Self-concept Disturbance : Low Self-esteem (Cause and Effect Mechanism)

Self-concept Disturbance : Low Self-esteem

Definition

Low self-esteem is a negative behavior towards self and abilities, expressed directly or indirectly. (Scultz and Videback, 1998).


Etiology

Negative self-concept system


Signs and symptoms

There are 10 individual way of expressing direct low self esteem (Stuart and Sundeen, 1995)

• Mocking and self-criticism.
• Lowering or reduce the dignity of oneself.
• The guilt or worry.
• Physical manifestations: high blood pressure, psychosomatic, and substance abuse.
• Delay and hesitation in taking decisions.
• Disorders related, withdraw from social life.
• Withdraw from reality.
• Destructive self.
• Damage or harm another person.
• The hatred and rejection of self.

Cause and Effect Mechanism

Cause

1. Disturbed Body Image.

Definition
Body image disturbance is a change in the perception of the body caused by changes in the size, shape, structure, functions, limitations and meaning of objects in frequent contact with the body, usually the client can not accept his condition, feeling less than perfect then there will be low self esteem.

Signs and symptoms

• Refuse to see, touch the body parts were changed.
• Rejecting explanations body changes.
• Negative perception of the body changes.
• Reveals despair.
• Reveals fear.

2. Ideal Self unrealistic

Definition: Ideal themselves are difficult to reach too high and unrealistic, ideal self murky and unclear, tend to be demanding. Failures experienced and fantasy that is too high can not be achieved frustrating and the resulting low self esteem.

Signs and symptoms

• Feel themselves worthless.
• Feelings of inadequacy.
• Guilty feeling.
• Perceived role strain.
• Pessimistic view of life.
• The rejection of the personal ability or inability to obtain a positive appreciation.

Effect

Social isolation: withdrawal

Definition: Withdraw an attempt to avoid interaction with others, avoid contact with other people. In addition to dance themselves an act of escape both the attention and interest of the immediate social environment (self-isolation) (Stuart and Sundeen, 1995).

Signs and symptoms

• Apathy.
• Sad facial expression.
• Afek blunt.
• Shy away from others.
• Clients seem to separate themselves with others.
• Less communication.
• Less eye contact.
• Silence.
• Less mobility.
• Disruption of sleep patterns (excessive sleep / lack of sleep).
• Taking sleeping fetal position.
• Physical health setbacks.
• Less attention to self-care.

Acute Pain - NCP for Eczema (Dermatitis)

Nursing Care Plan for Eczema (Dermatitis)

Dermatitis, a common skin condition, refers to inflammation of the skin that can manifest in various forms. It encompasses a range of conditions, each with its own causes and symptoms. This article provides insights into the causes, types, and general management of dermatitis.

Causes:

• Contact Dermatitis: This type of dermatitis occurs when the skin comes into contact with allergens or irritants, leading to redness, itching, and sometimes blistering. Common culprits include certain cosmetics, metals, plants, and chemicals.
• Atopic Dermatitis: Often referred to as eczema, atopic dermatitis is a chronic condition characterized by dry, itchy skin. It can be linked to genetic factors, environmental triggers, and immune system dysfunction.
• Seborrheic Dermatitis: This form primarily affects areas rich in oil glands, such as the scalp, face, and chest. It is associated with an overgrowth of yeast on the skin and may result in redness, scales, and dandruff.
• Nummular Dermatitis: This type is characterized by coin-shaped patches of irritated skin, often triggered by dry conditions, irritants, or allergy-provoking substances.

Types:

Dermatitis can be categorized into several types based on its specific characteristics and triggers. Understanding the type of dermatitis is crucial for effective management and treatment.

Acute Pain

Acute pain is a common experience resulting from injury, surgery, or illness, serving as a vital warning signal for the body. Understanding its causes, proper assessment, and effective management are essential aspects of providing comprehensive care. This article explores the nuances of acute pain to facilitate a better understanding of its dynamics.

Nursing Care Plan for Eczema (Dermatitis)

Nursing Diagnosis : Acute Pain related to skin lesions

Goal: Pain is reduced / no pain.

