Ventricular Septal Defects - 7 Nursing Diagnosis and Interventions

Nursing Care Plan for VSD in Children

1. Decreased Cardiac Output related to cardiac malformations.

Goal: to improve cardiac output.

Outcomes: signs of improvement in cardiac output.

Intervention:

• Observe the quality and strength of the heartbeat, peripheral pulses, skin color and warmth.
• Assess the degree of cyanosis (mucous membranes, clubbing).
• Monitor signs of CHF (anxiety, tachycardia, tachipnea, shortness of breath, tired while drinking milk, periorbital edema, oliguria and hepatomegaly.
• Collaboration for the provision of drugs as indicated.

2. Impaired gas exchange related to pulmonary congestion.

Goal: improved gas exchange.

Outcomes: no signs of pulmonary vascular resistance.

Intervention:

• Monitor the quality and rhythm of breathing.
• Adjust the position of the child with Fowler position.
• Avoid child of an infected person.
• Give adequate rest.
• Give oxygen as indicated.

3. Activity intolerance related to imbalance between oxygen consumption by the body and oxygen supply to the cells.

Goal: client activity are met.

Outcomes: Children participate in activities according to ability.

Intervention:

• Allow the child frequent breaks and avoid disturbances during sleep.
• Suggest to do the game and light activity.
• Help children to choose activities appropriate to the age, condition and capacity of the child.
• Give the period of rest after activity.
• Avoid the ambient temperature is too hot or cold.
• Avoid things that cause fear / anxiety child.

4. Delayed Growth and Development related to an inadequate supply of oxygen and nutrients to tissues.

Goal: There is no change of growth and development.

Outcomes: Growth of children according to the growth curves of weight and height.

Intervention:

• Provide a balanced diet, high nutrients to achieve adequate growth.
• Monitor height and weight.
• Involve the family in providing nutrition to children.

5. Imbalanced Nutrition: less than body requirements related to fatigue at mealtime and increased caloric needs.

Goal: nutritional needs are met.

Outcomes: The child maintains food and beverage intake.

Intervention:

• Measure body weight each day with the same scales.
• Record intake and output correctly.
• Give small portions of food frequently.
• Give drink that much.

6. Risk for infection related to declining health status.

Goal: avoid infection.

Outcomes: no signs of infection.

Intervention:

• Monitor vital signs.
• Avoid contact with infected individuals.
• Give adequate rest.
• Provide optimal nutritional needs.

7. Parental Role Conflict related to hospitalization of children, fears of the disease.

Goal: There is a change in the role of parents.

Outcomes:

• Parents express their feelings.
• Parents are sure to have an important role in the success of the treatment.

Intervention:

• The motivation of parents to express their feelings in relation to the child.
• Discuss with parents about the treatment plan.
• Provide clear and accurate information.
• Involve parents in the care of the child while in hospital.
• The motivation to involve families in the care of other family members of children.

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Impaired Swallowing and Altered Family Processes r/t Newborns with Esophageal Atresia

Nursing Diagnosis and Interventions for Newborns with Esophageal Atresia

Nursing Diagnosis : Impaired Swallowing related to mechanical obstruction.

Goal: Patient getting adequate nutrition.

Outcomes: The baby gets enough nutrients and showed satisfactory weight gain.

Intervention:

• Give fed through gastrostomy in accordance with the provisions.
• Continue oral feeding as applicable, under the conditions of infants and surgical repair.
• With strict observation.
• Monitor input and output weight.
• Teach families about proper feeding techniques.

Rational:

• To meet the nutritional needs of infants
• To assess the adequacy of nutrient inputs.
• To make sure the baby is able to swallow without choking.
• To provide nutrients to allow oral feeding.
• To prepare for the return.

Nursing Diagnosis : Altered Family Processes related to babies with physical defects.

Goal: patient (family) prepared for child care at home.

Outcomes : Families demonstrate the ability to provide care to infants, understanding the signs of complications, and appropriate action.

Intervention:
Teach the family about the skills and needs of nursing home observations:

• Give position.
• Signs of respiratory distress.
• Signs of complications; refusing to eat, dysphagia, increased cough.
• The need for tools and materials needed.
• Gastrostomy care if the infant had surgery, including techniques such as suction, feeding, or ostomy care operasidan side, and a replacement bandage.

