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Saturday, November 13, 2010

Cara Membuka File Office 2007 di Office 2003

Posted by vini np at 6:20 PM 0 comments




Pernahkah kalian mengalami kejadian, ketika akan membuka file excel, power point atau word di laptop teman kita, atau malah mau buka di komputer kita sendiri, tapi filenya tidak terbuka??
yah, pasti lah format file nya berbeda. Format file word 2003 berupa .doc , excel 2003 berupa .xls dan powerpoint 2003 berupa .ppt , sedangkan pada word 2007 berupa .docx , excel 2007 .xlsx, dan powerpoint 2007 .pptx.

Naaaaaahh.......



untuk menyiasatinya agar file berformat office 2007 ini dapat di buka di Office 2003 caranya adalah seperti ini :
1. Download program gratis dari Microsoft yaitu FileFormatConverter.exe untuk mendownload file ini klik disini.

2. Setelah selesai download FileFormatConverter.exe lanjut install hingga selesai.

3. Setelah installasi selesai maka file office 2007 pun dapat dibuka di office 2003.

:D :D




sumber:

Saturday, November 6, 2010

Nursing Care Plan Gastritis

Posted by vini np at 2:39 PM 0 comments
Nursing Care Plan - Gastritis

Definition

Gastritis is an inflammation of the gastric mucosa; it may be acute or chronic. Acute gastritis, the most common stomach disorder, produces mucosal reddening, edema, and superficial surface erosion. Chronic gastritis is common among elderly people and people with pernicious anemia. It's often present as chronic atrophic gastritis, in which all stomach mucosal layers are inflamed, with a reduced number of chief and parietal cells. Acute or chronic gastritis can occur at any age.



Aetiology

The cause of gastritis can be distinguished according to their classification as follows :

* Acute Gastritis
The reason is analgesic drugs, especially anti-inflammatory aspirin (low-dose aspirin which can cause erosion had gastric mucosa).
Chemicals eg lisol, alcohol, smoking, caffeine pepper, steroids and digitalis.

* Chronic Gastritis
The cause and pathogenesis are generally unknown.
Gastritis is a common occurrence in the elderly, but the thought of drinking alcohol, and smoking.



Clinical manifestations

1. Clinical manifestations usually appear on other Acute Gastritis, namely anorexia, nausea, vomiting, epigastric pain, gastrointestinal bleeding in Haematemesis melena, a further sign of anemia.

2. Chronic gastritis
Most clients do not have any complaints, only a minority complain heartburn, anorexia, nausea, and anemia complaints and physical examination abnormalities are not met.



Assessment

1. Predisposing factors and precipitation
Predisposing factors are chemicals, smoking, caffeine, steroids, analgesic drugs, anti-inflammatory, vinegar or pepper.
Precipitation factor is the habit of consuming alcohol and smoking, drug use, diet and irregular diet, and lifestyles such as lack of rest.

2. Test dignostik
* Endoscopy : multi erosion would seem that some bleeding and it's usually spread.
* Check Hispatologi : will look mucosal damage due to erosion through the mucosa never muscular.
* Check radiology
* The laboratory :
o Gastric Analysis : to determine the level of secretion of HCL, HCL secretion declines in clients with chronic gastritis.
o Levels of serum vitamin B12 : normal values 200-1000 Pg / ml, vitamin B12 levels are low megalostatik anemia.
o Hemagiobin levels, hematocrit, platelets, leukocytes, and albumin.
o Gastroscopy
To determine the mucosal surface (change) to identify areas of bleeding and tissue taken for biopsy.



Nursing Diagnosis

Disturbance nutritional needs less than body requirements related to inadequate intake, anorexia.


Purpose :

Overcome nutritional deficiencies.



Results Criteria :

Stable weight, normal laboratory values albumin, no nausea and vomiting, normal body weight, normal bowel sounds.



Intervention :

Review of food intake, body weight balanced on a regular basis, provide regular oral care, encourage clients to eat little but often, give food in warm, auscultation bowel sounds, examine food preferences, such as supervising the laboratory examination: Hb, Ht, albumin.