Expected outcomes:

• Appeasement reached taste disturbances.
• Expressed with words that itching has subsided.
• Show no symptoms of the skin excoriations due to scratching.
• Comply with the prescribed therapy.
• Keep adequacy skin hydration and lubrication ..
• Shows the intact skin; skin showed, advances in healthy appearance.

Interventions :

Independent:

1. Check the area involved.
R /: An understanding of the extent and characteristics of the skin include assistance in preparing an intervention plan.

2. Efforts to find the cause of the disorder sense of comfort.
R /: Helps identify the appropriate actions to provide comfort.

3. Record the results of observations in detail by using descriptive terminology.
R /: An accurate description of the skin eruption is necessary for diagnosis and treatment. Many skin conditions seem similar but have different etiologies.

4. Anticipating allergic reactions that may occur; obtain a history of drug use.
R /: Rash thorough especially with sudden onset may indicate an allergic reaction to the drug.

5. Control irritant factors.
R /: Itching aggravated by heat, chemical, and physical.

6. Maintain humidity of approximately 60%; use a humidifier.
R /: With low humidity, the skin will lose water.

7. Maintain a cool environment.
R /: Coolness reduce itching.

8. Use a mild soap or soap made for sensitive skin.
R /: These include the absence of a solution detegen, dyes or reinforcement material.

9. Remove excess clothing or equipment in the bed.
R /: Increase the cool environment.

10. Wash bed linens and clothes with a mild soap.
R /: harsh soaps can cause skin irritation.

11. Stop the repeated exposure to detergents, cleaners and solvents.
R /: Any substance that abolishing water, lipid or protein of the epidermis, will alter the skin barrier function.

12. Use skin care measures to maintain skin integrity and improve patient comfort.
R /: Skin is an important barrier that must be maintained integrity in order to function correctly.

13. Make a compress air with lukewarm water or cold compresses to relieve itching.
R /: Sucking water gradually from gauze compress will soothe the skin and relieve pruritus.

Collaboration:

14. Apply lotion and skin cream immediately after bathing.
R /: This action helps to relieve the symptoms.

15. Instruct the patient to avoid the use of an ointment or lotion purchased without a prescription.
R /: Problems patients can be caused by irritation or sensitization due to the treatment itself.

16. Keep nails patient, always trimmed.
R /: Cutting the nail will reduce skin damage from scratching.

 

Bibliography:

1. Bieber, T. (2008). Atopic dermatitis. New England Journal of Medicine, 358(14), 1483-1494. doi: 10.1056/NEJMra074081

2. James, W. D., Berger, T. G., & Elston, D. M. (2015). Andrews' Diseases of the Skin: Clinical Dermatology (12th ed.). Elsevier.

Imbalanced Nutrition: Less Than Body Requirements related to Vertigo

Nursing Care Plan for Vertigo


Imbalanced Nutrition: less than body requirements related to loss of appetite, nausea and vomiting

NOC:

• Nutritional status: the level of nutrients available to meet the metabolic needs.
• Nutritional status: food and fluid intake: the amount of food and fluids in the body consumption for the next 24 hours.
• Nutritional status: nutritional value: adequacy of nutrients consumed by the body.

Achieved after treatment for 3 days

Expected outcomes:

• Clients will maintain ideal body weight.
• Clients expressed tolerance to the recommended diet.
• Maintaining body mass and body weight within normal limits.
• Reported adequacy level of energy.

NIC interventions:
1. Management of eating disorders.
2. Management of nutrients.
3. Help raise the weight.

Nursing activities:

• Measure client's weight at appropriate intervals.
• Determine weight client idea.
• Provide information regarding the resources available. such as dietary counseling, exercise programs.
• Discuss with the client regarding a medical condition that affects body weight.
• Discuss the risks associated with over- or underweight.
• Help clients to develop a meal plan that is balanced and consistent with the level of energy use.

Nausea related to Vertigo (NCP for Vertigo)

Nausea related to Vertigo (NCP for Vertigo)

Nursing Care Plan for Vertigo

NOC:

• Degree of comfort: a feeling of relief physically and psychologically.
• Fluid balance: the balance of fluids in the intracellular and extracellular space of the body.
• Nutritional status: food and fluid intake: the amount of food and fluids into the body within 24 hours.

