Nursing Care Plan for Nasal Polyps

Every normal human being has a sensory organ, the organ of smell, hearing, taste, and sight. These organs are not uncommon or even very prone to crash, resulting in impaired sensory perception on the sufferer.

The nose is one of the sensory organ that functions as an organ of smell. If the nose was down, it will affect multiple body systems, such as breathing and smelling.

One of the disorders of the nose is nasal polyps. Nasal polyps are sessile soft mass in the nasal cavity caused by mucosal inflammation. Its surface is smooth, greyish white and somewhat translucent because it contains a lot of liquid. The shape can be round or oval, single or multiple, unilateral or bilateral.

Polyps can arise in people with both men and women, from the age of the children to the elderly. If there are polyps in children under 2 years of age, should be excluded the possibility meningocele, or meningoencephalocele.

Nasal polyps were more common in patients with non-allergic asthma (13%) compared to patients with allergic asthma (5%). Nasal polyps mainly found in adulthood and is more common in men, where the ratio between men and women 2:1 or 3:1.


Definition

Nasal polyps are masses of soft, white or grayish contained in the nasal cavity. Most often originate from the ethmoid sinus, multiple, and bilateral. Usually in adults. In children may be a symptom of cystic fibrosis.

Nasal polyps are soft mass, which stemmed in the nasal cavity caused by mucosal inflammation. Its surface is smooth, greyish white and somewhat translucent because it contains a lot of liquid. The shape can be round or oval, single or multiple, unilateral or bilateral. (Anonymous, 2010).


Etiology

Occurs due to hypersensitivity reactions or allergic reaction in the nasal mucosa. Polyps can arise in people with both men and women, from the age of the children to the elderly. If there are polyps in children under 2 years of age, should be excluded the possibility of meningocele or meningoencephalocele.

Once thought to predispose to the onset of nasal polyps is a disease of allergic rhinitis or atopy, but more and more studies that do not support this theory and experts to date suggests that the etiology of nasal polyps is not known with certainty.

Polyps are caused by an allergic reaction or an inflammatory reaction. Stemmed shape, does not contain blood vessels. In nasal polyps can grow a lot, especially if the origin of the ethmoid sinuses. When the origin of the maxillary sinus, the polyps that grow only one, and are facing the nostril into the nasopharynx (turbinate). This situation is called turbinate polyps. Turbinate polyps usually larger than nasal polyps. Polyps were to be removed, because if not, as complications can occur sinusitis. Polyps that can grow a lot, so sometimes people seem enlarged nose, and if its spread is not treated after polyps removed, it can grow back. Therefore do not be tired of seeing, because often one surgery for polyp repeated bargaining.

Which may be a predisposing factor occurs polyps include:
a) Allergies, especially allergic rhinitis.
b) Chronic sinusitis.
c) Irritation.
d) Nasal obstruction by anatomical abnormalities such as septal deviation and turbinate hypertrophy.


Clinical Manifestations

The main symptoms caused by nasal polyps are nasal congestion. This blockage is not intermittent, and progressively advancing. In the great obstruction can cause symptoms of hyposmia even anosmia. If polyps are increasingly clogging the paranasal sinuses, sinusitis will arise with symptoms of headache and rhinorrhea. If the cause is allergies, then the main symptoms are sneezing and nasal irritation.

Persistent nasal obstruction, rhinorrhea and heavier. Blockage can occur hyposmia or anosmia. When the clog ostium, can occur purulent sinusitis with nasal mucus. Because due to allergies, the main symptoms are sneezing and nasal irritation.

On clinical examination a mass appears grayish white or reddish yellow in the nasal cavity. Sessile polyps so easily moved, soft consistency, not painful when pressed, easy bleeding, and did not shrink in the use of vasoconstrictor.


Data Analysis

1. Data

• Subjective Data: decreased appetite.
• Objective Data: weight loss, not eating out.

Etiology:

• Polyp
• Decrease the sense of smell

Problem

• Impaired sensory perception : olfactory

2. Data:

• Subjective Data: client felt there was a blockage in the nose.
• Objective Data: Respiration 24 x / minute, irregular breathing patterns, reflecting the ventilator inspiratory muscles, the additional breathing (Ronchi).

Etiology:

• There are masses
• Flow / drainage of secretions retained
• Nasal congestion

Problem

• Ineffective airway clearance

3. Data

• Subjective Data: client feel weak, appetite down.
• Objective Data: slim, body weight decreased (from 65 kg to 61 kg), albumin less than 3.2, Hb less than 11 hair look red at kids, thin subcutaneous layer.

Etiology

• Nasal congestion
• Impaired olfactory
• Decreased appetite

Problem

• Imbalanced nutrition less than body requirements

Cataract Care Plan - Pre and Post Operative

Definition

Cataract is a condition in which the normally clear lens of the eye becomes cloudy and clear change.

Cataract is the opacity of the progressive lens or the lens capsule.

Cataract is a cloudiness in the lens of each state, which can occur due to hydration (addition of liquid), lens protein denaturation, or due to both of them, usually occurs in both eyes and progressive.


Etiology

• Physical
• Chemical
• Elderly
• Disease predisposing
• Genetic and developmental disorders
• Virus infection in the future growth of the fetus.