NCP - Nursing Care Plan Constipation

Posted by vini np at 2:31 PM 0 comments
Nursing Diagnosis: Constipation
Impaction; Obstipation
NOC Outcomes (Nursing Outcomes Classification)
Suggested NOC Labels

* Bowel Elimination
* Medication Response
* Self-Care Toileting

NIC Interventions (Nursing Interventions Classification)
Suggested NIC Labels

* Constipation/Impaction Management
* Bowel Training
* Teaching: Prescribed Medication

NANDA Definition: Decrease in normal frequency of defecation accompanied by difficult or incomplete passage of stool and/or passage of excessively hard, dry stool

Constipation is a common, yet complex problem; it is especially prevalent among elderly patients. Constipation often accompanies pregnancy. Diet, exercise, and daily routine are important factors in maintaining normal bowel patterns. Too little fluid, too little fiber, inactivity or immobility, and disruption in daily routines can result in constipation. Use of medications, particularly narcotic analgesics or overuse of laxatives, can cause constipation. Overuse of enemas can cause constipation, as can ignoring the need to defecate. Psychological disorders such as stress and depression can cause constipation. Because privacy is an issue for most, being away from home, hospitalized, or otherwise being deprived of adequate privacy can result in constipation. Because "normal" patterns of bowel elimination vary so widely from individual to individual, some people believe they are constipated if a day passes without a bowel movement; for others, every third or fourth day is normal. Chronic constipation can result in the development of hemorrhoids; diverticulosis (particularly in elderly patients who have a high incidence of diverticulitis); straining at stool, which can cause sudden death; and although rare, perforation of the colon. Constipation is usually episodic, although it can become a lifelong, chronic problem. Because tumors of the colon and rectum can result in obstipation (complete lack of passage of stool), it is important to rule out these possibilities. Dietary management (increasing fluid and fiber) remains the most effective treatment for constipation.

* Defining Characteristics: Infrequent passage of stool
* Passage of hard, dry stool
* Straining at stools
* Passage of liquid fecal seepage
* Frequent but nonproductive desire to defecate
* Anorexia
* Abdominal distention
* Nausea and vomiting
* Dull headache, restlessness, and depression
* Verbalized pain or fear of pain

* Related Factors: Inadequate fluid intake
* Low-fiber diet
* Inactivity, immobility
* Medication use
* Lack of privacy
* Pain
* Fear of pain
* Laxative abuse
* Pregnancy
* Tumor or other obstructing mass
* Neurogenic disorders

* Expected Outcomes Patient passes soft, formed stool at a frequency perceived as "normal" by the patient.
* Patient or caregiver verbalizes measures that will prevent recurrence of constipation.

Ongoing Assessment

* Assess usual pattern of elimination; compare with present pattern. Include size, frequency, color, and quality. "Normal" frequency of passing stool varies from twice daily to once every third or fourth day. It is important to ascertain what is "normal" for each individual.
* Evaluate laxative use, type, and frequency. Chronic use of laxatives causes the muscles and nerves of the colon to function inadequately in producing an urge to defecate. Over time, the colon becomes atonic and distended.
* Evaluate reliance on enemas for elimination. Abuse or overuse of cathartics and enemas can result in dependence on them for evacuation, because the colon becomes distended and does not respond normally to the presence of stool.
* Evaluate usual dietary habits, eating habits, eating schedule, and liquid intake. Change in mealtime, type of food, disruption of usual schedule, and anxiety can lead to constipation.
* Assess activity level. Prolonged bed rest, lack of exercise, and inactivity contribute to constipation.
* Evaluate current medication usage that may contribute to constipation. Drugs that can cause constipation include the following: narcotics, antacids with calcium or aluminum base, antidepressants, anticholinergics, antihypertensives, and iron and calcium supplements.
* Assess privacy for elimination (e.g., use of bedpan, access to bathroom facilities with privacy during work hours). Many individuals report that being away from home limits their ability to have a bowel movement. Those who travel or require hospitalization may have difficulty having a bowel movement away from home.
* Evaluate fear of pain. Hemorrhoids, anal fissures, or other anorectal disorders that are painful can cause ignoring the urge to defecate, which over time results in a dilated rectum that no longer responds to the presence of stool.
* Assess degree to which patient’s procrastination contributes to constipation. Ignoring the defecation urge eventually leads to chronic constipation, because the rectum no longer senses, or responds to, the presence of stool. The longer the stool remains in the rectum, the drier and harder (and more difficult to pass) it becomes.
* Assess for history of neurogenic diseases, such as multiple sclerosis or Parkinson’s disease. Neurogenic disorders may alter the colon’s ability to perform peristalsis.

