NURSING ACN-II

Liaquat University of Medical and Health SciencesJamshoro Sindh

Advance Concept of Nursing

Khairunisa(BScN Year I)

College of Nursing, JPMC

Mrs. Ruth K. Alam

Liaquat University of Medical and Health SciencesJamshoro Sindh

Advance Concept of Nursing

Mussarat Begum(BScN Year I)

College of Nursing, JPMC

Mrs. Ruth K. Alam

LIAQUAT UNIVERSITY OF MEDICAL

AND HEALTH SCIENCEJAMSHORO SINDH

Valvular Heart DiseaseMs. Capt. Dur-e-Yakhta

ACN IIMs. Yasmin

OBJECTIVES

By the end of this session the learners will be

able to:

1. Define Valvular Heart Disease.

2. Discuss etiology and pahtophysiology of Valvular Heart Disease.

3. Identify signs and symptoms of Valvular Heart Disease.

4. Describe the management of Valvular Diseases.

5. Explain Nursing management in Valvular Heart Disease.

6. Enlist Nursing intervention in Valvular Heart Disease.

7. Know about preventing of Valvular Heart Disease.

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VALVULAR HEART DISEASEThe heart valves when healthy keep blood flowing through the heart an lungs in the proper unilateral direction.

Diseased valve may impede the flow of blood from one chamber to the next (valvular stenosis) or they may allow blood to leak (regurgitate) back into the chamber from which blood is being pumped (valvular insufficiency or regurgitation).

Valvular Disease1. Mitral valve stenosis/Regurgitation.

2. Aortic valve stenosis/Regurgitation.

3. Tricuspid valve/Regurgitation.

4. Mitral valve prolapse syndrome.

Mitral Valvular Disease

The mitral (bicuspid) valve lies between the left atrium and ventricle. The mitral valve allows free blood flow forward, from the left atrium to the left ventricle. Equally important, it prevents backward flow from the ventricle to the atrium. Lesions of the mitral valve either obstruct the flow of blood from atrium to ventricle (stenosis) or allow blood to leak back from ventricle to atrium (regurgitation). In either case, mitral valve lesions overwork the left atrium.

Mitral Stenosis

Mitral stenosis is the commonest valvular lesion in people with rheumatic heart disease.

Etiology

Mitral stenosis results in obstruction to left ventricular filling. It must be differentiated from other (rare) conditions that impede left heart filling such as LA tumors, thrombus and cor triatriatum, and pulmonary vein stenosis.

Reheumatic fever – the most common cause of mitral stenosis, which ultimately leads to retraction, scarring, thickening, calcification, and immobility of the valve leaflets and subvalvular

apparatus. Two-thirds of cases of rheumatic mitral stenosis occur in women.

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Other conditions – rare causes of mitral include:

Mitral annulus calcification (elderly).

Malignatn carcinoid syndrome.

Systemic lupus erythematosus.

Rheumatoid arthritis.

Congenital causes – in infants and children, mitral stenosis occur as a result of congenital deformity of the mitral valve, obstructing membranes, or abnormalities of the MV apparatus.

Pathophysiology

Valvulitis, from acute rheumatic infective endocarditis.

Leads to fibrosis and retraction of the valve leaflets.

The chordae tendinease contract and shorten and the mitral commissures fuse.

As the valves become calcified and immobile, the valvular orifice narrows, preventing normal passage of blood from left atrium to left ventricle.

The left atrium hypertrophies to compensate for the narrowed orifice.

Blood trapped in the atrium causes congestion and pulmonary hypertension.

These conditions overwork the right ventricle, sometimes leading to right ventricular failure. Inadequate filling of the left ventricle (preload) sometimes results in reduced cardiac output.

Diagnosis

Only 50% to 60% of patients may remember having had an attack of acute rheumatic fever (ARF).

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Signs and Symptoms

1. Pulmonary Signs and Symptoms

a) Dyspnea

Dyspnea is the most common symptom.

With moderate mitral stenosis, dyspnea occurs in settings that require increased cardiac output (CO) (fever, anemia, pregnancy, exercise).

As mitral stenosis progresses, dyspnea occurs with minimal exertion and eventually at rest.

b) Hemoptysis

Hemoptysis is caused by rupture of thin-walled bronchial veins due to an acute rise in pulmonary venous pressure. Hemoptysis may be massive and life-threatening. Other causes of hemoptysis include pulmonary edema and chronic bronchitis.

c) Hoarseness

Hoarseness due to compression of the left recurrent laryngeal nerve by a dilated left atrium (LA) or pulmonary artery (PA) (Ortner’s syndrome) is a rare symptom.

2. Cardiac Symptoms

Fatigue – is secondary to diminished CO.

Palpitation – is commonly the result of atrial arrhythmias.

Chest pain – occur in 10% to 15% of patients.

Systemic embolism – phenomena occur as a result of LA body or appendage thrombus formation due to AF, stagnant LA blood now, decreased CO, and LA dilatation. Patients with suffering a systemic embolic event than do patients with a normal MV in sinus rhythm.

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3. Physical Examination

Patients with a low CO have pink patches on the cheeks (mitral facies).

Signs of systemic venous hypertension occur when RV failure is present. These signs include:

Jugular venous distention (a prominent V wave suggests associated TR).

Peripheral edema.

Hepatomegaly.

Ascites

An RV lift is palpable along the left sternal border when significant pulmonary hypertension is present.

Sinus tachycardia or AF (more common) is present in advanced cases.

Diagnostic Findings

Diagnostic Procedure Findings

Chest X-ray Left atrial enlargement; Pulmonary venous congestion; Right ventricular enlargement.

Electrocardiogram Left atrial hypertrophy; P-mitrale (prolonged, notched P wave); Right ventricular hypertrophy; Atrial fibrillation.

Echocardiogram Thickened mitral valve with diminished movement of leaflets; Left atrial enlargement; Right ventricular enlargement.

Cardiac Catheterization Increased pressure gradient across mitral valve; Increased left atrial pressure; Increased pulmonary

vascular resistance; Increased left ventricular end-diastolic pressure (LVEDP) preload); Increased pulmonary artery wedge pressure (PAWP); Decreased cardiac output.

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Management

1. Medical Therapy

a) Antibiotics

i) Rheumatic fever

Rheumatic fever antibiotic prophylaxis should follow recommended guidelines.

ii) Infective endocarditis

Antibiotic prophylaxis for infective endocarditis is necessary for all patients.

b) Diuretics and Sodium Restriction

Diuretic therapy and dietary sodium restriction are indicated when pulmonary vascular congestion is present.

c) Treatment of Atrial Fibrillation

i) Digitalis

Digitalis is used to decrease the ventricular response to AF.

ii) Beta Blockers and Calcium Channel Blockers

Beta blockers and Calcium channel blockers (verapamil, diltiazem) are alternative agents that can be administered in oral or intravenous form to slow the ventricular response to AF.

iii) Warfarin

Long-term therapy sufficient to prolong the INR to 2.0 to 3.0 is recommended for patients with mitral stenosis and chronic or paroxysmal AF to decrease the risk of thromboembolic events.

