Patient Teaching & Home Health Guidance for Patient with Bronchiectasis:

• Instruct on early signs of pulmonary or sinus infection: change in amount or color of sputum or nasal drainage, Hemoptysis, increased Dyspnea, fever, chills, fatigue, headache, chest pain.
• Emphasize importance of completing full course of antimicrobial therapy to prevent relapse or development of resistant strains of organisms; include education on proper delivery of intravenous and/or aerosolized antibiotics.
• Teach patient and significant other effective airway clearance techniques to remove secretions and optimize ventilation. In addition to postural drainage and chest percussion, the patient may be instructed on proper use of the Flutter or PEP devices. The Vest is an alternative to chest percussion.
• Encourage the patient to drink plenty of fluids to thin secretions and aid expectoration
• Educate on avoidance of potential lung irritants: secondhand smoke, dust, noxious fumes, occupational exposures, and respiratory infections.
• Instruct the patient to avoid air pollutants and people with known upper respiratory tract infections.
• Inform patient of variety of pharmacologic and non-pharmacologic smoking cessation strategies and aids.
• If appropriate, advise the patient to stop smoking because it stimulates secretions and irritates the airways.

Nursing assessment for Bronchiectasis

Patient’s history of recurrent bronchopulmonary infections and symptoms of chronic productive cough are hallmark features of bronchiectasis. Pain and dyspnea are also common.

1. The history of acute, even if delayed, onset of bronchiectasis can sometimes be traced to a defi nite illness, pneumonia, or aspiration event in patients with postobstructive or infectious bronchiectasis. Those patients with underlying congenital or immune disorders usually demonstrate a more insidious disease onset (Luce, 1994).
2. Cough is present in 90% of patients (Nicotra et al., 1995).
3. Daily (often purulent) sputum production occurs in 75% of patients and varies in volume from 10–500 ml (Nicotra et al., 1995).
4. Pleuritic chest pain represents distended peripheral airways or distal pneumonitis adjacent to a visceral pleural surface. This symptom occurs in 50% of bronchiectasis patients (Barker, 2002).
5. Repeated episodes of fever, pleurisy, and/or sinusitis are also common.
6. Weakness, dyspnea, and weight loss are seen in patients during infectious exacerbations or those with extensive disease.
7. The St. George’s Respiratory Questionnaire (SGRQ) has been validated as a useful tool for assessment of health-related quality of life in patients with bronchiectasis (Wilson, Jones, O’Leary, Cole, & Wilson, 1997). Test items are divided into three major areas: symptomatology; activity tolerance; and impact of the condition on daily life including employment, need for medications, and sense of control or panic over one’s health.

Physical examination findings are neither sensitive nor specific for bronchiectasis.

1. Crackles are the most common adventitious auscultatory finding, followed in frequency by wheezing, rhonchi, and a pleural friction rub (Barker, 2002; Mysliwiec & Pina, 1999; Nicotra et al., 1995).
2. Digital clubbing is rare (Barker, 2002; Mysliwiec & Pina, 1999).
3. Nasal polyps and sinusitis may also be evident (Luce, 1994).
4. Patients may have fetid breath chronically or solely during episodes of purulent sputum production.
5. Generalized weight loss and use of accessory muscles accompany severe disease.

Diagnostic Test for Bronchiectasis

1. Radiographic imaging studies are the principal diagnostic tools for Bronchiectasis (chest roentgenogram, non-contrast computed tomography (HRCT) and spiral volumetric scans.
2. Bronchoscopy is used to examine airways for obstructing tumors or foreign bodies, to evaluate the degree and site of hemoptysis, and to detect or remove inspissated secretions (Barker & Bardana, 1988; George, Matthay, Light, & Matthay, 1995).
3. Functional assessment of the bronchiectasis patient includes pulmonary function testing with spirometry and lung volumes, and arterial blood gas analysis.
4. Laboratory studies are important in the diagnosis and follow-up of patients:

• The complete blood count with cell differential may reveal leukocytosis or increased neutrophil levels during acute exacerbations; anemia may be present in chronic infections (Swartz,1998).
• Quantitative serum immunoglobulin levels of IgA, IgM, IgE, IgG
• Sputum smear reveals large numbers of white blood cells and both gram-positive and gram-negative organisms
• Sweat chloride testing is used to screen for cystic fibrosis in young adults with no identifiable predisposing cause for bronchiectasis.
• Aspergillus titers are indicated when an Aspergillus organism is cultured or if radiographic exam (chest X-ray or HRCT) demonstrates central bronchiectasis (Barker & Bardana, 1988).