Achieved after treatment for 3 days

Expected outcomes:

• Stable weight.
• There are no sunken eyes.
• Skin hydration is not compromised.
• Intake and output balance within 24 hours.
• Clients reported no nausea.
• The fluid balance indicator shows 1-5: extreme, severe, moderate, light, no problem.

NIC interventions:
1. Management of fluids: an increase in fluid balance and prevention of complications.
2. Monitoring of fluid: the collection and analysis of client data to regulate fluid balance.
3. Monitoring of nutrients.

Nursing activities:

• Monitor the subjective symptoms of nausea on the client.
• Monitor for weight gain.
• Monitor the level of energy, malaise, fatigue, fatigue.
• Monitor the skin turgor.
• Teach clients a deep breath technique to suppress the gag reflex.
• Teach clients to eat slowly but often.
• Collaborative: antiemetic drugs in accordance with the recommendation.
• Raise the head of the bed in the lateral position to prevent aspiration.
• Monitor the nutritional status.

Nursing Diagnosis and Interventions for Diarrhea in Children

Nursing Care Plan for Diarrhea in Children

Nursing Diagnosis 1. Deficient Fluid Volume r / t excessive loss through the feces and vomit and limited intake (nausea).

Intervention and Rationale:
1. Give the oral and parenteral fluids in accordance with rehydration program.
R /: In an effort rehydration to replace fluids out with feces.
2. Monitor intake and output.
R /: Provides information about the status of the balance of fluids to determine the need for fluid replacement.
3. Assess vital signs, signs / symptoms of dehydration and laboratory results.
R /: Assessing the status of hydration, electrolyte and acid-base balance.
4. Collaboration execution of definitive therapy.
R /: Provision of drugs causally important after the cause of diarrhea in the know.


Nursing Diagnosis 2. Imbalanced Nutrition: less than body requirements r / t disruption of nutrient absorption and increase intestinal peristalsis.

Intervention and Rationale:
1. Maintain bed rest and activity restrictions during the acute phase.
R /: Lowering the metabolic needs.
2. Maintain the status of fasting, during the acute phase (according to the program of therapy) and immediately start feeding orally once conditions permit.
R /: oral dietary restrictions may be set during the acute phase to reduce peristalsis causing nutritional deficiencies. Feeding as soon as possible is important, after the client's clinical situation allows.
3. Assist with the implementation of appropriate feeding a diet program.
R /: Meeting the nutritional needs of the client.
4. Collaboration parenteral nutrition as indicated.
R /: Resting gastrointestinal work and overcome / prevent further nutritional deficiencies.


Nursing Diagnosis 3. Acute Pain r / t Hiperperistaltik, irritation perirektal fissure.

Intervention and Rationale:
1. Set a comfortable position for a client, for example with the knee flexed.
R /: Lowering the surface tension of the abdomen and reduce pain.
2. Perform the transfer of activities to provide a sense of comfort like a warm compress massage the back and abdomen.
R /: Increase relaxation, shifting the focus of attention of clients and improve coping skills.
3. Clean the anorectal area with mild soap and water after defecation and provide skin care.
R /: Protecting skin from the stool acidity, prevent irritation.
4. Collaboration of analgesic drugs and or anticholinergic indicated.
R /: Analgesics as anti-pain and anticholinergic agents to reduce spasm of the GI tract can be given appropriate clinical indications.
5. Assess pain (scale 1-10), changes in the characteristics of pain, verbal and non-verbal instructions
R /: Evaluating the development of pain to define interventions.

Nursing Diagnosis 4. Anxiety: family r / t changes in the health status of children.

Intervention and Rationale:
1. Encourage clients to discuss concerns and provide feedback on appropriate coping mechanisms.
R /: To help identify the cause of anxiety and alternative solutions to problems.
2. Emphasize that anxiety is a common problem in the elderly client whose children experienced the same problem.
R /: Help reduce stress by knowing that the client is not the only person experiencing such problems.
3. Create a quiet environment, show a friendly attitude and sincere in helping clients.
R /: Reduce external stimuli that can lead to increased anxiety.

Nursing Diagnosis 5. Knowledge deficit: family: about the condition, prognosis and therapy needs r / t exposure limited information, misinterpretation of information and or cognitive limitations.

