Common nursing diagnosis  in Nursing Care Plans for Renal Calculi/Kidney stones:  Acute pain, Altered urinary elimination, Deficient knowledge (treatment plan), Impaired urinary elimination, Ineffective tissue perfusion: Renal, Risk for imbalanced fluid volume, Risk for infection, Risk for injury

Nursing Assessment Nursing Care Plans for Delusional Disorder

Nursing Diagnosis for Delusional Disorder

Nursing Care Plans Delusional Disorder with nursing diagnosis; Disturbed Thought Processes, Social Isolation, Activity Intolerance, Ineffective Coping, Risk for Self-directed or Other-directed Violence.

Nursing assessment nursing care Plans for Delusional Disorders

Assess for positive symptoms of schizophrenia. These symptoms reflect aberrant mental activity and are usually present early in the first phase of the schizophrenic illness.

Alterations in Thinking

• Delusion: false, fixed belief that is not amenable to change by reasoning. The most frequent elicited delusions include:
  • Ideas of reference.
  • Delusions of grandeur.
  • Delusions of jealousy.
  • Delusions of persecution.
  • Somatic delusions.
• Loose associations: the thought process becomes illogical and confused.
• Neologisms: made-up words that have a special meaning to the delusional person.
• Concrete thinking: an overemphasis on small or specific details and an impaired ability to abstract.
• Echolalia: pathologic repeating of another’s words.
• Clang associations: the meaningless rhyming of a word in a forceful way.
• Word salad: a mixture of words that is meaningless to the listener.

Alterations in Behavioral Responses

• Bizarre behavioral patterns
  • Motor agitation and restlessness
  • Automatic obedience or robotlike movement
  • Autonomic obedience or robotlike movement
  • Negativism
  • Stereotyped behaviors
  • Stupor
  • Waxy flexibility (allowing another person to reposition extremities)
• Agitated or impulsive behavior
• Assess for negative symptoms of schizophrenia that reflect a deficiency of mental functioning
  • Alogia (lack of speech)
  • Anergia ( inability to react)
  • Anhedonia ( inability to experience pleasure)
  • Avolition (lack of motivation or initiation)
  • Poor social functioning
  • Poverty of speech
  • Social withdrawal
  • Thought blocking
• Assess for associated symptoms of schizophrenia
  • Substance use, abuse, or dependence
  • Depression
  • Fantasy
  • Violent or aggressive behavior
  • Water intoxication
  • Withdrawal

Common nursing diagnosis found in Nursing Care Plans for Delusional Disorder

• Disturbed Thought Processes related to perceptual and cognitive distortions, as demonstrated by suspiciousness, defensive behavior, and disruptions in thought
• Social Isolation related to an inability to trust
• Activity Intolerance related to adverse reactions to psychopharmacologic drugs
• Ineffective Coping related to misinterpretation of environment and impaired communication ability
• Risk for Self-directed or Other-directed Violence related to delusional thinking and hallucinatory experiences

Nursing Care Plans for Delusional Disorder

Characteristics of delusional disorder

• Nonbizarre delusions of at least 1 month’s duration
• No positive or negative symptoms of schizophrenia present
• Tactile or olfactory hallucinations may be present and related to the delusional theme
• Functioning not markedly impaired and behavior not obviously bizarre or odd
• Only brief mood episodes, if any
• Not due to direct physiologic effects of a chemical or a general medical condition

Etiology of delusional disorder

Etiology of the delusional disorder is unknown. Risk factors associated with the disorder include advanced age, sensory impairment/isolation, family history, social isolation, personality features (e.g. unusual interpersonal sensitivity), and recent immigration. Some have reported higher association of delusional disorder with widowhood, celibacy, and history of substance abuse. Age of onset is later than schizophrenia and earlier in men compared to women.

Subtypes of delusional disorder

Persecutory Type

Here the person affected believes that he or she is being followed, spied on, poisoned or drugged, harassed, or conspired against. The person affected may get preoccupied by small slights that can become incorporated into the delusional system. These individuals may resort to legal actions to remedy perceived injustice. Individuals suffering from these delusions often become resentful and angry with a potential to get violent against those believed to be against them.

Jealous Type

Individuals with this subtype have the delusional belief that their spouses/lovers are unfaithful. Jealousy is a powerful emotion and when it occurs in delusional disorder or as part of another condition, it can be potentially dangerous and has been associated with violence including suicidal and homicidal behavior.

Delusions of infi delity have also been called conjugal paranoia . The term Othello syndrome has been used to describe morbid jealousy.

Erotomanic Type

Persons with delusional disorder of the erotomanic type have delusions of being loved by another. The patient believes that a perceived suitor, usually more socially prominent than herself, is in love with her. Erotomania shares many features with, is derived from, and is often referred to as de Clerambault’s syndrome .

