Nursing Diagnosis for Risk for Suicide

Nursing Diagnosis: Risk for Suicide Application of NANDA, NOC, NIC

Nursing Diagnosis: Risk for Suicide
Gail B. Ladwig

NANDA Definition: At risk for self-inflicted, life-threatening injury

Related Factors:

Behavioral

History of previous suicide attempt; impulsiveness; buying a gun; stockpiling medicines; making or changing a will; giving away possessions; sudden euphoric recovery from major depression; marked changes in behavior, attitude, school performance

Verbal

Threats of killing oneself; states desire to die/end it all

Situational

Living alone; retired; relocation, institutionalization; economic instability; loss of autonomy/independence; presence of gun in home; adolescents living in nontraditional settings (e.g., juvenile detention center, prison, half-way house, group home)

Psychological

Family history of suicide; alcohol and substance use/abuse; psychiatric illness/disorder (e.g., depression, schizophrenia, bipolar disorder); abuse in childhood; guilt; gay or lesbian youth

Demographic

Age: elderly, young adult males, adolescents; race: Caucasian, Native American; gender: male divorced, widowed

Physical

Physical illness; terminal illness; chronic pain

Social

Loss of important relationship; disrupted family life; grief, bereavement; poor support systems; loneliness; hopelessness; helplessness; social isolation; legal or disciplinary problem; cluster suicides

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NOC Outcomes (Nursing Outcomes Classification)

Suggested NOC Labels

· Cognitive Ability

· Depression Control

· Distorted Thought Control

· Impulse Control

· Self-Mutilation Restraint

· Suicide Self-Restraint

· Will to Live

Client Outcomes

· Does not harm self

· Expresses decreased anxiety and control of hallucinations

· Talks about feelings; expresses anger appropriately

· Obtains no access to harmful objects

· Yields access to harmful objects

NIC Interventions (Nursing Interventions Classification)

Suggested NIC Labels

· Anxiety Reduction

· Coping Enhancement

· Crisis Intervention

· Suicide Prevention

· Surveillance

Nursing Interventions and Rationales

· Establish a therapeutic relationship with client This study demonstrated the importance of this relationship in identifying and preventing suicide (Rudd et al, 2000).

· Monitor, document, and report client's potential for suicide. Traits such as impulsivity, poor social adjustment, and mood disorders are associated with adolescent suicide attempts (Brent et al, 1994).

· Be alert for warning signs of suicide:

o Verbalizations such as, "I can't go on," "Nothing matters anymore," "I wish I were dead"

o Becoming depressed or withdrawn

o Behaving recklessly

o Getting affairs in order and giving away valued possessions

o Showing a marked change in behavior, attitudes, or appearance

o Abusing drugs or alcohol

o Suffering a major loss or life change

Suicide is rarely a spur-of-the-moment decision. In the days and hours before people kill themselves, there are usually clues and warning signs (Befrienders International, 2001).

· Assess for suicidal ideation when the history reveals:

o Depression

o Alcohol or other drug abuse

o Other psychiatric disorder

o Attempted suicide

o Recent divorce and/or separation

o Recent unemployment

o Recent bereavement

o Chronic pain

Clinicians should be alert for suicide when the above factors are present in asymptomatic persons (National Guideline Clearing House, 2001). This study revealed that clients with chronic pain and depression expressed suicidal ideation (Fisher et al, 2001). The process leading to suicide in young people is often untreated depression (Houston, Hawton, Shepperd, 2001).

· Refer to mental health counseling and possible hospitalization if there is evidence of suicidal intent, which may include evidence of preparatory actions (e.g., obtaining a weapon, making a plan, putting affairs in order, giving away prized possession, preparing a suicide note).

· Question family members regarding the preparatory actions mentioned. Clinicians should be alert for suicide when these factors are present in asymptomatic persons (National Guideline Clearing House, 2001).

· Refer family members and friends to local mental health agencies and crisis intervention centers if client has suicidal ideation or there is a suspicion of suicidal thoughts. Clients at risk should receive evaluation and help (National Guideline Clearing House, 2001).

· Consider outpatient commitment for actively suicidal client. Involuntary outpatient commitment can improve treatment, reduce the likelihood of hospital readmission, and reduce episodes of violent behavior in persons with severe psychiatric illnesses (Torrey, Zdanowicz, 2001).

