Nursing Diagnosis and Interventions for Morbid Obesity

Morbid obesity is a multifactorial disease, which occurs due to excessive accumulation of fat tissue, so as to disturb the health. Obesity occurs when a large and growing number of fat cells in a person's body. When a person to gain weight, the fat cell size will increase and then the numbers increased. Research to study a variety of hormones and the neuroendocrine system, which regulates energy balance and body fat is a long standing challenges in the field of biology, with obesity as an important public health focus. Today we live in an era when more weight (body mass index (BMI) 23-24.9 kg / m2) and obese (BMI 25-30 kg / m2) has become an epidemic, with allegations that the increased prevalence of obesity will reach 50% in 2025 for developed countries.

Actual current health worker must appear together more and more to know about the regulation of body weight, the mechanism of the development of overweight and obese, and the number of comorbidities associated with almost all subspecialty. Because only by studying it we can conduct a comprehensive approach to effective treatment for obesity.




Nursing Diagnosis and Interventions for Morbid Obesity

1. Imbalanced Nutrition: more than body requirements related to the increase in the intake of nutrients.

Interventions:

• Create a meal plan with the patient.
• Measure body weight per day.
• Emphasize the importance of realizing full and stop inputs.
• Give liquid diet, softer, high in protein and fiber and low in fat with the addition of liquid as needed.
• Refer to a dietitian
• Encourage clients to do a lot of activities.

Rationale:

• After the act of division, decreased gastric capacity of approximately 50 ml, so the need to eat a little.
• Supervision loss and nutritional needs.
• Overeating may cause nausea / vomiting.
• Provide nutrients without adding calories.
• Need help planning a diet that meets the nutritional needs.
• Do a lot of activities can burn more calories.

2. Ineffective breathing pattern related to a decrease in lung expansion.

Goal: breathing pattern becomes effective.

Expected outcomes:

• Maintain adequate ventilation.
• Not experiencing cyanosis or other signs of hypoxia.

Interventions:

• Monitor the speed / depth of breath. auscultation of breath sounds.
• Investigate cyanosis, increased restlessness.
• Elevate the head of the bed 30 degrees.
• Encourage deep breathing exercises.
• Change position periodically and ambulation as early as possible.
• Give supplemental oxygen.
• help the patient use breathing apparatus.
• Monitor pulse oximetry when indicated.

Rationale:

• Respiratory snore decrease ventilation, can cause hypoxia.
• Encourage the development of the diaphragm or lung expansion and minimize the maximum pressure in the abdominal contents.
• Increase the maximum lung expansion and airway clearance.
• Increase air filling the entire segment of the lung, mobilize and remove secretions.
• Maximizing preparations for the exchange of oxygen and decreased breath work. Increase lung expansion, lowering atelectasis.
• Show ventilation / oxygenation and acid-base status, used as a basis for evaluating the need for respiratory therapy.

3. Activity intolerance related to being overweight.

Goals: The need to move fulfilled.
Expected outcomes:

• Physical activity increases.
• Normal ROM.
• The client can perform the activity.

Interventions:

• Create a schedule of activities to do and ask the client to do it with discipline.
• Help the client to engage in activities that hard to do.
• Make sure the client motivation to sustain the movement.
• Encourage the client perform normal daily activities, according to ability.
• Collaboration with physiotherapy.

Rationale:

• Reduce stiffness and familiarize the client activity.
• Help clients to more easily perform the activity.

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Nursing Management for Necrotizing Enterocolitis

Necrotizing Enterocolitis (NEC) is a serious disease of the newborn gastrointestinal tract, characterized by extensive tissue death occurs in the intestinal wall. The disease is becoming one of the problems in neonates with very low birth weight (VLBW infants). In general, NEC is more common in premature neonates than full-term neonates. Risk factors causes of NEC are premature birth, early enteral feeding, the intestinal mucosal injury, and the presence of bacteria in the intestine.

Causes

This disease most often appears in sick neonates, and is a surgical emergency that occurs most frequently among neonates. Necrotizing enterocolitis is a disease that predominantly occurs in preterm neonates. In the premature neonate, there is a lowering immunocompetence, immaturity of the gastrointestinal tract, and abnormalities of peristalsis. This can lead to maldigestion and malabsorption of nutrients that stimulate the growth of bacteria, colonization and intestinal ischemia in premature neonates. Moreover, cardiorespiratory instability, homeostatic, and poor blood flow autoregulation, causing premature neonates more susceptible to ischemic events, or hypoxia and put them at risk for NEC.


