jaundice case prresentation

7/30/2019 Jaundice Case Prresentation

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MANISHA COLLEGE OF NURSING

CASE PRSENTATION

ON

JAUNDICE

Submitted to Submitted by


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Submission on

General objectives:

At the end of class students will able to understand and gain knowledgeregarding jaundice and implementing the patient in clinical area.

Specific objectives:

Students will able to

to introduce the jaundice

to define the definition of jaundice

to enumerate the etiological and risk factors, classification/ types of

jaundice

to explain the pathophysiology of jaundice

to know the diagnostic evaluation of jaundice

to list out the clinical manifestation of jaundice

to describe the medical management of jaundice

to discuss the nursing management of jaundice

to conclude the jaundice


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INTRODUCTION

I am nimisha rajan , studying 2nd

year M.Sc (N) in Manisha College of

Nursing Dept of child health Nursing. I am going to specialitypracticals in R.K

childrens Hospital, there I am posted in CICU there I find one case i.e; jaundice

. So as felt to this s my case presentation

Mrs. L.uday, 3 years, male from jagadamba centeradmitted in

R.K.childrens Hospital in CICU on 29-3-13 at 4:30pm under the consultant of

Dr. Naveen with the complains of yellowing of the skin and the whites of the

eyes


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IDENTIFICATION

Student Profile Patient Profile

Name Of The Student: Mrs. Nimisha Rajan

2nd year M.Sc(N)

Subject: Child Health Nursing

Topic:jaundice

Submitted to: Mrs. C.R.sa

M.Sc(N); Lecturer

Dept.of Medical Surgical Nrsing

Submitted on:

Venue:

Time duration:

No.of.persons attended

date of care started

total days of nursing care

Name of the patient: Mr.L.Uday

Age:3years

Sex: male

Address: 6-57-6/1; road no:9

Jagadamba center,visakhapatnam

E.P NO: 11794104

Bed no:1

Ward:CICU

Education: nil

Occupation: nil

Marital status: single

Date of admission:

29/03/13 at 4:30pm

Name of the doctor: Dr. Naveen


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Diagnosis: jaundice

HISTORY COLLECTION

Chief complains:

My patient Mr.L.uday, 3years, male admitted in R.K.Childrens Hospital

complains yellowing of the skin and the whites of the eyeslast 2 days.

Present medical history:

She admitted in CICU due to yellowing of the skin and the whites of the

eyes2 days on wards with complain of jaundice as diagnosed by physician

Past medical history:

There is no past medical history

Present surgical history:

Not significant of surgical history

Family history:

Family profile:

Slink name of the familymembers age sex relationship occupation remark

1

2

L.Nooka raju

L.Lakshmi

30y

27y

M

F

Father

mother

Employ

House

wife

-

-


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Nutritional history:

Sl.no Time Diet Amount Caloric Protein Carbohydrate Fat

1.

2.

3.

4.

5.

7am

8-30am

12:30pm

4:00pm

8:30pm

milk

idly -2with chutney

rice with

curry

milk

rice with

curry

150ml

2nos

200 grms

150ml

150 grms

110k.cal

372k.cal

690k.cal

110k.cal

372k.cal

3.0

6.9

6.9

3.0

20.8

4.0

58.9

74.5

4.0

58.9

3.8

0.2

5.2

3.8

0.2

Personal history:

Diet: patient diet includes vegetarian and non vegetarian. he takes food in per

day 3 times & non veg-2 times/week.

Rest & sleep: disturbed sleep pattern

Elimination: abnormal bowel & bladder (bowelconstipation & urination is

frequently & small amount of urine is passing)

Socio economic history: nil

Environmental history:-

Housing: building and own house

Ventilation: adequate ventilation

Electricity: present

Water supply: municipality tap

Physical examination:

vitals signs patient value normal value remarks

Temperature

Pulse

Respiration

Blood pressure

Spo2

98.60F

92b/min

22b/min

120/60mmhg

93%

98.60F

72b/min

16-18b/min

120/80mmhg

100%

normal

abnormal

abnormal

abnormal

normal


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Genarl appearance:

Consciousness: conscious

Orientation: oriented time, place, and date

Nourishment: moderate nourished

Health: un healthy

Body build: moderate

Activity: dull

Look: anxious

Hygiene: moderately hygiene

Speech: clear

REVIEW OF SYSTEMS

Skin /integumentary system:

Colour:black

Texture: wrinkles skin/dry skin

Skin turgor:present

Hydration: well hydrated

Discolouration: no discolouration of skin

Subjective symptoms: dry skin is present

Nails:

Nail beds: pale in colour

Nail plates: flat, absnce of clubbing

Cyanosis: no central and peripheral cyanosis

Colour: black

Texture: dry


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Eyes:

eye brows: symmetric

Eyelashes: equally distributed

Papillary reflex: abnormal

Conjunctiva: abnormal

Vision: abnormal vision (blurred vision)

Ears:

Pinna: normally placed

Cerumen: no defect

Otarrhea: no discharges from ear

Hearing: no defect in hearing process

Nose:

Nasal septum: no deviation of nasal septum

Nasal pathway: clear nasal pathway

Smell: no defect

Mouth & pharynx:

Lips: absence of cracks and pale in colour

Tongue: coated tongue

Bleeding : no history of bleeding

Tooth decay: history of tooth decay

Dental care: no history of dental caries

Neck:

ROM: not possible

Lymph nodes: not palpable


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Trachea: present in midline

Thyroid gland: not enlarged

Jugular vein: not distended.

SYSTEMIC EXAMINATION

Respiratory system:

History of smoking: smoking habit is evident but at present she is stoped

Sputum: sputum with thick expectoration

Asthma: no h/o asthma

Wheezing: present

Haemoptysis: no H/o of haemoptysis

Cough: present

Shortness of breath: present

Inspection: on inspection the thoracic cavity is normal, no deviations, no

lesions are found

Palpation: no palpable masses detected on palpation

Percussion: on percussion wheezing sounds and adventious breath sounds are

evident

Auscultation: on auscultation rounchi, wheezing sounds are evident. Abnormal

bronchial vesicular sounds are evident.

Cardiovascular system:

H/O hypertension: hypertensive

Varicose veins: no H/o varicose veins

Dysponea: present

Orthopnea: not evident


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Chest pain: evident

Palpitation: present

Heart sounds: present S1 S2 sounds

Pluse:92b/min

Heart beat: abnormal rate and rhythm

Inspection: on inspection the thoracic cavity is normal and clear, no lesions

detected, sutured mark presented

Palpation: no palpable masses detected

Percussion: no percussion performed

Auscultation: on auscultation at 5 areas , pulmonic, aortic, erbs point, mitral,

apical area. S1 S2 sounds are clear and gallop sounds present

INVESTIGATIONS

Slink Name of the

investigation

Pt value Normal value Remarks

1.

2.

3.

4.

5.

6.

7.

Hb%

TWBC

DC P

L

E

platelet count

bil.urea

sr. creatine

ECG

11.1gms

8300cells/cumm

86%

11%

0.3%

1.7 laks/cumm

47mg/dl

1.0

Extremetachycardia

lt.ant. hemiblock

invented T

wave

ST-T

abnormality

excessive

overload oflt. atrium, lt.

12-14gms

1,500000cells/cumm

4,5000c/cumm

10-40mg/dl

0.5-1.4mg/dl

normal

abnormal

abnormal

abnormal

abnormal

normal

abnormal


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8. x-ray

ventricular

hypertrophy

abnormal abnormal abnormal

MEDICATIONS

Slink Medications Dose Route Time Nursing responsibility

1.

2.

3.

4.

5.

6.7.

Inj. Dytor20

Inj. Taxim

Inj. PNZ

T. Ivas

T.Mtoprolol

oxygen inhalationfloret}

nitrofix} nebulisation

duolin}

1gm

1gm

40mg

10mg

25mg

IV

IV

IV

oral

oral

BD

8th

hrlyOD

BD

OD

assess the patient general

condition of client

observe the client for side

effects

immediate nursing

intervention are to be

done

administration of

alternatives agonist to

prevent the sid effects

administer continuousoxygen inhalation


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LIVER

INTRODUCTION:

The gastrointestinal tract (GIT) consists of a hollow muscular tube

starting from the oral cavity, where food enters the mouth, continuing

through the pharynx, oesophagus, stomach and intestines to the rectum

and anus, where food is expelled.

There are various accessory organs that assist the tract by secreting

enzymes to help break down food into its component nutrients. Thus the

salivary glands, liver, pancreas and gall bladder have important functions

in the digestive system.

Food is propelled along the length of the GIT by peristaltic movements of

the muscular walls. ANATOMY AND PHYSIOLOGY:

The primary purpose of the gastrointestinal tract is to break food down

into nutrients, which can be absorbed into the body to provide energy.

First food must be ingested into the mouth to be mechanically processedand moistened.