Nursing Diagnosis That Could Be Found In Patient with Bronchiectasis

1. Impaired gas exchange related to ventilation–perfusion inequality
2. Ineffective airway clearance related to bronchoconstriction, increased mucus production, ineffective cough, bronchopulmonary infection, and other complications
3. Ineffective breathing pattern related to shortness of breath, mucus, bronchoconstriction and airway irritants
4. Self-care deficits related to fatigue secondary to increased work of breathing and insufficient ventilation and oxygenation
5. Activity intolerance due to fatigue, hypoxemia, and ineffective breathing patterns
6. Ineffective coping related to reduced socialization, anxiety, depression, lower activity level, and the inability to work
7. Deficient knowledge about self-management to be performed at home.

Nursing Assessment

The patient typically reports gross, painless, intermittent hematuria and often with clots. Patients may complain of suprapubic pain after voiding, and also complain of bladder irritability, urinary frequency, nocturia, and dribbling. If he reports flank pain, he may have an obstructed ureter.

Patient’s history

Gross, painless, intermittent hematuria is the most frequently reported symptom. Occult blood may be discovered during a routine urinalysis. Dysuria and urinary frequency are also reported. Burning and pain with urination are present only if there is infection. The patient may not seek medical attention until urinary hesitance, decrease in caliber of the stream, and flank pain occurs. Other symptoms may include suprapubic pain after voiding, bladder irritability, dribbling, and nocturia.

Physical assessment

The physical examination is usually normal. A bladder tumor becomes palpable only after extensive invasion into surrounding structures.

Psychosocial assessment

Diagnosis of cancer and treatment of cancer with radical cystectomy and creation of a urinary diversion system can threaten sexual functioning of both men and women. The procedure can cause impotence in men and psychological problems similar to those that accompany a hysterectomy and oophorectomy in women. In addition, a portion of the vagina may be removed, thus affecting intercourse. The psychological impact of a stoma and external urinary drainage system can cause changes in body image and libido.

Diagnostic tests for bladder cancer

To confirm a bladder cancer diagnosis, the patient typically undergoes

• Cystoscopy should be performed when hematuria first appears.
• Biopsy (If the test results show cancer cells, further studies will determine the cancer stage and treatment).
• Excretory urography can identify a large, early-stage tumor or an infiltrating tumor; delineate functional problems in the upper urinary tract; assess hydronephrosis; and detect rigid deformity of the bladder wall.
• Urinalysis can detect blood and malignant cells in the urine.
• Retrograde cystography evaluates bladder structure and integrity. Test results also help confirm a bladder cancer diagnosis. A bone scan can detect metastases. A computed tomography scan can define the thickness of the involved bladder wall and disclose enlarged retroperitoneal lymph nodes. Ultrasonography can find metastases in tissues beyond the bladder and can distinguish a bladder cyst from a bladder tumor.
• Laboratory tests, such as a complete blood count and chemistry profile, may be ordered to evaluate conditions such as anemia that are associated with bladder cancer.

Nursing diagnosis bladder cancer

Common nursing diagnosis found in nursing care plans for bladder cancer

• Acute pain
• Anxiety
• Disturbed body image
• Fear
• Impaired skin integrity
• Impaired urinary elimination
• Ineffective coping
• Ineffective therapeutic regimen management
• Risk for infection
• Sexual dysfunction

Nursing Assessment nursing care plans for Benign Prostatic Hyperplasia (BPH)

BPH Clinical features depend on the extent of prostatic enlargement and on the lobes affected. Patient history, generally, men with suspected BPH have a history of frequent urination, nocturia, straining to urinate, weak stream, and an incomplete emptying of the bladder. Patient usually complains of a group of symptoms known as prostatism: decreased urine stream caliber and force, an interrupted stream, urinary hesitancy, and difficulty starting urination, which results in straining and a feeling of incomplete voiding. As the obstruction increases, the patient may report frequent urination with nocturia, dribbling, urine retention, incontinence and, possibly, hematuria.