Rational

• To prevent aspiration.
• To prevent delays in action.
• So that practitioners can be notified.
• To ensure proper care after discharge.

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Nursing Care Plan for Esophageal Atresia

Esophageal atresia occurs in about one in 3000-4500 live births, one third of affected children are usually born prematurely. In over 85% of cases, a fistula between the trachea and distal esophageal, accompanying atresia. Very rarely, esophageal atresia or tracheal esophageal fistula occur alone or with a strange combination. Esophageal atresia is a congenital abnormality include group consisting of disruption of continuity of the esophagus with or without connection to the trachea. Infants with Esophageal Atresia is unable to swallow saliva and marked with a bunch of very large amount of saliva and requires suction repeatedly.

The possibility of atresia increased with the discovery of polyhydramnios. Nasogastric tube can still be passed at the time of birth of all babies are born with maternal polyhydramnios as well as infants with excessive mucus, soon after the birth to prove or disprove the diagnosis. In esophageal atresia hose will not pass more than 10 cm from the mouth (confirmation with Rongent chest and abdomen).

Until now not known what teratogenic substances that can cause abnormalities Esophageal Atresia, just reported recurrence rate of about 2% if one of the affected siblings. But now, the theory about the occurrence of esophageal atresia according to most experts no longer associated with a genetic disorder. The debate on embryo-pathological process continues, and only a little is known.

The triggers that cause congenital birth as esophageal atresia are as follows:

• In the case of polyhydramnios.
• Preterm infants.
• If the catheter is used for resuscitation at birth can not enter into the stomach.

There are some circumstances that the symptoms and signs of esophageal atresia, among others:

• Mouth foaming (bubbles of air from the nose and mouth) and saliva from the mouth of a baby is always melted.
• Cyanosis.
• Cough and shortness of breath.
• Symptoms of pneumonia caused by regurgitation of saliva from the esophagus were clogged and regurgitation of gastric fluid through the fistula into the airway.
• Abdominal bloating or bulge, because the air through the fistula into the stomach and intestines.
• Oliguria, because there is no fluid intake.
• Usually accompanied by other congenital abnormalities, such as heart defects, atresia of the rectum or anus.
• The presence of aspiration when the baby is drinking.
• Projectile vomiting.

Nursing Diagnosis for Esophageal Atresia

1. Impaired swallowing related to mechanical obstruction.
2. Risk for injury related to surgical procedures.
3. Anxiety related to difficulty swallowing, discomfort due to surgery.
4. Altered family processes related to children with physical defects.

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Thyroid Cancer - 3 Nursing Diagnosis and Interventions

Nursing Care Plan for Thyroid Cancer

Thyroid cancer is a malignancy of the thyroid which has 4 types, namely: papillary, follicular, medullary and anaplastic. Thyroid cancer rarely causes enlargement of the gland, often causing small growth (nodule) in the glands. Most thyroid nodules are benign, thyroid cancer can usually be cured.

Thyroid cancer often limits the ability to absorb iodine and limit the ability to produce thyroid hormone, but sometimes produce enough thyroid hormone resulting in hyperthyroidism.

Thyroid cancer occurs in cells of the thyroid gland, which produces hormones serve to regulate the speed of the heart beat, blood pressure, body temperature and weight.

Nursing Diagnosis for Thyroid Cance

1. Ineffective airway clearance related to obstruction of the trachea by the pressure of the tumor mass.
2. Pain (acute / chronic) related to the presence of pressure / swelling of the tumor nodule.
3. Impaired verbal communication related to vocal cord injury.

Nursing Interventions and Rationale

1. Ineffective airway clearance related to obstruction of the trachea by the pressure of the tumor mass.

Goal: Effective airway.

Outcomes:

• There is no difficulty breathing.
• Easy exit discharge.
• Not complaining of shortness of breath.
• Respiration in the normal range (16-20).

Interventions :

• Monitor respiratory rate, depth and breath work.
• Auscultation of breath sounds, note the presence of crackles.
• Assess for dyspnea, stridor and cianosis.
• Note the quality of breathing.
• Collaboration of oxygen therapy if necessary.