Secondly, digestion occurs mainly in the stomach and small intestine

where proteins, fats and carbohydrates are chemically broken down into

their basic building blocks.

Smaller molecules are then absorbed across the epithelium of the small

intestine and subsequently enter the circulation. The large intestine plays

a key role in reabsorbing excess water. Finally, undigested material and

secreted waste products are excreted from the body via defecation

(passing of faeces).

In the case of gastrointestinal disease or disorders, these functions of the

gastrointestinal tract are not achieved successfully. Patients may develop

symptoms ofnausea,vomiting,diarrhoea, malabsorption, constipation or

obstruction.
http://www.virtualmedicalcentre.com/symptoms.asp?sid=8http://www.virtualmedicalcentre.com/symptoms.asp?sid=8http://www.virtualmedicalcentre.com/symptoms.asp?sid=8http://www.virtualmedicalcentre.com/symptoms.asp?sid=8http://www.virtualmedicalcentre.com/symptoms.asp?sid=8http://www.virtualmedicalcentre.com/symptoms.asp?sid=8http://www.virtualmedicalcentre.com/symptoms.asp?sid=8


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Gastrointestinal problems are very common and most people will have

experienced some of the above symptoms several times throughout their

lives.

ANATOMY OF GASTROINTESTINAL:

UPPER GASTROINTESTINAL TRACT

The upper gastrointestinal tract consists of the esophagus, stomach,

and duodenum.The exact demarcation between "upper" and "lower" can vary.

Upon dissection, the duodenum may appear to be a unified organ, but it is oftendivided into two parts based upon function, arterial supply, or embryology.

LOWER GASTROINTESTINAL TRACT

The lower gastrointestinal tract includes most of the small intestine and all of

the large intestine. According to some sources, it also includes the anus.

Bowel orintestine

Small Intestine: Has three parts:

Duodenum: Here the digestive juices from the pancreas(digestive

enzymes) and hormones and the gall bladder(bile) mix. The digestive

enzymes break down proteins and bile andemulsify fats into micelles.

The duodenum contains Brunner's glands which produce bicarbonate.

In combination with bicarbonate from pancreatic juice, this

neutralizes HCl of the stomach.

Jejunum: This is the midsection of the intestine, connecting the

duodenum to the ileum. It contains the plicae circulares, and villi to

increase the surface area of that part of the GI Tract. Products of
http://en.wikipedia.org/wiki/Esophagushttp://en.wikipedia.org/wiki/Stomachhttp://en.wikipedia.org/wiki/Duodenumhttp://en.wikipedia.org/wiki/Dissectionhttp://en.wikipedia.org/wiki/Small_intestinehttp://en.wikipedia.org/wiki/Large_intestinehttp://en.wikipedia.org/wiki/Anushttp://en.wikipedia.org/wiki/Bowelhttp://en.wikipedia.org/wiki/Intestinehttp://en.wikipedia.org/wiki/Small_Intestinehttp://en.wikipedia.org/wiki/Duodenumhttp://en.wikipedia.org/wiki/Pancreashttp://en.wikipedia.org/wiki/Digestive_enzymeshttp://en.wikipedia.org/wiki/Digestive_enzymeshttp://en.wikipedia.org/wiki/Gall_bladderhttp://en.wikipedia.org/wiki/Bilehttp://en.wikipedia.org/wiki/Emulsifyhttp://en.wikipedia.org/wiki/Micelleshttp://en.wikipedia.org/wiki/Duodenumhttp://en.wikipedia.org/wiki/Brunner%27s_glandshttp://en.wikipedia.org/wiki/HClhttp://en.wikipedia.org/wiki/Jejunumhttp://en.wikipedia.org/wiki/Plicae_circulareshttp://en.wikipedia.org/wiki/Intestinal_villushttp://en.wikipedia.org/wiki/Intestinal_villushttp://en.wikipedia.org/wiki/Plicae_circulareshttp://en.wikipedia.org/wiki/Jejunumhttp://en.wikipedia.org/wiki/HClhttp://en.wikipedia.org/wiki/Brunner%27s_glandshttp://en.wikipedia.org/wiki/Duodenumhttp://en.wikipedia.org/wiki/Micelleshttp://en.wikipedia.org/wiki/Emulsifyhttp://en.wikipedia.org/wiki/Bilehttp://en.wikipedia.org/wiki/Gall_bladderhttp://en.wikipedia.org/wiki/Digestive_enzymeshttp://en.wikipedia.org/wiki/Digestive_enzymeshttp://en.wikipedia.org/wiki/Pancreashttp://en.wikipedia.org/wiki/Duodenumhttp://en.wikipedia.org/wiki/Small_Intestinehttp://en.wikipedia.org/wiki/Intestinehttp://en.wikipedia.org/wiki/Bowelhttp://en.wikipedia.org/wiki/Anushttp://en.wikipedia.org/wiki/Large_intestinehttp://en.wikipedia.org/wiki/Small_intestinehttp://en.wikipedia.org/wiki/Dissectionhttp://en.wikipedia.org/wiki/Duodenumhttp://en.wikipedia.org/wiki/Stomachhttp://en.wikipedia.org/wiki/Esophagus


