COMMON PROBLEMS

By:- firoz qureshiDept. psychiatric nursing

OXYGEN INSUFFICIENCY• FACTORS AFFECTING OXYGENATION

Oxygenation is influenced by 3 types of factors:

1. PHYSIOLOGICAL FACTORS

Cardiac disorders.

• Impaired vulvar function• Myocardial hypoxia• Peripheral tissue hypoxia

OXYGEN INSUFFICIENCY Respiratory disorders.• Hyperventilation• Hypoventilation• Hypoxia Others• Anemia • Pregnancy• Fever & infection• CNS alteration• Influences of chronic disease

OXYGEN INSUFFICIENCY2. DEVELOPMENTAL FACTORS • Infants & toddlers: They are at risk for upper

respiratory tract infections [URIs].• School age children & adolescent: They are exposed

to respiratory infection & respiratory risk factors such as smoking.• Young & middle age students: They are exposed to

multiple cardiopulmonary risk factors like unhealthy diet, lack of exercise, stress & drug uses.• Older adult: The physiologic changes occur.

Ventilation and transfer of respiratory gases decline with age, leading to lower oxygenation levels.

OXYGEN INSUFFICIENCY3. LIFESTYLE FACTORS

• Cigarette smoking• Junk foods• Spicy & fatty foods• No exercise• Stress• Substance abuse.

OXYGEN INSUFFICIENCYSYMPTOMS

• Body weakness• Muscle ache• Depression• Dizziness• Irritability• Infection• Fatigue• Memory loss• Acidity• Lowered immunity• Bronchial problems• Irrational behavior

INTERVENTIONSo SUCTIONING When a client is unable to clear respiratory tract secretions with coughing, the nurse must use suctioning to clear the airway.

TYPES1. Oropharyngeal2. Nasopharyngeal3. Orotracheal4. Nasotracheal

OXYGEN THERAPY

OXYGEN THERAPY CONTD…..

INDICATIONS

• COPD• Hypoxemia• Pulmonary embolism• Pneumonia• Pneumothorax• Pulmonary edema• Myocardial infarction

OXYGEN THERAPY CONTD…..

GOALS • To relieve hypoxemia.• To reduce work of breathing.• To decrease the work of

myocardium.• To release tissue hypoxia.

NEBULIZATION

NEBULIZATION CONTD………

Nebulization is a process of adding medications to inspired air by mixing particles of varying size with the air.

It is often used for administration of bronchodilators & mucolytic agents.

It can be useful in following conditions:• COPD • Cystic fibrosis• Bronchiectasis• Palliative care• Asthma.

NURSING INTERVENTIONSMaintain optimum level of health.Prevent respiratory infections.Health education related to cardiopulmonary health.Annual influenza vaccines are recommended for older

clients.Pneumococcal vaccine is recommended for clients at

increased risk of developing pneumonia & immunosuppressed.

Patients are encouraged to eat healthy low fat, high fiber diet.

Maintain healthy behavior like elimination of cigarette & other tobacco

NURSING INTERVENTIONS CONTD……Exercise is useful in promoting & maintaining

health.Patients are advised to avoid alcohol &

caffeine.Avoid exposure to second hand smoke.Avoid exposure to chemicals & pollutants.

FLUIDS & ELECTROLYTES IMBALANCES

• Fluid electrolyte balances within the body are necessary to maintain health and function in all body systems. Body fluids regulated by fluid intake, hormonal control & fluid output. This physiological balance is termed as homeostasis.

CAUSES• Loss of plasma• Loss of blood• Excessive perspiration• Fever• Decreased oral intake• Use of diuretics

CAUSES CONTD………

• Congestive heart failure• Renal failure• Cirrhosis of the liver• Excessive sodium intake• Diabetes inspidus• Diabetic ketoacidosis• Osmotic diuresis.

NURSING INTERVENTIONS

• History collection• Physical examination

NURSING INTERVENTIONS CONTD….

HYPOVOLEMIA• Oral fluid

replacement• Oral rehydration

therapy• IV therapy• Drug therapy

according to cause

HYPERVOLEMIA• Drug therapy•Weight

measurement• Regulate IV fluids• Diet therapy

restricts fluid & sodium.

NURSING INTERVENTIONS CONTD….

HYPONATREMIA

•IV fluids•Drug therapy•Water restriction

HYPERNATREMIA

•IV fluids•Drug therapy•Oral drink [water]

NURSING INTERVENTIONS CONTD….

HYPOMAGNESEMIA

•Oral Mg salt• IV/IM Mg

sulphate

HYPERMAGNESEMIA

•Ca gluconate•Diuresis/dialysis

NURSING INTERVENTIONS CONTD….

HYPOKALEMIA•Oral K

supplements• IV K

supplements

HYPERKALEMIA• Na polystyrene

Sulfonate• IV insulin & glucose• IV Ca solution• Hemodialysis

NURSING INTERVENTIONS CONTD….

HYPOCALCEMIA• IV Ca Gluconate• Oral Ca• Oral Ca &vitamin

D

HYPERCALCEMIA• Oral Potassium

oxide• IV saline &

frusemide• Hemodialysis

PROTEIN ENERGY MALNUTRITION

PROTEIN ENERGY MALNUTRITION CONTD…….