· Counsel parents and homeowners to restrict unauthorized access to potentially lethal prescription drugs and firearms within the home. Identifying teens at high risk of firearm suicide and limiting access to firearms is a type of public health intervention likely to be successful in preventing firearm suicides (Shah, Hoffman, Wake, Marine, 2000).

· See care plan for Risk for self-directed Violence.

Multicultural

· Assess for the influence of cultural beliefs, norms, and values on the individual's perceptions of suicide. What the individual believes about suicide may be based on cultural perceptions (Leininger, 1996).

· With the client's consent, facilitate family-oriented crisis intervention. Family-oriented crisis intervention can clarify stresses and allow assessment of family dynamics (Baker, 1988).

· Facilitate modeling and role-playing for client and family regarding healthy ways to start a discussion about the client's suicide attempt. It is helpful for families and the client to practice communication skills in a safe environment before trying them in a real-life situation (Rivera-Andino, Lopez, 2000).

· Identify and acknowledge the stresses unique to culturally diverse individuals. Financial difficulties and maintaining cultural values are two of the most common family stressors cited by women of color (Majumdar, Ladak, 1998).

· Encourage the family to demonstrate and offer caring and support to each other. The familial characteristics of care and support may be associated with fostering resiliency in African-American families. Resilience is the ability to experience adverse conditions and successfully overcome them (Calvert, 1997).

· Validate the individual's feelings regarding concerns about current crisis and family functioning. Validation lets the client know that the nurse has heard and understands what was said, and it promotes the nurse-client relationship (Stuart, Laraia, 2001; Giger, Davidhizer, 1995).

Nursing Diagnosis for Cesarean section (C-section)

Nursing Care Plan for C-section - Nursing Diagnosis for Cesarean section (C-section)
Cesarean Section or C-section is a surgery carried out to deliver a baby. When there are multiple babies or any other problems, the woman is unable to have normal vaginal delivery, then her abdomen is medically cut to take the baby out. Mostly C-section is operated when unexpected complications occur during delivery. These can be:

• Health problems in mother that might be long-term
• Abnormal position of the fetus
• Congested room for the baby to go through vagina
• Any defects in the baby
• Carrying more than one baby

It is generally safe for both mother and baby but is a major surgery with many risks. Moreover, recovery takes a long time than in normal delivery.

Nursing Diagnosis for Cesarean section (C-section)

1. Acute pain related to postoperative wound

2. Risk for infection related to invasive procedures, skin damage, decrease in Hb

3. Risk for injury (mother) related to tissue trauma

4. Risk for impaired gas exchange (the fetus)

5. Deficient Knowledge : up to surgery

6. Anxiety

Source : http://nandanursingdiagnosis.blogspot.com/2011/10/nursing-diagnosis-for-cesarean-section.html

Nursing Diagnosis for Gastroenteritis - 5 Diagnosis

Gastroenteritis is a swelling of the lining of the stomach and intestines, frequently accompanied with acute diarrhea and vomiting, mild fever and stomach cramps. Gastroenteritis attacks can take from anywhere between six hours to 3 days to pass. Symptoms ordinarily are caused by toxins produced by bacteria in the food or by a swelling of the intestine through having a virus or bacteria being present. Ordinarily, food poisoning results in a much quicker onset of symptoms, which can strike the sufferer within the hour of eating infected foods.

Gastroenteritis is frequently connected with diarrhea given it occurs most often in the home ordinarily resulting from poor hygiene. Pre-cooked meats particularly chicken, raw egg dishes and shellfish are the most frequent causes of bacterial and viral gastroenteritis. Further culprits include foods which are past their sell by dates. Seafood's and to some extent dairy products, often smell bad when they have gone off, but this does not always the case with other foods. It is therefore extremely important to store food correctly and always consume before its use by date.

Gastroenteritis : Causes, Symptoms, and Management

Gastroenteritis, commonly known as the stomach flu, is an inflammation of the gastrointestinal tract characterized by symptoms like diarrhea, abdominal cramps, nausea, and vomiting. While typically a self-limiting condition, understanding its causes, symptoms, and appropriate management is essential for timely recovery.

Causes:

Gastroenteritis is often triggered by viral or bacterial infections. Viruses such as norovirus, rotavirus, and adenovirus are common culprits, especially in cases affecting children. Bacterial infections may result from consuming contaminated food or water, with pathogens like Salmonella, Escherichia coli (E. coli), and Campylobacter being frequent causes.