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digestion (sugars, amino acids, fatty acids) are absorbed into the

bloodstream.

Ileum: Has villi and absorbs mainly vitamin B12 and bile acids, as

well as any other remaining nutrients.

Large Intestine: Has three parts:

Caecum: The Vermiform appendix is attached to the caecum.

Colon: Includes the ascending colon, transverse colon, descending

colon and sigmoid Flexure: The main function of the Colon is to

absorb water, but it also contains bacteria that produce

beneficial vitamins like vitamin K.

Rectum

Anus: Passes fecal matterfrom the body.

The Ligament of Treitz is sometimes used to divide the upper and lower GI

tracts

FUNCTIONS OF LIVER:

The liver regulates most chemical levels in the blood and excretes a

product called bile, which helps carry away waste products from the liver. All

the blood leaving the stomach and intestines passes through the liver. The liver

processes this blood and breaks down the nutrients and drugs into forms that are

easier to use for the rest of the body. More than 500 vital functions have beenidentified with the liver. Some of the more well-known functions include the

following:
http://en.wikipedia.org/wiki/Ileumhttp://en.wikipedia.org/wiki/Intestinal_villushttp://en.wikipedia.org/wiki/Vitamin_B12http://en.wikipedia.org/wiki/Bile_acidshttp://en.wikipedia.org/wiki/Large_Intestinehttp://en.wikipedia.org/wiki/Caecumhttp://en.wikipedia.org/wiki/Vermiform_appendixhttp://en.wikipedia.org/wiki/Caecumhttp://en.wikipedia.org/wiki/Colon_(anatomy)http://en.wikipedia.org/wiki/Ascending_colonhttp://en.wikipedia.org/wiki/Transverse_colonhttp://en.wikipedia.org/wiki/Descending_colonhttp://en.wikipedia.org/wiki/Descending_colonhttp://en.wikipedia.org/wiki/Sigmoid_Flexurehttp://en.wikipedia.org/wiki/Bacteriahttp://en.wikipedia.org/wiki/Vitaminhttp://en.wikipedia.org/wiki/Vitamin_Khttp://en.wikipedia.org/wiki/Rectumhttp://en.wikipedia.org/wiki/Anushttp://en.wikipedia.org/wiki/Fecal_matterhttp://en.wikipedia.org/wiki/Ligament_of_Treitzhttp://en.wikipedia.org/wiki/Ligament_of_Treitzhttp://en.wikipedia.org/wiki/Fecal_matterhttp://en.wikipedia.org/wiki/Anushttp://en.wikipedia.org/wiki/Rectumhttp://en.wikipedia.org/wiki/Vitamin_Khttp://en.wikipedia.org/wiki/Vitaminhttp://en.wikipedia.org/wiki/Bacteriahttp://en.wikipedia.org/wiki/Sigmoid_Flexurehttp://en.wikipedia.org/wiki/Descending_colonhttp://en.wikipedia.org/wiki/Descending_colonhttp://en.wikipedia.org/wiki/Transverse_colonhttp://en.wikipedia.org/wiki/Ascending_colonhttp://en.wikipedia.org/wiki/Colon_(anatomy)http://en.wikipedia.org/wiki/Caecumhttp://en.wikipedia.org/wiki/Vermiform_appendixhttp://en.wikipedia.org/wiki/Caecumhttp://en.wikipedia.org/wiki/Large_Intestinehttp://en.wikipedia.org/wiki/Bile_acidshttp://en.wikipedia.org/wiki/Vitamin_B12http://en.wikipedia.org/wiki/Intestinal_villushttp://en.wikipedia.org/wiki/Ileum


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Production of bile, which helps carry away waste and break down fats

in the small intestine during digestion

Production of certain proteins for blood plasma

Production of cholesterol and special proteins to help carry fats through

the body

Conversion of excess glucose into glycogen for storage (glycogen can

later be converted back to glucose for energy)

Regulation of blood levels of amino acids, which form the building

blocks of proteins

Processing of hemoglobin for use of its iron content (the liver stores

iron)

Conversion of poisonous ammonia to urea (urea is an end product of

protein metabolism and is excreted in the urine)

Clearing the blood of drugs and other poisonous substances

Regulating blood clotting

Resisting infections by producing immune factors and removing

bacteria from the bloodstream

When the liver has broken down harmful substances, its by-products are

excreted into the bile or blood. Bile by-products enter the intestine and

ultimately leave the body in the form of feces. Blood by-products are filtered

out by the kidneys, and leave the body in the form of urine.

