Risk for Infection and Risk for Trauma - NCP for Encephalitis

Nursing Care Plan for Encephalitis

Encephalitis is an infection of the CNS caused by viruses or other micro-organisms are non-purulent.

Pathogenesis of encephalitis

Viruses enter the patient's body through the skin, respiratory tract and gastrointestinal tract. Upon entry into the body, the virus will spread throughout the body in several ways:
1 Local: limited flow viruses infect the mucous membrane or the surface of a particular organ.
2 Primary hematogenous Dissemination: the virus into the blood then spread to organs and breed in these organs.
3 Spread through the nerves: Surface viruses multiply in the mucous membranes and spreads through the nervous system.

Prodromal period lasts 1-4 days characterized by fever, headache, dizziness, vomiting, sore throat, malaise, pain in the extremities and pale.
Other symptoms such as anxiety, irritable, behavior changes, disturbance of consciousness, seizures.
Sometimes accompanied Neurological signs such as Aphasia, Hemiparesis, Hemiplegia, Ataxia, brain nerve paralysis.

Symptoms that may occur in Encephalitis:
Increased body heat, photo phobia, headache, vomiting, lethargy, sometimes accompanied by a stiff neck when the infection of the meninges.
Children looked nervous sometimes accompanied by changes in behavior. May be accompanied by impaired vision, hearing, speech and seizures.


Assessment

1. Identity
Encephalitis can occur in all age groups.

2 The main complaint
Increased body heat, seizures, decreased consciousness.

3. History of present illness
At first the child cranky, restless, vomiting, increased body heat approximately 1-4 days, headache.

4. Past medical history
Previous clients suffering from coughs, colds approximately 1-4 days, had suffered from herpes disease, infectious disease of the nose, ears and throat.

5. Family Health History
There families who suffer from diseases caused by viruses eg herpes etc.. Bacteria example: Staphylococcus aureus, Streptococcus, E-Coli, etc..

6 Immunization
When was the last given DTP immunization.
Because encephalitis can occur post pertussis immunization.
Growth and Development.


Nursing Diagnosis : Risk for Infection related to the body's resistance to infection down.

Goal: prevent infection

Criteria results:
Timely healing period without evidence of spread of infection endogenous.

Intervention
1. Defense aseptic technique and proper hand washing techniques either officers or visitors. Monitor and limit visitors.
R /: Reduce the risk of secondary infection. Controlling the spread of infection source.

2 Observations temperature regularly and clinical signs of infection.
R /. Early detection of signs of infection is an indication of the development of meningococcemia.

3 Give antibiotics as indicated.
R /. Drugs are selected depending on the type of infection and sensitivity of the individual.


Nursing Diagnosis : Risk for trauma related to generalized seizure activity.

Purpose: There was no trauma.

Criteria results:
Not having a seizure / other concomitant injuries.

Intervention:

1 Provide security for patients by giving pads, bed barriers remain attached and give a booster in the mouth, airway remains free.
R /: Protecting the patient in the event of a seizure, a booster mouth so that the tongue was not bitten.
Note: enter the mouth wedge mouth only when relaxation.

2 Maintain bed rest in the acute phase.
R /: Reduce the risk of falls / trauma during the vertigo.

Collaboration

3 Give the drug as indicated.
R /. An indication for the treatment and prevention of seizures.

4 Observation of vital signs.
R /: Detection of seizures themselves can be somewhat further action.

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7 Signs and Symptoms of Nasopharyngeal Carcinoma

Symptoms and signs are often found in nasopharyngeal cancer are:

1. Epistaxis: approximately 70% of patients experience these symptoms, including 23.2% of patients treated with these early symptoms. When sucking strongly secretions from the nasal cavity or nasopharynx, soft palate dorsal part rubbing against the surface of the tumor, so that the blood vessels in the tumor surface was torn and cause epistaxis. Arise mild epistaxis, severe nasal massive hemorrhage can occur.
2. Nasal congestion: often just next door and progressively intensified. This is due to a tumor of the posterior nostril clog.
3. Tinnitus and decreased hearing: the cause is a tumor in faringeus recess and the lateral wall of the nasopharynx infiltrate, pressing the eustachian tubes, causing negative pressures in the tympanic cavity, until there transudative otitis media. For patients with mild symptoms, actions dilatation eustachian tubes can relieve temporarily. The decline in hearing ability due to conduction barriers, generally accompanied by fullness in the ear.
4. Cephalalgia: uniqueness is a continuous pain in the temporoparietal region, or occipital one side. This is often due to the insistence of the tumor, infiltration of cranial nerves or cranial base bone, may also be due to local infection or irritation of the blood vessels which causes cephalalgia reflective.
5. Involuntary cranial nerve: nasopharyngeal cancer, and expansion infiltrate directly into the superior, destruction can cross the cranial base, or through channels or natural gaps cranial, go to petrosphenoid, of the fossa intracranial media (including foramen sphenotic, petrosis apex of the temporal bone, the foramen ovale, and the area spongiosus sine) makes the cranial nerves III, IV, V and VI involuntary, manifested by ptosis of the upper face, paralysis of the eye muscles (including the abduction of its own nerve paralysis), trigeminal neuralgia or temporal area pain due to irritation of the meninges (sphenoidal fissure syndrome), if there also involuntary second cranial nerve, called the orbital apex syndrome or petrosphenoid.
6. Enlarged lymph nodes of the neck: Typical location of lymph nodes metastases is the upper deep coli group, but because the lymph node groups covered surface sternocleidomastoid muscle, and the lump is not painful, it was initially difficult to know. There are some patients with metastatic lymph nodes perama appeared in the region of spiral strands coli accessory in the posterior triangl.
7. Symptoms of distant metastasis: the most frequent location of metastases to the bones, lungs, liver. The most common metastasis to the pelvic bones, vertebrae, ribs and all four extremities. Manifestation of bone metastases is a continuous pain and local tenderness, a fixed location and not arbitrary and gradually intensified. At this phase is not always there is a change in the X-ray, bone scan the entire body can help with the diagnosis. Liver metastases, lung can be very hidden, sometimes discovered when a routine follow-up is done by Xray thorax, liver examinations with CT or ultrasound.

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Disturbed Sleep Pattern, Knowledge Deficit and Anxiety - NCP Nasopharyngeal Carcinoma

Nursing Care Plan for Nasopharyngeal Carcinoma

Nasopharyngeal carcinoma is a malignant tumor derived from epithelial nasopharyngeal mucosa or glands found in the nasopharynx.

Nasopharyngeal carcinoma is the most carcinomas in the ENT.

It was found more in men than in women, with a ratio of 3: 1 by age / average age of 30 -50 years.


1. Nursing Diagnosis for Nasopharyngeal Carcinoma : Disturbed Sleep Pattern related to pain in the head.

Goal: Impaired sleep pattern of patients will be resolved.

Outcomes :

• Patients easily sleep within 30-40 minutes.
• Patients calm and fresh faces.
• Patients can express rested.

Interventions:
1 Create a comfortable and quiet environment.
Rationale: A comfortable environment can help improve sleep / rest.

2 Assess the patient's sleep habits at home.
Rationale: Knowing the change of the things that a patient when sleeping habits will affect the patient's sleep patterns.

3 Assess the causes of sleep disorders such as anxiety, effects of drugs and bustling atmosphere.
Rationale: Knowing the causes of other sleep disorders experienced and perceived patient.

4 Instruct the patient to use at bedtime and relaxation techniques.
Rational: Introduction to sleep will allow the patient to fall into sleep, relaxation techniques will reduce tension and pain.

5. Assess for signs of lack of sleep to meet the needs of patients.
Rationale: To determine whether requirements are met or the patient's sleep due to disruption of sleep patterns so that appropriate action can be taken.




2. Nursing Diagnosis for Nasopharyngeal Carcinoma : Knowledge Deficit: about the disease process, diet, care and treatment related to a lack of information.

Goal: Patient obtaining clear and correct information about the disease.

Outcomes :

• Patients learn about the disease process, diet, care and treatment and able to explain again if asked.
• Patients can perform self-care based on the knowledge gained.

Interventions:
1 Assess the level of knowledge of the patient / family about diabetes disease and Nasopharyngeal Cancer.
Rationale: To provide information on the patient / family, nurses need to know the extent to which the information or knowledge that is known to the patient / family.

2 Assess the patient's educational background.
Rationale: In order for nurses to provide explanations using words and sentences that can be understood according to the level of patient education patient.

3 Explain the disease process, diet, care and treatment in patients with language and words are easy to understand.
Rationale: In order for the information can be received easily and precisely so as to avoid misunderstandings.

