Nursing Assessment of Pleural Effusion : Physical Examination


Provision of nursing care is a therapeutic process that involves cooperation relationships with clients, families or communities to achieve optimal health level (Canpernito, 2000.2).

Nurses need a scientific method in the therapeutic process is the nursing process. The nursing process is used to assist nurses in nursing practice systematically in troubleshooting existing nursing, where the four components influence each other, namely: assessment, planning, implementation and evaluation. (Budianna Keliat, 1994.2).


Pleural Effusion Physical Examination

1. General health status

The level of consciousness of patients needs to be studied, how the general appearance of the patient, the patient's facial expression during conducted diagnose, attitudes and behavior of patients towards the officer, how the mood of patients to determine the patient's level of anxiety and tension. There should also be height weight measurements of patients.


2. Respiratory System

Inspection in patients with pleural effusion; diseased hemithorax convex shape, horizontal ribs, widened space between the ribs, decreased respiratory movement. Encouragement of the mediastinum towards the contra lateral hemithorax known from the position of the trachea and ictus cordis. Respiration tends to increase and the patient is usually dyspnea.

Vocal fremitus decreased mainly for pleural effusion fluid amount is more than 250 cc. Besides, it is also found on palpation of the chest wall movement on the left chest pain.

Sensitive to percussion sound dim depending on the amount of fluid. If the liquid does not fill the pleural cavity, there will be an upper limit to the liquid in the form of a curved line above the lateral end to medical patients in a sitting position. This line is called Ellis-Damoiseau-line. The most obvious line at the front of the chest, in the back is less clear.

Auscultation of breath sounds decreased until it disappears. In a sitting position to a more fluid upper thinner, and behind it there is compression atelectasis of the lung parenchyma, may be found auscultation signs of compression atelectasis around the upper limit of the liquid. Coupled with a sign i - e does it mean when people are asked to say the words i will e nasal voice, called egophony (Alsagaf H, Ida Bagus, Widjaya Adjis, Abdol Mukty, 1994.79)


3. Cardiovascular system

On inspection to note the location of ictus cordis, normally located on ICS - 5 at the left midclavicular linea with a width of 1 cm. This examination aims to determine whether there is cardiac enlargement. Palpation to calculate heart rate and be aware of the depth and the absence of a regular heart rate, should also check for vibrations that thrill ictus cordis. Percussion to determine the limits of the heart where the heart area sounded dull. It aims to determine is there any heart or left ventricular enlargement. Auscultation to determine the first and second heart sound gallop and is there a single or a third heart sound that is a symptom of heart trouble and is there a murmur which showed an increase in blood flow turbulence.


4. Digestive System

On inspection note, if abdominal bulge or flat, protruding belly edge or not, prominent umbilicus or not, but it is also necessary in inspection presence or absence of nodules or masses.

Auscultation to listen to sound normal intestinal peristalsis where the value 5-35 times per minute. On palpation should also be noted, is there any abdominal tenderness, is there a mass (tumor, stool), abdominal skin turgor to determine the degree of hydration of the patient, whether palpable liver, the spleen is also palpable. Tympanik normal abdominal percussion, a mass of solid or liquid will cause a dull sound (liver, ascites, urinarta bladder, tumors).


5. Neurological System

On inspection of the level of awareness needs to be studied as well, GCS examination is required. Is there composmentis or somnolence or comma. Pathological reflexes, and how the physiological reflex. Additionally sensory functions also need to be assessed as hearing, sight, smell, touch and taste.


6. Musculoskeletal System

On inspection to note is there pretibial edema, palpation at both extremities to determine the level of peripheral perfusion as well as the examination capillary refil time. By inspection and palpation examination of muscle strength were compared between the left and right.

7. Integumentary System

Inspection of the general condition of skin hygiene, the presence or absence of color in the skin lesions, in patients with pleural effusion, usually will appear cyanosis due to failure of the O2 transport system. On palpation need to be checked on the warmth of the skin (cold, warm, fever). Then the skin texture (smooth-soft-rough) as well as skin turgor to determine the degree of hydration of a person.
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Impaired Skin Integrity - NCP for Dermatitis

Dermatitis or eczema is inflammation of the skin. It is characterized by itchy, erythematous, vesicular, weeping, and crusting patches.

Dermatitis symptoms vary with all different forms of the condition. They range from skin rashes to bumpy rashes or including blisters. Although every type of dermatitis has different symptoms, there are certain signs that are common for all of them, including redness of the skin, swelling, itching and skin lesions with sometimes oozing and scarring.

Although the symptoms of atopic dermatitis vary from person to person, the most common symptoms are dry, itchy, red skin. Typical affected skin areas include the folds of the arms, the back of the knees, wrists, face and hands.

Nursing Diagnosis for Dermatitis : Impaired skin integrity related to the dryness of the skin

Goal :
The skin can return to normal.

Outcomes:
The client will maintain skin hydration in order to have a good and downs of inflammation.

Characterized by :
  • revealed an increase in skin comfort,
  • reduced the degree of exfoliation,
  • reduced redness,
  • reduced blisters, due to scratching,
  • healing damaged skin areas.

Intervention:
1. Shower at least once a day for 15-20 minutes. Immediately apply ointment or cream that has been prescribed after a shower. Bathing more frequently if signs and symptoms increased.
Rationale: With bath water will seep under the skin saturation. Application of a moisturizing cream for 2-4 minutes after bathing to prevent water evaporation from the skin.

2. Use warm water not hot.
Rationale: hot water causes vasodilation which will improve pruritus.

3. Use moisturizing soap, or soap for sensitive skin. Avoid bubble bath.
Rational: soap that contains moisturizers less alkaline content and do not make dry skin, dry soap may increase complaints.