DEFINITION:

The liver is an important organ of the body that is responsible for

detoxification, metabolism, synthesis and storage of various substances.

It's the largest internal organ in the body (the skin is considered the largest

organ in the entire body) and it weighs about 3 pounds (1500g). It's located just

under the ribs in the right upper part of the abdomen. Most of the liver is


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protected by the rib cage, but it is possible for doctors to feel the edge of it by

pressing deep into the abdomen when the patient inhales a big breath of air.

Risk Factors

Factors that may increase your chances of getting jaundice are similar to risk

factors for liver and gallbladder disorders. They may include:

Drinking too much alcohol

Using illicit drugs

Taking medicines that may harm the liver

Being exposed to hepatitis A, hepatitis B, orhepatitis C

Being exposed to certain industrial chemicals

Causes of Acute Liver Failure

In Infants

Infections:Herpes simplex, echovirus, adenovirus, hepatitis B,

parvovirus, others

Drugs / toxins:Acetaminophen

Cardiovascular:Extracorporeal membrane oxygenation, hypoplastic left

heart syndrome, shock, asphyxia, myocarditis

Metabolic:Galactosemia, tyrosinemia, iron storage, mitochondrial

condition, HFI, fatty acid oxidation, others

In Toddlers and Older Children

Infections: Hepatitis A, B and D, NANB hepatitis, Epstein-Barr virus,

cytomegalovirus, herpes, leptospirosis, others

Drugs / toxins: Valproic acid, isoniazid, halothane, acetaminophen,

mushroom, phosphorous, aspirin, others

Cardiovascular: Myocarditis, heart surgery, cardiomyopathy, Budd-Chiari syndrome
http://pediatrics.med.nyu.edu/conditions-we-treat/conditions/jaundice?ChunkIID=12069http://pediatrics.med.nyu.edu/conditions-we-treat/conditions/jaundice?ChunkIID=11896http://pediatrics.med.nyu.edu/conditions-we-treat/conditions/jaundice?ChunkIID=11800http://pediatrics.med.nyu.edu/conditions-we-treat/conditions/jaundice?ChunkIID=11798http://pediatrics.med.nyu.edu/conditions-we-treat/conditions/jaundice?ChunkIID=11796http://pediatrics.med.nyu.edu/conditions-we-treat/conditions/jaundice?ChunkIID=11796http://pediatrics.med.nyu.edu/conditions-we-treat/conditions/jaundice?ChunkIID=11798http://pediatrics.med.nyu.edu/conditions-we-treat/conditions/jaundice?ChunkIID=11800http://pediatrics.med.nyu.edu/conditions-we-treat/conditions/jaundice?ChunkIID=11896http://pediatrics.med.nyu.edu/conditions-we-treat/conditions/jaundice?ChunkIID=12069


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Metabolic: Fatty acid oxidation, Reye's syndrome, leukemia, others

PATHOPHYSIOLOGY:


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BOOK PICTURE PATIENT PICTURE

CLINICAL MANIFESTATION:

The manifestations of heartfailure depends on the specific

ventricular involved the precipitating

cause of failure, the degree of

impaired, the rate of progression the

duration of the failure and the clientsunderlying conditions.

The signs and symptoms of heart

failure can be related to which

ventricles are affected. Left sided heart

failure causes different manifestationsthen right sided heart failure. In

chronic heart failure. Patient may haveright and left ventricular failure.

left side heart failure:

Pulmonary congestion includes:-

dysnea, cough, pulmonary crackles

low oxygen saturation levels

heart sounds s3 or ventricular gallop

detected on auscultation, orthopnea,paraxymal nocturnal dysnea,

adventitious breath sounds heard in

various areas of lungs, oliguria,

insomnia, tachycardia, palpitations

right side heart failure:

Congestion in peripheral tissues

and the viscra predominates

Increased jugular venous distension

Systemic clinical manifestation: oedema of lower extremities hepatomegaly as cites

anorexia and nausea, weakness and

weight gain due to retention of fluid

Assessing for heart failure:

general: fatigue

decreased activity tolerance dependent edema

CLINICAL MANIFESTATION:

breathlessness

cough

fever

oedema in lower extremities

tachycardia

increased pulse and respiration

rate

oliguria

insomnia

Assessing for heart failure:

general: fatigue

decreased activity tolerance dependent edema


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weight gain

cardiovascular: third heart sound s3

apical impulses enlarged with

leftlateral displacement pallor and cyanosis jugular venous distension(JVD)

respiratory:

dysnea on exertion

pulmonary crackles that dont

clear with cough orthopnea

paroxysmal nocturnal dysnea

(PND)cerbro vascular: un explained confusion or

altered mental status

light headedness

renal: oliguia and decreased frequency

during the day nocturia

gastro intestinal:

anorexia and nausea enlarged liver

ascites

hepato jugular reflux

DIAGNOSTIC EVALUATIONS

history collection and physicalexamination

assessment of ventricular function serum chemistries, cardiac

enzymes, BNP levels, liver function

tests, serum electrolytes,

BUN,CBC. Chest x-ray 12 lead ECG Echocardiography Exercise stress testing

Nuclear imagaing studies Hemodynamic monitoring

cardiovascular: apical impulses enlarged with

left lateral displacement

jugular venous distension(JVD)

respiratory:

dysnea on exertion

pulmonary crackles that dont

clear with cough paroxysmal nocturnal dysnea

(PND)

cerbro vascular:

un explained confusion or

altered mental status

light headedness

renal: oliguia and decreased frequency

during the day

gastro intestinal:

no significance

DIAGNOSTIC EVALUATIONS

history collection and physicalexamination

Hemoglobin Total White Blood Count Direct countP;L;E

Platelet count

Bilirubin urea Serum creatinine ECG Chest x- ray Routine urinalysis


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Cardiac catherization Routine uninalysis

MEDICAL MANAGEMENT

The goal of management of heartfailure to relieve patient symptoms,

to improve functional status and

quality of life and to extend

survival.

medical management based on type

, severity and cause of heart failure

specific objectives of medical

management includes the following

eliminates or reduce any etiologiccontributory factors such as

controlled hyprtension or aterial

fibrillation with a rapid ventricular

response

optimize pharmacologic and othertherapeutic regimens

reduce the work load on the heart

by reducing preload and after load

promote a life style conducive to

cardiac health

prevent episodes of acutedecompensate heart failure

managing the patient with heart

failure includes providing

comprehensive education and

counselling to the patient andfamily

it is important that patient and

family understand the nature ofheart failure and the importance of

their participation in the treatment

regimen life style recommendations

include restriction of dietary

sodium, avoidance of excessive

fluid intake, alcohol and smoking

weight reduction when indicates

and regular exercisespharmacologic therapy

MEDICAL MANAGEMENT

Inj. Dytor 20- 1gm, IV,BD

Inj. Taxim 1grm, IV 8th

hrly

Inj. PNZ 40mg, IV, OD

T. IVAS10mg oral, BD

T. Metoprolo 25mg, oral, OD

Continuous O2 inhalation

Floret

Nitrofix nebulisation

duolin


21/30

angiotensin I- converting enzyme

inhibitors

angiotensin II receptor blockers

hydralazine and isosorbid dinitrate

betablockers and calcium channelblockers

diuretics

digitalis

intravenous infusion

- nesiritide

- milrinome

- dobutamine

medications for diastolic

dysfunctionother medications for heart failure: anticoagulants

non steroidal inflammatory drugs

Nutritional therapy: a low sodium (2-3g/day) diet and

avoidance of drinking excessiveamount of fluid are usually

recommended

dietary restriction of sodiumreduces fluid retention and the

symptoms of peripheral andpulmonary congestion

diet needs to be made with

consideration of good nutirion as

well s the patients likes and dislikes

and cultural food patterns

Additional therapy:

supplemented oxygen other interventions

coronary artery revascularization

with PTCA; CABG surgery may

be considered

ventricular function may improvein some patients when coronary

flow is increased.

