Rehabilitation Therapy for Stroke

Disability caused by the stroke, depending on which part is damaged, and how extensive the damage.

In general, defects that arise can be grouped into five, among others:

• Paralysis or impaired movement set (motor)
• Disturbance of taste (sensory), including pain
• Language disorder (aphasia)
• Impaired thinking or memory (memory)
• Emotional disturbances.

In order to overcome the problems mentioned above, then the post-stroke rehabilitation process will perform in a holistic therapy and variations, such as physical therapy, occupational therapy, speech therapy, counseling and spiritual guidance.

Let us identify what is being done therapy at rehabilitation

What is Physical Therapy?

Physical therapy or better known as a physiotherapist, is part of the Medical Rehabilitation Teams that play a role in the training of patients with abnormal posture, movement disorders and muscle problems. Physiotherapist tasks are: To assist patients in performing exercise or muscle manipulation in accordance with patients' problems, such as muscle strengthening exercises, hydrotherapy, balance and coordination exercises, stretching exercises etc.. Help patients cope with muscle problems with the tools for instruction specialist physiotherapy.

What is Occupational Therapy?

Occupational Therapy is part of a team that plays a role in Medical Rehabilitation: Helping the patient to perform fine motor movements. Train the patient in performing activities of daily living such as moving from sitting to standing, bathing, dressing, eating, etc.. Train the patient to make adaptive movements with various tools. Assist the patient in the process of returning to work.

What is Speech Therapy?

Is part of a team that plays a role in Medical Rehabilitation: Helping the patient to communicate to aid communication with exercises such as pronunciation (articulation) or with a communication tool. Help patients with swallowing disorders (dysphagia) with training / special maneuvers to facilitate the process of swallowing.

Counseling Psychology

Help provide mental support for the patient while the patient is depressed. A test of intellectual (IQ tests) when needed.

Medical Social Officer

To evaluate patient residence and employment and provide education to organize an easier place to live according to the condition of the patient performs the activity of the patient. Helped find donors when there are patients who require a fee. If necessary, helping patients to gain skills in accordance with the patient's condition, to be used for livelihood.

Spiritual director can help to support mental patients in the religious field.

Read More »

Impaired Physical Mobility related to Stroke

Nursing Diagnosis for Stroke: Impaired Physical Mobility

A stroke is also referred to as a brain attack, and it occurs when a blood vessel leading to the brain ruptures or gets blocked due to plaque deposits. When plaque accumulates on the wall of arteries, it is known as arthrosclerosis.

A stroke leads to several complications because the patient experiences weakness, paralysis and they cannot perform daily living activities. Their quality of life reduces, as they cannot shop, socialize and feed themselves. A stroke also leaves a person with visual defects and this causes them to eat their meals partially. They will consume just what they can see. The visual orientation might get affected from left to right. A visual problem can lead to the grave neglect of food and diet, and leaves a deficit in their nutrition.

Strokes affect millions of individuals around the United States each year, claiming more than 150,000 lives annually. Of those who survive, about one-third suffers from permanent disabilities. For decades, physicians have noticed that strokes impact men and women differently, though no conclusive study has discovered the reason.


Impaired Physical Mobility related to Stroke

Nursing Diagnosis for Stroke: Impaired Physical Mobility related to the involvement of neuromuscular weakness.

Expected outcomes are:

• Maintain the optimal position of function as evidenced by the lack of footdrop contracture.
• Maintain / improve strength and function of the affected body part or compensation.

Nursing Interventions for Stroke - Impaired Physical Mobility

1. Assess functional ability / extent of initial damage by way of regular, classified by scale of 0-4.

Rational: To identify strengths, weaknesses and can provide information through the recovery.

2. Change position at least every 2 hours (back, oblique) and if possible more often if placed in a compromised position.

Rational: Lowering the risk of trauma / ischemia area damaged tissue is more bad circulation and decrease of sensation and minimize pressure sores.

3. Put on the tummy one or two feet a day if the patient can tolerate it.

Rationale: Helps to maintain a functional hip extension.