2. Surgical Therapya) Valvular Surgery

Valvular surgery is another common operation. Indications for this surgery include:

Progressive impairment of cardiac function due to scarring and thickening of the valve with either (a) impaired narrowing of the valvular opening (stenosis) or (b) incomplete closure (insufficiency, regurgitation).

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Gradual enlargement of the heart with symptoms of decreased activity, shortness of breath, and congestive heart failure.

Today, surgeons can implant several different types of valves. Valve prostheses are divided into two broad groups:i) mechanical prostheses and (ii) porcine bioprosthetic valves. Commonly implanted mechanical prostheses include:

Caged-ball valve (Starr-Edwards): the most extensively used valve.

Eccentric monocusp or tilting disc valve.

Caged-disc valve (Cooley-Cutter).

3. Intervention Therapy

Intervention therapy is indicated for the patient with moderate to severe symptomatic mitral stenosis despite medical therapy (NYHA class III and IV with mitral valve area <1.0cm2/m2).

a) Open Mitral Commissurotomy

Open mitral commissurotomy, performed with direct vision on cardiopulmonary bypass, is indicated in the symptomatic patient with moderate to severe mitral stenosis whose valve is flexible and free of significant calcification or regurgitation.

At surgery, the fused commissures are separated, atrial thrombus is removed, and separation of fused chordae or papillary muscles is performed.

This procedure is preferable to prosthetic mitral valve replacement (MVR) because of lower periopreative mortality, lower long-term morbidity, and lack of requirement for long-term anticoagulation if sinus rhythm is maintained.

Approximately 50% of patients require repeat surgery (commissurotomy or MVR) within 10 years. After 10 years,

the incidence of restenosis dramatically, requiring repeat operation.

b) Percutaneous Balloon Mitral Valvuloplasty (PBMV)

Percutaneous balloon mitral valvuloplasty is an alternative to surgical commissurotomy.

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c) Prosthetic Valve Replacement

Mitral valve replacement (MVR) is indicated in symptomatic, severe mitral stenosis when he valve is not amenable to open commissurotomy or percutaneous balloon mitral valvuloplasty.

Mitral valve replacement is associated with greater preioperative mortality and long-term morbidity compared to other mitral procedures.

In most cases, mitral valve replacement requires life-long anticoagulation.

Other Valvular Disorders

Valve

Disorder

Assessment Data Diagnostic Findings Nursing and

Medical

Intervention

Mitral regurgitation (Insufficiency)

Pansystolic, blowing, high-pitched murmur – at apex, radiating to axilla; Weak-ness, fatigue; Left ventricular failure: Dyspnea, orthopnea, PND, pulmonary crackles, S3 and S4; Palpitations; Right ventricular failure: Neck vein distention, peripheral edema, hepatomegaly.

Chest X-ray:

Left atrial and ventricular enlargement; Pulmonary vascular congestion.

Electrocardiogram:

Left atrial hypertrophy;P-mitrale; Atrial fibrillation; Left ventricular hypertrophy.

Echocardiogram:

Bizarre motion of mitral leaflets; Hyperdynamic left ventricle; Enlarged left atrium and ventricle.

Cardiac catheterization:

Increased left atrial pressure; Increased amount of regurgitant flow; Rule out prolapse and congenital disorders; Increased left ventricular end-diastolic pressure (preload); Increased pulmonary artery wedge pressure; Decreased

Antibiotic prophylaxis; Activity limitations; Sodium restriction; Diuretics; Digitalis; Vasodilators; Anticoagulation

cardiac output.

Continued

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Valve Disorder

Assessment Data Diagnostic Findings Nursing and Medical

Intervention

Aortic stenosis

Systolic, harsh, crescendodecrescendo murmur – right sternal border radiating to neck; Dyspnea, orthopnea, PND S3 and S4; Fatigue; Vertigo and syncope; Chest pain; Ventricular tachycardia; Bradycardia; Low pulse pressure; Palpable thrill at second right intercostals space

Chest X-ray:Calcification of aortic valve; Left ventricular enlargement; Prominent ascending aorta.Electrocardiogram:Left ventricular hypertrophy; Sinus tachycardia, atrial fibrillation; AV conduction delay; Left and right bundle branch block (BBB).Echocardiogram:Limited aortic valve movement; Thickened left ventricular wall.Cardiac catheterization:Increased pressure gradient in systole across aortic valve; Decreased size of aortic orifice; Increased left ventricular end-diastolic pressure.

Antibiotic prophylaxis; Digitalis; Diuretics; Sodium restriction; Activity restrictions; Vasodilators; Oxygen (p.r.n.).

Aortic regurgitation (insufficiency)

Diastolic, blowing, decrescendo murmur – left sternal border, increases with inspiration; Loud S2; Dyspnea, orthopnea, PND; Fatigue, weakness; Syncope; Palpitations (water-hammer pulse); Pulmonary congestion, S3 and S4; Sinus tachycardia, PVCs; Wide pulse pressure; Large and diffuse diastolic thrill, left sternal border; Neck vein distention, ankle edema; hepatomegaly, ascites.

Chest X-ray:Calcification of aortic valve; Left ventricular enlargement; Dilation of ascending aorta.Electrocardiogram:Left ventricular hypertrophy; Sinus tachycardia, PVCs.Echocardiogram:Dilated and hyperdynamic left ventricle; Enlargement of aortic root and left atrium; Early closure of mitral valve; Diastolic fluttering of aortic valve.Cardiac catheterization:Decreased aortic diastolic pressure; Increased left ventricular end-diastolic pressure; Decreased regurgitant flow; Reflux through aortic valve.

Antibiotic prophylaxis; Digitalis; Diuretics; Vasodilators; Sodium restriction; Oxygen (p.r.n.); Activity restrictions..

Continued

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Valve Disorder

Assessment Data Diagnostic Findings Nursing and Medical

Intervention

Tricuspid stenosis

Diastolic, rumbling murmur – left sternal border, increases with inspiration; Signs of right ventricular failure: neck vein distention, peripheral edema, hepatomegaly, RUQ pain.

Chest X-ray:Right atrial enlargement.Electrocardiogram:Tall, peaked P wave – right atrial hypertrophy; Atrial arrhythmias.Echocardiogram:Thickening and abnormal motion of tricuspid valve.Cardiac catheterization:Increased pressure across tricuspid valvegradient in systole across aortic valve; Decreased size of aortic orifice; Increased left ventricular end-diastolic pressure.