Physical examination. Inspect and palpate the bladder for distension. Physical examination reveals a visible midline mass above the symphysis pubis, which represents an incompletely emptied bladder. Palpation discloses a distended bladder, A digital rectal exam (DRE) reveals a rubbery enlargement of the prostate, but the degree of enlargement does not consistently correlate with the degree of urinary obstruction. Some men have enlarged prostates that extend out into soft tissue without compressing the urethra. Determine the amount of pain and discomfort that is associated with the DRE.

Diagnostic tests Benign Prostatic Hyperplasia (BPH)

Several tests help to confirm Benign Prostatic Hyperplasia (BPH) diagnosis:

• Excretory urography may indicate urinary tract obstruction, hydronephrosis, calculi or tumors, and filling and emptying defects in the bladder.
• Elevated blood urea nitrogen
• Serum creatinine levels suggest impaired renal function.
• Urinalysis and urine culture
• Cystourethroscopy
• Intravenous pyelography (IVP)
• Transrectal prostatic ultrasound (TRUS)
• A prostate-specific antigen test may be performed to rule out prostatic cancer.

Nursing diagnosis nursing care plans for  Benign Prostatic Hyperplasia (BPH)

Primary nursing diagnosis:

Urinary retention (acute or chronic) related to bladder obstruction

Common nursing diagnosis found in patient with Benign Prostatic Hyperplasia (BPH)

• Acute pain
• Fear/Anxiety [specify level]
• Impaired urinary elimination
• deficient Knowledge regarding condition,prognosis, treatment, self-care, and discharge needs
• Risk for infection
• Risk for injury
• Sexual dysfunction
• Urinary retention

Patient’s history because Anemia symptoms usually develop insidiously Patient’s history may not help to establish disease onset. The patient may report signs and symptoms of anemia (progressive weakness and fatigue, shortness of breath, and headache) or signs of thrombocytopenia (easy bruising and bleeding, especially from the mucous membranes)

Inspection patients with Anemia may reveal pallor if the patient is anemic, and ecchymosis, petechiae, or retinal bleeding if thrombocytopenia is present. You may note alterations in the level of consciousness and weakness if bleeding into the central nervous system has occurred.

Auscultation may reveal bibasilar crackles, tachycardia, and a gallop murmur if severe anemia results in heart failure.

Fever, oral and rectal ulcers and sore throat may indicate the presence of an infection but without characteristic inflammation due to leukopenia.

Diagnostic test for Anemia

• Complete blood count (CBC): Hgb; hematocrit (Hct); RBC count, morphology, indices, and distribution width index; platelet count and size; and WBC count and differential.
• Bone marrow biopsies

Nursing diagnosis for Anemia

• Activity Intolerance related to Imbalance between oxygen supply or delivery and demand
• Impaired oral mucous membrane
• Imbalanced Nutrition: Less than Body Requirements related to Failure to ingest or inability to digest food or absorb nutrients necessary for formation of normal RBCs
• Constipation/Diarrhea related to Decreased dietary intake, changes in digestive processes Drug therapy side effects
• Risk for Infection Inadequate secondary defenses—decreased Hgb, leukopenia, or decreased granulocytes (suppressed inflammatory response) Inadequate primary defenses—broken skin, stasis of body fluids, invasive procedures, chronic disease, malnutrition
• Risk for deficient fluid volume
• Deficient Knowledge regarding condition, prognosis, treatment, self-care, prevention of crisis, and discharge needs related to Lack of exposure, recall  Information misinterpretation Unfamiliarity with information resource
• Fatigue
• Fear
• Ineffective coping
• Ineffective thermoregulation

• Thalassemia major:  severe anemia, splenomegaly or hepatomegaly with abdominal enlargement, frequent infections, bleeding tendencies e.g.  epistaxis, and anorexia, small bodies and large heads, mentally disabled, mongoloid.
• Thalassemia intermediate:  anemia, jaundice, and splenomegaly, hemosiderosis caused by increased intestinal absorption of iron.
• Thalassemia minor:  mild anemia usually with no signs or symptoms.