Symptoms:

The hallmark symptoms of gastroenteritis include diarrhea, which can be watery or contain blood, abdominal cramps, nausea, and vomiting. Individuals may also experience fever, headache, and muscle aches. Symptoms can manifest suddenly and vary in severity, with dehydration being a potential concern, particularly in cases of persistent vomiting and diarrhea.

Management:

• Fluid Replacement: One of the primary concerns with gastroenteritis is dehydration due to fluid loss. Rehydration is crucial, and oral rehydration solutions or, in severe cases, intravenous fluids may be recommended.
• Dietary Modifications: While the stomach is recovering, a temporary shift to a bland diet may be beneficial. This often includes easily digestible foods like bananas, rice, applesauce, and toast (BRAT diet).
• Probiotics: Probiotics, found in yogurt or available as supplements, may help restore the balance of beneficial bacteria in the gut, aiding in recovery.
• Antimicrobial Medications: In cases caused by bacterial infections, antimicrobial medications may be prescribed. However, these are typically reserved for specific instances, as indiscriminate use can contribute to antibiotic resistance.
• Symptomatic Treatment: Over-the-counter medications may be used to alleviate symptoms such as fever, pain, or nausea. However, their use should be guided by healthcare professionals.

Nursing Diagnosis for Gastroenteritis

1. Fluid Volume Deficit

2. Imbalanced Nutrition Less Than Body Requirements

3. Impaired Skin Integrity

4. Acute Pain

5. Knowledge Deficit

Source : http://nandanursingdiagnosis.blogspot.com

 

 

Bibliography:

1. Guarino, A., Ashkenazi, S., Gendrel, D., Lo Vecchio, A., Shamir, R., & Szajewska, H. (2014). European Society for Pediatric Gastroenterology, Hepatology, and Nutrition/European Society for Pediatric Infectious Diseases evidence-based guidelines for the management of acute gastroenteritis in children in Europe: update 2014. Journal of Pediatric Gastroenterology and Nutrition, 59(1), 132-152. doi: 10.1097/MPG.0000000000000375

2. Riddle, M. S., DuPont, H. L., & Connor, B. A. (2016). ACG Clinical Guideline: Diagnosis, Treatment, and Prevention of Acute Diarrheal Infections in Adults. American Journal of Gastroenterology, 111(5), 602–622. doi: 10.1038/ajg.2016.126

Nursing Diagnosis for Self-Care Deficit - Bathing / Hygiene

Nursing Diagnosis for Self-Care Deficit - Bathing / Hygiene

Definition

Circumstances where individuals have failed to implement or complete ability bathing / hygiene activities.

Data:

Lack of ability to bathe themselves (including washing the whole body, combing hair, brushing teeth, doing skin care and nails as well as the use of makeup)

• Can not or no desire to wash the body or body parts.
• Can not use the source water.
• Inability to feel the need for hygiene measures.

Lack of ability to wear his own clothes (including underwear routine or special clothing, not the clothes the night)

• Failure of the ability to use or release of clothes.
• Inability to fasten clothing.
• Inability to dress themselves satisfactorily.

Expected outcomes are:

Individuals will
1. Identifying the love of self-care activities.
2. Demonstrated that optimal hygiene in care after assistance is given.
3. Participate in physical and or verbal self-care activities

• Carry out the shower activity at its optimal level.
• Reported satisfaction with the achievements despite the limitations.
• Connecting a feeling of comfort and satisfaction with the cleanliness of the body.
• Demonstrate ability to use adaptive assistive devices.
• Describe the factors that cause of the lack of ability to bathe.

Source : http://nursing-diagnosis-nanda.blogspot.com/2012/04/self-care-deficit-bathing-hygiene.html

Nursing Diagnosis Excess Fluid Volume

Nursing Diagnosis Excess Fluid Volume related to decreased glomerular filtration rate (decrease in cardiac output) and the retention of sodium / water.

Characterized by:
Orthopnea, S3 heart sound, oliguria, edema, weight gain, hypertension, respiratory distress, abnormal heart sounds.

Objectives / evaluation criteria:
Clients will be demonstrating the stable fluid volume with the balance of inputs and expenditures, breath sounds clean / clear, vital signs within an acceptable range, stable weight and no edema, fluid restriction expressed understanding of the individual.