4 Describe the procedure performed, the benefits to the patient and involve the patient.
Rationale: With explanatory and there and participate directly in the action taken, the patient will be more cooperative and less anxiety.

5 Use the images to provide an explanation (if there is / enable).
Rational: The pictures can help recall the explanation that has been given.



3. Nursing Diagnosis for Nasopharyngeal Carcinoma : Anxiety related to lack of knowledge about the disease.

Goal: anxiety is reduced / lost.

Outcomes :

• Patients can identify the cause of anxiety.
• Volatile emotions, calm the patient.
• Adequate rest.

Interventions:
1 Assess the level of anxiety experienced by the patient.
Rationale: To determine the level of anxiety experienced by patients so that nurses could provide rapid and appropriate intervention.

2 Give the opportunity for patients to express a sense of anxiety.
Rational: It can lighten the burden of the patient's mind.

3 Use therapeutic communication.
Rationale: To be built up trust between the nurse-patient so that the patient cooperative in nursing actions.

4 Give accurate information about the disease and encourage patients to participate in the act of nursing.
Rationale: Accurate information about the disease and the patient's participation in taking action to reduce the burden of the patient's mind.

5. Give confidence to patients that nurses, physicians, and other health team always strive to provide the best relief and optimal as possible.
Rationale: A positive attitude of the health care team will help reduce the anxiety felt by the patient.

6 Provide opportunities for families to accompany the patient in turn.
Rationale: The patient will feel calmer when there are family members who wait.

7 Create a quiet and comfortable environment.
Rationale: a quiet and comfortable environment can help reduce patient anxiety.

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Nursing Care Plan for Emphysema - Assessment and Diagnosis

Definition of Emphysema

Emphysema is a condition in which the alveoli become stiff expands and continuously filled the air even after expiration. (Kus Irianto.2004.216)

Emphysema is a chronic obstructive disease due to lack of elasticity in the lungs and alveoli surface area. (Corwin.2000.435)


Classification

There are two major types of emphysema, which are classified based on the changes that occur in the lungs:

1. Panlobular (panacinar), ie damage to the respiratory bronchi, alveolar ducts and alveoli. All air space in the little lobes much enlarged, with little inflammatory disease. The characteristics that have chest hyperinflation, and is characterized by dyspnea on exertion, and weight loss.
2. Centrilobular (centroacinar), the pathological changes mainly occur in the center of the secondary lobes, and peripheral of acini remain good. Often there is chaos-ventilation perfusion ratio, which lead to hypoxia, hypercapnia (increased CO2 in the arterial blood), polycythemia and heart failure episodes right. The condition leads to cyanosis, peripheral edema, and respiratory failure.

Etiology

Some things that can lead to pulmonary emphysema, namely:
1. Cigarette
Smoking can lead to pathological disorders of the airway ciliary movement, inhibits the function of alveolar macrophages, causing hypertrophy and hyperplasia of bronchial mucous glands.

2. Pollution
Industry and air pollutants can also cause emphysema. The incidence and mortality rates of emphysema can be said to be always higher in areas with high concentrations of industrialization, air pollution as well as tobacco smoke, can cause interference with cilia inhibits the function of alveolar macrophages.

3. Infection
Respiratory tract infections will cause more severe lung damage. Diseases such as respiratory infections, pneumonia, acute bronchiolitis and bronchial asthma, can lead to airway obstruction, which in turn can lead to emphysema.

4. Genetic

5. Exposure to dust


Clinical Manifestations

• Dyspnea.
• On inspection: chest shape 'barrel chest'.
• Chest breathing, abnormal breathing is not effective, and the use of accessory muscles of respiration (sternocleidomastoid).
• On percussion: hyperresonance and decreased fremitus in all lung fields.
• On auscultation: audible breath sounds with crackles, and expiratory length.
• Anorexia, weight loss, and general weakness.
• Distended neck veins during expiration.

Pathophysiology

Pulmonary emphysema is a lung development, accompanied by tearing of the alveoli that can not be recovered, can be either global or localized, the majority know the whole lung.

Charging excessive air with obstruction, occurs as a result of partial obstruction of the bronchi or bronchioles where the output of the air in the alveoli become more difficult than the input. In such a situation occurs that increases the accumulation of air in the distal alveoli.

In emphysema the narrowing of the airways, it can lead to narrowing of the airway obstruction and tightness, constriction of the airways caused by reduced lung elasticity.