Intervention and Rationale:
1. Assess the client's family readiness following study, including knowledge of diseases and their treatments.
R /: The effectiveness of learning is influenced by physical and mental readiness as well as background knowledge before.
2. Describe the process of their disease, its causes and consequences of the disruption of daily fulfillment of daily activities.
R /: An understanding of this issue is important to increase the participation of the client's family and the family in the treatment process client.
3. Explain the purpose of the medication, dosage, frequency and route of administration as well as possible side effects.
R /: Increase understanding client and family participation in treatment.
4. Explain and demonstrate how perineal care after defecation.
R /: Increase the independence and control the client's family to the child care needs.

Causes and Care Plan of Diarrhea in Infants

Causes and Care Plan of Diarrhea in Infants

Nursing Care Plan of Diarrhea in Infants

Diarrhea is not a topic that is often discussed, except when it occurs in infants. Every parent would be concerned about all things unusual happened to the baby, ranging from problems of diarrhea, food, until sleep patterns. And that was troublesome was the baby can not express what they feel except with the language of tears. So, inevitably every parent should be a good researcher for their children.

Feces during diarrhea in infants may appear in the texture, color and smell different. Such differences in the texture of the stool usually depends on what the baby feeding (breast milk, formula or solids).

One or two times a watery stool that comes out on the baby may not have to worry about. It usually occurs in the first weeks or months of the baby. However, if too frequent or severe diarrhea, this is no longer the time for you to hold a nursing home, you should immediately take the baby to the doctor.


Causes of Diarrhea in Infants

Babies with diarrhea can be caused by many factors, among others:

• Food allergies or are sensitive to a drug.
• Drinking too much fruit juice.
• Poisoning.
• Infections caused by viruses, bacteria and parasites.

Diarrhea occurs because the causes above that goes into the baby's digestion (by mouth). It could be the baby food and drink was contaminated / polluted with bacteria, parasites or viruses, toxins to chemicals. Do not just oriented on food and beverages consumed by the baby alone, hands touch the baby against something, then the baby put his hand into the mouth, is also a driveway for the causes of diarrhea.

Baby feeding equipment must also be assured of cleanliness, clean of bacteria / viruses and chemicals / pharmaceuticals. It's useless if you maintain the cleanliness of food and his hands but not keeping his dishes. Generally, mothers of households use chemicals / sort of detergent sold in the market for washing utensils. Well, the rinsing process must be done properly, make sure the cutlery has been rinsed clean to prevent chemicals washers are no longer living in tableware. The best thing after that is boiling all his dishes. And do not forget to give sense to the person who washes tableware your family, especially baby equipment. If you are in doubt, you should do yourself.

The mother / baby sitter alone should have to frequently wash their hands before and after eating, after changing diapers, after using the bathroom. These are all important to prevent diarrhea.

If you are breastfeeding your baby, you should not use laxatives because most of laxatives will go to the baby through breast milk will eventually cause diarrhea for the baby.


Effect of Diarrhea in Infants

Diarrhea will obviously disrupt the normal balance of water and salt (electrolytes) in infants. When the water and electrolytes lost in significant amounts (for diarrhea), babies will become dehydrated. And the loss of water and electrolytes in infants should get a replacement as soon as possible. In infants, dehydration can occur very quickly. Can directly take place on the day he diarrhea or the next day and it was very dangerous, especially for newborns.

Here are the signs of dehydration in infants:

• Urinate more often than usual.
• Irritability (fussy).
• Dry mouth.
• No tears when crying.
• Lethargic and often sleepy (unconventional).
• Sunken soft spot (fontanel concave).
• Inelastic skin (the skin is not immediately return after pressed or pinched).

When there is the above symptoms, do not wait any longer, let alone still would defer to care for her at home, immediately go to the doctor. Also, immediately go to the doctor if your baby has these symptoms:

• Fever over 38.8 degrees Celsius.
• Abdominal pain (toddlers who can express her feelings).
• Blood or pus in the stool, or black stools, white or red.
• Lethargy.
• Vomiting.