Predisposing Factors

• Low birth weight and preterm.
• Neonates with asphyxia.
• Neonates with respiratory distress syndrome / recurrent apnea.
• Neonates born PRM or other perinatal infections.
• Neonates with umbilical vein catheterization.
• Cyanotic congenital heart disease.
• Hypothermia, hypotension and other general state of disorder.

Clinical Manifestation

Symptoms that appear on the NEC may occur suddenly but onset usually occurs in 1-2 weeks after birth and can occur up to several weeks. NEC onset inversely related to gestational age, where neonates born at 28 weeks tend to suffer from the disease is greater than in more mature age neonates.

Here are some of the clinical picture shown by the neonate:

• Aspirate / bilious vomiting.
• Food intolerance.
• Bloody stools.
• Distension and abdominal pain may progress to the stage of perforation with an overview: Abdominal pain increases. Abdominal wall hard and looked pale. Edema of the abdominal wall. Bowel sounds disappear. There are abdominal mass.
• Sepsis with clinical features: temperature instability. Jaundice. Apnea and bradycardia. Lethargy. À hypoperfusion shock (Lissaueur Tom and Avroy Fanaroff: 86).

Nursing Management for Necrotizing Enterocolitis

Basic principles of nursing management of NEC is planning nursing care in acute abdomen with the threat of septic peritonitis. The aim is to prevent worsening of the disease, intestinal perforation, and shock. If NEC occurs in epidemic group, the patients should be considered for isolation.


1. General Care
Neonates treated in an incubator in a private room with a notice of action aseptic / antiseptic. Monitoring of vital signs carried out continuously, fluid and electrolyte balance properly recorded and performed abdominal x-ray.

2. Rest Intestine
Oral feeding was stopped, decompression of the stomach by placing orogastric tube (evidence level III, level B recommendation). Lavement given when the neonate has not defecation.

3. Nutrition: Parenteral and Enteral.

4. Antibiotics.

5. Acidosis.

6. Disseminated intravascular coagulation
This situation can be suspected when: Low hematocrit. Low platelets. Prothrombin time elongated. Thromboplastin time elongated. Decreased fibrinogen.

7. Surgery.

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Sample Nursing Care Plan for Uterine Prolapse (Post Operative)

Uterine Prolapse (Post Operative)

Assessment

Subjective Data:

• Pain in the area of operation.
• Tired.
• Dizzy.
• Nausea, bloating.

Objective Data :

• There is a wound in the groin.
• Fasting.
• Mucous membranes dry mouth.

Possible Nursing Diagnosis for Uterine Prolapse (Post Operative)

1. Acute pain related to the surgical wound.
2. Risk for fluid volume deficit related to vomiting after surgery.
3. Impaired skin integrity related to the surgical wound.
4. Risk for hypertermia related to surgical wound infection.
5. Knowledge deficit: surgical wound care related to lack of information.

Nursing Interventions for Uterine Prolapse (Post Operative)

1. Acute pain related to the surgical wound.

Goal: Pain disappeared after the act of nursing.
Expected outcomes:

• Pain is reduced gradually.

Interventions:

• Assess the patient's pain intensity.
• Observation of vital signs and patient complaints.
• Place the patient on a bed with a technique that is appropriate to the surgery performed.
• Give the sleeping position that is fun and safe.
• Instruct the patient to immediately move gradually.
• Give appropriate analgesic therapy medical program.
• Take action with the child nursing care.
• Teach relaxation techniques.

2. Risk for fluid volume deficit related to vomiting after surgery.

Goal: There is no shortage of fluid volume.
Expected outcomes:

• Elastic skin turgor, not dry,
• No nausea and vomiting.

Interventions:

• Observation of vital signs every 4 hours.
• Monitor the infusion.
• Give drink and eat gradually.
• Monitor for signs of dehydration.
• Monitor and record the fluid in and out.
• Measure body weight per day.
• Record and inform the doctor about vomiting.

3. Impaired skin integrity related to the surgical wound.

Goal: Damage to skin integrity is resolved.
Expected outcomes:

• The surgical wound is clean, dry, no swelling. no bleeding.