Rationale :

• To determine the presence of early complications.
• To determine the presence of crackles or not.
• Knowing the client's breathing.
• Preventing the occurrence of dyspnea.
• Helping clients breathing.

2. Pain (acute / chronic) related to the presence of pressure / swelling of the tumor nodule.

Goal: reduced pain.

Outcomes:

• Pain reported lost / diminished.
• Pain scale: 0-2.
• Looks relax.
• There are no complaints to swallow.

Interventions :

• Observe for signs of pain both verbal and nonverbal.
• Teach and instruct the patient to use relaxation techniques.
• Collaboration of analgesics.

Rationale :

• Anticipate if there is pain.
• Provide comfort to the client.
• To reduce pain.

3. Impaired verbal communication related to vocal cord injury.

Goal: verbal communication breakdowns resolved.

Outcomes:

• Being able to create a method of communication in which needs can be understood.

Interventions :

• Assess speech function periodically.
• Keep communication simple.
• Provide appropriate alternative communication methods.

Rationale :

• To determine the condition of the client.
• In order not to force the client to speak.
• Adjust to the client's condition.

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Postpartum Hemorrhage - 5 Nursing Diagnosis and Interventions

Nursing Care Plan for Postpartum Hemorrhage

Nursing Diagnosis forPostpartum Hemorrhage

1. Fluid volume deficit related to vaginal bleeding.
2. Ineffective tissue perfusion related to vaginal bleeding.
3. Anxiety / fear related to changes in circumstances or the threat of death.
4. Risk for infection related to bleeding.
5. Risk for shock : hypovolemic related to bleeding.

Nursing Diagnosis 1. Fluid volume deficit related to vaginal bleeding.

Goal : Prevent dysfunctional bleeding and improve fluid volume.

Interventions and Rationale :
1. Advise patients to sleep with feet higher, while the body remained supine.
R / : With feet higher will increase the venous return , and allowing the blood to the brain and other organs.

2.Monitor vital signs.
R / : Changes in vital signs when bleeding occurs more intense.

3.Monitor intake and output every 5-10 minutes.
R / : Change the output is a sign of impaired renal function.

4. Evaluation of the urinary bladder.
R / : Full urinary bladder prevents uterine contractions.

5. Perform uterine massage with one hand and the other hand placed above the simpisis.
R / : Uterine massage stimulate uterine contractions and helps release the placenta, one hand above simpisis prevent inversion uterine.

6. Limit vaginal and rectal examination.
R / : Trauma that occurs in the vagina and rectum increases the incidence of bleeding was greater, in case of laceration of the cervix / perineal, or there is a hematoma.
When the blood pressure decreases, pulse became weak, small and fast, the patient feels sleepy, more intense bleeding, immediate collaboration.


Nursing Diagnosis 2. Ineffective tissue perfusion related to vaginal bleeding.

Goal : Vital signs and blood gases within normal limits.

Interventions and Rationael :
1. Monitor vital signs every 5-10 minutes.
R / : Changes in tissue perfusion causing changes in vital signs.

2. Note the discoloration of the nail, lip mucosa, gums and tongue, skin temperature.
R / : With vasoconstriction and relationship to vital organs, circulation in peripheral tissues is reduced, causing cyanosis and cold skin temperature.

3. collaboration :
Monitor blood gas levels and pH (changes in blood gases and pH levels are a sign of tissue hypoxia)
Give oxygen therapy (oxygen transport is needed to maximize circulation to tissue).


Nursing Diagnosis 3. Anxiety / Fear related to changes in circumstances or the threat of death.

Goal : The client can verbalize anxiety and said anxiety is reduced or lost.

Interventions and Rationael :
1. Assess the client's psychological response to the post- childbirth bleeding.
R / : Perceptions of client influence the intensity of anxiety.

2. Assess the client's physiological responses (tachycardia, tachypnea, shaking).
R / : Changes in vital signs lead to changes in the physiological responses.

3. Treat the patient calm, empathetic and supportive attitude.
R / : Provide emotional support.

4. Provide information about care and treatment.
R / : Accurate information can reduce the anxiety and fear of the unknown.

5. Help clients identify a sense of anxiety.
R / : The expression can reduce feelings of anxiety.

6. Assess the client's coping mechanisms used.
R / : Prolonged Anxiety can be prevented with proper coping mechanisms.


Nursing Diagnosis 4. Risk for infection related to bleeding.