Nursing Interventions Excess Fluid Volume :

Monitor urine output, record the number and color of the time in which diuresis occurs.
Rational: Spending a little and concentrated urine may be due to decreased renal perfusion. Supine position so that helps diuresis of urine may be increased during bed rest.

Monitor / calculate the balance of income and expenditure for 24 hours.
Rational: diuretic therapy may be caused by a sudden loss of fluid / redundant (hypovolaemia), although edema / ascites is still there.

Keep sitting or bed rest with semifowler position during the acute phase.
Rationale: The position is increasing kidney filtration thus improving diuresis.

Monitor blood pressure and CVP (if any).
Rational: Hypertension and increased CVP indicates fluid overload and may indicate an increase in pulmonary congestion, heart failure.

Assess bowel sounds. Record complaints of anorexia, nausea, abdominal distension and constipation.
Rational: visceral congestion can interfere with the function of gastric / intestinal tract.

Administration of drugs as indicated (collaboration)
Consult with the dietitian.
Rational: to provide an acceptable diet that meets client needs calories in sodium restriction.

Source : http://nursing-diagnosis-nanda.blogspot.com/2011/10/nursing-diagnosis-interventions-for.html

6 Nursing Diagnosis for Liver Abscess

Liver abscess is a relatively uncommon but life-threatening disorder that occurs when bacteria or protozoa destroy hepatic tissue. The damage produces a cavity, which fills with infectious organisms, liquefied hepatic cells, and leukocytes. Necrotic tissue then walls off the cavity from the rest of the liver.
A liver abscess occurs when bacteria or protozoa destroy hepatic tissue, producing a cavity, which fills with infectious organisms, liquefied liver cells, and leukocytes. Necrotic tissue then walls off the cavity from the rest of the liver. Liver abscess carries a mortality of 10% to 20%, despite treatment. Liver abscess affects both sexes and all age-groups, although it's slightly more prevalent in hospitalized children (because of a high rate of immunosuppression) and in females (most commonly those between ages 40 and 60).

6 Nursing Diagnosis for Liver Abscess

1. Impaired Liver Function
2. Acute pain
3. Deficient knowledge (diagnosis and treatment)
4. Imbalanced nutrition: Less than body requirements
5. Risk for impaired skin integrity
6. Risk for infection

Source : http://nursing-diagnosis-nanda.blogspot.com/2012/04/nursing-diagnosis-and-interventions-for.html

Risk of Infection

Risk of infection is a nursing diagnosis which is defined as "the state in which an individual is at risk to be invaded by an opportunistic or pathogenic agent (virus, fungus, bacteria, protozoa, or other parasite) from endogenous or exogenous sources" and was approved by NANDA in 1986. Although anyone can become infected by a pathogen, patients with this diagnosis are at an elevated risk and extra infection controls should be considered.

Endogenous sources

The risk of infection depends on a number of endogenous sources. Skin damage from incision as well as very young or old age can increase a patient's risk of infection. Examples of risk factors includes decreased immune system secondary to disease, compromised circulation secondary to peripheral vascular disease, compromised skin integrity secondary to surgery, or repeated contact with contagious agents.

Assessment

The patient should be asked about a history of repeated infections, symptoms of infection, recent travel to high-risk areas, and their immunization hishttp://www.blogger.com/img/blank.giftory. They should also be assessed for objective signs such as the presence of wounds, fever, or signs of nutritional deficiency.

Intervention

The specific nursing interventions will depend on the nature and severity of the risk. Patients should be taught how to recognize the signs of infection and how to reduce their risk. Surgery is a frequent risk factor for infection and a physician may prescribe antibiotics prophylactically. Immunization is another common medical intervention for those who are at high risk for infection.

Source : http://en.wikipedia.org/wiki/Risk_of_infection

Marjory Gordon

Marjory Gordon is a nursing theorist and professor who created a nursing assessment theory known as Gordon's functional health patterns. She remains the international leader in this area of nursing scholarship. Dr. Gordon served as the first president of the North American Nursing Diagnosis Association. She has been a Fellow of the American Academy of Nursing since 1977 and was named as a Living Legend by the same organization in 2009.

Academic appointment

Dr. Gordon is an emeritus professor of nursing at Boston College in Chestnut Hill, Massachusetts.

Writing and scholarship

Dr. Gordon is the author of four books, including the Manual of Nursing Diagnosis, now in its twelfth edition. Her books appear in ten different languages, in forty-eight countries and six continents.