4. Perform the exercise of active and passive range of motion.

Rationale: Minimizing muscle atrophy helps increase circulation mensegah contractures.

5. Chock limb in a functional position, use a board foot (food board) during the period of paralysis flaksid, maintaining a neutral head position.

Rational: To prevent contractures (foot drop) and facilitate their role if it works again.

6. Use the support arm when the patient is in an upright position, as indicated.

Rationale: During paralysis flaksid use of buffers can reduce the risk of subluksasio arm and shoulder arm syndrome.

7. The position of the knee and hip in extension position.

Rationale: Maintaining a functional position.

8. Collaboration / consultation with physiotherapists actively resistive exercises and ambulation.

Rationale: a special program can be developed to determine / find a need, which means / avoid these shortcomings in the balance, coordination and strength.

Read More »

Hemorrhoids

Hemorrhoids are massive clumps or cushions of tissue caused by swollen veins in the anal canal. Most people think this condition is abnormal but it is actually very common among men and women. This problem is most often not life threatening but can be painful.

Hemorrhoids are a very common health problem. Hemorrhoids cause serious problems in about 4% (over 10 million) of people in the United States. Prevalence of hemorrhoidal disease increases with age until the seventh decade and then diminishes slightly. Hemorrhoids also increase in pregnancy due to direct pressure on the rectal veins.

The anal canal contains a rich network of arteries that give it a constant supply of blood. This explains why bleeding from hemorrhoids is bright red rather than dark red, and why bleeding from hemorrhoids sometimes can be severe.

Causes

Most common causes of hemorrhoids:

• straining with bowel movements (from constipation or hard stools)
• diarrhea
• constant sitting
• sitting on the toilet for a long time
• childbirth
• pressure of the fetus in pregnant women
• heavy lifting
• familial tendency
• obesity

Types

If the hemorrhoid occurs inside the rectum, it is referred to as an internal hemorrhoid. If it originates at the lower end of the anal canal near the anus, it is referred to as an external hemorrhoid.

Most people do not know they have internal hemorrhoids since they are painless and cannot be seen. External hemorrhoids however can get irritated and clot under the skin, causing a pain.

Symptoms

Symptoms of hemorrhoids include:

• rectal bleeding
• pain around the anus and rectum
• irritation and itching
• bulge or lump at the anus

Physicians use a grading system to describe the severity of hemorrhoids:

1st degree - Hemorrhoids that bleed but do not prolapse.

2nd degree - Hemorrhoids that prolapse and retract on their own (with or without bleeding).

3rd degree - Hemorrhoids that prolapse but must be pushed back in by a finger.

4th degree - Hemorrhoids that prolapse and cannot be pushed back in.




Nursing Diagnosis for Hemorrhoids Before Surgery

1. Acute Pain

2. Risk for Constipation


Nursing Diagnosis for Hemorrhoids After Surgery

1. Acute pain: the surgical wound

2. Activity intolerance

3. Knowledge Deficit

4. Risk for Infection

Read More »

Nursing Care Plan for Angina pectoris - 4 Diagnosis and Interventions

1. Acute Pain related to myocardial ischemia

Nursing interventions:

• Review the description and the factors that aggravate the pain.
• Observation of vital signs every 5 minutes on each attack of angina pectoris.
• Create a quiet environment, limit the visitor when necessary.
• Put the client on total bedrest during episodes of angina (the first 24-30 hours) with a semi-Fowler position.
• Give soft foods and let the client rest 1 hour after meals.
• Teach distraction and relaxation techniques.
• Medical collaboration in terms of drug delivery.

2. Activity intolerance related to decreased cardiac output.

Nursing interventions:

• Maintain bed rest in a comfortable position.
• Provide adequate rest periods, aids in the fulfillment of self-care activities in accordance with the indication.
• Record the color and quality of the pulse.
• Increase client activity on a regular basis.
• ECG Monitor with frequent, and record ECG if there are complaints of angina pectoris.