Antibiotic prophylaxis; Digitalis; Diuretics; Sodium restriction.

Tricuspid regurgitation (insufficiency)

Same as for tricuspid stenosis

Chest X-ray:Right atrial and ventricular enlargement.Electrocardiogram:Tall, peaked P wave; Right ventricular hypertrophy.Echocardiogram:Right ventricular dilation; Paradoxical septal motion; Tricuspid valvular thickening and abnormal motion.

Same as for tricuspid stenosis.

Nursing Management in Valvular Heart Disease

1. Nursing Assessment

Nursing assessment involves gathering subjective and objective data concerning (a) the type, severity and progress of the valvular disorder; (b) the degree of heart failure; (c) the person’s tolerance to activity; (d) the person’s support systems; and (e)

the degree of knowledge that the person and significant others have concerning the nature of and intervention for the disorder.

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2. Nursing Diagnoses

Nursing diagnoses that may apply to people with valvular disease include the following:

Alteration in cardiac output: decreased, due to valvular abnormalities and/or arrhythmias.

Knowledge deficit regarding the nature of the valvular disorder and its intervention.

Knowledge deficit regarding ongoing home self-care.

Decreased activity tolerance due to valvular dysfunction and heart failure.

Anxiety due to the uncertain nature of the disease and its intervention.

Coping deficit due to the chronic nature of the valvular disease and activity limitations.

3. Nursing Goals

With appropriate and individualized interventions, the nurse can facilitate accomplishment of the following goals and intervention outcomes:

i) The person will maintain or restore hemodynamic stability, as evidenced by clear lungs on auscultation, maintenance of stable dry weight, urine output averaging greater than 30 ml per hour, no reported (or observed) dyspnea of orthopnea, normal vital signs, regular heart rhythm, absence of S3 and 4 heart sounds, and decreased or absent peripheral edema.

ii) The person and/or significant others will demonstrate understanding of the underlying valvular disorder and prescribed treatment as evidenced by ability to describe (a) the disease process, (b) factors contributing to symptoms and (c) rationale for intervention. They will

actively participate in the prescribed health behaviors that enhance success of intervention.

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iii) The person will demonstrate progression toward an optimal level of physical activity tolerance, based on underlying cardiovascular status and psychosocial readiness. The person will demonstrate the ability to pace activity, verbalize improvement in fatigue, and express acceptance of any imposed activity restrictions.

iv) The person will show few behavioral and physical symptoms of anxiety and will use anxiety relief techniques.

v) The person will use adaptive coping strategies, as evidenced by the ability to recognize personal coping patterns and identify appropriate support systems and personal strengths.

Nursing Intervention

1. Nursing Diagnosis: Alteration in Cardiac Output: Decreased, Due to Valvular Abnormalities and/or Arrhythmias

The main goal of nursing intervention for valvular heart disease is to help the person maintain a normal cardiac output, thereby preventing manifestations of heart failure, venous congestion, and inadequate tissue perfusion.

To evaluate the effectiveness of therapeutic interventions, perform ongoing hemodynamic assessment.

Monitor vital signs closely.

A decrease in cardiac output manifests in a compensatory rise in heart rate, a drop in blood pressure, or a decrease in urinary output.

Carefully auscultate the chest to identify the presence of adventitious breath sounds (crackles, rhonchi) or heart gallops (S3, S4).

2. Nursing Diagnosis: Knowledge Deficit Regarding Ongoing Home Self-care

Before discharge, prepare detailed learning/teaching guidelines for the person and significant others concerning the therapeutic regimen.

Give information concerning prescribed medications.

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Medications frequently prescribed include digoxin, diuretics, potassium supplements, anticoagulants, and prophylactic antibiotics.

Clearly explain their rationale, dosages, side effects and special considerations in their use.

You must also review exercise prescriptions with the person.

Aortic stenosis often requires activity restrictions, whereas other valve problems usually are self-limiting.

In addition, address dietary restrictions, and plan interdisciplinary follow-up.

Make sure the person knows whom to call when questions arise.

Preventing Valvular Heart Disease

Rheumatic heart disease, the most common cause of valvular heart disease, is preventable. Community nurses working in health care centers or schools can often detect individuals with beta-hemolytic streptococcal infections (the precursor to rheumatic heart disease). The nurse needs to refer these individuals for appropriate diagnosis and intervention.

References

1. Nursing people experiencing cardiovascular structural disorders; pp 991-1001.

2. Chung, EK and Tighe DA (1999). Valvular Heart Disease In: Pocket Guide to Cardiovascular Diseases. Blackwell Science Inc; pp 229-238.

LIAQUAT UNIVERSITY OFMEDICAL & HEALTH SCIENCES

JAMSHORO SINDH

Bladder Cancer

Farzana Kouser(BScN Part I Student)

ACN-II

Mrs. Munira A. Ali

Contents

Bladder Cancer

Definitions

Types

Pathophysiology

Etiology and Incidence

Clinical manifestation.

Investigation.

Management.

Nursing Diagnosis.


References.

1

BLADDER CANCER

Cancer

It is a general term to describe malignant growth in the

tissue of which carcinoma is of epithelial and sarcoma of

connective tissue, origin as in bone and muscle.

Types of Cancer

Cancer are classified by their microscopic appearance and

the body site from which they arise. The name of cancer is

derived from the type of tissue in which develops, most

common are:

1. Carcinomas (Cancer Tumor)

Malignant tumors arise from epithelial cells.

2. Melanomas (Melano-Black)

Cancerous growth of melanocytes, skin cell produces

pigment melanin.

3. Sarcoma

Any cancer arises from muscle cell or connective

tissues.

i) Osteogenic Sarcoma (Bone origin)

Destroy the bone tissues.

4. Leukemia

Cancer of blood.

5. Lymphoma

Malignant disease of lymphatic tissue.

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Pathophysiology

Cancer is disease process that began

Abnormal cell arise from normal body cell

Result from poorly understood mechanism of change

As disease progresses locally

Abnormal cell proliferate

Ignoring growth – regulating signals in the microenvironment surrounding cell

Cell acquire invasive characteristics

Change occur surrounding the tissue

Cell infiltrates these tissue and access to lymph and blood vessels

By which blood transported metastasis

To other part of body

Cancer is not a single disease with a single cause rather it

is a group of distinct disease with different causes,

manifestations, treatments and prognoses.

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Bladder

Urinary bladder is a hallow muscular organ, which acts as a

reservoir.

Etiology

1. Cigarette smoking.

2. Carcinogens work environment such as dyes, rubber,

leather, ink or paint.

3. Coffee drinking.

4. Chronic parasitic infection.

Incidence

Age: More common after 50 years.

In man than woman (3:1).

Clinical Manifestions

Hematuria.

UTI.

Producing frequency.

Urgency.

Dysuria.

Alteration in voiding.

