PBL PRESENTATION

GROUP 1

(WEEK 1)

GROUP 1

Muhamad Shukur bin Amir DNM/1399/11Nik Nurul Athirah binti Nik Mod Kamal DNM/1441/11Nur ‘Izzatul Asna binti Ismail DNM/1444/11Mysara Izzati binti Ishak DNM/1409/11Nur Athirah binti Aziz DNM/1482/11Nur Ain bt.Dzulkiply DNM/1512/11Norhazliana bt. Che Harun DNM/1430/11

Scenario 1: Nursing Management for Fever

Mariam age 16, was brought to clinic by her parent because she’s having epigastric pain. Dr. Kamariah has done an assessment on her and decided that she needs to be admitted at 7Utara for further management.

Scenario 1

Health History

Name : Mariam Age : 16 years old Gender : Female

OBJECTIVES

Define epigastric,pain and epigastric pain.

Identify anatomy and physiology of epigastric.

Describe the nursing implication for pharmacologic agents used to reduce the symptom.

Apply the nursing process for management

EPIGASTRIC PAIN AND MANAGEMENT OF FEVER

DEFINITION

Epigastric• The middle of upper abdomen.

Pain• The International Association for the Study

of Pain (IASP) define, ”pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage or it is described in terms of such damage”. Pain can be a major factor inhibiting the ability and willingness to recover from illness.

Cont.

Epigastric pain

• Epigastric pain is pain that is localized to the region of the upper abdomen immediately below the ribs. Often, those who experience this type of pain feel it during or right after eating or if they lie down too soon after eating. It is a common symptom of gastroesophageal reflux disease (GERD) or heartburn. It may be associated with the gastric contents moving upward into the back of the throat, causing inflammation and a burning pain.

SIGN and SYMPTOM

severe burning feeling in the abdomen, chest and neck that prevents sleep.

constipation, diarrhea, and vomiting, depending on the underlying cause.

Epigastric pain may accompany other symptoms, which vary depending on the underlying disease, disorder or condition.

ANATOMY AND PHYSIOLOGY

REGION OF ABDOMEN

Epigastric area

ETHIOLOGY OF EPIGASTRIC PAIN

Epigastric pain is the result of overeating, drinking alcohol while eating, or consuming greasy or spicy foods.

caused by digestive conditions such as acid reflux or lactose intolerance.

Gastroesophageal reflux disease (GERD) is another possible cause of epigastric pain.

Inflammatory diseases or cancers affecting the gallbladder, pancreas or stomach may result in epigastric pain.

Common Causes of Epigastric PainDyspepsia (indigestion)Gastritis (inflammation of the stomach lining)Gastroesophageal reflux disease (GERD), a condition in which acidic stomach contents flow back into the esophagusHeartburnLactose intolerancePregnancySide effects to medications, such as aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs)

Other Causes of Epigastric PainBarrett’s esophagus (cellular changes in the esophagus that may lead to esophageal cancer)Esophagitis (inflammation of the esophagus)Gallstones or gallbladder diseaseHiatal hernia (protrusion of the stomach into the chest through a hole in the diaphragm)Pancreatic cancerPancreatitis (inflammation of the pancreas)Peptic ulcer or perforated peptic ulcer, resulting in stomach bleeding or an intestinal ulcerStomach or esophageal cancer

Serious or Life-threatening causes of Epigastric Pain

In some cases, epigastric pain may be a symptom of a serious or life-threatening condition that should be immediately evaluated in an emergency setting. These include:Angina (chest pain due to the heart not getting enough oxygen)Heart attack (myocardial infarction)

What are the potential complications of epigastric pain?

Cancer of the esophagus, stomach, or other organsEsophageal scarring and narrowingMyocardial infarction (heart attack), if the pain is due to anginaPoor nutrition due to a decreased desire to eatPoor quality of lifeSpread of cancerSpread of infection

TYPE OF PAIN

ACUTE PAIN• usually of recent onset and is most commonly

associated with a specific injury. It is time limited and generally has a defined cause and purpose. It may be mild, moderate or severe in nature and is usually sudden in onset.