Goal : Not an infection (lochia is no smell , and vital signs within normal limits)

Interventions and Rationale :
1. Note the changes in vital signs.
R / : Changes in vital signs (temperature) is indicative of infection.

2. Note the signs of fatigue, chills, anorexia, uterine contractions were flabby, and pelvic pain.
R / : The signs are an indication of the occurrence of bacteremia, shock is not detected.

3. Monitor uterine involution and lochia spending.
R / : Uterine infection, inhibit involution and lochia spending prolonged occurs.

4. Consider the possibility of infection in other places, such as respiratory infections, mastitis and urinary tract.
R / : Infection elsewhere worsen the situation.

5. Collaboration :
Give iron (anemia aggravate the situation).
Give antibiotics (antibiotics are necessary for the proper state of infection).

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Nursing Care Plan for Premature Babies

Newborn infants with gestational age 37 weeks or less at birth is called premature babies. Although small, premature infants in size according to pregnancy, but the development of intra-uterine rudimentary, can cause complications during the post-natal. Newborns whose weight was 2500 grams, or less with a gestational age of more than 37 weeks is called small for gestational age, is different from the premature, although 75 % of neonates whose weight was below 2500 grams born prematurely.

Clinical problems occur more often in premature infants than in full-term infants. Prematurity caused immaturity system development and function, restricting the infant's ability to cope with the problem of disease.

A common problem among others ; respiratory distress syndrome (RDS), necrotizing enterocolitis, hyperbilirubinemia, hypoglycemia, thermoregulation, patent ductus arteriosus (PDA), pulmonary edema, intraventricular hemorrhage. Another additional stressor in infant and parents include hospitalization for illness in infants. Parental responses and coping mechanisms they can cause interference in the relationship between them. Necessary planning and adequate measures for these problems.


Etiology and Precipitating Factors :

Problems in the mother during pregnancy :

• Diseases / disorders such as hypertension, toxemia, placenta previa, placental abruption, cervical incompetence, multiple fetuses, malnutrition and diabetes mellitus.
• Low socioeconomic level and inadequate prenatal care.
• Preterm labor, or induced abortion.
• Abuse consumption in the mother, such as ; drugs, alcohol, smoking and caffeine.

Assessment
1. History of pregnancy.
2. Status of the newborn.
3. Physical examination head to toe, including : cardiovascular, gastrointestinal, integument, musculoskeletal, neurologic, pulmonary, renal, reproduction.
4. Supporting data

• X-ray of the chest and other organs to determine the presence of abnormalities.
• Ultrasonography to detect abnormalities of organs.
• Stick glucose to determine glucose levels decrease.
• Serum calcium levels, decreased levels means there is hypocalcemia.
• Bilirubin levels, to identify improvement (due to premature are more sensitive to hyperbilirubinemia)
• Electrolyte levels, blood gas analysis, blood type, blood culture, urinalysis, fecal analysis, and so forth.

Nursing Diagnosis

1. Risk for respiratory distress related to immaturity of the lungs, with decreased production surfactan that cause hypoxemia and acidosis.

2. Risk for hypothermia or hyperthermia related to prematurity or changes in ambient temperature.

3. Imbalanced nutrition less than body requirements related to inadequate glycogen reserves, iron, and calcium and loss of glycogen stores due to the high rate of metabolism, inadequate intake of calories, and lose calories.

4. Fluid and Electrolyte imbalances related to immaturity, radiation environment, the effect fototherapy or loss through the skin or lungs.

5. Risk for infection related to immunologic immaturity of the baby and the possibility of infection from mothers or medic / nurse.

6. Risk for impaired skin integrity related to immaturity and fragile skin.

7. Impaired sensory perception : visual, auditory, kinesthetic, gustatory, tactile and olfactory related to less stimulation or excessive in the intensive care environment.

8. Knowledge Deficit (family) about treatment of the sick infant at home.

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Care Plan Examples for Community Health Nursing

Nursing Care Plan - Community Health Nursing


Community is a social group who live in a place, interacting with each other, know each other and have the same interests. Communities are groups of people who live in the same location with the same under the rule, the area or the same location where they live, the social groups that have the same interest.

