eye, and will lead to an abscess in the body of the glass. Exogenous endophthalmitis caused by penetrating trauma or secondary infection following surgery on the open eyeball. Endogenous endophthalmitis caused by the spread of bacteria, fungi or parasites from the focus of infection in the body.
Inflammation by bacteria provide a picture of severe pain, red and swollen eyelids, anterior chamber murky, sometimes accompanied by hypopyon. In the body of the glass can be found masses of white gray and light hippion satellite abscesses form in the body of the glass.



NURSING CONCEPTS

A. Assessment

• Assessment sharp eyesight.
• Assessment of pain.
• Symmetry eyelid.
• Eye reaction to light / eye movement.
• Color eyes.
• The ability to open and close the eyes.
• Assessment of visual field.
• Inspect the outside structure of the eye and inspection nodes for the presence of swelling / inflammation.

Data Focus

• Pain (mild to severe).
• Photophobia (sensitivity to light) or blepharospasme (eyelid spasms).
• Sharpness of vision.

Nursing Diagnosis

1.  Acute Pain: eye related to inflammation and inflammatory processes.
2.  Disturbed Sensory Perception (specify: visual) related to the inflammatory process.
3.  Disturbed Body Image related to loss of vision.
4.  Disturbed Sleep Pattern related to pain.
5.  Anxiety related to lack of knowledge about the disease.
6. Knowledge Deficit related to lack of information.

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5 Nursing Diagnosis with Interventions for Chronic Kidney Disease

Nursing Diagnosis for Chronic Kidney Disease

According to Doenges (1999) and Lynda Juall (2000), nursing diagnoses that appear in patients with CKD are:

1. Decreased Cardiac Output.
2. Fluid and Electrolyte imbalances.
3. Imbalanced Nutrition.
4. Ineffective Breathing Pattern.
5. Impaired Skin Integrity.

Nursing Interventions for Chronic Kidney Disease

Decreased Cardiac Output related to increased cardiac load.

Goal:

• Decreased cardiac output does not occur with the outcome criteria:
• maintain cardiac output and blood pressure with evidence of cardiac frequency in the normal range, strong peripheral pulses, and the same with capillary refill time.

intervention:
1 Auscultation of heart and lung sounds.
R: The presence of tachycardia, irregular heart rate.

2 Assess for hypertension.
R: Hypertension may occur due to interference with the system of the renin-angiotensin-aldosterone system (caused by renal dysfunction).

3 Investigate complaints of chest pain, note the location, radiation, severity (0-10 scale).
R: HT and CRF can cause pain.

4 Assess activity level, response to activity.
R: Fatigue can also accompany CRF anemia.



Fluid and Electrolyte imbalances related to secondary edema (fluid volume unbalanced because of the retention of Na and H2O).

Goal: Maintain ideal body weight without excess fluid with outcome criteria: no edema, the balance between inputs and outputs.

intervention:
1 Assess fluid status with daily weigh, balance input and output, skin turgor, vital signs.

2 Limit your fluid intake.
R: fluid restriction akn determine ideal body weight, urine output, and response to therapy.

3 Explain to the patient and family about the liquid restrictions.
R: Understanding to increase cooperation of patients and families in the fluid restriction.

d. Instruct the patient / teach the patient to record the use of fluid intake and output mainly.
R: To determine the balance of inputs and outputs.



Imbalanced Nutrition, Less Than Body Requirements related to anorexia, nausea, vomiting.
Goal: Maintain adequate nutrient inputs to the outcome criteria: demonstrate stable weight.

intervention:
1 Monitor the consumption of foods / liquids.
R: Identifying nutritional deficiencies.

2 Notice of nausea and vomiting.
R: Symptoms that accompany the accumulation of endogenous toxins that can alter or lower income and require intervention.

3 Give food a little but often.
R: The portion of a smaller can increase food intake.

4 Increase visits by people nearby during meals.
R: Provides transfer and improve the social aspects.

5. Provide frequent mouth care.
R: Lowering stomatitis oral discomfort and unwelcome taste in the mouth that can affect food intake.



Ineffective Breathing Pattern related to hyperventilation secondary: compensation via respiratory alkalosis.