Pelvic or back pain.

Investigation

Urography.

Tomography.

Ultrasonography.

Biopsies.

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Management

Treatment of Bladder cancer depends on the grade of

tumor.

1. Transurethral resection or fulguration (superficial

bladder cancer).

2. Chemotherapy.

3. Cystectomy.

Nursing Diagnosis

1. Alteration in urinary elimination pattern.

2. High risk for infection.

3. High risk for injury.

4. Alteration in nutrition.

5. Alteration in comfort (pain).

Nuring Intervention

1. Prevention of infection.

2. Prevention of injury related to bleeding disorder.

3. Maintenance of tissue integrity.

4. Relief of pain.

5. Decreasing fatigue.

6. Rehabilitation.

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References

Smeltzer SC and Bare BG. Oncology: Nursing the

Patient with Cancer In: Brunner and Suddaraths

Text Book of Medical and Surgical Nursing.

7th Edition. JB Lippincott Co 1992.

Tertora-Grabowski. Principles of Anatomy and

Physiology. 7th Edition.

Estimated Cancer Deaths by Site and Sex

Liaquat University of Medical & Health SciencesJamshoro Sindh

Diabetes Mellitus

ACN-II

Maqbool AhmedM. Farooq SaeedKamla Kumari

(BScN Part-I Students)

Mrs. Munira A. Ali

OBJECTIVES

At the end of this session the learners will be able to:

8. Define Diabetes mellitus.

9. Enlist types of Diabetes mellitus.

10. Describe pathophysiology.

11. Enlist causes of Diabetes mellitus.

12. Explain clinical manifestation of Diabetes mellitus.

13. Enlist investigation for diagnosis of Diabetes mellitus.

14. Manage Diabetes mellitus.

15. Explain complications of Diabetes mellitus.

16. Demonstrate sites of insulin administration.

17. Enlist nursing diagnosis of Diabetes mellitus.

18. Explain necessary nursing intervention regarding Diabetes mellitus.

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DIABETES MELLITUS

Definition

Diabetes mellitus is a clinical syndrome characterized by hyperglycemia

due to absolute or relative deficiency of insulin.

Diabetes mellitus is a group of chronic endocrine (pancreatic) metabolic

disorder caused by deficiency, absence or resistance to the action of insulin

characterized by hyperglycemia.

Types of Diabetes mellitus

The types of diabetes mellitus is describe by National Data Group in 1979 as

follow:

1. Type 1 or Insulin Dependent Diabetes Mellitus

In this type of diabetes, the beta cell of islet of Langerhans in pancreas could not

produce insulin. It occurs in any age, mostly before 30 years. It is also called

“Juvenile Diabetes Mellitus”.

2. Type 2 or Non-Insulin Dependent Diabetes Mellitus

It was formally called “Adult-Onset” or “Maturity-Onset” diabetes. In this type

insulin are present but there is a resistance to the biologic activity of insulin in liver

and peripheral tissues. This is mostly occurred after 35 years of age.

3. Diabetes Mellitus Associated With Other Condition or Syndrome

Secondary diabetes condition known or suspected to cause the disease like

pancreatic disease, hormonal abnormalities.

4. Gestational Diabetes

Gestational diabetes onset during pregnancy usually in the second or third trimester

due to hormones secreted by the placenta, which inhibit the action of insulin.

Pancreas

The pancreas is a pale grey gland weighing about 60 grams. It is about 12 to 15 cm

long and is situated in the epigastric and left hypochondriac regions of the

abdominal cavity. It consists of a broad head, a body and a narrow tail. The head

lies in the curve of the duodenum, the body behind the stomach and the tail lies in

front of the left kidney and just reaches the spleen. The abdominal aorta and the

inferior vena cava lie behind the gland.

Structure

The pancreas is both an exocrine an endocrine gland. The exocrine part consists of

a large number of lobules made up of small alveoli, the walls of which consist of

secretory cells. Each lobule is drained by a tiny duct and these unite eventually to

form the pancreatic duct that extends the whole length of the gland and opens into

the duodenum at its midpoint. Just before entering the duodenum the pancreatic

duct joins the common bile duct to form the ampulla of the bile duct. The duodenal

opening of the ampulla is controlled by the sphincter of Oddi.

The islets of Langerhans are the endocrine part, consisting of groups of specialized

cells distributed throughout the gland. They secrete the hormones glucagon and

insulin. The islets have no ducts sot he hormones pass directly into the blood.

The pancreas in relation to the duodenum and biliary tractPart of the anterior wall of the duodenum removed

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Physiology

1. Endocrine Pancreas Hormones

The endocrine pancreas produces hormones necessary for the metabolism and

cellular utilization of carbohydrates, proteins and fats. The cells that produce these

hormones are clustered in groups of cells called the “Islets of Langerhans”. There

are three different types of cells in these islets.

i) Alpha Cells

These cells produce the hormone “Glucagon”. Glucagon stimulates the

breakdown of glycogen in the liver, the formation of carbohydrates in the

liver and the breakdown of lipids in the liver and in the adipose tissue. The

primary function of glucagon is to decrease glucose oxidation and to

increase blood glucose levels.

ii) Beta Cells

Beta cells secrete the hormone insulin. Insulin facilitates the movements of

glucose across the cell membranes into cells, decreasing blood glucose

levels. Insulin prevents the excessive breakdown of glycogen in the liver

and in muscle, facilitates lipids formation, inhibiting the breakdown of

stored fats and helps move amino acids into cells for proteins synthesis.

iii) Delta Cells

These cells produce a substance called “Somatostatin”. Somatostatin is a

neurotransmitter, and inhibits the production of both glucogan and insulin.

Pathophysiology

Type 1 (IDDM)

Insulin dependent diabetes mellitus/Type 1 or Juvenile diabetes can occurs at any

age but most commonly before the age of 30 years. It is the result of the

destruction of the beta cells of the islets of the Langerhans. When beta cells are

destroyed, then insulin is no longer produced. The destruction of the beta cells is

result from a combination of three factors:

1. Genetic predisposition.

2. Viral or toxic chemical.

3. Autoimmune attack.

The disease develops in five stages.

i) Genetic predisposition.

ii) Environmental trigger.

iii) Active autoimmunity.

iv) Progressive beta cells dysfunction.

v) Overt diabetes mellitus.

1. Genetic Predisposition

There is a relationship between the occurrence of IDDM and genetic

predisposition. The general risk of IDDM ranges from 1 in 400 to 1 in 1000. The

children of a person with diabetes have 1 in 20 to 1 in 50 risks. The genetic

markers that determine immune response have been found in 95% of people

diagnosed with IDDM are DR3 and DR4 histocompalibality. Further, if the father

have DM, then the risk is 2.5%, if mother then 2%, if both then 15% and if sibling,

then 3%.

