SHINGLES (HERPES ZOSTER)

After chickenpox infection, the varicella zoster virus (VZV) lies dormant in the ganglia of the spinal nerve tracts. Shingles is an infectious viral condition caused by a reactivation of this latent VZV. Reactivation usually occurs in individuals with impaired inmunity; it is common among older adults. 

VZV produces painful vesicular eruptions along the peripheral distribution of nerves from posterior ganglia and is usually unilateral and characteristically occurs in a linear distribution, abruptly stopping at the midline both posteriorly and anteriorly. Although VZV typically affects the trunk of the body, the virus may also be noted on the buttocks or face. With facial involvement there is concern about involvement of the eye and cornea, potentially resulting in permanent loss of vision. Secondary infection resulting from scratching the lesions is common.

Shingles is characterized by burning, pain and neuralgia.

An individual with an outbreak of VZV is infectious for the 2 to 3 days after the eruption. The incubation period ranges from 7 to 21 days. The total course of the disease is 10 days to 5 weeks from onset to full recovery.

Some individuals may experience painful postherpetic neuralgia long after the lesions heal. 

Common risk factors:
-Skin lesions (papules, vesicles, pustules).
-Crusted-over lesions.
-Itching and scratching.
Common expected outcomes:
-Patient remains free of secondary infection, as evidenced by intact skin without redness or lesions.
-Risk for disease transmission is minimized through use of universal precautions.

Source: Nursing Care Plans Diagnoses, Interventions and Outcomes. Meg Gulanick, 8th Edition.

CONSTIPATION (CARE PLAN) AND RISK SCALE

CONSTIPATION (NANDA - 1 diagnosis)

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

Common Related Factors
-Inadequate fluid intake
-Low-fiber diet
-Inactivity, immobility
-Medication use
-Lack of privacy
-Fear of pain with defecation
-Habitual denial and ignoring of urge to defecate
-Laxative abuse
-Stress/depression
-Tumor or other obstruction mass
-Neurogenic disorders

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
-Verbalized pain or fear of pain with defecation


Common Expected Outcome
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.

Source: Nursing Care Plans Diagnoses, Interventions and Outcomes. Meg Gulanick, 8th Edition.

ETON/NORGINE CONSTIPATION RISK SCALE

LAXATIVES

1. Bulk-forming laxatives:

-Ispaghula husk (Fibrelief, Fybogel, Isogel, Ispagel orange, Regulan).

-Methylcellulose (Celevac).

-Sterculia (Normacol).

2. Stimulant laxatives:

-Bisacodyl

-Dantron (Co-danthramer, Co-danthrusate).

-Docusate sodium (Dioctyl, Docusol, Norgalax Micro-enema).

-Glycerol (Glycerol suppositories).

-Senna (Manevac, Senokot).

-Sodium picosulfate (Dulcolax).

3. Faecal softeners:

-Arachis oil

-Liquid paraffin

4. Osmotic laxatives:

-Lactulose.

-Macrogols (Laxido, Movicol).

-Magnesium salts (Magnesium hydroxide Mixture, Magnesium hydroxide with liquid paraffin, Magnesium sulphate).

-Phosphates (rectal): Carbalax, Fleet Ready-to-use enema, Phosphates Enema. 

-Sodium citrate (rectal): Micolette Micro-enema, Micralax Micro-enema, Relaxit Micro-enema.

5. Bowel cleansing solutions: Citrafleet, Citramag, Fleet Phospho-soda, Klean-Prep, Moviprep, Picolax).

6. Peripheral opioid-receptor antagonists (licensed for the treatment of opioid-induced constipation in patients receiving palliative care):

-Methylnaltrexone Bromide (Relistor sc injection).

Source: BNF 57 March 2009.

RISK FOR UNSTABLE BLOOD GLUCOSE LEVEL (CARE PLAN GUIDE)

This is my first post regarding Care Plans in English. All  information in this blog about care plans is just a guide as they need to be individualized and rationales (which I omitted) should be included, each diagnosis developed is based on NANDA International label.

RISK FOR UNSTABLE BLOOD GLUCOSE LEVEL (NANDA -1 diagnosis)

Definition: risk for variation of blood glucose/sugar levels from the normal range.

Common Risk Factors

-Insulin deficiency or insulin excess.

-Excessive glucose intake in relation to metabolic needs.

-Medication side effects.

-Imbalance of activity and food intake.

Common Expected Outcome

-Patient maintains blood glucose levels within defined target ranges.

Source: Nursing Care Plans Diagnoses, Interventions and Outcomes. Meg Gulanick, 8th Edition.

THE PREVENTION AND TREATMENT OF PRESSURE ULCERS

Source: NICE 2005, RCN

PRESSURE ULCERS (IMPAIRED SKIN INTEGRITY) 

CARE PLAN

The National Pressure Ulcer Advisory Panel defines pressure ulcer as "a localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure in combination with shear and/or friction".

Common related factors:
-Extremes of age.
-Inmobility.
-Imbalanced nutritional state.
-Mechanical factors (friction, shear and pressure)
-Pronounced bony prominences.
-Impaired circulation.
-Impaired sensation.
-Incontinence.
-Moisture.
-Radiation.
-Chronic disease state.
-Inmunological deficit.
-Impaired cognition.

Defining characteristics:
-Destruction of skin layers.
-Disruption of skin surfaces.
-Invasion of body structures.
-Pressure ulcer stages:

• Deep tissue injury (new stage): purple or maroon localized area of intact skin or blood-filled blister resulting from pressure damage or underlying soft tissue.
• Stage I

• Stage II

• Stage III

• Stage IV

• Unstageable: Full thickness tissue loss in which actual depth of ulcer is completely obstructed by slough or eschar in the wound bed.

Common expected outcomes:
-Patient receives stage-appropiate wound care, experiences pressure reduction and has controlled risk factors for prevention of additional ulcers.
-Patient experiences healing of pressure ulcers.

Source: Nursing Care Plans Diagnoses, Interventions and Outcomes. Meg Gulanick, 8th Edition.