Complication

• Frequent infections of the respiratory tract.
• The immune system is less than perfect.
• The level of lung damage more severe.
• Chronic inflammatory process in the airways.
• Pneumonia.
• Atelaktasis.
• Pneumothorax.
• Increase the risk of respiratory failure in patients.

Nursing Assessment  for Emphysema

1. Activity / Rest
Symptoms: Exhaustion, fatigue, malaise, inability to perform daily activities because of difficulty breathing, inability to sleep, need to sleep sitting up high, dyspnea at rest or in response to activity or exercise.
Symptoms: Fatigue, anxiety, insomnia, general weakness / loss of muscle mass.

2. Circulation
Symptoms: Swelling of the lower extremities.
Signs: Increased blood pressure, increased heart rate / severe tachycardia, dysrhythmias, distended neck veins, edema dependent, not associated with heart disease, heart sounds dim (which is associated with increased AP diameter of the chest), color of skin / mucous membranes: normal or gray / cyanosis, pallor may indicate anemia.

3. Foods / Liquids
Symptoms: Nausea / vomiting, poor appetite / anorexia (emphysema), inability to eat due to respiratory distress, permanent weight loss (emphysema), weight gain showed edema (bronchitis).
Signs: poor skin turgor, dependent edema, sweating, drop in body weight, decrease in muscle mass / fat subcutaneously (emphysema), abdominal Palpitations can cause hepatomegaly (bronchitis).

4. Hygiene
Symptoms: Decreased ability / enhancement needs help doing everyday activities.
Signs: Health less, body odor.

5. Respiratory
Symptoms: Shortness of breath (dyspnea hidden emergence as the prominent symptom of emphysema), especially at work, the weather or the recurrence of episodes of difficult airway (asthma), sense of chest pressure, inability to breathe (asthma)
"Air Hunger" chronic.
Shape settled with sputum production every day (especially when awake) for a minimum of 3 consecutive months each year at least 2 years. Sputum production (green, white and yellow) can be a lot of (chronic bronchitis)
Intermittent episodes of cough is usually not productive at an early stage can occur despite earning (emphysema)
A history of recurrent pneumonia: exposure to chemical pollution / respiratory irritants in the long term (eg, cigarette smoke) or dust / smoke (eg, abscess, or coal dust, sawdust)
The use of oxygen at night or continuously.

Signs: Respiratory: usually fast, slow, use of accessory muscles
Chest: hyperinflation with the elevation of the AP diameter, minimal movement of the diaphragm.
Breath sounds: may dim with expiratory wheezing (emphysema); spreads, soft or crackles, wheezing lungs throughout the area.
Percussion: hyperresonant the lung area
Color: pale with cyanotic lips and nail beds.

6. Security
Symptoms History of allergic reaction or are sensitive to substances / environmental factors, presence / recurrence of infection, redness / sweating (asthma).

7. Sexuality
Symptoms: Decreased libido.

8. Social interaction
Symptoms: The relationship of dependence, lack of support systems, improved inability / long illnesses.
Symptoms: Inability to / make maintaining respiratory sounds, physical mobility limitations, abnormalities with the family members.

9. Counseling / Learning
Symptoms: The use / abuse of drugs breathing, difficulty stopping smoking, regular alcohol use, failure to improve.



Nursing Diagnosis  for Emphysema

1. Impaired gas exchange related to ventilation-perfusion abnormalities secondary to hypoventilation.

2. Excess fluid volume related pulmonary edema.

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Clinical Manifestations and Diagnostic Examination of Cataract

Cataract is the name given to a clouding of the lens resulting in a reduction in visual acuity by a screen which is lowered in the eyes, like seeing the falls.

Type of cataract is the most common senile cataract and senile cataract is a degenerative process (deterioration). The changes coincided with presbyopia, but besides that it also becomes yellow and cloudy color, which would interfere with the refraction of light.

Although the so-called senile cataract but earlier changes can occur in middle age, at the age of 70 years most people have experienced changes in the lens even though it may only cause slight vision impairment.

Etiology of Cataract

• Aging (senile cataract).
• Trauma.
• Other eye diseases (uveitis).
• Systemic disease (diabetes).
• Congenital defect (a hereditary disorder as a result of prenatal viral infection, such as German Measles).