3. Anxiety related to fear of the threat of sudden death.

Nursing interventions:

• Explain all procedures act.
• Increase expression of feelings and fear.
• Encourage family and friends to consider the client as before.
• Tell the client that the medical program has been made to reduce / limit the attack to come and increase the stability of the heart.
• Collaboration.

4. Knowledge Deficit: (need to learn) about the disease, treatment needs related to the lack of information.

Nursing interventions:

• Emphasize the need to prevent angina attacks.
• Push to avoid the factors / situations as the originator of angina episodes.
• Assess the importance of weight control, smoking cessation, dietary changes and exercise.
• Show / encourage clients to monitor their own pulse rate during the activity, avoid stress.
• Discuss the steps taken in the event of an attack of angina.
• Encourage clients to follow a predetermined program.

Read More »

Angina Pectoris

Angina pectoris or chest pain is one of the conditions which are triggered by the problems in the cardiovascular system. Angina Pectoris that results from insufficient blood flow to the heart. Angina pectoris may not result in permanent damage to the heart muscle (this may not be true for severe angina pectoris), While the sufferer doesn't really feel the pain around his or her chest, the disease causes discomfort around the chest such as the sensations of choking, burning, squeezing, heaviness, and pressure.

Types of Angina Pectoris

• Stable angina is found more often in people. The symptoms of this type occur regularly and are predictable. Usually, people with this type suffer from the chest discomfort during exercise and stress, or after consuming heavy meals. Generally, the symptoms last not more than five minutes and improve when the patient rests or takes medications such as nitroglycerin, amlodipine besylate, or ranolazine.
• Unstable angina is found less often but more serious than the first type. Unlike the stable one, the occurrence of unstable angina cannot be predicted. The symptoms of this type also tend to be more severe. Unstable angina usually creates more pain and occurs longer and more frequent. Usual medication or resting cannot improve the symptoms. While unstable angina differs from heart attack, it is often noted as the precursor to heart attack.

Causes

The problem arises due to insufficient blood flow to the heart, which may be due to hardening of the arteries (Arteriosclerosis) or plaqueing of the arteries (Atherosclerosis), or spasm of the arteries. Other causes may include Anemia, rapid heartbeat (tachycardia), or other heart disease.

Signs and symptoms

Signs and symptoms of this heart related condition may include tightness or pressure in the chest that may radiate to the left shoulder and arm, or possibly the neck and jaw. Other symptoms may include difficulty breathing, anxiety, sweating, or pale skin.

Treatment

During an attack of angina pectoris, a person should rest and take nitroglycerin under the tongue. This may be enough to eliminate the symptoms. Depending on possible underlying conditions, other treatment such as balloon angioplasty or other surgeries may be recommended, or certain medications (beta-blockers, daily aspirin) may be needed. In most cases, a patient can benefit from a healthy diet and exercise, which should be prescribed by their doctor.

Nursing Diagnosis for Angina Pectoris

1. Acute pain related to myocardial ischemia.

2. Activity intolerance related to decreased cardiac output.

3. Anxiety related to fear of the threat of sudden death.

4. Knowledge Deficit: (need to learn) about the disease, treatment needs related to the lack of information.

Read More »

Therapeutic Activities - Nursing Actions

Definition: Advice and assistance in specific activity; physical, cognitive, social and spiritual to increase the range, frequency, or duration of an individual or group activity

Therapeutic Activities - Actions of Nursing:

1. Collaborated with occupational therapists, physical therapists or recreation therapists, to plan and monitor program activities, in a proper way.
2. Determine the patient's commitment to increase the frequency or range of activities.
3. Help to explore the personal meaning of the usual activities.
4. Helps to choose activities consistent with the physical, psychological and social.
5. Helps focus on what patients can do rather than focusing on its shortcomings.
6. Helps to identify and obtain resources needed for the desired activity
7. Helps to get transportation, in a proper way.
8. Help the patient to identify a preferred activity.
9. Help to identify meaningful activities.
10. Help the patient to make a schedule for specified periods in diversional activities into daily routines.
11. Help the patient / family to identify deficiencies in the level of activity
12. Instruct patient / family to maintain health and function in accordance with the role of physical activity, social, spiritual and cognitive.
13. Instruct patient / family how to show the desired activity or suggested
14. Help the patient / family to adapt the environment to accommodate the desired activity.
15. Provide activities to improve the field of attention in consultation with occupational therapists
16. Facilitate the change of activity when the patient has limited time, energy or movement.
17. Referring to the community center or program activities
18. Assist with regular physical activity (eg ambulation, transfer, movement and personal care), as needed.
19. Provide the gross motor activity for patients with hyperactive
20. Create a safe environment for the movement of large muscles, as indicated
21. Provide motor activity to relieve muscle tension.
22. Provide a group game that is not competitive, structured and active.
23. Support involvement in recreational and diversional activities that aim to reduce anxiety: the group singing, voley, tennis, walking, swimming, simple tasks and simple, the game is simple; routine tasks, housekeeping, dress up, puzzles and cards.
24. Provide positive reinforcement for those who actively participate
25. Help the patient to develop self-motivation and reinforcement
26. Monitor response to emotional, physical, social and spiritual activities of the
27. Help the patient / family to monitor their own progress toward goals to be achieved.

Read More »

Assessment of Mental Status in Elderly

How To Assess Mental Status in Elderly

Elderly group can experience a variety of mental disorders such as in the younger age groups. To identify mental problems that arise in the elderly need to do the assessment. Nursing assessment is an early stage that determines the next step to determine nursing diagnoses and planning.

Nursing assessment in psycho-geriatric clients is a complex process. Influence aspects of biological, psychological, and sociocultural due to the aging process leading to difficulties in identifying the problems that arise. Mental status assessment is a systematic approach to collect data on psychosocial functioning.

This assessment includes: General appearance of clients, awareness, affective functions, characteristic speech, orientation, attention and concentration, judgment, memory, perception, as well as content and process of thought. This study aims to determine the thoughts and mental processes that affect the achievement of optimal levels of functioning elderly. This assessment is integrated in the interview and physical examination.

Assessment of Mental Status in Elderly

General appearance

General appearance, can provide a picture of psychological functioning. General appearance, including: physical appearance, coordination of movement, facial expression and posture. Physical appearance include: how to dress, care and personal hygiene.

Observations can be done to assess the general appearance:

• Is the client's physical appearance indicates a psychological dysfunction?
• Does gait, posture and facial expressions indicate a psychological disorder?
• Are there signs of tardive dyskineksia or unfavorable effects caused by medication?

Awareness

Awareness is the ability of individuals to make contact with their environment and with oneself (through the five senses). When the consciousness of both (not decrease) the orientation capabilities such as time, place and people will be fine and able to process incoming information effectively (through memory and judgment). In assessing the level of awareness needs to be considered:

• effect of medication
• affective disorder
• pathologic conditions

Observations can be done to assess the level of consciousness:

• Is the level of awareness of current clients?
• Are there fluctuations in the level of awareness of the client. If there is any particular pattern?
• Are there physical factors that affect the level of consciousness, ie the influence of medication, pathologic conditions, and affective disorders?
• Are there psychosocial factors that influence the level of awareness such as: anxiety, depression, or sleep disorders?

Affective Functions

Things that need to be considered in assessing an affective function in the elderly are:

• Important to assess the significance of an event for the elderly to assess the depth and duration affect the displayed
• Emotional expression is influenced by cultural and personal characteristics
• In the elderly usually do not express their feelings directly / verbally. Therefore it is important to observe iti the reaction of indirect / non-verbal of the elderly.
• Important to use terms that are acceptable to the elderly at the time of the interview by focusing on the feelings felt by the elderly. Can be initiated by using the open ended question such as: how is he today?

Observations can be done to assess the affective functions:

• How do you feel current clients?
• Are the indicators that describe the mood / anxiety / depression on the client?
• Are there any factors that cause anxiety following on the client such as pathological conditions, treatments or interventions that affect the central nervous system?
• How that is done by the client to cope with feelings that are not as usual?
• Are there things you want to discuss about the client's feelings?