Therapeutic Interventions

* Encourage daily fluid intake of 2000 to 3000 ml/day, if not contraindicated medically. Patients, especially elderly patients, may have cardiovascular limitations, which require that less fluid is taken.
* Encourage increased fiber in diet (e.g., raw fruits, fresh vegetables); a minimum of 20 g of dietary fiber per day is recommended. Fiber passes through the intestine essentially unchanged. When it reaches the colon, it absorbs water and forms a gel, which adds bulk to the stool and makes defecation easier.
* Encourage patient to consume prunes, prune juice, cold cereal, and bean products. These are "natural" cathartics because of their high-fiber content.
* Encourage physical activity and regular exercise. Ambulation and/or abdominal exercises strengthen abdominal muscles that facilitate defecation.
* Encourage a regular time for elimination. Many persons defecate following first daily meal or coffee, as a result of the gastrocolic reflex; depending on the person’s usual schedule, any time, as long as it is regular, is fine.
* Encourage isometric abdominal and gluteal exercises. Exercises, unless contraindicated, strengthen muscles needed for evacuation.
* Digitally remove fecal impaction. Stool that remains in the rectum for long periods becomes dry and hard; debilitated patients, especially elderly patients, may not be able to pass these stools without manual assistance.
* Suggest the following measures to minimize rectal discomfort:
o Warm sitz bath
o Hemorrhoidal preparations These shrink swollen hemorrhoidal tissue.
* For hospitalized patients, the following should be employed:
o Orient patient to location of bathroom and encourage use, unless contraindicated. A sitting position with knees flexed straightens the rectum, enhances use of abdominal muscles, and facilitates defecation.
o Offer a warmed bedpan to bedridden patients; assist patient to assume a high-Fowler’s position with knees flexed. This position best uses gravity and allows for effective Valsalva maneuver.
o Curtain off the area. This provides privacy.
o Allow patient time to relax.

Education/Continuity of Care

* Consult dietitian if appropriate. Persons unaccustomed to a high-fiber diet may experience abdominal discomfort and flatulence; a gradual increase in fiber intake is recommended.
* Explain or reinforce to patient and caregiver the importance of the following:
o A balanced diet that contains adequate fiber, fresh fruits, vegetables, and grains Twenty grams per day is recommended.
o Adequate fluid intake Drink 8 glasses/day or 2000 to 3000 ml/day.
o Regular meals Successful bowel training relies on routine.
o Regular time for evacuation and adequate time for defecation
o Regular exercise/activity
o Privacy for defecation
* Teach patients and caregivers to read product labels. It is important for patients and caregivers to determine the fiber content per serving.
* Teach use of pharmacological agents as ordered, as in the following:
o Bulk fiber (Metamucil and similar fiber products) These increase fluid, gaseous, and solid bulk of intestinal contents.
o Stool softeners (e.g., Colace) These soften stool and lubricate intestinal mucosa.
o Chemical irritants (e.g., castor oil, cascara, Milk of Magnesia) These irritate the bowel mucosa and cause rapid propulsion of contents of small intestines.
o Suppositories These aid in softening stools and stimulate rectal mucosa; best results occur when given 30 minutes before usual defecation time or after breakfast.
o Oil retention enema This softens stool.







source:http://nursingcareplan.blogspot.com/2009/07/ncp-nursing-diagnosis-constipation.html

NCP - Nursing Care Plan Diarrhea

Posted by vini np at 2:16 PM 17 comments
Nursing Diagnosis: Diarrhea
Loose Stools, Clostridium difficile (C. difficile)
NOC Outcomes (Nursing Outcomes Classification)
Suggested NOC Labels

* Bowel Elimination
* Fluid Balance
* Medication Response

NIC Interventions (Nursing Interventions Classification)
Suggested NIC Labels

* Diarrhea Management
* Enteral Tube Feeding
* Teaching: Prescribed Medications

NANDA Definition: Passage of loose, unformed stools

Diarrhea may result from a variety of factors, including intestinal absorption disorders, increased secretion of fluid by the intestinal mucosa, and hypermotility of the intestine. Problems associated with diarrhea, which may be acute or chronic, include fluid and electrolyte imbalance and altered skin integrity. In elderly patients, or those with chronic disease (e.g., acquired immunodeficiency syndrome [AIDS]), diarrhea can be life-threatening. Diarrhea may result from infectious (i.e., viral, bacterial, or parasitic) processes; primary bowel diseases (e.g., Crohn’s disease); drug therapies (e.g., antibiotics); increased osmotic loads (e.g., tube feedings); radiation; or increased intestinal motility such as with irritable bowel disease. Treatment is based on addressing the cause of the diarrhea, replacing fluids and electrolytes, providing nutrition (if diarrhea is prolonged and/or severe), and maintaining skin integrity. Health care workers and other caregivers must take precautions (e.g., diligent hand washing between patients) to avoid spreading diarrhea from person to person, including self.

* Defining Characteristics: Abdominal pain
* Cramping
* Frequency of stools
* Loose or liquid stools
* Urgency
* Hyperactive bowel sounds or sensations

* Related Factors: Stress
* Anxiety
* Medication use
* Bowel disorders: inflammation
* Malabsorption
* Increased secretion
* Enteric infections
* Disagreeable dietary intake
* Tube feedings
* Radiation
* Chemotherapy
* Bowel resection
* Short bowel syndrome
* Lactose intolerance

* Expected Outcomes Patient passes soft, formed stool no more than three times per day.