Goal: breathing pattern back to normal / stable.

intervention:
1 Auscultation of breath sounds, note the presence of crakles.
R: To declare the existence of the collection of secretions.

2 Teach patient effective coughing and deep breathing.
R: Cleaning the airway and facilitate the flow O2.

3 Adjust the position as comfortable as possible.
R: Preventing the occurrence of shortness of breath.

4 Limit to move.
R: Reduce workload and prevent tightness or hypoxia.


Impaired Skin Integrity related to pruritis

Goal: The integrity of the skin can be maintained with the outcome criteria: Maintain intact skin, Shows behaviors / techniques to prevent damage to the skin.

intervention:
1 Inspection of the skin to change color, turgor, vascular, note the presence of redness.
R: Indicates area of ​​poor circulation or damage that may lead to the formation of pressure sores / infections.

2 Monitor fluid intake and hydration of the skin and mucous membranes.
R: Detecting the presence of dehydration or overhydration affecting circulation and tissue integrity.

3 Inspection of the area depends on edema
R: Tissue edema is more likely to be damaged / torn.

4 Change positions as often as possible.
R: Reduce pressure on edema, poorly perfused tissue to reduce ischemia.

5. Give skin care.
R: Reduce drying, skin tears.

6 Maintain a dry linen.
R: Lowering dermal irritation and the risk of skin damage.

7 Instruct the patient to use a damp and cold compresses to put pressure on the area pruritis.
R: Eliminate the discomfort and reduce the risk of injury.

8 Encourage wear loose cotton clothes.
R: Preventing direct dermal irritation and improve skin moisture evaporation.


Nursing Management for Chronic Kidney Disease

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Nursing Management for Chronic Kidney Disease

Chronic Kidney Disease

Chronic Kidney Disease or end stage renal disease (ESRD) is a progressive renal dysfunction and irreversible failure where the body's ability to maintain metabolism and fluid and electrolyte balance, causing uremia (retention of urea and other nitrogen waste in the blood). (Brunner & Suddarth, 2001; 1448).


Causes

• Infections such as chronic pyelonephritis, glomerulonephritis.
• Hypertensive vascular disease, for example, benign nephrosclerosis, malignant nephrosclerosis, renal artery stenosis.
• Connective tissue disorders such as systemic lupus erythematosus, polyarteritis nodosa, progressive systemic sclerosis.
• Congenital and hereditary disorders such as polycystic kidney disease, renal tubular acidosis.
• Metabolic diseases such as; DM, gout, hyperparathyroidism, amyloidosis.
• Toxic nephropathy, for example; analgesic abuse, lead nephropathy.
• Obstructive nephropathy for example; upper urinary tract: calculi neoplasms, fibrosis netroperitoneal. Lower urinary tract: prostatic hypertrophy, urethral stricture, congenital anomalies of the neck of the bladder and urethra.
• Urinary tract stones are caused hidrolityasis.

Clinical manifestations

Clinical manifestations according Suyono (2001) are as follows:
a. Cardiovascular disorders.
Hypertension, chest pain, and shortness of breath due to pericarditis, pericardial effusion and heart failure due to fluid retention, heart rhythm disturbances and edema.

b. Pulmonary disorders
Shallow breathing, Kussmaul breathing, cough with thick sputum and ripple, crackling noises.

c. gastrointestinal disorders
Anorexia, nausea, and fomitus related to protein metabolism in the gut, bleeding in the gastrointestinal tract, ulceration and bleeding mouth, ammonia breath odor.

d. Musculoskeletal disorders.
Resiles leg syndrome (sore on his leg that has always driven), burning feet syndrome (tingling and burning, especially on the soles of the feet), tremor, myopathy (weakness and limb muscle hypertrophy).

e. Integumentary Disorders.
Skin pale due to anemia and yellowish due to accumulation urokrom, itching caused by toxic, thin and brittle nails.

f. Endocrine disorders.
Sexual Disorders: fertility libido, and erectile decrease, menstrual disorder and amenorrhea. Glucose metabolic disorders, metabolic disorders of fat and vitamin D.

g. Disorders of fluid electrolyte and acid-base balance.
Usually the retention of salt and water but can also occur sodium loss and dehydration, acidosis, hyperkalemia, hypomagnesemia, hypocalcemia.

h. Hematology system.
Anemia caused by decreased production of erythropoietin, so that stimulation of erythropoiesis in the bone marrow is reduced,
hemolysis due to decreased life span of erythrocytes in uremia toxic atmosphere, can also malfunction thrombosis and thrombocytopenia.