Characteristics of speech

Characteristics of speech include: understanding, articulation, pauses, quality, quantity and coherent. Cultural factors may affect the characteristics of speech.

Observation to study the characteristics of the speech:

• Is the client able to answer according to questions asked?
• Does normal speech pause, slow or fast?
• Is the tone of voice to show certain feelings such as anger, resentment, sadness, despair, etc.?
• Does the voice sound soft or hard?
• Is adal articulation difficulties?
• Are the sentences pronounced coherent elderly?
• Is there the following factors that may affect the characteristics of speech such as: dry mouth, toothless, the effects of medication or alcohol?
• Are there signs of agnosia, aphasia, or word repetition?

Orientation

The orientation includes orientation to place, person and time.

Interviews to assess client orientation:

• People: Who are your name, What was the name of your child? What was the name my husband / wife?, Etc.
• Time: What time is it? , When should you eat breakfast? What day is it? , Boast what now? , etc.
• Place: Where may you now? , Where is your address? What is the name of this town? , What is the name of this place? etc.

Attention and Concentration

Nurses must observe and record the response shown by the elderly at the time of assessment, when answering questions.

Observations to assess attention and concentration:

• What about client behavior during the interview?
• Whether clients eager to answer questions?
• If it does not answer the question or the answer given is incorrect because it is not capable, cultural factors or lack of motivation?
• Is there a signs of anger, resentment, sadness, despair, etc.?

Memory

The memory includes a new memory, short-term memory and long-term memory. Memory impairment can identify any impairment of intellectual / cognitive. The Short Portable Mental Status Quesionnaire (SPMQ) is used to detect the level of intellectual impairment.


Pereption

Perception is the power to know things, qualities, relations and differences through a process to observe, learn and interpret the following senses get stimulated.

Read More »

3 Nursing Diagnosis Interventions for Pneumonia

Nursing Diagnosis for Pneumonia and Nursing Interventions for Pneumonia

1. Nursing Diagnosis Knowledge Deficit: about the condition and the need for action

Related to:

• Less exposed to information
• Less to remember
• Misinterpretation

Possible evidenced by:

• Requests for information
• Statement of misconception
• Repeat mistakes

Expected outcomes are:

• Stated understanding of disease processes and treatment conditions
• Do changes in lifestyle

Nursing Interventions for Pneumonia :

• Review of normal lung function
• Discuss aspects of the inability of the disease, duration of healing and hope of recovery
• Provide written and verbal form
• Emphasize the importance of continuing effective cough
• Emphasize the need to continue antibiotic therapy for the recommended period.

2. Nursing Diagnosis for Pneumonia : Risk for Fluid Volume Deficit

Risk factors:

• Excessive loss of fluids (fever, sweating, hyperventilation, vomiting)

Expected outcomes are:

• Balance of fluid balance
• Moist mucous membranes, normal turgor, capillary filling fast.

Nursing Interventions:

• Assess changes in vital signs
• Assess skin turgor, mucous membrane moisture
• Note the report nausea / vomiting
• Monitor input and output, note the color, character of urine
• Calculate the fluid balance
• Fluid intake of at least 2500 / day
• Give the drug as an indication: antipyretic, antiemetic
• Provide additional IV fluids as necessary

3. Nursing Diagnosis : Pain (Acute / Chronic)

Related to:

• Inflammatory lung parenchyma
• Cellular reactions against circulating toxins
• Persistent cough

Possible evidenced by:

• Chest pain
• Headache, joint pain
• Protect an area hospital
• Distraction behaviors, restlessness

Expected outcomes are:

• Cause the pain is gone / controlled
• Show relaxed, rest / sleep and increased activity quickly.

Nursing Interventions:

• Determine the characteristics of pain
• Vital Signs Monitor
• Teach relaxation techniques
• Advise and assist the patient in the technique of chest compressions during episodes of coughing.

Read More »