Ongoing Assessment

* Assess for abdominal pain, cramping, frequency, urgency, loose or liquid stools, and hyperactive bowel sensations.
* Culture stool. Testing will identify causative organisms.
* Inquire about the following:
o Tolerance to milk and other dairy products Patients with lactose intolerance have insufficient lactase, the enzyme that digests lactose. The presence of lactose in the intestines increases osmotic pressure and draws water into the intestinal lumen.
o Medications patient is or has been taking Laxatives and antibiotics may cause diarrhea. C. difficile can colonize the intestine following antibiotic use and lead to pseudomembranous enterocolitis; C. difficile is a common cause of nosocomial diarrhea in health care facilities.
o Idiosyncratic food intolerances Spicy, fatty, or high-carbohydrate foods may cause diarrhea.
o Method of food preparation Fried food or food contaminated with bacteria during preparation may cause diarrhea.
o Osmolality of tube feedings Hyperosmolar food or fluid draws excess fluid into the gut, stimulates peristalsis, and causes diarrhea.
o Change in eating schedule
o Level of activity
o Adequacy or privacy for elimination
o Current stressors Some individuals respond to stress with hyperactivity of the GI tract.
* Check for history of the following:
o Previous gastrointestinal (GI) surgery Following bowel resection, a period (1 to 3 weeks) of diarrhea is normal.
o GI diseases
o Abdominal radiation Radiation causes sloughing of the intestinal mucosa, decreases usual absorption capacity, and may result in diarrhea.
* Assess impact of therapeutic or diagnostic regimens on diarrhea. Preparation for radiography or surgery, and radiation or chemotherapy predisposes to diarrhea by altering mucosal surface and transit time through bowel.
* Assess hydration status, as in the following:
o Input and output Diarrhea can lead to profound dehydration and electrolyte imbalance.
o Skin turgor
o Moisture of mucous membrane
* Assess condition of perianal skin. Diarrheal stools may be highly corrosive, as a result of increased enzyme content.
* Explore emotional impact of illness, hospitalization, and/or soiling accidents by providing privacy and opportunity for verbalization.

Therapeutic Interventions

* Give antidiarrheal drugs as ordered. Most antidiarrheal drugs suppress GI motility, thus allowing for more fluid absorption.
* Provide the following dietary alterations as allowed:
o Bulk fiber (e.g., cereal, grains, Metamucil)
o "Natural" antidiarrheals (e.g., pretzels, matzos, cheese)
o Avoidance of stimulants (e.g., caffeine, carbonated beverages) Stimulants may increase GI motility and worsen diarrhea.
* Check for fecal impaction by digital examination. Liquid stool (apparent diarrhea) may seep past a fecal impaction.
* Encourage fluids; consider nutritional support. Fluids compensate for malabsorption and loss of nutrients.
* Evaluate appropriateness of physician’s radiograph protocols for bowel preparation on basis of age, weight, condition, disease, and other therapies. Elderly, frail, or those patients already depleted may require less bowel preparation or additional intravenous (IV) fluid therapy during preparation.
* Assist with or administer perianal care after each bowel movement (BM). This prevents perianal skin excoriation.
* For patients with enteral tube feeding, employ the following:
o Change feeding tube equipment according to institutional policy, but no less than every 24 hours. Contaminated equipment can cause diarrhea.
o Administer tube feeding at room temperature. Extremes of temperature can stimulate peristalsis.
o Initiate tube feeding slowly.
o Decrease rate or dilute feeding if diarrhea persists or worsens. This prevents hyperosmolar diarrhea.

Education/Continuity of Care

* Teach patient or caregiver the following dietary factors that can be controlled:
o Avoid spicy, fatty foods.
o Broil, bake, or boil foods; avoid frying.
o Avoid foods that are disagreeable.
* Encourage reporting of diarrhea that occurs with prescription drugs. There are usually several antibiotics with which the patient can be treated; if the one prescribed causes diarrhea, this should be reported promptly.
* Teach patient or caregiver the following measures that control diarrhea:
o Take antidiarrheal medications as ordered.
o Encourage use of "natural" antidiarrheals (these may differ person to person).
* Teach patient or caregiver the importance of fluid replacement during diarrheal episodes. Fluids prevent dehydration.
* Teach patient or caregiver the importance of good perianal hygiene after each BM. Hygiene controls perianal skin excoriation and minimizes risk of spread of infectious diarrhea.




source: http://nursingcareplan.blogspot.com/2009/07/ncp-nursing-diagnosis-diarrhea.html

Friday, November 5, 2010

Nursing Care Sample

Posted by vini np at 8:51 PM 0 comments
Morning all! (´∀`) J( 'ー`)し
This is a nursing care plan sample about sleep, that i've just found a week before.


Download here

November

Posted by vini np at 8:28 PM 0 comments
First posting on November! =D
I'll post some English article to improve my blog and will try to post nursing care journals!
 

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