Nursing Diagnoses of Diarrhea

1. Deficient Fluid Volume r / t excessive loss through the feces and vomit and limited intake (nausea).
2. Imbalanced Nutrition: less than body requirements r / t disruption of nutrient absorption and increase intestinal peristalsis.
3. Pain (acute) r / t Hiperperistaltik, irritation perirektal fissure.
4. Anxiety: family r / t changes in the health status of children.
5. Knowledge deficit: family: about the condition, prognosis and therapy needs r / t exposure limited information, misinterpretation of information and or cognitive limitations.

Eye Cancer: Types, Symptoms and Nursing Diagnosis

Eye Cancer

Eye cancer is a lump in or around the eyes caused by abnormal cell growth and uncontrolled. Although quite rare, eye cancer can be about anyone and any age.


Type of Eye Cancer

Eye cancer is divided into several types. Cancer that develops in the eye called intraocular cancer, while cancer that develops around the eyes called the extra ocular cancer.

Intraocular Eye Cancer

Intraocular eye cancer types include:

• Ocular Melanoma : Cancer usually is developing in a layer of the eyeball, muscles that focus the eye, the iris (the colored part of the eye), or the inner surface of the conjunctiva (the eyelids). Melanoma be one type of cancer is the most common intraocular eye.
• Retinoblastoma : Cancer generally develops in the nerve cells of the retina, and can be one or both eyes. This condition is often an inherited condition and develop in children, mostly children under five years old. The good news, more than nine out of 10 children with retinoblastoma cured with proper treatment.
• Non-Hodgkin's lymphoma : Usually develops in the lymph nodes. Lymph nodes are glands throughout the body that are part of the body's natural immune system. However, non-Hodgkin's lymphoma are sometimes also progressed in the eye.

Extraocular Eye Cancer

Extraocular eye cancer include:

• Basal cell carcinoma: A type of skin cancer most commonly occurs. Usually develops near the eyes, especially in the lower eyelids. Growing small red pimples on the skin. This cancer usually does not spread to other body parts, but if left untreated can affect the surrounding tissue.
• Rhabdomyosarcoma: Is a type of eye cancer that is very rare that develops in the muscles that move the eyes. Rhabdomyosarcoma cases mostly occur in children.
• Optic nerve tumors: Also includes rare tumor that develops in the eye optic nerve, the nerve that connects the eye to the brain.
• Squamous cell carcinoma: This cancer usually develops on the surface of the eyelids.

Secondary Eye Cancer

Sometimes the cancer can spread from other parts of the body to the eye. This condition is called secondary cancer of the eye. Secondary eye cancer is most likely to occur in women with breast cancer, and in men with lung cancer.


Symptoms of Eye Cancer

Symptoms of eye cancer varies depending on the type and location. If someone intraocular cancer, such as ocular melanoma, is usually not accompanied by symptoms and be detected in a routine eye examination. That is why it is very important to check the eyes to an eye specialist at least once every two years.



Symptoms of eye cancer include:

• Vision (sight) lost partial or complete.
• See flashing lights or spots.
• A dark spot on the iris grow.
• Bumps visible on the eyelids with crusting or bleeding.
• Watery eyes.
• Pain in or around the eye.

But keep in mind, these symptoms are not caused by the absolute eye cancer because it can also be caused by other health problems, but if you experience any of these symptoms, immediately consult an ophthalmologist.


Nursing Diagnosis of Eye Cancer

1) Disturbed Sensory Perception (visual)
2) Disturbed Body Image

Nursing Diagnosis and Intervention for Abnormal Heart Rhythms (Arrhythmias)

Heart Rhythm Disorders or Arrhythmia is a common complication in myocardial infarction. Arrhythmias or dysrhythmias are changes in the frequency and heart rhythm caused by abnormal electrolyte conduction or automatic (Doenges, 1999). Arrhythmias arising from electrophysiological changes in the cells of the myocardium. These electrophysiological changes manifest as changes in the form of an action potential is a graph recording the electrical activity of cells (Price, 1994). Heart rhythm disorder is not confined to the irregularity of the heart rate but also including rate and conduction disturbances (Hanafi, 1996)

Etiology of cardiac arrhythmias in the outline can be caused by:

• Inflammation of the heart, such as rheumatic fever, myocardial inflammation (myocarditis due to infection).
• Disorders of coronary circulation (coronary atherosclerosis or coronary artery spasm), such as myocardial ischemia, myocardial infarction.
• Because the drug (intoxication), among others by digitalis, quinidine and anti-arrhythmia drugs other.
• Electrolyte balance disorders (hyperkalemia, hypokalemia).
• Disorders of the autonomic nervous system settings that affect the work and heart rhythm.
• Ganggguan psychoneurotic and central nervous.
• Metabolic disorders (acidosis, alkalosis).
• Endocrine disorders (hyperthyroidism, hypothyroidism).
• Heart rhythm disorders due to cardiomyopathy or heart tumor.
• Heart rhythm disorders due to degeneration (fibrosis of the conduction system of the heart).

Clinical Manifestations

• Change in BP (hypertension or hypotension); The pulse may be irregular; pulse deficit; irregular heart rhythm sound, extra sound, pulse decreased; pale skin, cyanosis, sweating; edema; Urine output decreases as weight decreases cardiac output.
• Syncope, dizziness, throbbing, headache, disorientation, confusion, lethargy, change in pupil.
• Mild to severe chest pain, may be lost or not with antianginal drugs, anxiety.
• Shortness of breath, cough, change of speed / depth of respiration; additional breath sounds (krekels, crackles, wheezing) may exist indicate respiratory complications such as left heart failure (pulmonary edema) or pulmonary tromboembolitik phenomena; hemoptysis.
• Fever; redness of the skin (adverse drug reactions); inflammation, erythema, edema (thrombosis siperfisial); loss of muscle tone / strength.

Nursing Diagnosis and Intervention for Abnormal Heart Rhythms (Arrhythmias)

Risk for decreased cardiac output related to electrical conduction disturbances, decreased myocardial contractility.

Expected outcomes:

• Maintain / increase cardiac output adequate as evidenced by blood pressure / pulse in the normal range, adequate urine output, palpable pulse same, usual mental status.
• Showed a decrease in the frequency / absence of dysrhythmias.
• Participate in activities that decrease myocardial work.

Intervention:

• Raba pulse (radial, femoral, dorsalis pedis) record the frequency, regularity, amplitude and symmetrical.
• Auscultation of heart sounds, note the frequency, rhythm. Note the extra heart rate, decreased pulse.
• Monitor vital signs and examine the adequacy of cardiac output / tissue perfusion.
• Determine the type of dysrhythmias and note the rhythm: tachycardia; bradycardia; atrial dysrhythmias; ventricular dysrhythmias; heart block.
• Provide quiet environment. Assess the reason for limiting the activity during the acute phase.
• Demonstrate / encourage use of behavioral stress management ie deep breathing relaxation, guided imagery.
• Investigate reports of pain, note the location, duration, intensity and relieving factors / ballast.
• Note the non-verbal instructions pain, for example; facial frown, cry, change in BP
• Prepare / do cardiopulmonary resuscitation as indicated.

Collaboration:

• Monitor laboratory tests, for example; electrolyte.
• Give supplemental oxygen as indicated.
• Give the drug as indicated: potassium, anti-dysrhythmia.
• Prepare for elective cardioversion aids.
• Help installation / maintain pacemaker function.
• Enter / maintain input IV.
• Prepare for invasive diagnostic procedures.
• Prepare for the installation of automatic cardioverter or defibrillator.

Diagnostic Examination in Patients with Bronchiectasis

Bronchiectasis is a permanent abnormal dilation of one or more branches of a large bronchus (Barbara, 1998).

Classification

Based on bronchography and bronchiectasis pathology can be divided into three, namely:

• Cylindrical bronchiectasis
• Fusiform bronchiectasis
• Cystic or saccular bronchiectasis.

Etiology

• Infection
• Heriditer abnormalities or congenital abnormalities
• Mechanical factors that facilitate the onset of infection
• Patients often have a history of pneumonia as a complication of measles, whooping cough, or other infectious diseases in childhood.