Cardiac resynchronization therapy

Cardiac transplantation Mechanical circulation assistance

Nutritional therapy: Provided a low sodium (2-3g/day)

diet and avoidance of drinkingexcessive amount of fluid are

usually recommended

dietary restriction of sodiumreduces fluid retention and the

symptoms of peripheral andpulmonary congestion

diet needs to be made with

consideration of good nutirion as

well s the patients likes and dislikes

and cultural food patterns

Additional therapy:

supplemented oxygen


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with an implanted ventricular

assist device

ultra filtration

COLLABORATIVE THERAPY: treatment for underlying cause

o2 therapy at 2-6l/min by nasal

cannula

rest activity period

drug therapy

daily weights

sodium restricted diet

circulatory assisted devices

cardiac resynchronization therapywith internal cardio ventriculardefibrillator

cardiac transplantation

Complication:based on assessment data, potential

complication that may developincluding the following :

hypotension, poor perfusion andcardiogenic shock

dysrhythmias

thrombo embolism

pericardial effusion and cardiactamponade.

NURSING MANAGEMENT:

Assessment:Subjective data:

importance health information

Past health history: CAD,HTN,

cardiomyopathy, congenital heart

disease or valvular, DM, thyroid or

lung disease rapid or irregular heart

rate.medications: use of an compliance

with any cardiac medications, use ofdiuretics, estrogens, corticosteroids,

COLLABORATIVE THERAPY: treatment for underlying cause

o2 therapy at 2-6l/min by nasal

cannula

rest activity period

drug therapy

daily weights

sodium restricted diet

Complication:

not significant

NURSING MANAGEMENT:

Assessment:

Subjective data:

importance health i nformation

Past health history: CAD,HTN, rapid

or irregular heart rate.

medications: use of an compliance

with any cardiac medications, use of

diuretics, corticosteroids, non steroidal


23/30

non steroidal inflammatory drugs, over

the counter drug, herbal supplements.

Functional health pattern:

Health perception health

management:- fatigue, anxiety,depression.

Nutritional metabolic- usual

sodium intake, nausea, vomiting,

anorexia, stomach bloating,

weight gain, ankle swelling

Elimination: nocturia, decreased

day time urinary output,

constipation

Activity exercises: dysnea,orthopne, cough, palpitations,

dizziness, fainting

Sleep and rest: number of pillowsused for sleeping, paroxysmal

nocturnal, dysnea, insomnia.

Cognitive perceptual: chest pain

or heaviness, abdominal

discomfort; behavioural changes;visual changes.

objective data:

Integumentary: cool, diaphoretic

skin, cyanosis or pallor, peripheral

oedema.

Respiration: tachypnea, crackles,

rhonchi, wheezes, frothy, blood

tinged sputum.

Cardiovascular: tachycardia, s3&s4 murmurs, pulses alterations,

PMI displaced inferiorly and

posterior jugular vein distension

Gastro intestinal: abdominal

distension, hepatosplenomegaly,

ascites.

Neurologic: restlessness,

confusion, decreased alteration or

memory.

inflammatory drugs, over the counter

drug

Functional health pattern:

Health perception health

management:- fatigue, anxiety,depression.

Nutritional metabolic- usual

sodium intake, ankle swelling

Elimination: decreased day time

urinary output, constipation

Activity exercises: dysnea,

cough, palpitations, dizziness,

fainting

Sleep and rest: dysnea, insomnia. Cognitive perceptual: chest pain

or heaviness, abdominal

discomfort; behavioural changes;visual changes.

objective data:

Integumentary: cool, peripheral

oedema.

Respiration: tachypnea, wheezes,

tinged sputum.

Cardiovascular: tachycardia, s3

&s4 murmurs, pulses alterations,

increased jugular vein pressure

Gastro intestinal: abdominal

distension

Neurologic: restlessness,

confusion, decreased alteration or

memory.


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NURSING DIAGNOSIS:

1. Deficient Fluid Volume related to inadequate fluid intake, photo-therapy, and

diarrhea.

Goal:

Adequate neonatal body fluids

Intervention:

Record the number and quality of stools,

Monitor skin turgor,

Monitor intake output,

Give water between breast-feeding or give bottle.

2. Hyperthermia related to the effects of phototherapy

Goal:

The stability of the baby's body temperature can be maintained

Intervention:

Give a neutral ambient temperature,

Keep the temperature between 35.5 - 37 C,

Check vital signs every 2 hours.

3. Impaired skin integrity related to hyperbilirubinemia and diarrhea

Goal:The integrity of the baby's skin can be maintained

Intervention:

Assess skin color every 8 hours,

Monitor direct and indirect bilirubin,

Change position every two hours,

Massage the area that stands out,

Keep skin clean and moisture.
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4.Anxiety related to medical therapy given to the baby.