She has contributed significantly to the development of standardized nursing language. Dr. Gordon's work in this sphere has implications for research, education, evaluation of competency, and the establishment of a core of nursing knowledge based on evidence. This language will also form the basis of the nursing component of the electronic medical record.

Education

Marjory Gordon is an alumna of the Mount Sinai Hospital School of Nursing. She earned her bachelor's and master's degrees from Hunter College of the City University of New York and her PhD from Boston College.

Source : http://en.wikipedia.org/wiki/Marjory_Gordon

Phases of the Nursing Process

Phases of the Nursing Process

The nursing process is goal-oriented method of caring that provides a framework to nursing care. It involves six major steps:

• A - Assess (what data is collected?)
• D - Diagnose (what is the problem?)
• O - Outcome Identification - (Was originally a part of the Planning phase, but has recently been added as a new step in the complete process).
• P - Plan (how to manage the problem)
• I - Implement (putting plan into action)
• E - Evaluate (did the plan work?)
  

According to some theorists, this six-steps description of the nursing process is outdated and misrepresents nursing as linear and atomic

Self-care Deficit Nursing Theory

The self-care deficit nursing theory is a middle range nursing theory that was developed between 1959 and 2001 by Dorothea Orem. It is also known as the Orem model of nursing. It is particularly used in rehabilitation and primary care settings where the patient is encouraged to be as independent as possible.

Central philosophy

The nursing theory is based upon the philosophy that all "patients wish to care for themselves". They can recover more quickly and holistically if they are allowed to perform their own self-cares to the best of their ability.

Self-care requisites

Self-care requisites are groups of needs or requirements that Orem identified. They are classified as either:

• Universal self-care requisites - those needs that all people have
• Developmental self-care requisites - 1. maturational: progress toward higher level of maturation. 2. situational: prevention of deleterious effects related to development.
• Health deviation requisites - those needs that arise as a result of a patient's condition

Self-care deficits

When an individual is very unable to meet their own self-care requisites, a "self-care deficit" occurs. It is the job of the Registered Nurse to determine these deficits, and define a support modality.

Support modalities

Nurses are encouraged to rate their patient's dependencies or each of the self-care deficits on the following scale:http://www.blogger.com/img/blank.gif

• Total Compensation
• Partial Compensation
• Educative/Supportive

Universal Self-Care Requisites (SCRs)

The Universal self-care requisites that all or health are:

• Air
• Water
• Food
• Elimination
• Activity and Rest
• Solitude and Social Interaction
• Hazard Prevention
• Promotion of Normality
  

The nurse is encouraged to assign a support modality to each of the self-care requisites.

Source : http://en.wikipedia.org/wiki/Self-care_deficit_nursing_theory

Risk for Deficient Fluid Volume related Nausea and Vomiting

Risk for deficient Fluid Volume related to a sense of nausea and vomiting,
characterized by:

• Sometimes diarrhea.
• Abdominal distension.
• Tense abdomen.
• Decreased appetite.
• There is a sense of nausea and vomiting.

Purpose: Maintaining the balance of fluid volume

Results Criteria:

• The client is not diarrhea.
• A good appetite.
• The client no nausea and vomiting.

Nursing Intervention :

1) Monitor vital signs.
Rational: This is an early indicator of hypovolemia.

2) Monitor intake and urine output and concentration.
Rational: Decreased urine output and concentration will improve the sensitivity / sediment as one the impression of dehydration and require increased fluids.

3) Give fluid little by little but often.
Rationale: To minimize the loss of fluids.

Nursing Diagnosis Self-Care Deficit - Nursing Care Plan Stroke

Stroke Definition :

That stroke is a disease affects the blood vessels That blood supply to the brain. Without blood to supply oxygen and Nutrients and to remove waste products, brain cells begin to die Quickly. Stroke is Sometimes Called a "brain attack. Stroke is a medical emergency and can cause permanent neurological damage or even death if not promptly diagnosed and treated.

The cause of stroke is an interruption in the blood supply, with a resulting depletion of oxygen and glucose in the affected area. This reduces or abolishes IMMEDIATELY neuronal function, and also initiates the ischemic cascade the which Causes neurons to die or Be Seriously Damaged, Further impairing brain function.