Test and Diagnostics

In providing nursing services primarily intervention is necessary investigations required either medically or collaboration include:

1 laboratory examination of blood

• Hematology: hemoglobin, hematocrit, erythrocytes, leukocytes, platelets.
• RFT (renal function test): urea and creatinine
• LFT (liver function test)
• Electrolytes: Chloride, potassium, calcium
• Coagulation studies: PTT, PTTK
• BGA

2 Urine

• Urine routine
• Urine specific: ketone bodies, rock crystal analysis.

3. Cardiovascular examination

• ECG
• ECO

4. Radiodiagnostic

• Abdominal ultrasound.
• Abdominal CT scan.
• BNO / IVP, FPA.
• Renogram.
• RPG (retio pyelography).

NURSING MANAGEMENT

Nursing management in patients with CKD is divided into three, namely:

a) Conservative

• Laboratory examination of blood and urine.
• Observation of fluid balance.
• Observation of edema.
• Limit fluid intake.

b) Dialysis

• Peritoneal dialysis: usually done in cases of emergency. While dialysis can be done anywhere that is not acute CAPD (Continues Peritonial Ambulatory Dialysis)
• Hemodialysis: dialysis That is done through invasive action in the vein by using a machine. At first hemodiliasis performed through the femoral region, but to simplify it done:
• AV fistula: combining veins and arteries.
• Double lumen: directly in the heart area (vascularization to the heart).

c) Operations

• Stone retrieval.
• Kidney transplant.

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Impaired Urinary Elimination related to Uterine Fibroids

Nursing Care Plan for Uterine Fibroids

A uterine fibroid is a leiomyoma (benign tumor from smooth muscle tissue) that originates from the smooth muscle layer (myometrium) of the uterus. Fibroids are very common in women in their 30s and 40s. But fibroids usually do not cause problems. Many women never even know they have them.

Uterine fibroids are noncancerous growths of the muscle tissue of the uterus. Fibroids can range in number and size from a single growth to multiple growths, and from very small to large. As many as 70% to 80% of all women will have fibroids by age 50. The medical term for fibroids is leiomyoma or myoma.

Often fibroids do not cause symptoms. Or the symptoms may be mild, like periods that are a little heavier than normal. If the fibroids bleed or press on your organs, the symptoms may make it hard for you to enjoy life. Fibroids make some women have:

Long, gushing periods and cramping.
Fullness or pressure in their belly.
Low back pain.
Pain during sex.
An urge to urinate often.


Fibroids, particularly when small, may be entirely asymptomatic. Symptoms depend on the location of the lesion and its size. Important symptoms include abnormal gynecologic hemorrhage, heavy or painful periods, abdominal discomfort or bloating, painful defecation, back ache, urinary frequency or retention, and in some cases, infertility. There may also be pain during intercourse, depending on the location of the fibroid. During pregnancy they may also be the cause of miscarriage, bleeding, premature labor, or interference with the position of the fetus.

Fibroids may cause very mild symptoms or none at all. In women who do feel symptoms, these uterine growths can cause:

• Pressure on the bladder or rectum
• Frequent urination
• Constipation and/or rectal pain
• Lower back and/or abdominal pain

If fibroids become very large, they can distend the stomach, making a woman look pregnant.


Impaired Urinary Elimination related to Uterine Fibroids :

• Monitor inputs and outputs as well as the characteristics of urine
• Determine the client's normal voiding pattern and note the variations
• Encourage clients to increase fluid intake
• Check all the urine, note the presence of stones and send output to a laboratory for analysis
• Investigate complaints of a full bladder: suprapubic palpation to distention. Note the decrease in urine output, edema periorbital / dependent
• Observations of changes in mental status, behavior or level of consciousness
• Supervise laboratory tests, samples of electrolytes, BUN creatinine
• Take a urine for culture and sensitivity
• Give the drug as indicated, for example:
• Note the catheter patency was settled, when using
• Irrigation with acidic or alkaline solution as indicated

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