Goal:Parents know about treatment, symptoms can be identified to deliver the health

care team.

Intervention:

Review knowledge of the client's family,

Give the cause of yellow health education, therapy and treatment process.

Give health education on infant care to home.

Theory application Roys adaptation model

Introduction:

Sister callista Roy began her nursing career in 1963. After receiving B.Sc(N)

noting from moult saint marry college.

1960receives Ms in nursing

1977 her doctorate in sociology

Roys model is characterised as a system theory with a strong analogies of

intervention.

General system:
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Due to set of organized components released to form a whole employee

feedback cycle of input, through put, output.

INPUT: Input includes tensions adaption level (the range of stimuli to which

persons adaptation early)

THROUGH PUT: through put makes use of a person processes and effect

ions. Process refers to control mechanism that a person uses as a adaptive

system. Effectors refers to the physiologic function, self concept and role

function involved in adaptation.

OUTPUT: output is the outcome of the system when system is a person.

Output refers to persons behaviour.

Metaparadigm and RAM:

Human being:Person is a bio psychological being in constant interaction

with changing environment and recipient the nursing care as living system

Environment: Environment and surrounding and effect the development

and behaviour of the persons group. The internal and external are the part of

the persons environment.

For ex: elderly person admitted to hospital all the conditions of influence on

him/her.

Health: heath is a process whereby individual are striving to achieve their

maximum potential. It can be seen in healthy people, exercises regularly, not

smoking pay attention dietary pattern. It is a process to relieve acute and

chronic illness and terminal stages of diseases & to control the sign and

symptoms, to promote health of the persons by promoting adaptive

responses.

Nurses: the nurses to reduce the ineffective responses as output behaviour

of the person. The nurse promotes the health in all life processes. The nurses

suggested by the model include approaches aimed at maintaining adaptive


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responses that support the persons effort to creativity use his or her coping

mechanism.

INPUT THROUGH PUT OUT PUT

Feed back

Demoraghpical

variables of the

patient

name age,

sex,

education,

occupation

income

- Earlydetection and

screening

programs

-monitor thevital signs

-Administercontinuous

oxygen &

medication

- health

education

about disease

condition

-The client will

have knowledge

regarding

disease process

Adequate

knowledge in

disease process

Rehabilitation &

follow up


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NURSES NOTES

Name of the patient: L.Uday Ward:C ICU

Age: 3years Diagnosis: jaundice

Sex: Male Dr. Name: Dr. Naveen

E.p no: 11794104 Bed. no: 4

Time Diet Medication Nurses Care Plan

7

830

800

1030

Idly with

chutneywater 50ml

coconut

water

100ml

rice porage

1 cup

1/4/13Inj. Dytor 20 1gm IV BD

Inj. Taxim 1gm IV 8th

hrly

Inj. PNZ 40mg IV OD

T.Ivas 10mg oral BD

T. Metoprolo 25mg Oral

ODfloret}

nitrofix} nebulisation

duolin}

o2 inhalation

observation:

Patient is very thin & less activityand weakness; cough; fever;

breathlessness.

Monitored vital signs

Temp:98.60F

Pluse:92b/min

Resp:22b/min

Blood pressure:120/60mmhg

SpO2: 93%

Provide position changing

frequently

Provide complete bed rest

Provide calm environment Administer medication as per

physician prescribed

Administered O2

Provide nebulisation

History collection and performed

physical examination


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Provide psychological support

Provided health education about

Diet

Exercises

Personal hygiene

Relaxation therapy.

lakshmi/St.N

HEALTH EDUCATION

Watch your baby for signs of jaundice returning or getting worse.

Yourbabys skin or the whites of the eyes turn yellow.

If jaundice gets worse, the yellow color will move from the eyes toyour baby's face; then it will move down your baby's body toward the

feet.

Breastfeed your baby often, at least 10 to 12 times every 24 hours.

(Remember, most babies with jaundice improve after eating for several

days.)

If you are using formula, discuss the best feeding schedule with your

doctor.

Bibliography:


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Brunner &Suddarths text book of Medical Surgical Nursing, 12th edition;

volume:1; page no:825-838 & 685-690

Lewis text book of Medical Surgical Nursing, Elsevier publication; page

no:820-837

Joyce. M. Black text book of Medical Surgical Nursing, 7th

edition;

volume:2; page no:1649-1669 & 1548-559

Ross & Willison anatomy &physiology 2nd edition,2001; pageno:678-682.

Mosby doug consult for nurses, 2006, mosby publication

jaundice case prresentation

Documents