Self-Care Deficit Nursing Nanda Diagnosis Definition:

Impaired ability to perform or complete activities of daily living, Such as feeding, dressing, bathing, toileting.

The nurse may encounter the patient with a self-care deficit in the hospital or in the community.

Nursing Diagnosis Self-Care Deficit - Nursing Care Plan Stroke

related to weakness, neuromuscular disorders, decreased muscle strength, decreased muscle coordination, depression, pain, damage to the perception

Goal: The ability to care for self-rising

Expected outcomes:

a. Demonstrating changes in lifestyle to meet the needs of daily living

b. Perform self-care according to ability

c. Identify and utilize sources of aid


Nursing Interventions Self-Care Deficit Nursing Care Plan for Stroke

1. Monitor the client's skill level in caring for themselves

2. Provide assistance to the needs that really need it

3. Create an environment that allows clients to perform ADLs independently

4. Involve the family in helping clients

5. Client's motivation to perform ADLs according to ability

6. Provide aids themselves when possible

7. Collaboration: plug the DC if necessary, consultation with a occupational or physiotherapy.

Source : http://careplannursing.blogspot.com/2012/01/self-care-deficit-nursing-care-plan-for.html

Nursing Diagnosis for Renal Transplantation

Kidney transplantation or renal transplantation is the organ transplant of a kidney into a patient with end-stage renal disease. Kidney transplantation is typically classified as deceased-donor (formerly known as cadaveric) or living-donor transplantation depending on the source of the donor organ. Living-donor renal transplants are further characterized as genetically related (living-related) or non-related (living-unrelated) transplants, depending on whether a biological relationship exists between the donor and recipient.


Nursing Diagnosis for Renal Transplantation

1. Risk for infection related to altered immune system secondary to immunosuppressant medications

2. Risk for altered oral mucous membrane related to increased susceptibility to infection secondary to immunosuppression.

3. Risk for self-concept disturbance related to transplant experience, potential for rejection, and side effects of medications.

Kidney Transplant Medical Treatment

Kidney Transplant Medical Treatment

The most critical part of kidney transplantation is preventing rejection of the graft kidney.

• Different transplant centers use different drug combinations to fight rejection of a transplanted kidney.
• The drugs work by suppressing your immune system, which is programmed to reject anything "foreign," such as a new organ.
• Like any medication, these drugs can have unpleasant side effects.
• Some of the most common immune-suppressing drugs used in transplantation are described here.
  • Cyclosporine: This drug interferes with communication between the T cells of the immune system. It is started immediately after the transplant to suppress your immune system and continued indefinitely. Common side effects include tremor, high blood pressure, and kidney damage. These side effects are usually related to the dose and can often be reversed with proper dosing.
  • Corticosteroids: These drugs block T-cell communication as well. They are usually given at high doses for a short period immediately after the transplant and again if rejection is suspected. Corticosteroids have many different side effects, including easy bruising of the skin, osteoporosis, avascular necrosis (bone death), high blood pressure, high blood sugar, stomach ulcers, weight gain, acne, mood swings, and a round face. Because of these side effects, many transplant centers are trying to reduce the maintenance dose of the drug as much as possible or even to replace it with other drugs.
  • Azathioprine: This drug slows the production of T cells in the immune system.Azathioprine isusually used for long-term maintenance of immunosuppression. The most common side effects of this drug are suppression of the bone marrow, which produces blood cells, and liver damage. Many transplant centers are now using a newer drug called mycophenolate mofetil instead of azathioprine.
  • Newer antirejection drugs include tacrolimus, sirolimus, and mizoribin, among others. These drugs are now being used to try to reduce side effects and to replace drugs after episodes of rejection.
  • Other costly and experimental treatments include using antibodies to attack specific parts of the immune system to decrease its response.

Signs and Symptoms of Testicular Torsion

In the fetus the testicle develops within the abdomen and migrates down into the scrotum, trailing its blood supply behind it like a leash. In the scrotum the testicle resides within a smooth sack called the tunica vaginalis. The testicle can spin and move about within the sack. As males grow and age the testicle develops connections with the sack making it harder for the testicle to spin or twist. This is why torsion is usually seen in younger men, adolescents, and children.

It can occur during fetal development leading to neonatal torsion or vanishing testis and is one of the main cause for monarchism (single testicle).