Somatic Type

Delusional disorder with somatic delusions has been called monosymptomatic hypochondriacal psychosis . This disorder differs from other conditions with hypochondriacal symptoms in degree of reality impairment. Munro ( 1991 ) has described the largest series of cases and has used content of delusions to defi ne three main types:

Delusions of Infestations (Including Parasitosis).

Delusional parasitosis has been described in association with many physical illnesses such as vitamin B 12 defi ciency, pellagra, neurosyphilis, multiple sclerosis, thalamic dysfunction, hypophyseal tumors, diabetes mellitus, severe renal disease, hepatitis, hypothyroidism, mediastinal lymphoma, and leprosy. Use of cocaine and presence of dementia has also been reported. Psychogenic parasitosis was also known as Ekbom’s syndrome before being referred to as delusional parasitosis .

Delusions of Dysmorphophobia

This condition includes delusions such as of misshapenness, personal ugliness, or exaggerated size of body parts.

Delusions of Foul Body Odors or Halitosis.

This is also called olfactory reference syndrome.

Grandiose Type

This is also referred to as megalomania . In this subtype, the central theme of the delusion is the grandiosity of having made some important discovery or having great talent. Sometimes there may be a religious theme to the delusional thinking such that the person believes that he or she has a special message from god.

Mixed Type

This subtype is reserved for those with two or more delusional themes. However, it should be used only where it is difficult to clearly discern one theme of delusion. This subtype is used for cases in which the predominant delusion cannot be subtyped within the above mentioned categories. A possible example is certain delusions of misidentification, for example, Capgras’s syndrome , named after the French psychiatrist who described the ‘illusions of doubles.’

The delusion here is the belief that a familiar person has been replaced by an imposter. A variant of this is Fregoli’s syndrome where the delusion is that the persecutors or familiar persons can assume the guise of strangers and the very rare delusion that familiar persons could change themselves into other persons at will (intermetamorphosis).

COMPLICATIONS of delusional disorder

• If left undiagnosed, untreated, or ineffectively treated, schizophrenia can lead to profound inability to function and contribute to the problem of homelessness in our society.
• Neglect of other medical conditions; therefore, complications due to untreated medical illness are common.
• Depression and suicide.
• Substance use, abuse, or dependency.

Nursing care plans for Delusional Disorder

Nursing Assessment nursing care plans for Renal Calculi/Kidney stones

Typically, assessment findings vary depends with the size, location, and cause of the calculi:

Patient history reveals a history of pain, and determine the intensity, duration, and location of the pain. The location of the pain varies according to the placement of the stone. The pain usually begins in the flank area but later may radiate into the lower abdomen and the groin. Ask if the pain had a sudden onset. Patients may relate a recent history of hematuria, nausea, vomiting, and anorexia. In cases in which a urinary tract infection is also present, the patient may report chills and fever. Determine the patient’s history to identify risk factors

Physical Examination.

Common  symptom of renal calculi is severe pain, also referred as renal colic, which usually results from obstruction  of large, rough calculi occlude the opening to the ureteropelvic junction and increase the frequency and force of peristaltic contractions.  Pain intensity fluctuates and may be excruciating at its peak.

Patient with calculi in the renal pelvis and calyces may complain of more constant, dull pain. He may also report pain and severe abdominal pain. The patient with severe pain also typically complains of nausea, vomiting and, possibly, fever and chills. Hematuria  occur when calculi abrade a ureter, abdominal distention and, rarely, anuria

Inspection reveals a patient in intense pain who is unable to maintain a comfortable position. Assess the patient for bladder distension. Monitor the patient for signs of an infection such as fever, chills, and increased white blood cell counts. Assess the urine for hematuria. Auscultate the patient’s abdomen for normal bowel sounds. Palpate the patient’s flank area for tenderness. Percussion of the abdominal area is normal, but percussion of the costovertebral angle elicits severe pain.

Psychosocial Assessment: Patients with renal calculi may be extremely anxious because of the sudden onset of severe pain of unknown origin. Assess the  patient’s ability to cope. Since diet and lifestyle may contribute to the formation of calculi, the patient may face lifestyle changes. Assess the patient’s ability to handle such changes.

Diagnostic tests

• Kidney-ureter-bladder (KUB) radiography, and
• Excretory urography, retrograde pyelography,
• Abdominal computed tomography scan, or
• Abdominal or kidney magnetic resonance imaging
• Kidney ultrasonography.
• Urine culture of a midstream
• Evaluated A 24-hour urine

Other diagnostic test:

• Serial blood calcium and phosphorus levels indicate hyperparathyroidism and show an increased calcium level in proportion to normal serum protein levels.
• Blood protein levels are used to determine the level of free calcium unbound to protein.
• Increased blood uric acid levels may indicate gout.