Diagnostic Examination in Patients with Bronchiectasis

1. Examination of sputum
Sputum examination include; sputum volume, sputum color, cells and bacteria in the sputum. When there is an infection sputum volume will increase and become purulent and contains more leukocytes and bacteria. Sputum culture can produce the normal flora of the nasopharynx, streptococcus pneumoniae, Haemophilus influenza, Staphylococcus aereus, Klebsiella, aerobacter, Proteus, Pseudomonas aeruginosa. If found foul-smelling sputum showed anaerobic infection.

2. Examination of peripheral blood.
Usually found in the normal range. Sometimes found any leukocytosis showed suppuration active and anemia showed that chronic infection.

3. Examination of urine
Found within normal limits, sometimes found any significant proteinuria caused by amyloidosis, however serum immunoglobulins are usually within normal limits, can sometimes increase or decrease.

4. Examination of ECG
Regular ECG within normal limits except in advanced cases existing cor pulmonary complications or signs of cardiac stimulation. Spirometry in mild cases may be normal, but in severe cases there is an abnormality of obstruction by a decrease in expiratory volume 1 minute or decrease in vital capacity, usually accompanied by respiratory insufficiency which can lead to:

• Ventilation and perfusion imbalance.
• Increase the pressure difference alveoli-arterial PO2.
• Hypoxemia.
• Hypercapnia.

5. Additional examination to determine the predisposing factors examined:

• Immunological examination.
• Examination of spermatozoa.
• Bronchial biopsies and nasal mucosa (bronchopulmonary repeated).

6. PA and Lateral chest radiograph
Lung markings are usually found to be more rugged and boundaries become blurred markings, clustered, sometimes there is a wasp nest picture and description of the boundaries of cystic and fluid air surface. Most of the left lung lobe, because it has a smaller diameter and located right crosses mediastinum, lingual segment of the left upper lobe and medial lobes of the right lung.

7. Examination of bronchography
Bronchography not routinely done, but if there is any indication of where to evaluate the patient to be operated on, ie patients with pneumonia are limited to somewhere and repetitive who showed no clinical improvement after receiving conservative treatment or patients with massive hemoptysis.
Bronchography done after a steady state, after the administration of antibiotics and postural drainage is adequate so that the net bronchial secretions.

Ineffective Airway Clearance related to Bronchiectasis

4 Nursing Diagnosis for Amyotrophic Lateral Sclerosis (ALS)

Nursing Care Plan for Amyotrophic Lateral Sclerosis (ALS)

Amyotrophic Lateral Sclerosis, Lou Gehrig's disease, motor neuron disease is a neurological disease that attacks the neurons that control skeletal muscle.

Motor neurons located in the brain, brain stem and bone marrow, and serves as a control and communication unit that connects the nervous system with the striated muscle. Motor signals carried neurotransmitter from motor neurons in the brain, known as the "upper motor neuron", forwarded to the motor neurons in the bone marrow, which is known as the "lower motor neurons", and further forwarded to the relevant striated muscle. Motor neuron motoneuron often called, is a function of neurons under the control synaptothrophic of nerve growth factor (NGF).

Cause of Amyotrophic Lateral Sclerosis:

• The exact cause is unknown (genetic component of about 10% of all patients).
• Autoimmune disorder that attacks the immune complexes in renal glomerular and basement membrane (basemant).
• Metabolic interference in the production of nucleic acids by nerve fibers.
• Nutritional deficiencies associated with disturbances in metabolism enzymes.
• Viruses that cause metabolic disturbances in motor neurons.

Signs and Symptoms of Amyotrophic Lateral Sclerosis:

• Fasciculations accompanied by atrophy and weakness, especially in the muscles of the upper arm and hand.
• Speech disorders.
• Difficulty chewing, swallowing and breathing.
• Choking feeling.
• Discharge of excessive salivation.

Diagnostic Test:

• Electromyography showed electrical abnormality in the muscles that were attacked.
• Muscle biopsy may show atrophic fibers that criss between normal fibers.
• The content of protein in the cerebrospinal fluid rise in one-third of patients, but this finding alone can not ensure the occurrence of ALS disease.

Nursing Diagnosis for Amyotrophic Lateral Sclerosis (ALS)

1. Ineffective breathing pattern.
2. Risk for Imbalanced Nutrition: less than body requirements.
3. Impaired verbal communication.
4. Impaired physical mobility.