Health care is a specialized field of nursing which is a combination of science nursing, public health sciences and social sciences are an integral part of the health care provided to individuals, families, groups and communities either healthy or sick comprehensively through promotive, preventive , curative and rehabilitative and resocialization, involving the active participation of the community. Active participation with community health teams are expected to know the health problems faced and solved the problem.

Public health targets are individuals, families / groups and communities, with a focus on primary health efforts, secondary and tertiary. Therefore, public education about the health and social development will help the community in encouraging the spirit to care for themselves, independent living and self-determination in creating optimal health status.

Public participation is required in the individual case. Community as the subject and object of society is able to recognize expected, took the decision to maintain good health. Most of the primary health care goals of society are expected to be able to independently maintain and improve the health status of the community.


Assessment 

Community profile assessment framework (modified)

This assessment is the result of a modification of some previous theories about the community assessment.

Data collection

The data collection is intended to obtain information about health problems in the community to determine which actions should be taken to resolve the issue concerning the physical, psychological, social, economic, spiritual and environmental factors that influence.

Data collection can be done in the following way:

1. Interview or anamnesis

The interview is a mutual communication activities in the form of questions and answers between the nurse with the patient or the patient's family, the community on matters relating to the patient's health problems. Interviews should be conducted with a friendly, open, use simple language and easily understood by the patient or the patient's family, and subsequent interviews or anamnesis recorded in the format of the nursing process.

2. Observations

Observations conducted in community nursing covers aspects of physical, psychological, behavioral and attitude in order to nursing diagnosis. Observations were made using the five senses and the results are recorded in the format of the nursing process.

3. Physical examination

In one community nursing where nursing care is provided nursing care family, the physical examination were performed in an effort to help nursing diagnosis by means of inspection, percussion, auscultation and palpation.



Data processing

Once the data is obtained, the next activity is the processing of data in the following way:

• Classification of the data or categories of data.
• Calculation of percentage of coverage.
• Tabulation of data.
• Interpretation of the data.

Data analysis

Data analysis is the ability to associate the data with the cognitive abilities possessed that can be known about the gaps or problems faced by the community if it's a problem of health, or nursing problems.

1. Determination of the problem or the formulation of health problems

Based on the analysis of the data can be known health and nursing problems faced by the community, and can be formulated hereinafter intervention. However, the problem has been formulated not to be overcome at once. Therefore we need a priority issue.

2. Priority issues

In determining priority public health issues and nursing need to consider various factors such as the criteria are:

• Public attention.
• Prevalence.
• The severity of the problem.
• Possible problems to be overcome.
• Availability of community resources.
• Political aspects.

Selection or screening community health problems, according to the format Mueke (1988) have screening criteria, among others:

• In accordance with the role of community nurses.
• The amount at risk.
• The magnitude of the risk.
• The possibilities for health education.
• The public interest.
• Possibility to overcome.
• In accordance with the government program.
• A resource.
• Time resources.
• Funding resources.
• Equipment resources.
• Human resources.

Nursing Diagnosis

Nursing diagnosis is the individual's response to health problems whether actual or potential. The actual problem is a problem that is obtained at the time of assessment, while the potential problems are problems that may arise later. So the nursing diagnosis is a statement that is clear, concise and definite about the status and health problems that can be addressed by nursing actions. Thus nursing diagnosis is determined based on problems found. Nursing diagnosis will give an overview of public health issues and the status of both the real (actual), and which may occur.


Nursing Care Plan

Planning nursing is nursing action plans to be implemented to address the problems within their nursing diagnosis has been determined with the aim of fulfilling the needs of the client. So public health nursing care plan is based on pre-defined nursing diagnoses and nursing plan drawn up should include the formulation of objectives, plans nursing actions to be performed and the criteria for assessing the results of the achievement of objectives.

The steps in the planning of public health nursing are as follows:

• Identify alternative nursing actions.
• Set techniques and procedures to be used.
• Involve community participation in planning through village community consultation activities, or mini workshops.
• Consider the community resources and facilities available.
• Actions to be implemented must be able to meet the requirement, which was felt by the public.
• Leads to the objectives to be achieved.
• Action must be realistic.
• Arranged sequentially.

References :

(Mubarak, 2005).
(Elisabeth, 2007).
(Riyadi, 2007).

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