Nursing diagnosis Nursing Care Plans for Renal Calculi/Kidney stones

Common nursing diagnosis found in Nursing Care Plans for Renal Calculi/Kidney stones

• Acute pain
• Altered urinary elimination
• Deficient knowledge (treatment plan)
• Impaired urinary elimination
• Ineffective tissue perfusion: Renal
• Risk for imbalanced fluid volume
• Risk for infection
• Risk for injury

Nursing Care Plans for Renal Calculi/Kidney stones

Renal Calculi/Kidney stones

Renal Calculi/Kidney stones. Renal calculi, or nephrolithiasis, Kidney stones, are stones that form in the kidneys from the crystallization of minerals and other substances that normally dissolve in the urine. Renal calculi vary in size, with 90% less than 5 mm in diameter; some, however, grow large enough to prevent the natural passage of urine through the ureter. Renal calculi can form anywhere in the urinary tract, but they most commonly develop in the renal pelvis or calyces. Calculi may be solitary or multiple. Usualy these stones are composed of calcium salts. Other types are the struvite stones (which contain magnesium, ammonium, and phosphate), uric acid stones, and cystine stones. If the calculi remain in the renal pelvis or enter the ureter, they can damage renal parenchyma (functional tissue). Larger calculi can cause pressure necrosis. In certain locations, calculi cause obstruction, lead to hydronephrosis, and tend to recur. Renal calculi more common in males than females and are rare in blacks and children

Causes for Renal Calculi/Kidney Stones

The precise cause of renal calculi is unknown, although Renal Calculi/Kidney stones are associated with dehydration, urinary obstruction, calcium levels, and other factors.

• Metabolic conditions such as renal tubular acidosis, elevated serum uric acid levels Hyperparathyroidism, renal tubular acidosis, elevated uric acid, defective metabolism of oxalate, a genetically caused defect in metabolism of cystine, and excessive intake of vitamin D or dietary calcium may predispose a person to renal calculi.
• Urinary tract infections associated with alkaline urine have been linked with calculus formation. Cystine stones are associated with hereditary renal disease
• Dehydration. Decreased water excretion concentrates calculus-forming substances. Patients who are dehydrated have decreased urine, with heavy concentrations of calculus-forming substances. Urinary obstruction leads to urinary stasis, a condition that contributes to calculus formation.

• Infection. Infected, scarred tissue may be a site for calculus development. In addition, infected calculi (usually magnesium ammonium phosphate or staghorn calculi) may develop if bacteria serve as the nucleus in calculus formation. Struvite calculus formation commonly results from Proteus infections, which may lead to destruction of renal parenchyma.
• Changes in urine pH. Consistently acidic or alkaline urine may provide a favorable medium for calculus formation, especially for magnesium ammonium phosphate or calcium phosphate calculi.
• Obstruction. Urinary stasis allows calculus constituents to collect and adhere, forming calculi. Obstruction also encourages infection, which compounds the obstruction.
• Immobilization. Immobility from spinal cord injury or other disorders allows calcium to be released into the circulation and, eventually, to be filtered by the kidneys.
• Renal Calculi/Kidney stones occur more often in men than in women

Complications for Renal Calculi/Kidney stones

Calculi either remain in the renal pelvis and damage or destroy renal parenchyma, or they enter the ureter; large calculi in the kidneys cause pressure necrosis. Calculi in some sites cause obstruction, with resultant hydronephrosis, and tend to recur. Intractable pain and serious bleeding also can result from calculi and the damage they cause.

Possible Complications for Renal Calculi/Kidney stones:

• Decrease or loss of kidney function
• Scarring, Kidney damage,
• Obstruction of the ureter (acute unilateral obstructive uropathy)
• stones Recurrence
• Urinary tract infection (UTI)
• renal colic

Nursing care plans for Renal Calculi/Kidney stones

Nursing Diagnosis for Renal Calculi/Kidney stones

Cirrhosis hepatic disease

Nursing care Plans for Cirrhosis, Cirrhosis is a chronic hepatic disease that is characterized by destruction of the functional liver cells, which leads to cellular death. In cirrhosis, the damaged liver cells regenerate as fibrosis areas instead of functional cells, causing alterations in liver structure, function, blood circulation, and lymph damage. The major cellular changes include irreversible chronic injury of the functional liver tissue and the formation of regenerative nodules. These changes result in liver cell necrosis, collapse of liver support networks, distortion of the vascular bed, and nodular regeneration of the remaining liver cells.   This disease alters liver structure and normal vasculature, impairs blood and lymph flow, and ultimately causes hepatic insufficiency.