2. Viral or toxic chemical (Environmental)

The environmental factors precipitate rather than initiate the diabetes mellitus and

also trigger the development of DM. The triggers are infections as mumps, rubella

or coxsachie virus BA, or chemical toxin such as those found in smoked and cured

meats. An exposure to the virus or chemical, an abnormal autoimmune response

occurs in which antibodies respond to normal islet beta cells as though they were

foreign substances, destroying them. The symptoms of IDDM appear when about

90% of the beta cells are destroyed or in the acute stage of the process. When an

illness or stress increase the demand of insulin beyond the reserves of the damaged

cells.

3. Autoimmune Attack

(HLA-DR-3 and B-15 known to be associated with immune endocrinopathy are

found with increased frequency in IDD patient). There is a co-existence of IDDM

and other forms of autoimmune endocrinopathy such as adrenal insufficiency,

hoshimotois thyriditis, hyperthyroidism, pernicious anemia and collagen vascular

disease.

Type 2 (NIDDM)

There are two main problems related to insulin:

Insulin resistance.

Impaired insulin secretion.

Insulin Resistance

Insulin resistance to a decreased sensitivity of the tissue to insulin normality.

Insulin binds to special receptors on cell surfaces due to this binding a series of

reaction involved in glucose metabolism occurs with the cell.

Causes of Diabetes Mellitus

Type 1 is characterized by destruction of the pancreatic beta cell. Currently, it is

thought that a combination of genetic, immunologic and possibly environmental

factors contribute to beta cell destruction.

1. Immunological Factors

In diabetes, there is evidence of an autoimmune response. This is an abnormal

response in which antibodies are directed against normal tissue of a body.

2. Environmental Factors

It has been proposed that certain viruses or toxins may precipitate the autoimmune

process that leads to beta cell destruction.

3. Genetic Factors

Genetic factors are thought to play a role in the development of insulin resistance.

In addition, these certain risk factors that are known to be associated with the

development of type 2 diabetes is included.

Signs and Symptoms

Type 1 (IDDM)

Hyperglycemia/Glucose urea.

Polyuria.

Polydipsia.

Polyphagia.

Weight loss.

Malaise.

Fatigue.

Abrupt and rapid onset of hyperglycemia.

Postural hypotension.Type 2 (NIDDM)

Slow onset of manifestation.

Polyuria.

Polydipsia.

Polyphagia.

Weight is mostly gained/obese.

Blurred vision.

Fatigue.

Paresthesias.

Skin infection (pruritis, vaginitis).

Lack of energy.

Delay wound healing.

Diagnostic Tests

Blood test is a major test, which is employed to diagnose the presence and severity

of diabetes and includes:

Fasting blood sugar.

Random blood sugar.

Glucose tolerance test.

Urine ketoacetosis (Urine test for glucose).

Management

There are three methods of management of diabetes.

1. Diet alone.

2. Diet and oral hypoglycemic drug.

3. Diet and insulin.

1. Diet

The patient of diabetes mellitus needs balance and special diet as mention below:

Foods to be avoided altogether include sucrose, glucose and foods high in

sucrose/glucose.

Carbohydrate foods to be eaten in moderation such as breads of all kinds,

rolls, scones, biscuits, crisp breads; breakfast cereals and porridge,

potatoes, peas, baked beans; all fresh and dried fruit; pasta, custard, thick

soups; ‘diabetic foods’, milk; meat, fish, eggs, cheeses.

Foods, which can be eaten, as desired include green vegetables, clear soups,

meat extracts, tomato or lemon juice, tea and coffee.

Beside this, routine should be made for regular exercise and daily walk to

induce weight loss and to reverse the insulin resistance.

2. Oral Hypoglycemic Drugs

These drugs are valuable in the treatment of patient with NIDDM who fail to

respond to simple dietary restriction. There are two groups of oral hypoglycemic

drugs.

a) Sulphonylureas - Non-obese.

b) Biguanides - Obese.

3. Insulin

Types of Insulin

a) Regular (R) (Humiten R)

i) Clear solution.

ii) Rapid onset.

iii) Short duration.

Indication

New cases of diabetes with dehydration and or ketoacidosis.

In emergencies e.g., ketoacidosis or surgical procedure.

In all IDDM in combination with depot insulin.

b) Modified or Intermediate and long acting Insulin

(Mixtard – 70% N + 30% R)

i) Cloudy solution.

ii) Delayed onset.

iii) Prolong duration because insulin is pre-mixed with retarding agents e.g.,

protamine or zinc.

Indication

In IDDM along with unmodified insulin.

c) NPH (N) Intermediate Acting (Isophane)

Sites of Injection

Any areas of the body with subcutaneous tissue may be used for injection of

insulin. The sites that allow the most rapid absorption are:

1. Abdomen (around umbilicus – 2 inch diameter).

2. Deltoid muscles.

3. Thigh.

4. Hip.

Sites of Insulin Injection

Preparation of Insulin

Administration of Insulin

1. Select site.

2. Clean with spirit swab.

3. While administrating insulin gently pinch a fold of skin and inject the

needle at 90 degree angle.

4. Do not massage after injected insulin.

5. Rotation of injection sites is recommended, distance about one inch.

Complications of Diabetes Mellitus

Hypoglycemia.

Hyperglycemia.

Macrovascular disease.

Microvascular disease.

Retinopathy.

Nephropathy.

Coronary artery disease (Myocardial Infarction).

Cardiovascular disease (Stroke).

Peripheral vascular disease.

Neuropathy (Nerve damage).

Sensorimotor.

Autonomic neuropathy.

Foot ulcers.

Nursing Diagnosis

Risk for injury.

Anxiety.

Fatigue.

Ineffective management of therapeutic regimen.

Risk for fluid volume deficit.

Sexual dysfunction related to vaginitis.

Altered nutrition.


Maintenance of fluid and electrolyte balance. Intake and output are

measured.

Vital signs are monitored to detect signs of dehydration, tacychardia,

orthostatic, hypertension, etc.

Correction of metabolic abnormalities, glucose monitoring is performed

before meal and at bedtime. Insulin is administered as ordered.

In patient educational patient is taught survival skills including simple

pathophysiology, treatment modalities (insulin administration), monitoring

of blood glucose, urine ketones and prevention from complications.

Regular visit to the physician.

Teaching about appropriate preventive behavior (e.g., foot care and eye

care).

Normal range of blood glucose, the patient should know it.

Low literacy information is used as needed.

Family should be instructed to assist in diabetic management.

References

Smeltzen SC and Bare BG (1992). Text Book of Medical and Surgical

Nursing. Brunner and Suddarath (ed.). 7th Edition. JB Lippincott Co.

Kumar PJ. Clinical Medicine. 2nd Edition.

Edward CRW. Davidson’s Principles and Practice of Medicine. 16th

Edition.