Clinical Manifestations of Cataract

Cataract is diagnosed primarily by subjective symptoms. Usually clients reported a decrease in visual acuity and glare as well as some degree of functional impairment caused by loss of vision earlier. Objective findings usually include condensation pearly gray on the pupil so that the retina would not appear with the ophthalmoscope. When the lens has become opaque, light will be open, be transmitted with a sharp focused image on the retina. The result is blurred vision or dim, glare is annoying eye shadow with distortion and hard look at night. Pupils are normally black will look gray or white.

Diagnostic Examination of Cataract

• Snellen eye chart / tele binocular eye machine: may be impaired by damage to the cornea, lens, aqueous / vitreous humor, refractive error, nervous system disease, vision to the retina.
• Field of vision: the decline may be due to the tumor mass, carotid, glaucoma.
• Tonograph: IOP (12-25 mmHg)
• Gonioscopy measurements from the point distinguishes open-angle glaucoma closed.
• Provocative test: determining the presence / type of glaucoma.
• Ophthalmoscopy: examines the internal structure of the ocular, optic disc atrophy, papilledema, bleeding.
• Complete blood, LED: indicates anemia systemic / infection.
• ECG, serum cholesterol, lipids.
• Glucose tolerance test: controls of DM.

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4 Types, Clinical Manifestations and Management of Thyroid Carcinoma

Thyroid carcinoma including malignant disease group with a relatively good prognosis, but clinical propagation are difficult to predict. Clients with Thyroid Ca experiencing high stress and anxiety. Nurses obtain basic data on the client based on the level of knowledge of the disease, coping skills and family relationships. The nurse encourages the client to express their fears and discuss the disease.

Histological

According to WHO, malignant epithelial tumors of the thyroid are divided into:

• Follicular carcinoma.
• Papillary carcinoma.
• Medullary carcinoma.
• Poorly differentiated carcinoma (anaplastic).
• Others.

According to Mc Kenzi (1971), there are 4 types of different thyroid carcinoma tissues used for day-to-day implementation, namely:

• Papillary thyroid carcinoma.
• Follicular thyroid carcinoma.
• Medullary thyroid carcinoma.
• Anaplastic thyroid carcinoma.

The initial clinical manifestations of thyroid carcinoma is a form of solitude and a nodule in the thyroid gland that is painless. Signs and symptoms depend on the presence or absence of additional metastases as well as the location of metastases (spread of cancer cells) itself.


1. Papillary carcinoma.
Is a type of thyroid cancer that is often found, much to the women or the age group above 40 years. Papillary carcinoma is a slow-growing tumor and can appear many years before spreading to regional lymph nodes. When the tumor is localized in the thyroid gland, the prognosis is good if the action is a partial or total thyroidectomy.

2. Follicular carcinoma.
There is approximately 25% of all existing thyroid carcinoma, especially regarding the age group above 50 years. Attack the blood vessels which then spread to the bone and lung tissue. Rarely spread to the lymph nodes but can be attached / stuck in the trachea, neck muscles, large blood vessels and skin, which then causes dyspnea and dysphagia. When a tumor on "The recurrent laryngeal Nerves", the client becomes hoarse voice. The prognosis is good if the metastases are still little, at the time of diagnosis set.

3. Medullary carcinoma.
Arising in the thyroid parafollicular tissue. The number of 5-10% of all thyroid carcinomas and generally the people aged over 50 years. Spread past the lymph nodes and invade surrounding structures. These tumors often occur and are part of the Multiple Endocrine Neoplasia (MEN) Type II is also part of the endocrine diseases, in which there is excessive secretion of calcitonin, ACTH, prostaglandins and serotonin.

4. Anaplastic carcinoma.
The tumor is growing quickly and outstanding aggressive. This type of cancer directly invading adjacent structures, which give rise to symptoms such as:

• Stridor (sound raspy / hoarse voice sounded loud breath)
• Hoarseness.
• Dysphagia.

The prognosis is bad and most of the clients died about 1 year after diagnosis set. Clients with a diagnosis of anaplastic carcinoma can be treated with palliative surgery, radiation and chemotherapy.


Clinical Manifestations of Thyroid Carcinoma

Clinical suspicion of thyroid carcinoma is based on the observation that was confirmed by pathological examination and suspicion are divided into high, medium and low. Which includes high index of suspicion is:

• History of multiple endocrine neoplasia in the family.
• Rapid tumor growth.
• Palpable hard nodules.
• Fixation surrounding area.
• Paralysis of the vocal cords.
• Enlargement of the regional lymph nodes.
• The presence of distant metastases.