It needs emergency treatment to save the testicles. Other wise it can lead to permanent damage to the testicles leading to necrosis of testis and atrophy of testis. It can lead to sterility

Signs and symptoms of testicular torsion

• Severe sudden pain in the scrotum.
• Swelling of the scrotum.
• Redness of skin of the scrotum.
• Lower abdominal pain.
• Fever.
• Testicle is positioned at an higher level than normal or at an odd angle.

What Causes of Ventricular Fibrillation ?

The heart pumps blood to the lungs, brain, and other organs. Interruption of the heartbeat for only a few seconds can lead to fainting (syncope) or cardiac arrest.

Fibrillation is an uncontrolled twitching or quivering of muscle fibers (fibrils). When it occurs in the lower chambers of the heart, it is called ventricular fibrillation. During ventricular fibrillation, blood is not removed from the heart. Sudden cardiac death results.

The most common cause of VF is a heart attack. However, VF can occur whenever the heart does not get enough oxygen or if a person has other heart disorders.

Conditions that can lead to VF include:

• Congenital heart disease
• Electrocution accidents or injury to the heart
• Heart attack
• Heart muscle disease, including cardiomyopathies
• Heart surgery
• Ischemia (lack of oxygen to the heart muscle because of narrowed coronary arteries or shock)
• Sudden cardiac death (commotio cordis), typically occurring in athletes after a trauma over the surface of the heart
  

Most people with VF have no history of heart disease. However, many have risk factors for cardiovascular disease, such as smoking, high blood pressure, and diabetes.

Pathophysiology of Atrial fibrillation (AF)

Atrial fibrillation (AF) shares strong associations with other cardiovascular diseases, such as heart failure, coronary artery disease (CAD), valvular heart disease, diabetes mellitus, and hypertension. These factors have been termed upstream risk factors, but the relationship between comorbid cardiovascular disease and AF is incompletely understood and more complex than this terminology implies. The exact mechanisms by which cardiovascular risk factors predispose to AF are not understood fully but are under intense investigation. Catecholamine excess, hemodynamic stress, atrial ischemia, atrial inflammation, metabolic stress, and neurohumoral cascade activation are all purported to promote AF.

Because diabetes mellitus and obesity are increasing in prevalence and are associated with an elevated risk of AF, Fontes et al examined whether insulin resistance is an intermediate step for the development of AF. In a community-based cohort that included 279 patients who developed AF within 10 years of follow-up, no significant association was observed between insulin resistance and incident AF.

Although the precise mechanisms that cause atrial fibrillation are incompletely understood, AF appears to require both an initiating event and a permissive atrial substrate. Significant recent discoveries have highlighted the importance of focal pulmonary vein triggers, but alternative and nonmutually exclusive mechanisms have also been evaluated. These mechanisms include multiple wavelets, mother waves, fixed or moving rotors, and macro-reentrant circuits. In a given patient, multiple mechanisms may coexist at any given time. The automatic focus theory and the multiple wavelet hypothesis appear to have the best supporting data.
Automatic focus

A focal origin of AF is supported by several experimental models showing that AF persists only in isolated regions of atrial myocardium. This theory has garnered considerable attention, as studies have demonstrated that a focal source of AF can be identified in humans and that isolation of this source can eliminate AF.

The pulmonary veins appear to be the most frequent source of these automatic foci, but other foci have been demonstrated in several areas throughout the atria. Cardiac muscle in the pulmonary veins appears to have active electrical properties that are similar, but not identical, to those of atrial myocytes. Heterogeneity of electrical conduction around the pulmonary veins is theorized to promote reentry and sustained AF. Thus, pulmonary vein automatic triggers may provide the initiating event, and heterogeneity of conduction may provide the sustaining conditions in many patients with AF.
Multiple wavelet

The multiple wavelet hypothesis proposes that fractionation of wave fronts propagating through the atria results in self-perpetuating "daughter wavelets." In this model, the number of wavelets is determined by the refractory period, conduction velocity, and mass of atrial tissue. Increased atrial mass, shortened atrial refractory period, and delayed intra-atrial conduction increase the number of wavelets and promote sustained AF. This model is supported by data from patients with paroxysmal AF demonstrating that widespread distribution of abnormal atrial electrograms predicts progression to persistent AF. Intra-atrial conduction prolongation has also been shown to predict recurrence of AF. Together, these data highlight the importance of atrial structural and electrical remodeling in the maintenance of AF—hence the phrase "atrial fibrillation begets atrial fibrillation."