Diagnostic Test for Thalassemia

• RBC count and hemoglobin level
• X-rays of the skull and long bones

Nursing Diagnosis Nursing care plans for Thalassemia

• Activity intolerance
• Deficient knowledge (treatment regimen)
• Delayed growth and development
• Disturbed body image
• Ineffective tissue perfusion: Cardiopulmonary
• Interrupted family processes
• Risk for infection

NANDA Nursing Diagnosis

Suggestion on using NANDA Nursing Diagnosis Acute Pain: Distinguish between acute pain Nursing diagnosis with the chronicles pain Nursing diagnosis. One of the two sets is that diagnosis of a painful time. ONSET acute pain is less than 6 months, while the painful chronicles ONSET it is more than 6 months.  If you only have two diagnoses to indicate, pain is acute pain and chronic pain. Thus, there is no automatic diagnosis Crashes feel comfortable or feel comfortable painful chronic pain.

Definition Nursing Diagnosis for Acute Pain:

Unpleasant sensory and emotional experience arising from actual or potential tissue damage or described in terms of such damage (International Association for the Study of Pain); sudden or slow onset of any intensity from mild to severe with an anticipated or predictable end and a duration of less than 6 months

Nursing Outcomes Client Will:

• Report pain is relieved / controlled.
• Follow prescribed pharmacological regimen.
• Verbalize methods that provide relief.
• Demonstrate use of relaxation skills and diversion activities as indicated for individual situation.

Nursing Priority Nursing Diagnosis for Acute Pain

• To assess etiology/precipitating contributory factors:
• evaluate client’s response to pain:
• assist client to explore methods for alleviation/control of pain

Sample Clinical Applications using Nursing Diagnosis for Acute Pain:

Traumatic injuries, surgical procedures, infections, cancer, burns, skin lesions, gangrene, thrombophlebitis/pulmonary embolus, neuralgia

Nursing Assessment Nursing Care Plans for Breast Cancer

• Patient History. Assess the patient’s and family’s previous medical history of breast cancer or other Cancers.
• Palpation may identify a hard lump, mass, or thickening of breast tissue. Palpation of the cervical supraclavicular and axillary nodes may also disclose lumps or enlargement.
• Painless lump or mass in her breast or that she noticed a thickening of breast tissue
• Examine the axillary and supraclavicular areas for enlarged nodes. You may note the tumor is firm and immovable.
• Assess the patient for pain or tenderness at the tumor site.
• Inspect the breast skin for signs of advanced disease: the presence of inflammation, dimpling, orange peel effect, distended vessels, and nipple changes or ulceration

Diagnostic tests Breast Cancer

• Screening and early detection:  Mammography, Breast examinations, High-risk patients
• Mammogram
• Ultrasound of the breast
• Biopsy

Nursing diagnosis for breast cancer:

Common Nursing diagnosis found on Nursing Care Plans for Breast Cancer

• Acute pain
• Body image disturbance related to significance of loss of part or all of the breast
• Anxiety
• Fear
• Imbalanced nutrition: Less than body requirements
• Impaired physical mobility
• Impaired skin integrity
• Ineffective coping
• Ineffective role performance
• Risk for infection
• Risk for spiritual distress
• Bathing or hygiene self-care deficit
• Energy field disturbance

Patient’s history, early cervical cancer usually asymptomatic, establishes a thorough history with particular attention to the presence of the risk factors and the woman’s menstrual history. assess a history of later symptoms of cervical cancer, including abnormal bleeding or spotting between periods or after menopause, metrorrhagia or menorrhagia, dysparuenia and postcoital bleeding; leukorrhea in increasing amounts and changing over time from watery to dark and foul; and a history of chronic cervical infections. Determine if the patient has experienced weight gain or loss; abdominal or pelvic pain, often unilateral, radiating to the buttocks and legs, or other symptoms associated with neoplasms, such as fatigue. The patient history includes abnormal vaginal bleeding, such as a persistent vaginal discharge that may be yellowish, blood-tinged, and foul-smelling; postcoital pain and bleeding; and bleeding between menstrual periods or unusually heavy menstrual periods. The patient history may suggest one or more of the predisposing factors for this disease.