Andeoli, Plum and Smith. Cecil Essentials of Medicine. 2nd Edition.

Schroeder SA. Current Medical Diagnosis and Treatment. 32nd Edition.

Baunwald and Wilson. Harison’s Principles of Internal Medicine. 12th

Edition.

LIAQUAT UNIVERSITY OFMEDICAL & HEALTH SCIENCE

JAMSHORO SINDH

Health Perceptions / Management Pattern

Aster GhulamMahmood AhmedMaqbool Ahmed

Rukhsana Perveen

ACN-I

Miss. Yasmin Parpio

OBJECTIVES

By the end of this session the learners will

be able to:

19. Define the terms health, wellness and illness.

20. Explain the Health Belief Model (HBM).

21. Identify the risk factors affecting health.

22. Describe implementation of nursing measures for promotion of health behavior, lifestyle and elderly care.

23. Explain nursing care process related to altered health maintenance.

1

Definitions

1. Health

Health is a state of complete physical, mental

and social well being and not merely the absence of

disease or infirmity (WHO 1947).

2.. Wellness

Wellness is a level of well being in which a

person perceives of being healthy.

3. Illness

Illness is a highly personal state in which the

person feels unhealthy or ill. Disease alters body

function and results in a reduction of capacities or a

shortened life span.

Models of Health and Wellness

Health is such a complex concept for which

various researchers have developed models or

paradigms to explain health and its relationship to

illness or injury. Models help health professionals to

meet health and wellness needs.

2

Smith’s Model of Health

Judith Smith (1981) describes four models of

health.

1. Clinical Model

Health is identified by the absence of

sign/symptoms of disease and injury. When

sign/symptoms disappear, a person is considered

healthy.

2. Role Performance Model

In this model a person is considered healthy if

he can perform work, although he may possess any

potential problem (e.g., lung tumor).

3. Adaptive Model

In this model health is a creative process,

disease is a failure in adaptation. The aim of

treatment is to restore the ability to adapt and to

cope.

4. Eu-daemonistic Model

When people fulfill their requirements and

complete development that is actualization.

Actualization is fully developed personality. In this

model health is seen as a condition of actualization

or realization of a person’s potential.

3

Leavell and Clark’s (1965) Agent Host

Environment

This is also called ecologic model. It is used to

identify the risk factors that result from interaction

of environment, host and agent.

1. Agent – any environmental factor or

stressor, biochemical, physical,

mechanical or psychological.

2. Host – a person who is caused family.

3. Environment – all factors external to the

host, climate, sound, economic.

Health Illness Continuum

a) Dunn’s High Level Wellness Grid

Dunn describes a health grid. The gird

demonstrates the interaction of environment with

wellness-illness continuum.

i) High level wellness in a favorable

environment – a person implements to

support his lifestyle by using all resources.

ii) Emergent high level wellness in an

unfavorable environment – a person has

knowledge but does not implement

adequate self-care.

4

iii) Protected poor health in a favorable

environment – an ill person (multiple

fracture) or hypertensive who meets

health care system.

iv) Poor health in unfavorable environment

e.g., a young child starving in a drought

stricken country.

b) Travis Illness-Wellness Continuum

According to this continuum health is not a

state but an ability to function with different levels.

Health is dynamic process with one end to death

and other to highest level of wellness and the

individuals can place themselves at different

locations at one point a time. Just like different

culture had their own norms and standards, health

has its levels.

Illness-wellness Continuum

Wellness model

Treatment model

DeathDisability Symptoms Signs Awareness Education Growth

Wellness

Neutral point

5

Elder Client Problems and Care

Physiologic changes such as decreased vision,

loss of hearing, diminished sense of smell and taste,

tooth loss, poor reflex reactions, memory

impairment, skin lost effectiveness as barrier,

general hair loss, range of motion of joints

decreases may be incontinence of urine, food

absorption disturbance and constipation may occur.

Nursing Care

Focus especially on known problems, check

nutritional status, disability and establish

supportive relationship. Teach activities of daily

living, any associated disease such as arthritis,

COPD and CHF should be monitored carefully. Be

careful when take a sample of specimen of elder

client.

Smoking

Smoking is a dangerous and risky habit for

health. It drains economically and affects the

respiratory system, which may cause respiratory

problems and lung cancer in a client. Many deaths

occur in world due to smoking every year.

Teach a client the effects of smoking and its

results in future. Counsel, if a client is interested

himself to stop smoking.

6

Obesity

Obesity is a common problem of our society,

which is a main cause of disease of cardiovascular

system. Increased level of cholesterol suffers a

client for it.

Provide food pyramid guide to an obese client

and teach him to walk, jogging, and exercise and to

participate social activities to control his weight.

Infection

Establishment of a disease process that

involves invasion of the body tissue by

microorganisms and the reaction of the tissues to

their presence and to the toxins generated by them.

Infectious Agent

Bacteria, virus and fungi.

Mode of Transmission

Direct, indirect and airborne.

a)Direct Transmission – by coughing,

sneezing, kissing, sexual intercourse.

b)Indirect Transmission – using patient’s

utensils, clothes, needles, soiled dressing,

contaminated food, water, by vectors.

c)Airborne – by droplet infection like

tuberculosis, whooping cough, etc.

7

Barrier to Infection

Body is protected against infection by

immunities. Body’s natural immunity, antitoxins,

vaccines and phagocytosis.

Conditions Predisposing to Infection

1. Surgical wound – microorganisms can enter

during post-surgical procedures.

2. Anti-bacterial Immune Mechanisms –

abnormalities limited, prohibited, synthesis of

antibodies against foreign bodies

(microorganisms).

Entrance of microorganisms in these route can

cause infection through procedures.

3. Respiratory Tract.

4. Genito-urinary Tract

5. Invasive Drugs – contaminated drugs I/V

solutions can be infective cause.

24. Vein Puncture Site – I/V canula, syringe can

enter bacteria to vein.

25. Implanted Prosthetic Devices – PPM shunts,

etc.

8

Standard Precaution to Control Infection

1. Hand washing before and after every

procedure.

2. Gloves (sterilize).

3. Mask eye protection face shield.

4. Gown.

5. Linen (clean, dry linen) (remove soiled and

contaminated linen).

6. Discard syringe needles in a container and

place contaminated articles in a leak proof

bags/containers.

7. Place client in isolation room if have

communicable disease.

8. Prepare a sterile field e.g., an operation theatre

by fumigation by carbolizing, etc. and by

supplying pre-packed supplies.

Scenario

Zahid Ali age 54 years old admitted with a

complaint of dyspnea and cough. He is a known

asthmatic patient. His recent investigation report of

CBC shows decreased Hb 4.0 g/dl, WBC 3.7 and Plt

is 49.