CHRONIC PAIN• is a complex physiological and psychological

phenomenon that causes varying degrees of disability in a large portion of the population. Chronic pain is constant or intermittent in nature that persist over a period of time and it is often defined as pain that lasts for six months or more. Chronic pain also classified as a malignant or non-malignant.

Ethiology and Pathophysiology

Examples of disease:-DISEASE

Gastritis Peptic Ulcer Disease

Gastritis

Ethiology short-term inflammatory process that can be

initiated by numerous factors such as excess alcohol ingestion, drug affect aspirin, etc.

PhysiologyGastritis occur, result of breakdown in normal gastric mucosal

(protect stomach tissue from auto digestion by acid and enzyme pepsia)

Barrier broken

Acid diffuse into mucosaAllow HCl to enter

HCl acis stimulates the conversion of pepsinogen to pepsin

Also stimulate the release of histamine from mast cell

Tissue edema (disruption of capillary walls with loss of plasma into gastric lumen) occurs

hermorrhage

Peptic Ulcer Disease (PUD)

Ethiology infection by the organism Helicobacter pylori (H.pylori) which produces a chronic gastritis.

decreasing or increasing of gastrical secretions lead to peptic ulcer included in the difference between gastric and duodenal ulcer.

PathophysiologyStomach is protected from autodigestion by gastric mucosal barrier.

Mucosal barrier can be impaired and back-diffusion of acid can occur (under specific circumstances)

Barrier is broken

HCl acid freely enters mucosa

Injury tissue and cellular destruction and inflammation

Histamine release from damage mucosa

Vasolidation and increased caillary permeability

Stimulate further secretion of acid and pepsin

H.Pylori (agent to destroy mucosal barrier) may create chromic inflammation

Drugs inhibit synthesis of mucus e.g .aspirin cause abnormal permeability

Mucosal barrier disrupted, compensatory increase in blood flow

PHYSICAL EXAMINATION

Inspectionnote made of the shape of the abdomen, skin abnormalities, abdominal masses, and the movement of the abdominal wall with respiration.Auscultation for detection of altered bowel sounds, rubs, or vascular bruits.

Percussionuseful and kind test for abdominal tenderness or peritonism.

Palpationthe examination of the abdomen for crepitus of the abdominal wall, for any abdominal tenderness, or for abdominal masses. 

Definition ,sign and symptom of fever

An elevation at temperature above normal range of 36.5 MC due to an increase in body temperature regulator y set point

The increase in set point trigger increase muscle tone and shivering

Chill and rigor

Chill is a sensation of cold, usually with shivering.

Rigor is a shaking occurring during a high fever. occurs because cytokines and prostaglandins are released as part of an immune response and increase the set point for body temperature in the hypothalamus

It is sometimes considered a symptom for "chills

Vomiting(kemuntahan)

Ejection part or all of the contents of the stomach through the mouth, usually in a series of involuntary spasmic movements

Clinical Manifestation for Fever

• Pain• Nausea• Weakness, or fatigue• Chill and rigor

Medicine or drug

DEFINITION A drug or medicine given to reduce pain without resulting in loss of consciousness.

FEVERParacetamol, panadol

Generic Name acetaminophen

Brand Name

Tylenol and others

Group analgesics (pain relievers) and antipyretics (fever reducers)

Purpose relief of fever , relieves pain in mild arthritis,

Side Effect liver damage due to large doses, Doses of acetaminophen greater than the recommended doses are toxic to the liver and may result in severe liver damage.

VOMITING

Benadryl

Generic Name Diphenhydramine

Brand Name

Aler-Tab, Allergy, Allermax, Altaryl, Benadryl, Children's Allergy

Group AntihistaminePurpose Symptoms of allergies and the common

cold.Side Effect Sleepiness, fatigue, or dizziness, headache,

dry mouth; or difficulty urinating or an enlarged prostate.

NURSING DIAGNOSIS

Diagnosis kejururawatan

Objektif Intervensi Rasional

Sakit b/d epigastrik pain d/d aduan pesakit

Kesakitan pesakit akan dapat dikurangkan.

-Taksir keadaan dan tahap kesakitan pesakit.