Classification

Cataracts can be classified according to developmental and degenerative processes by:

1. Congenital Cataracts

Congenital cataract is a cloudiness in the lens that occur during the formation of the lens. Turbidity was there at the time the baby is born. Cataract is often found in infants born to mothers who had rubella, diabetes, toxoplasmosis, hipoparatiroidismo, galactosemia. There are also accompanying congenital abnormalities in the eye itself as microphthalmus, aniridia, coloboma, keratoconus, Ectopia lentis, megalocornea, hetero cornea iris.
Turbidity can be found in the form: hyaloidea persistent artery, anterior polar cataract, posterior, Axialis cataract, zonular cataract, stellate cataract, cataract totalis and congenital totalis membranacea.

2. Primary Cataracts

Primary cataracts by age, there are three groups, namely:
a. Juvenile Cataract (age <20 years)
b. Presenile Cataract (ages up to 50 years)
c. Senile Cataract (age> 50 years)

3. Senile Cataracts

Senile cataract is, all contained lens opacities in the elderly, the age group above 50 years.
Senile cataract is known in four stages, namely:

a. Incipient cataract
An early stage of cataract is clouding the lens is shaped patches of irregular opacities. Clients complain visual disturbances such as seeing double at the sight of one eye. At this stage, the process of degeneration absorb the liquid so that the anterior chamber has a normal depth. Iris in a normal position with mild cloudiness in the lens. Impaired visual acuity has not happened yet.

b. Immature cataract
Lens begins to absorb the liquid, so the lens is slightly convex, causing myopia and iris pushed ahead with a shallow anterior chamber. Anterior chamber angle can be closed so that may arise secondary glaucoma.

c. Mature cataract
An advanced lens degeneration process. At this stage, there was opacification of the lens. Fluid pressure within the lens is in equilibrium with the liquid in the eye so that the lens will return to normal size. Visual acuity had decreased and only a positive light projection.

d. Hypermature cataract
At this stage of the process further degeneration and cortical lens can melt lens, so the lens nucleus immersed in the lens cortex. At this stage, it can also happen that the degeneration of the lens capsule and cortical lens material liquid lenses that can be entered into the anterior chamber. Lens material to occlude the anterior chamber fluid, causing phacolytic glaucoma.

Clinical Manifestations

Cataracts develop slowly and do not cause pain accompanied by visual disturbances that appear gradually. Vision problems can be:

1. Difficulty seeing at night.
2. See the circle around the light or the light was blinding.
3. Decrease in visual acuity (even in daylight).
4. Frequently changing glasses.
5. Double vision in one eye. Sometimes cataract lens causing swelling and increased pressure within the eye (glaucoma), which can cause pain.
6. As there are dark spots in front of eyes.
7. Difficult to see objects that are dazzling.
8. Color change in the pupil or white.
9. Difficult to do the daily work.
10. Reading time illumination require brighter light.
11. Night vision much less.
12. 2. For a while obviously look closely.

Examination Support

1. Examination of visual acuity.
2. Check is performed to see visual acuity. This examination is conducted by the Snellen card is the card to see the person's visual acuity.
3. Slit lamp examination. See all makeup eye front with enlargement. With these tools can see the state of the cornea, manic eyes, black lining, and lenses.
4. Tonometry
5. Ophtalmoscope
6. Ocular examination

Pre Operative Cataract Care

1. Retinal function should be good, which is checked by the test beam projection.
2. There should be no infection in the eye or surrounding tissue.
3. There should be no glaucoma. In the state of glaucoma, retinal blood vessels have been adapted to high IOP. If surgery is performed, at the time the cornea is cut, IOP decreased, blood vessels rupture and cause severe bleeding. Also can cause bulbus oculi prolap of content, such as iris, glass body and lens.
4. Check the vision.
5. General state must either: no hypertension, no diabetes mellitus (blood glucose <150 mg / dl), no chronic cough and heart disease, such as cardiac decompensation.
6. Instruct the patient to bathe and wash before surgery, to reduce the risk of infection.
7. Give premedication drugs, and shaving eyelashes, appropriate advice doctor.

Cataract surgery is commonly performed and generally safe. After surgery are rare infections or bleeding in the eye that can lead to serious vision problems. To prevent infection, reduce inflammation and accelerate healing, for several weeks after surgery was given eye drops or ointment. To protect the eyes from injury, patients should wear glasses or protective goggles made of metal until the surgical wound is completely healed.

Post Operative Cataract Care

1. Limit the patient to perform an action that can increase IOP, including: coughing, bending, straining, sneezing, lifting objects weighing&gt; 7.5 kg, was lying beside the surgery.
2. Instruct the patient to wear glasses during the day and wear eye protection at night.
3. Give eye drops / eye ointment suitable doctor advice.
4. Observation of increased IOP is characterized by: severe pain, nausea, vomiting.
5. Observe for signs of infection, and advise the patient not to rub the eyes to prevent infection.
6. Instruct the patient to wash their hands before administering an ointment / eye drops.
7. Observe for signs of bleeding anterior eye chamber is characterized by changes in vision.
8. Observation for signs of retinal detachment, which is marked with a black dot seems, an increasing number of floaters or light and loss of part / whole field of view.