Nursing Diagnosis

Altered breathing pattern.

Altered health maintenance i.e., high risk for

infection.

Altered health maintenance i.e., high risk for

injury.

11

References

1. Erb and Kozier. Fundamental of Nursing. 5th

Edition. Blaise Wilkinsin California.

2. White L. Fundamental of Nursing. 1995

3. Smith and Duell. Clinical Nursing Skills. 4th

Edition. Appleton and Lange 1996.

Role Relationship PatternSTANDARD NURSING CARE PLAN

TITILE: HIGH RISK FOR INFECTIONPATENT’S NAME: Zahid Ali

D.O.A. 10/10/2005AGE:

54 YearsDIAGNOSIS: Anemia

C.R. NO.65296

CO-MORBITIES: AsthmaWARD NO.

12SIGN/DATE/TIME: M. Ahmed/10-10-05

BED NO.15

Date

Assessment(Data Statement)

Nursing Diagnosis Goal/Planning Nursing Intervention

10-1

0-20

05

Subjective Data:

Objective Data:A male patient 54 years old looks pale, weak and with respiratory distess.

Vital Sign:

Altered health mainten-ance i.e., high risk for infection related to decreased WBC i.e.,3.7 x 103 secondary to disease process and neutropnea

Short-term Goals:

Patient will be able to identify the measures to prevent infection within a day.

Long-term Goals:

Till hospitalization patient will remain free from symptoms of infection.Patient will not develop complications

Check vital signs 4 hourly.

Wash hands before and after any procedure and wear gloves.

Encourage iron supple-mentary diet to the patient.

Patient should be isolated.

Send and collect Lab reports.

Give medications on proper time and dose as prescribed by the doctor.

Check transfusion orders and transfuse to the patient on advised blood components.

Blood Pressure Temperature Heart rate Respiratory rate

Lab. Investigations

Hb WBC Platelet

90/70 mmHg 98 F 96 per min 30 per min

4 mg/dl 3.7 x 103

49

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Role Relationship Pattern

LIAQUAT UNIVERSITY OF MEDICAL & HEALTH SCIENCES

JAMSHORO SINDH

Role Relation Pattern

Muhammad Farooq Saeed

ACN I

Miss. Yasmin Parpio

65


Role is a comprehensive pattern of behaviors that is socially recognized

provides a means of identification and placing an individual in a society. Role is an

interaction point between the individual and society. Roles are responsibilities

including roles in family, work and social relationship. There are three types of

role i.e., acquired roles, achieved roles and interdependent roles.

Family is a structured system of a relationship in which individuals are

bound to one another by complex, interlocking relationship. Such type of

relationship is also known as kinship system. There are several forms of family.

Nuclear family consists of husband, wife and children. Nuclear Dyad family

consists of Husband and wife alone. Single Parent family consists of one head of

household (mother or father). Single Adult Alone family emerged either by chance

or choice, divorce or death of a spouse. Three Generation family consists of three

or more generations living in a single house. In Kin Networking family, nuclear

household or unmarried members live in close geographical proximity. Institution

family depends on children in orphanages or residential schools (hostel), and

Homosexual family depends upon homosexual couple with or without children.

The primary relationship in family members are husband and wife, mother and

daughter, father and son, father and daughter, mother and son, elder and younger

brother, elder and younger sister or brother and sister.

A Genogram resembles a family tree, however, it includes additional

relationships among individuals. The advantages of Genogram uses are to permit

the therapist and the patient to quickly identify and understand patterns in family

history. To map out relationships and traits that may otherwise be missed on family

background chart. To include basic information about number of families, number

of children of each family, birth order and deaths. Some gonograms also include

information on disorders running in the family such as alcoholism, depression,

diseases, alliances and living situations.

The factors affecting role relationship in family include socioeconomic

condition, family dynamics, changing roles (of institution), and gender role

expectation, type of personality and communication skills.

The development considerations according to age in neonate and infant are

attachment behavior such as crying, smiling, clinging, following and cuddling.

Depends on parents for basic needs, reciprocal interaction between infant and

parents, feeling of fear in case of loneliness and behavior in despair. In specific

66


consideration, it includes fulfilling of basic needs, assess infants emotionally

especially when they are alone or in despair, understand crying process and

respond symbolic interaction. In toddler, it includes sense of right or wrong,

confirmation of social demands, depend of mother (parents) and starting of social

interaction. In preschooler, make friends of same sex, capable of internalizing the

social norms and tolerate brief separation of their parents. In terms of school age

child, learn social roles as male and female, enjoy school and peer interaction,

make friends of same sex, capability of expressing feelings, acknowledge

limitations, get allowance for increasing interest outside from the home. In

adolescent, dependence and interdependence, intensive relationship with opposite

sex, spend more time alone, peer and social interaction according to family needs.

Young adults, peak level of biophysical and cognitive skills, meaningful intimate

relationship, primary focus on establishment of family, marriage and parenting,

thinking involves reasoning, consider past experiences, education and possible

outcomes of a situation and learn how to deal with personal and desired needs of

others. In middle age adult, productive years for an individual, parenting role,

mostly secure in a profession/career, initiation of biological and physical changes,

accept the changes of age, prone to chronic diseases/illnesses and finally for older

adult, volunteer role (choice, demand), elder role modeling and depending upon

others.

Manifestation of altered family functions depends on stress, life

disturbance, impaired concentration, effectiveness of performance even at job,

decreased thinking capability and affected decision-making process. Mediators of

roles include role playing skills (symbolic interaction) and self-conception

(values/attitudes, body image, self-esteem and self-awareness about abilities). Role

relationship should be assessed by altered family process,, anticipatory grieving,

dysfunctional grieving, social isolation, impaired social interaction, impaired

verbal communication and altered role performance.

Nursing diagnoses can be made in terms of altered family process by the

state in which a family that normally function effectively experiences a

dysfunction.. A state in which an individual or family experiences a natural

response involving psychosocial, physiological reactions to an actual or perceived

loss (person, object, function, status, relationship) is known as grieving. It further

divided into anticipatory grieving and dysfunctional grieving. Anticipatory

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grieving is the state in which an individual/group experiences reactions in response

to an expected significant loss or extended, unsuccessful use of intellectual and

emotional responses by which individual attempts to work through the process of

modifying self-concept based up the perception of potential loss. Dysfunction

grieving is the state in which and individual/group experiences prolong unresolved

grief and engage in detrimental (harmful) activities or extended, unsuccessful use

of intellectual and emotional responses by which individual attempts to work

through the process of modifying self-concept based up the perception of actual

loss.

Social isolation or aloneness experienced by the individual and perceived

as imposed by others and as a negative or threatened state. Impaired social

interaction is the state in which an individual participates insufficiently, excessive

quantity, or ineffective quality of social exchange. Impaired verbal communication

is the state in which an individual experiences a desired or absent ability to use or

understand language in human interaction, and altered role performance is

disruption in the way one perceives one’s role performance.