Physical Examination. Pelvic examination. Observe the patient’s external genitalia for signs of inflammation, bleeding, discharge, or local skin or epithelial changes.

Palpate for motion tenderness of the cervix (Chandelier’s sign); a positive Chandelier’s sign (pain on movement) usually indicates an infection. Also examine the size, consistency (hardness may reflect invasion by neoplasm), shape, mobility (cervix should be freely movable), tenderness, and presence of masses of the uterus and adnexa.

If the cancer has advanced into the pelvic wall, the patient may report gradually increasing flank pain, which can indicate sciatic nerve involvement. Leakage of urine may point to metastasis into the bladder with formation of a fistula. Leakage of stool may indicate metastasis to the rectum with fistula development.

Diagnostic test for Cervical Cancer

• Papanicolaou  examination ((Pap smear)
• Colposcopy followed by punch biopsy or cone biopsy
• The Vira/Pap test to examination of the specimen’s deoxyribonucleic acid (DNA) structure to detect HPV

Nursing diagnosis nursing care plans for Cervical Cancer

Common nursing diagnosis found in nursing care plans for Cervical Cancer:

• Pain (acute) related to postprocedure swelling and nerve damage
• Anxiety
• Fear
• Impaired physical mobility
• Impaired skin integrity
• Ineffective coping
• Ineffective sexuality patterns
• Risk for infection
• Sexual dysfunction

Nursing diagnosis for hypertension determine bay what we found in nursing assessment, and data from Diagnostic tests.

Nursing Assessment nursing care plan for Hypertension

Patient history, Elicit a history of previously elevated blood pressure, elevated cholesterol counts, a family history of hypertension, and the presence of risk factors. Ask the patient about early signs and symptoms, such as malaise, fatigue, general weakness, or a vague sense of discomfort. Ask if the patient has experienced any loss of vision, shortness of breath, chest pain, confusion, increased irritability, seizures, transient paralysis or stupor, sleepiness, visual disturbances, severe headaches, or vomiting

Physical examination, in many cases, the hypertensive patient has no symptoms, and the disorder is revealed incidentally during evaluation for another disorder or during a routine blood pressure screening program.

• Inspection may reveal peripheral edema in late stages when heart failure is present. Ophthalmoscopic evaluation may reveal hemorrhages, exudates, and papilledema in late stages if hypertensive retinopathy is present.
• Palpation of the carotid artery may disclose stenosis or occlusion. Palpation of the abdomen may reveal a pulsating mass, suggesting an abdominal aneurysm. Enlarged kidneys may point to polycystic disease, a cause of secondary hypertension. Systolic or diastolic pressure, or both, may be elevated. An increase in diastolic blood pressure from a sitting to a standing position suggests essential hypertension, whereas a fall in blood pressure from the sitting to the standing position indicates secondary hypertension.
• Auscultation may reveal an abdominal bruit to the right or left of the umbilicus midline or in the flanks if renal artery stenosis is present. Bruits may also be heard over the abdominal aorta and femoral arteries or the carotids.

Psychosocial examination. When symptoms are exacerbated, the patient may become anxious or fearful. Since hypertension can result in changes in lifestyle and perception of body image, assess The patient’s coping mechanisms

Nursing diagnosis for Hypertension

Primary Hypertension nursing diagnosis is knowledge deficit related to chronic disease management,

Possible nursing diagnosis, which is commonly found in nursing care plan for Hypertension:

• Noncompliance: Therapeutic regimen
• Fatigue
• Ineffective coping
• Ineffective tissue perfusion: Cardiopulmonary
• Risk for injury