4. Spread / give ointment or cream that has been prescribed two or three times per day.
Rationale: ointment or cream to moisturize the skin.
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Liver Cancer Symptoms, Causes and Prevention


The liver is one of the most important organs in the human body. As the gland, the liver produces bile to digest fat function, activating lipases, help power the absorption of fat in the intestine, and that does not change the substance into a water-soluble substance that is soluble in water. If the bile ducts in the liver congestion, bile enter the blood circulation so that the patient becomes yellowish skin. Such a person is said to be suffering from jaundice.

Liver cancer is cancer originating from the cells of the liver (primary liver cancer). However, there is also a cancer that occurs in the liver starts of other body parts (such as colon, lung or breast cancer) and then spread to the liver. Doctors call this metastatic cancer (secondary liver cancer).


Symptoms of Liver Cancer

Many people have no signs or symptoms in the early stages of primary liver cancer. But when have signs and symptoms, then that may occur include:
  • Weight loss.
  • Loss of appetite.
  • Pain in the upper abdomen area.
  • Nausea and vomiting.
  • Fatigue and weakness.
  • Enlargement of the liver.
  • Swelling in the abdominal area.
  • The skin and the whites of the eyes turn yellow.


Type of Liver Cancer

Primary liver cancer is derived from the liver cells are divided into several types, among others:
  • Hepatocellular carcinoma (HCC). Liver cancer is most common in children and adults. This cancer starts from hepatocytes which is the main type of liver cell.
  • Cholangiocarcinoma. Cancer is derived from the gall bladder duct.
  • Hepatoblastoma. It is a rare type of cancer that affects children aged 4 years and under. The many types of cancer are successfully treated.
  • Angiosarcoma and hemangiosarcoma. This rare type of cancer starts in the blood vessels in the liver and grow very quickly.


Risk Factors

Some factors that increase the risk of liver cancer include:
  • Sex. Men more likely to have liver cancer than women.
  • Age. Liver cancer is more common in patients aged between 20 to 50 years.
  • Chronic infection. People who have chronic viral hepatitis type B or C are at increased risk of liver cancer.
  • Cirrhosis. Is a condition in which the liver tissue damage continues to increase and is not curable, increase your chances of developing liver cancer.
  • Certain inherited liver disease in the family. Hemochromatosis, hepatitis and Wilson 's disease is a condition that may increase the risk of liver cancer.
  • Diabetes. People who have high blood sugar levels at risk of liver cancer.
  • Nonalcoholic fatty liver disease. Accumulation of fat in the liver increases the risk of liver cancer.
  • Exposed to toxic aflatoxins. Consuming food contaminated with toxic aflatoxins increases the risk of liver cancer. Corn and peanuts can be contaminated with toxic aflatoxins.
  • Excessive alcohol consumption. Consuming alcohol can increase the risk of liver cancer.
  • Obesity. Overweight can increase the risk of liver cancer.
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10 Ways to Overcome Insomnia (difficulty sleeping)

Humans spend a third of his time in bed. Sleep is a natural resting state in humans and many other species. Sleep is essential for health. Signs of life such as consciousness, pulse and respiratory rate changes.

Sleep is essential for health. Signs of life such as consciousness, pulse and respiratory rate changes. In normal sleep, normally functioning motor nerves, sensory nerves also for activities that require coordination with the central nervous system will be blocked, so that when sleep tends to not move and responsiveness was reduced.

Do you have trouble sleeping? Insomnia is difficulty initiating sleep and maintaining sleep. Usually trouble sleeping due to disturbances in the timing and mechanism of sleep. This is usually exacerbated by unhealthy behaviors, such as irregular hours of sleep, often staying up late, and the habit of consuming anything containing caffeine such as coffee and cigarettes.

There are several implications arising from lack of sleep, among others:
  1. Hallucinations.
  2. Irritable.
  3. Cognitive decline.
  4. Easy to forget.
  5. Yawning severe.
  6. Symptoms similar to ADHD (Attention Deficit Hyperactivity Disorder)
  7. Disorders moral judgment.
  8. Reduced responsiveness and accuracy.
  9. Vibration (fever or chills).
  10. Pain or muscle pain.

Well, that's some bad impacts that could occur if someone is having trouble sleeping. So do not underestimate these situation.


How to Overcome Insomnia (difficulty sleeping)

Instead of taking medication, you can try to overcome insomnia or disturbed sleep with a few tips below :

1. Doing regular exercise. Exercise should be done in the morning, instead of a few hours before bedtime. By exercising regularly, becomes optimal health and can fight stress better.

2. Avoid eating and drinking too much before bed.

3. Sleep in a comfortable environment. At bedtime, turn off the lights, turn off the things that make noise, make sure you are comfortable with the temperature of the room to sleep, and keep the clock from view that can make you anxious because they have not been asleep.

4. Reducing the consumption of drinks that are stimulants or keep you awake like tea, coffee, cigarettes.

5. Eat light foods that contain fewer carbohydrates before bed.

6. A shower or a warm bath 30 minutes or an hour before bedtime.

7. Sleep and wake up in a regular time period every day.

8. Drink a glass of warm milk.

9. Use the bed only for sleeping. This will make the body to adjust to the environment bed.

10. Clear your mind of all worries. One solution could be to pour your thoughts in a medium. It could also do meditation.

Another thing you need to know well is to avoid stress, because the body will not fall asleep while being comfortable when experiencing stress. Try to resolve your problem before it's time to sleep, to avoid you awake at night. Hopefully reviews like the above ways to overcome insomnia can be beneficial to you.
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