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LIAQUAT UNIVERSITY OF MEDICAL & HEALTH SCIENCE

JAMSHORO SINDH

Sexuality and Reproductive Pattern

Mukhtari SardarNabeela TabassumMuhammad Yousaf

ACN

Miss. Yasmin Parpio

69

Role Relationship Pattern 70


OBJECTIVES

By the end of this session the learners will

be able to:

26. Explain pattern description of sexual reproductive aspects of individual.

27. Enlist internal and external genital organs of male and female.

28. Define sexuality, sex and gender identity.

29. Describe types of sex.

30. Explain sexual concept and psychodynamic concern.

31. Enlist biological factors influencing sexuality.

32. Explain Nursing diagnosis and intervention.

71


1

Pattern Description

This pattern focuses on the sexual reproductive

aspects of individual over the entire life span.

Sexuality pattern involve sex male behavior gender

identification and physiologic and biology function

as well as the cultural and societal expectations of

sexual behavior. An individual’s anatomic structure

identifies sexual status, which determine the social

and cultural responses of other toward the

individual’s responsive behavior toward other.

Reproductive pattern involve the capability to

procreate, actual procreation and the ability to

express sexual feeling the success or failure of

psychologically and physically expressing sexual

feeling and procreating can effect an individual’s

lifestyle, health and self-concepts.

The Nurse may care for client who, because of

illness, violence or lifestyle experience alteration or

disturbance in their sexual health and affect their

sexuality and reproductive pattern.

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2

Internal and External Male and Female Genital Organs

The internal and external genital organs of

male and female are:

Male Genital Organs Female Genital Organs

1. Scrotum 1. Labia majora

2. Penis. 2. Labia menora

3. Perineum 3. Vestibules

4. Testes 4. Glands of biathlon

5. Epididymis 5. Prepuce

6. Vas deference (Ductus)

6. Clitoris

7. Seminal vesicles 7. Vagina

8. Ejaculatory ducts 8. Uterus

9. Prostate glands 9. Fallopian tubes

10 Bulbourethral gland (Cowper’s)

10. Ovaries

11. Male urethra

73


3

Sexuality

Sexuality includes all of those aspects of the human being that relate specifically to being boy or girl, man or woman. It is subject to life long dynamic change, as a function of the total personality. It concerned with the biologic, psychologic, sociologic, spiritual, and cultural variable of life.

Sex

It is the term most commonly used to denote biologic male and female status balance. It is also used to describe specific sexual behavior such as sexual intercourse.

Gender Identity

It is the individual’s persisting inner sense o the being male or female. It is development based on biologic sex and socio-cultural reinforcement, which is being at birth with identification of the baby as male or female.

Types of Sex

Biologic Sex

It includes the entire human being genetically determined anatomy and physiology, which is also influenced by intrauterine condition.

Sexual Identity or Sexual Orientation

It is the preference of a person for one sex or the other. Examples are:

1. Heterosexual – one who is sexually attracted to persons of the opposite sex (straight).

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2. Homosexual – one who is sexually attracted to persons of the same sex (gay, both sexes) and lesbian (woman).

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3

3. Rape – the act of forcing of a woman who has sexual intercourse against her will.

4. Gender Role Behavior – is the way a person acts as female or male, including the expression of what is perceived as gender appropriate behavior.

Sexual Concept

The development of sexuality begins with conception and changes throughout the life span. Every society develops expectations about acceptable forms of sexual expression.

Psychodynamic Concern

It is dynamic entity that changes our life span sexuality is a basic human characteristics and cannot be separated from life events.

Biological Factors Influencing Sexuality

Many factors influence a person’s sexuality.

1. Developmental level.

33. Culture.

34. Religion.

35. Values.

36. Personal ethics.

37. Disease processes.

38. Medication.

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4

Nursing Diagnosis

1. Sexual Dysfunction

It is defined as the state in which an individual experiences a change in sexual function that is viewed as unsatisfied unrewarding or inadequate.

2. Sexuality Pattern Altered

It is the state in which individual expresses concern regarding his/her sexuality.

3. Rape Trauma Syndrome

Force violent sexual penetration against the victim’s will and consents the trauma syndrome.


(Dysfunction)

a) Assess and monitor the patient and partner’s level of knowledge and understanding of his/her dysfunction.

b) Provide the patient (couple) with privacy and maintain confidently.

c) Provide the patient with a safe non-judgmental atmosphere.

(Pattern Altered)

d) Provide the patient with accurate information to increase the level of awareness.

e) Involve the couple in decision about the plan of care.

(Rape Trauma Syndrome)

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f) Assess the rape belief pattern and educate as needed.

g) Provide psychotherapy and rape support groups.

78


Scenario

Razia Begum age 45 years old have difficulty in

sexual desire and stated that, “I have irritation,

burning and feeling uncomfortable and also

unsatisfied in sex.

I am depressed and felt change in my interest in

others and myself. I am unable to achieved desired

satisfaction.

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STANDARD NURSING CARE PLAN

TITILE: UNCOMFORT SEXUAL PATTERNPATENT’S NAME: Razia Begum

D.O.A. 10/10/2005AGE: 45 Years

DIAGNOSIS: Sexual DysfunctionC.R. NO. 67296

CO-MORBITIES: NilWARD NO.

SIGN/DATE/TIME: M. Yousuf/11-10-05BED NO. 15

Date

Assessment(Data Statement)

Nursing Diagnosis Goal/Planning Nursing Intervention

10-1

0-20

05

Subjective Data:Patient verbalized that, “I have difficulty in sexual desire and have irritation, burning, feeling uncomfortable and also unsatisfied in sex. I am depressed and change my interest ourself and other and I am feeling. I am unable to achieve desired satisfaction.

Objective Data:Female patient 45 years old was admitted with diagnosis sexual dysfunction change complaining of sex and change in sexual desire and feeling uncomfortable the during sex eue to this she is not satisfied from sexual desire and looking depress.

Vital Sign:

Sexual dysfunction related to sexual desire and burning during sex.

Short-term Goals:

Patient will have decrease complaint of sexual dysfunction after 3 days.

Long-term Goals:

Patient will have identify and know how to manage sexual dysfunction.

Build the relationship with patient.

Provide privacy for expressing sexuality.

Provide accurate information on affects of treatment on sexual function.

Use adequate amount of water soluble lubricant.

Use vaginal steroid cream and take sizs bath.

Advised the investigation, e.g., Urine C/S.

Blood Pressure Temperature Heart rate Respiratory rate

Lab. Investigations

Hb ESR

110/75 mmHg 99.8 F 96 per min 20 per min

12 mg/dl 12 mg/dl

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NURSING ACN-II

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