Moderate suspicion:

• Age less than 20 years, or more than 60 years.
• History of neck radiation.
• Sex man with a solitary nodule.
• It is not clear fixation surrounding area.
• Diameter greater than 4 cm and cystic.

Low suspicion:

• Signs or symptoms outside / in addition to that mentioned above

Thyroid carcinoma clinically divided into classes, namely:

• Infra Thyroid.
• Neck glands Spleen metastasis.
• Extra Thyroid invasion.
• Far metastasis.

Clinical symptoms that can be found around the organs suppression, disruption and pain when swallowing, difficulty breathing, hoarseness, cervical lymphadenopathy and distant metastasis can occur. Most often to the lungs, bones and liver.

Management of Thyroid carcinoma

1. Surgery (thyroidectomy).
2. Radiation internal / external.
3. Chemotherapy.
4. Hormonal.
5. Others.

Evaluation

Made by examining fingerprints all over the body, combined with examination tiroiglobulin levels (Tg) serum periodically in the first 3-6 months. Tg is influenced by TSH and is likely to increase if there is residual thyroid gland. Tg levels less than 1 ng ml during the hormone was stopped, suggesting ablation therapy has been successful. Tg is considered as a sign of thyroid carcinoma is quite sensitive but not specific. The level of calcitonin for medullary carcinoma is an indication of metastasis.
Periodic evaluation is very important because thyroid carcinoma which has been declared successful ablation after 5-10 years turns malignant process could arise again. Recommended control 1 year for the first 5 years after total ablation declared successful, then once every 2 years.

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Nursing Diagnosis : Impaired Physical Mobility, Anxiety and Knowledge Deficit

Nursing Care Plan for Guillain-Barre Syndrome


1. Impaired Physical Mobility related to neuromuscular damage.

Goal / Outcomes:
Maintain body function with no complications (contractures, pressure sores).

Nursing Intervention :

Independent

1. Assess the strength of the motor / functional abilities using a scale of 0-5.
R /: Specifies the development / re-emergence of signs that hinder the achievement of goals / expectations of the patient.

2. Provide patient positioning lead to a sense of comfort.
R /: Reduce fatigue, enhance relaxation, reduce the risk of ischemia / damage to the skin.

3. Chock extremities and joints with pillows.
R /: Maintaining the limb in a position fisilogis, prevent contractures and loss of joint function.

4. Perform passive range of motion exercises.
R /: Stimulates circulation, improve muscle tone and increase joint mobilization.

Collaboration

5. Confirm with / refer to the physical therapy / occupational therapy.



2. Anxiety related to situational crisis.

Goal / Outcomes:
Appear relaxed and report anxiety is reduced to the level can be overcome.

Nursing Interventions:

Independent

1. Place the patient near the nurses' station, check the patient regularly.
R /: To provide assurance that immediate assistance can be done if the patient suddenly becomes not have the ability.

2. Provide primary care / nurse relationships are consistent.
R /: Improve mutual trust of patients and help to reduce anxiety.

3. Provide alternative forms of communication if necessary.
R /: Reduce feelings of helplessness and feelings of isolation.

4. Discuss the change in self-image, fear of losing the ability to settle, loss of function, death, problems regarding the need penyebuhan / repair.

Collaboration

5. Provide a brief description of the treatment, the patient's treatment plan, including the closest.
R. /: A good understanding can increase the need for patient cooperation activities and the involvement of patients and also the closest in care planning will be able to maintain some sense of control over themselves for life which will further enhance the self-esteem.



3. Knowledge Deficit related to less remembering, cognitive limitations.

Goal / Outcomes:
Patients know and understand about the disease.

Nursing Interventions:

Independent
1. Determine the patient's knowledge and ability to participate in the rehabilitation process.
R /: Influencing choice of interventions that will be done.

2. Review the patient's knowledge about the disease and its prognosis.
R /: The knowledge base is an important thing to make informed choices and participate in rehabilitation efforts.

3. Suggest to reveal what is in the natural, social, and increase independence.
R /: Increasing returns to normal and the development of his feelings on the situation.

4. Identify safety measures to find defeswit sensory-motor individually.
R /: Reduce the risk of injury / lower the actual risk of complications can still be prevented.

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