Source : http://emedicine.medscape.com/article/151066-overview#a0104

What is Fibrillation ?

Fibrillation is an arrhythmia that affects either the atria as a pair, or the ventricles as a pair, producing “a-fib”, or “v-fib”, respectively. (Come to think of it, if a person is in VF, do their atria fibrillate as well? Does it matter?) Most cardiac rhythms are organized – they’re regular in some way, producing some sort of regular (as opposed to disorganized), rhythmic motion of the chambers, hopefully producing a blood pressure. In fibrillation, the cardiac tissue of the chambers involved wiggles about like (classic phrase) “a bag of worms”. Does a chamber wiggling like a bag of worms pump any blood, produce a cardiac output, eject any fraction of its contents? No, it does not!

As I always try to point out, all the waves that you see on EKG strips actually represent some kind of physical motion of one or the other set of cardiac chambers, and the trick is to try to visualize what those chambers are doing in any given rhythm situation. Let’s see if a quick review of some strips helps the visualization process. Can I have the first slide please?

Here we are: look familiar? Sinus rhythm. Organized, rhythmic, producing stable contraction of the chambers – first the atria, then the ventricles. So - visualizing on the mental screen, that’s what I see: nice orderly motion, first above, then below.

Okay so far? Right – next slide, please. OK: atrial flutter. Still organized: the atria are contracting rapidly, sure, at about 300 bpm, and the ventricles are responding to every third or fourth impulse, slowly enough that the ventricular chambers have time to fill up nicely between beats, fast enough to probably maintain a good blood pressure. So I visualize the atria clipping along, with the ventricles contracting every third or fourth time.

This one? Well – is it organized? Actually it is: see the pattern of doubles? It’s a little easier to figure out by looking at the lower part of the strip – this is a sinus rhythm, and after every sinus beat comes a PAC, followed by a compensatory pause. So yes, still organized. “Regularly irregular”.

How about this one? Yup, VT. Ugly, scary, but still organized, regular – the chambers (which ones?) are moving in a steady manner. On your mental screen you should see the ventricular walls contracting very rapidly – do they have time to fill? Should we shock this rhythm? It depends…

Sample Nursing Diagnosis for Colostomy

Colostomy

Colostomy is a surgical procedure that brings one end of the large intestine out through the abdominal wall. Stools moving through the intestine drain into a bag attached to the abdomen.
Description

The procedure is usually done after:

• Bowel blockage (obstruction)
• Bowel resection
• Injuries

The colostomy may be short-term or permanent.

Colostomy is done while you are under general anesthesia (asleep and pain-free). It may either be done with a large surgical cut in the abdomen, or with a small camera and several small cuts (laparoscopy).

The type of approach used depends on what other procedure done needs to be done. In general, the surgical cut is made in the middle of the abdomen. The bowel resection or repair is done as needed.

Nursing Care Plan for Colostomy

Sample Nursing Diagnosis for Colostomy

1. Risk for Impaired Skin Integrity : risk factors may include absence of sphincter at stoma and chemical irritation from caustic bowel contents, reaction to product/removal of adhesive, and improperly fitting appliance.

2. Risk for Diarrhea/Constipation : risk factors may include interruption/alteration of normal bowel function (placement of ostomy), changes in dietary/fluid intake, and effects of medication.*

3. Deficient Knowledge [Learning Need] regarding changes in physiologic function and self care/treatment needs may be related to lack of exposure/recall, information misinterpretation, possibly evidenced by questions, statement of concern, and inaccurate follow-through of instruction/development of preventable complications.

4. Disturbed Body Image may be related to biophysical changes (presence of stoma; loss of control of bowel elimination) and psychosocial factors (altered body structure, disease process/associated treatment regimen, e.g., cancer, colitis), possibly evidenced by verbalization of change in perception of self, negative feelings about body, fear of rejection/reaction of others, not touching/looking at stoma, and refusal to participate in care.

5. Impaired Social Interaction may be related to fear of embarrassing situation secondary to altered bowel control with loss of contents, odor, possibly evidenced by reduced participation and verbalized/observed discomfort in social situations.

6. Risk for Sexual Dysfunction: risk factors may include altered body structure/function, radical resection/treatment procedures, vulnerability/psychologic concern about response of SO(s), and disruption of sexual response pattern (e.g., erection difficulty)