Interventions:

• Observation of the state of the surgical wound of signs of inflammation: fever, redness, swelling and discharge.
• Treat the wound with sterile technique.
• Keep around the surgical wound.
• Give nutritious foods and encourage patients to eat.
• Involve the family to keep the clan surgical wound environment.
• Teach family in the care of the surgical wound.

4. Risk for hypertermia related to surgical wound infection.

Goal: Hyperthermia is resolved.

Expected outcomes:

• The surgical wound is clean, dry, not swollen. no bleeding.
• The temperature in the normal range (36-37 ° C).

Interventions:

• Observation of vital signs every 4 hours.
• Give appropriate antibiotic therapy medical program.
• Give a warm compress.
• Monitor the infusion.
• Ambulatory surgical wound with sterile technique.
• Keep the surgical wound.
• Monitor and record the fluid in and out.

5. Knowledge deficit: surgical wound care related to lack of information.

Goal: The client knows how to take care of the surgical wound.

Expected outcomes:

• Parents understand the operation wound care.
• Parents can maintain cleanliness and surgical wound treatment.

Interventions:

• Teach parents how to care for the surgical wound and keep it clean.
• Discuss about the wishes of the family wanted to know.
• Allow the patient's family to ask.
• Explain about the care of patients at home, do not wet and dirty bandage.
• Suggest to continue treatment / take medication regularly at home, and control back to the doctor.

Evaluation

1. Obtain pain relief.
2. Patients receive adequate fluid intake volume.
3. Improved patient skin integrity.
4. Good skin turgor.
5. The client's body temperature within normal limits.
6. Gain knowledge about uterine prolapse and treatment program.
7. Mentions how the surgical wound care is good and right.

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Nursing Diagnosis and Interventions for Mental Retardation

Nursing Diagnosis and Interventions for Mental Retardation

1. Delayed Growth and Development r / t abnormalities in cognitive function.

Goal: Growth and development goes according to stages.

Interventions :

• Assess the factors causing developmental disorders of children.
• Identification and use of educational resources to facilitate optimal child development.
• Provide stimulation activities, according to age.
• Monitor the patterns of growth (height, weight, head circumference and refer to a dietitian to obtain nutritional intervention)

2. Impaired Verbal Communication r / t delayed language skills of expression and reception.

Goal: Communication fulfilled in accordance stages of child development.

Interventions:

• Improve communication verbal and tactile stimulation.
• Give repetitive and simple instructions.
• Give enough time to communicate.
• Encourage continuous communication with the outside world, for example: newspapers, television, radio, calendar, clock.

3. Risk for Injury r / t aggressive behavior / uncontrolled motor coordination.

Goal: Indicates changes in behavior, lifestyle to reduce risk factors and to protect themselves from injury.

Intervention:

• Provide a safe and comfortable position.
• Difficult child behavior management.
• Limit excessive activity.
• Ambulate with assistance; give special bathroom.

4. Impaired social interaction r / t trouble speaking / social adaptation difficulties

Goal: Minimize disruption of social interaction.

Intervention:

• Help children identify personal strengths.
• Give knowledge to people nearby, about mental retardation.
• Encourage children to participate in activities with friends and other family.
• Encourage the children to maintain contact with friends.
• Give positive reinforcement on the results achieved by children.

5. Family processes, Interrupted r / t have children mental retardation.

Goal: Family show an understanding of the child's illness and its treatment

Intervention:

• Assess understanding family about the child's illness and treatment plan.
• Emphasize and explain other health team, about the child's condition, procedures and therapies are recommended.
• Use every opportunity to improve understanding of the disease and its treatment family
• Repeat as often as possible information.

6. Self-care deficit r / t the physical and mental incompetence / lack of maturity development.

Goal: Perform self-care, appropriate age and developmental level of the child.

Intervention:

• Identification of the need for personal hygiene and provide assistance as needed.
• Identification of difficulties in self-care, such as lack of physical movement, cognitive decline.
• Encourage children to do their own maintenance.

Education for parents:

• For each stage of child development ages.
• Support the involvement of parents in child care.
• Anticipatory guidance and management face a difficult child behavior.
• Inform the existing educational facilities and groups, etc.

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