CAUSESPoverty Inadequate intake of food Infections (diarrhea, respiratory infections, measles, intestinal worm

infections)Poor environmental conditionsLarge family sizePoor maternal health & nutritional statusFailure of lactationPremature termination of breast feedingDelayed weaningSocial & cultural feeding practicesLBWMalabsorption states

PROTEIN ENERGY MALNUTRITION CONTD…….

TYPES OF PEMMarasmusKwashiorkor

PROTEIN ENERGY MALNUTRITION CONTD…….

MANAGEMENT1. Patient evaluation2. Intake of food3. Prevention of complication & death4. Provide adequate calories to replace losses & to promote

growth5. Treatment of life threatening problems6. Correction of specific deficiencies7. Reversion of metabolic abnormalities8. Emotional & physical stimulation9. Prevent relapse

ALTERED BODY TEMPRATURE

ALTERED BODY TEMPRATURE CONTD….

CAUSES1) Extreme in environmental temperature2) Infection3) Exercise4) Hormones5) Stress6) Injury7) Trauma8) Brain injury9) Age

ALTERED BODY TEMPRATURE CONTD….

MANAGEMENTI. Monitor vital signs.II. Assess temperature.III. Assess skin color.IV. Provide adequate nutrition & fluids.V. Maintain intake/output chart.VI. Reduce physical activity.VII. Provide oral hygiene.VIII. Provide dry clothing & bed linen.IX. Provide prescribed drugs.

UNCONSCIOUSNESS

UNCONSCIOUSNESS CONTD…

CAUSESA. Head injuriesB. Carbon monoxide poisoning C. StrokeD. HypoxiaE. EpilepsyF. SeizureG. EclampsiaH. ArrhythmiaI. Heart failureJ. Dehydration K. CVAL. Electric shockM. HypoglycemiaN. Hypothermia

UNCONSCIOUSNESS CONTD…

SYMPTOMS

a) Unresponsivenessb) Lack of consciousnessc) Lack of awarenessd) Inability to speake) Light headednessf) Incontinenceg) Palpitationsh) Confusion

UNCONSCIOUSNESS CONTD…

MANAGEMENTi. Maintaining patent airway.ii. Provide proper position.iii. Maintain CV function.iv. Protecting the client.v. Maintain the fluid balance & managing nutritional needs.vi. Monitor & maintain bowel functions.vii. Maintain genitourinary function.viii. Maintaining skin integrityix. Providing sensory stimulationx. Prevent complications.

SLEEP PATTERN & ITS DISTURBANCES

SLEEP PATTERN & ITS DISTURBANCES CONTD…….STAGES OF SLEEP• Non rapid eye movement(NREM)• Rapid eye movement(REM)

SLEEP PATTERN & ITS DISTURBANCES CONTD…….CAUSES• Life style patterns• Depression• Fear• Noise• Illness• Drug withdrawal• Stress• Pain• Hyperactivity• Hormonal changes• Unfamiliar environment• Side effects of drugs• Urinary incontinence

SLEEP PATTERN & ITS DISTURBANCES CONTD…….SIGNS & SYMPTOMSoAwakening earlieroLethargyoDifficulty in concentrationoYawningoRemaining asleepoIrritabilityoFatigueoDisorientationoSlurred speech

SLEEP PATTERN & ITS DISTURBANCES CONTD…….MANAGEMENT Evaluate the patient for substance abuse, sleep medication &

primary sleep disorders. Educate the patient about exercise. Provide favorable environment for sleep. Assess the usual sleep pattern. Reduce fear & anxiety. Complete basic needs before sleep. Use relaxation techniques. Reduce interruption during sleep. If prescribed administer medication for sleep. Avoid smoking & drinking alcohol before bedtime.

PAIN CONTD……………

TYPESPain Location• Referred • Visceral• ColickyDuration • Acute• ChronicPain intensity• Mild• Moderate• Severe Pain etiology• Physiologic• Pathologic

PAIN CONTD……………MANAGEMENT The WHO 3 Step Ladder for Pain Management

Step 1:-• Acetaminophen & NSAIDS including acetylsalicylic acid are the main drugs of

step 1 of the WHO analgesics ladder. Step 2:- • Several opioid analgesics are conventionally available in combination with either

acetaminophen/ acetylsalicylic acid & are commonly uses to manage moderate pain.

Step 3:-• The pure agonist opioid analgesics comprise step 3 of the WHO analgesic ladder

SENSORY DEPRIVATION

SENSORY DEPRIVATION CONTD……CHARACTERISTICSPhysical behavior (drowsiness, excessive

yawning)Escape behavior (eating, exercise, sleeping,

running away)Changes in perception (illusions &

hallucinations)Changes in affecting (crying, increased

irritability, confusion, panic)

SENSORY DEPRIVATION CONTD……PREVENTING SENSORY ALTERATION

• To create a functional & meaningful environment while keeping limitations in mind.• Offering care that provides rest &comfort.• Physical activity & exercise.• Varied sights sounds, smells, body positions & textures

can be helpful in providing a variety of sensations.• Teaching is a significant nursing responsibility.