-rehatkan dan posisikan pesakit pada posisi yang selesa

-rancang prosedur yang akan dilakukan pada pesakit

-kawal kemasukan pelawat di luar waktu waktu melawat

-beri analgesik seperti yang dipreskripsikan oleh doktor

-taksir semula keadaan pesakit

-Untuk memudahkan tindakan kejururawatan seterusnya -untuk keselesaan pesakit

-untuk mengurangkan pergerakan pesakit

-supaya pesakit dapat berehat

-untuk mengurangkan kesakitan pesakit

Diagnosis kejururawatan

Objektif Intervensi Rasional

Demam b/d infeksi d/d bacaan suhu badan pesakit tinggi(37.5-40 darjah Celcius)

Demam pesakit akan berkurangan dengan bacaan suhu badan normal(36.5-37.4 darjah Celcius) dalam masa sehari

-Taksir tahap keadaan pesakit.

-pantau tanda-tanda vital pesakit setiap 4jam sekali.

-lakukan mandi berjelum

-pastikan ventilasi yang mencukupi seperti pasang kipas atau penyaman udara

-supaya tindakan kejururawatan dapat diambil-Untuk mengesan sebarang keabnormalan

-untuk menggalakan pengaliran haba daripada badan pesakit ke persekitaran secara konduksi

-menggalakkan pembebasan haba daripada badan pesakit ke persekitaran

Diagnosis kejururawatan

Objektif Intervensi Rasional

Risiko dehidrasi b/d kemuntahan d/d kulit pesakit kering

Tahap hidrasi pesakit akan terkawal dan kulit pesakit lembab

-tafsir keadaan dan tahap hidrasi pesakit

-catat setiap pengambilan dan pengeluaran cecair pesakit dalam carta pengambilan dan pengeluaran.

-monitor keadaan urin (amaun,warna dan bau)

-untuk mengesan tahap hidrasi dan tanda-tanda dehidrasi pesakit

-pesakit akan mengalami dehidrasi sekiranya tahap pengeluaran cecair adalah lebih banyak daripada pengambilan

-mengesan tanda-tanda dehidrasi seperti warna urin yang gelap,pekat dan bau yang kuat

Diagnosis kejururawatan

Objektif Intervensi Rasional

-monitor keputusan BUSE:kreatinin

-tafsir semula keadaan dan tahap hidrasi pesakit

-untuk mengesan ketidakseimbangan elektrolite dalam badan

-untuk memudahkan tindakan kejururawatan diambil

Diagnosis kejururawatan

Objektif Intervensi Rasional

Bimbang b/d proses penyakit d/d pesakit kelihatan bimbang dan gelisah

Kebimbangan pesakit akan dapat dikurangkan

-tafsir tahap kebimbangan pesakit

-galakkan pesakit memberitahu perasaannya tentang penyakit dan kebimbangan dan masalah yang menyebabkannya tertekan

-libatkan sistem sokongan seperti keluarga dan individu yang rapat dengan pesakit untuk memberi sokongan emosi

-memudahkan tindakan kejururawatan seterusnya dilakukan

-luahan secara verbal dapat mengurangkan tekanan dan kebimbangan

-sokongan daripada individu seperti ini mudah diterima oleh pesakit

Diagnosis kejururawatan

Objektif Intervensi Rasional

-terangkan setiap tatacara yang akan dilakukan kepada pesakit dan beri sokongan untuk mengurangkan ketakutan dan kebimbangan

-tafsir semula tahap kebimbangan pesakit

-Kebimbangan akan menyebabkan peningkatan keperluan oksigen dan menambah burukkan keadaan pernafasan pesakit

-supaya intervensi seterusnya dapat dijalankan

REFERENCES Indigestion. National Digestive Diseases

Information Clearinghouse (NDDIC). http://digestive.niddk.nih.gov/ddiseases/pubs/indigestion/. Accessed May 8, 2011.

Epigastric pain, gastroesophageal reflux (GER), and gastroesophageal reflux disease (GERD). National Digestive Diseases Information Clearinghouse (NDDIC). http://digestive.niddk.nih.gov/ddiseases/pubs/gerd/. Accessed May 6, 2011.

Priscilla Lemone (2009). Medical Surgical Nursing,.Critical Thinking in Client Care,4th Edition.

THANK YOU…