Pathophysiology of Cirrhosis

Patient teaching discharge and home healthcare guide for Diabetes Mellitus:

1. Teach the patient sign and symptoms of hypoglycemia and hyperglycemia
2. Teach the patients about medication purpose, dosage, route, and possible side effects of all prescribed medications.
3. In patients with self-administer insulin, demonstrate patient the appropriate preparation and administration techniques.
4. Teach to the patient signs and symptoms of diabetic neuropathy and emphasize the need for safety precautions because neuropathy decreased sensation can hide sense injuries
5. Tell to the patient the Prognosis of Diabetes Mellitus, Insulin resistance increases with age, After the first few years of treatment, the majority of people with type 2 diabetes require more than one medicine to keep their blood sugar controlled
6. Teach the patient how to manage diabetes when he has a minor illness, such as a cold, or flu.
7. To encourage compliance with lifestyle changes, emphasize how blood glucose control affects long-term health.
8. Teach the patient how to care for his feet.
9. Advise him to wear comfortable, nonconstricting shoes and never to walk barefoot
10. To prevent diabetes, teach people at high risk to avoid risk factors ”for example, maintaining proper weight and exercising regularly, teach to patients you can help to prevent type 2 diabetes by maintaining your ideal body weight, especially if you have a family history of diabetes. Diet and exercise have been shown to delay the onset of diabetes in people who are in the early stages of insulin resistance. If you already have been diagnosis Diabetes Mellitus type 2, you can delay or prevent complications by keeping tight control of your blood sugar.
11. Advise patients to have annual ophthalmologic examinations for early detection of diabetic retinopathy
12. Encourage the patient and his family to obtain additional information about Diabetes mellitus from nearby Diabetic foundations.

Nursing diagnosis Diabetes mellitus. Diabetes mellitus

Focused Nursing assessment For Diabetes Mellitus

• Patient history Patients with type 2 diabetes generally report a family history of diabetes mellitus, gestational diabetes
• Skin changes, especially on the legs and feet, may represent impaired peripheral circulation
• Ask if the patient has experienced excessive thirst (polydipsia), excessive urination (polyuria), or excessive hunger (polyphagia).
• In diagnostic test at least two occasions where the fasting plasma glucose level has been greater than or equal to 126 mg/dl, random blood glucose level greater than or equal to 200 mg/dl, blood glucose level greater than or equal to 200 mg/dl 2 hours after ingestion of 75 g of oral dextrose.

Common nursing diagnosis found in Diabetes Mellitus care plans

Imbalanced Nutrition: More than Body Requirements, Fear, Risk for Injury, Activity Intolerance, Deficient Knowledge, Risk for Impaired Skin Integrity, Ineffective Coping, Deficient knowledge (diagnosis and treatment), Disturbed sensory perception: Visual, tactile, Imbalanced nutrition: Less than body requirements, Impaired urinary elimination, Ineffective tissue perfusion: Renal, cardiopulmonary, peripheral, Risk for infection, Sexual dysfunction

Nursing diagnosis Diabetes Mellitus by nursing priority

1. Imbalanced Nutrition: Less/More than Body Requirements
2. Ineffective tissue perfusion: Renal, cardiopulmonary, peripheral
3. Impaired urinary elimination
4. Disturbed sensory perception: Visual, tactile
5. Activity Intolerance
6. Ineffective Coping
7. Sexual dysfunction
8. Fear
9. Deficient Knowledge
10. Deficient knowledge (diagnosis and treatment)
11. Risk for Impaired Skin Integrity
12. Risk for Injury
13. Risk for infection

Respiratory System

Nursing diagnosis pneumonia. Pneumonia, acute infection of the lung parenchyma that often impairs gas exchange. Pneumonia is an inflammatory condition of the interstitial lung tissue in which fluid and blood cells escape into the alveoli. The inflammatory process causes the lung tissue to stiffen, thus resulting in a decrease in lung compliance and an increase in the work of breathing. The fluid-filled alveoli cause a physiological shunt, and venous blood passes  unventilated portions of lung tissue and returns to the left atrium unoxygenated, patient begins to exhibit the signs and symptoms of hypoxemi

Focused Nursing assessment in  pneumonia care plans

• Vital sign: blood pressure,  body temperature, the pulse or rate of heartbeats, the respiration or rate of breathing
• Crackles, wheezing, or rhonchi over the affected lung area
• Dullness when you percuss
• Presence of cyanosis, and presence of dyspnea or tachypnea

Common nursing diagnosis found in pneumonia

Impaired gas exchange, Ineffective coping, Risk for deficient fluid Volume, Risk for infection Ineffective airway clearance, Acute pain, Anxiety, Hyperthermia, Imbalanced nutrition: Less than body requirements,

Nursing diagnosis for pneumonia base in nursing priority

1. Ineffective airway clearance
2. Impaired gas exchange
3. Imbalanced nutrition: Less than body requirements
4. Acute pain
5. Hyperthermia
6. Anxiety
7. Ineffective coping
8. Risk for deficient fluid volume
9. Risk for infection