Skip to main content

Asuhan Keperawatan Pasien Illeus Obstruksi

PENGKAJIAN
  1. Identitas klien

  2. Aktifitas / istirahat
    Lemah, gelisah
  3. Sirkulasi
    Takikardia, berkeringat
  4. Eliminasi
    Perubahan warna urine dan feces, distensi abdomen
  5. Makanan / cairan
    Mual / muntah, nyeri epigastrium
  6. Nyeri / kenyamanan
    Adanya insisi pembedahan
  7. Pernafasan
    Peningkatan frekuensi pernafasan, pernafasan tertekan ditandai oleh nafas pendek, dangkal
  8. Laboratorium
    Antara lain : Hb/Ht, leukosit, trombisit, elektrolit, AGD


DIAGNOSA KEPERAWATAN
  1. Pola nafas tidak efektif

  2. Resiko tinggi kekurangan volume cairan

  3. Gangguan integritas kulit

Comments

Popular posts from this blog

Nanda Approved Nursing Diagnosis 2010 -2011

NANDA Approved Nursing Diagnosis 2007-2008 contains 188 nursing diagnosis, latest NANDA-I Approved Nursing Diagnosis 2009-2011 contains an additional 21 new nursing diagnosis, 9 revisions diagnosis and some of diagnosis are not used again. Total nursing diagnosis at this time is 205 nursing diagnosis. Nanda I usually revised every 2 years, but this time NANDA I publish a list of NANDA Nursing Diagnosis for period of three years. for complete list of NANDA Approved Nursing Diagnosis 2009-2011, Source : Nanda - Approved Nursing Diagnosis 2010 -2011 : http://ncp-blog.blogspot.com/2010/11/nanda-approved-nursing-diagnosis-2010.html Related Articles

Nursing Diagnosis for Rheumatoid Arthritis (RA)

Nursing Diagnosis for Rheumatoid Arthritis (RA) Rheumatoid Arthritis (RA) is a chronic, systemic inflammatory disorder that may affect many tissues and organs, but principally attacks synovial joints. The process produces an inflammatory response of the synovium (synovitis) secondary to hyperplasia of synovial cells, excess synovial fluid, and the development of pannus in the synovium. The pathology of the disease process often leads to the destruction of articular cartilage and ankylosis of the joints. Rheumatoid arthritis can also produce diffuse inflammation in the lungs, pericardium, pleura, and sclera, and also nodular lesions, most common in subcutaneous tissue. Although the cause of rheumatoid arthritis is unknown, autoimmunity plays a pivotal role in both its chronicity and progression, and RA is considered a systemic autoimmune disease. Nursing Diagnosis for Rheumatoid Arthritis (RA) Acute Pain / Chronic related to distention of tissue by the accu

Psyciatric Nursing Care for Elderly

Mental Health Nursing Care for the Elderly Every year the definition of elderly changes, but maybe its fair to talk about the age of 65 as being the start of elderly. While this definition is somewhat arbitrary, it is many times associated with the age at which one can begin to receive pension benefits. At the moment, there is no United Nations standard numerical criterion, but the UN agreed cutoff is 60+ years to refer to the older population. Elderly mental health care is an important issue that affects almost one in every five American adults who are in fact known to be affected by some form of mental illness or the other. These mental illnesses include suffering from dementia and psychosis, delirium as well as depression and schizophrenia. Elderly mental health care today suffers from many lacunae and among these lacunae is the fact the majority of elders suffering from mental ailments shirk from getting them treated. It is commonly found that such elders will