Author: Dr. Prince

Nursing Care Plans for Depression – Best Nursing Care Plans(2022)

This article discusses Nursing Care Plans for Depression plus its causes, symptoms, preventions, treatments and interventions.

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Disclaimer: The information presented in this article is not medical advice; it is meant to act as a quick guide to nursing students for learning purposes only and should not be applied without an approved physician’s consent. Please consult a registered doctor in case you’re looking for medical advice.

Introduction

Depression is a mood illness characterized by a continuous sense of melancholy and a loss of interest. It affects how you feel, think, and behave and can lead to several mental and physical difficulties. It’s also known as major depressive disorder or clinical depression. A depressed person may find it challenging to carry out day-to-day tasks and feel like life isn’t worth living. A person suffering from depression may feel unhappy all of the time.

Bereavement or the loss of a job are examples of significant life events that can contribute to depression. On the other hand, doctors only consider grieving to be an element of depression if it persists.

Depression is a long-term issue, not a blip on the radar. It comprises episodes with symptoms that last at least two weeks. Depression can endure weeks, months, or even years.

Symptoms and signs of Depression

The following are some of the signs and symptoms of depression:

A depressed mood
Decreased interest or pleasure in previously enjoyed activities
Changes in appetite
Unintentional weight loss or gain
Restlessness and pacing up and down,
Slowed movement and speech
Fatigue or loss of energy
Feelings of worthlessness or guilt
Difficulty thinking, concentrating or making decisions.
Recurrent thoughts of death or suicide, or an attempt at suicide recurrent thoughts of death or suicide, or an attempt at suicide

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Depression in Female

According to the Centers for Disease Control and Prevention, depression is about twice as common in women as it is in men (CDC).

Sources of depression that are more common in females include:

Irritability \sanxiety
Fluctuations in mood
Ruminating on weariness (dwelling on negative thoughts)

In addition, several kinds of depression are exclusive to women, such as:

Depression after childbirth
Premenstrual dysphoric disorder

Depression in men

According to the American Psychological Association, approximately 9% of males in the United States experience depression or anxiety.

Males with depression are more prone than females to drink excessively, be angry, and take risks due to t their illness.

Other signs and symptoms of depression in men include:

Avoiding social situations and families
Working without taking a break having.
Trouble balancing work and family duties.
Exhibiting harsh or dominating behaviour in relationships

Depression in Students at college

College can be stressful since students are exposed to new lives, cultures, and experiences for the first time. Some students struggle to cope with these changes, and as a result, they may develop sadness, anxiety, or both.

The following are some of the signs and symptoms of depression in college students:

Difficulty concentrating on schoolwork
Sleeplessness
Excessive napping
A decrease or increase in appetite
Avoiding social situations and activities that they previously enjoyed

Depression in Adolescents

According to CDC, physical changes, peer pressure, and other factors can all contribute to depression in teenagers.

They may exhibit the following signs and symptoms:

Withdrawing from friends and family
Difficulty concentrating on schoolwork
Feeling guilty, helpless, or worthless
Restlessness, such as an inability to sit still

Risk factors of Depression

Depression most commonly strikes people in their teens, twenties, and thirties, although it can strike anyone at any age. Women are diagnosed with depression at a higher rate than men, which may be attributable to women being more prone to seek therapy.

The following factors appear to enhance the chance of acquiring or triggering depression:

Personality traits- low self-esteem, being overly reliant, self-critical, or pessimistic.

Traumatic or stressful experiences – physical or sexual abuse, the death or loss of a loved one, a strained relationship, or financial difficulties.

Family members who have struggled with depression, bipolar disorder, alcoholism, or suicide.

In an unsupportive situation, when one is lesbian, gay, bisexual, or transgender or has differences in the development of genital organs that aren’t unmistakably male or female (intersex).

Mental health disorders- anxiety disorder, eating disorders, or post-traumatic stress disorders.

Alcohol or recreational drug abuse

Cancer, stroke, chronic pain, or heart disease are examples of severe or chronic illnesses.

Certain medications, such as antihypertensive drugs and sleeping pills

Complications Resulting from Depression

Depression is a severe illness that can have devastating consequences for you and your family. If depression isn’t treated, it can lead to emotional, behavioural, and physiological issues that influence every aspect of your life.

The following are some examples of depression-related complications:

Obesity, or excess weight, can contribute to heart disease and diabetes.

Physical ailment or pain

Misuse of alcohol or drugs

Anxiety, panic disorder, or social phobia are all examples of anxiety disorders.

Workplace or school issues, as well as family conflicts and relationship issues

Isolation from others

Suicidal thoughts, attempts, or thoughts of suicide

Self-mutilation, such as cutting.

Premature death as a result of medical issues

Prevention of Depression

There is no surefire strategy to keep depression at bay. These tactics, on the other hand, maybe beneficial. They include:

Take actions to manage stress, build resilience, and improve your self-esteem.

To assist you in getting through difficult times, reaching out to family and friends, especially during times of crisis.

To prevent depression from escalating, seek treatment as soon as you see a problem.

To assist prevent a return of symptoms, consider obtaining long-term maintenance treatment.

Medical Management for Depression

Depressive symptoms can be relieved with just medication and brief psychotherapy (cognitive-behavioural therapy, interpersonal therapy). Additionally, combination therapy has been linked to significantly greater rates of depressed symptom improvement, improved quality of life, and better treatment adherence. CBT’s potential to prevent relapse is also supported by research.

Patients who are not responding well to drugs or who are suicidal may benefit from electroconvulsive therapy.

Medications

Selective serotonin reuptake inhibitors (SSRIs). SSRIs have the benefit of being easy to dose and having minimal toxicity in overdose. They are also the first-line treatments for depression that has developed late in life. SSRIs include the following: Citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline, vilazodone, and vortioxetine are the medications used to treat depression.

SNRIs (serotonin/norepinephrine reuptake inhibitors): SNRIs, such as venlafaxine, desvenlafaxine, duloxetine, and levomilnacipran, can be utilized as first-line medicines in patients who have considerable tiredness or pain syndromes associated with a depressive episode. In individuals who have not responded to SSRIs, SNRIs can be used as a second-line treatment.

Antidepressants. Bupropion, mirtazapine, nefazodone, and trazodone are some examples of atypical antidepressants. They’ve all been shown to be successful in treating major depressive disorder when administered alone, and they can also be used in combination therapy for more difficult-to-treat depression.

Tricyclic antidepressants (TCAs)

Electroconvulsive Therapy (ECT)

ECT is an extremely successful depression treatment. The onset of action may be faster than with medication treatments, with benefits frequently visible within a week of starting treatment. Patients who do not react to medication therapy, are psychotic, or are suicidal or harmful to themselves should consider an ECT course (typically up to 12 sessions). As a result, the following are some of the indications for using ECT:

A fast antidepressant reaction is required—drug therapy failure.

Patient inclination

Suicide risk is high.

Medical morbidity and mortality are at high risk.

Psychotherapy

Evidence-based psychotherapies such as Cognitive Behavior Therapy and Interpersonal Therapy have been demonstrated to be beneficial in the treatment of depression.

CBT (cognitive-behavioural therapy)

CBT is a systematic and didactic kind of treatment that focuses on assisting people in identifying and changing harmful thinking and behaviour patterns. It is predicated on the idea that depressed people display the “cognitive triad” of sadness, which involves a negative perception of themselves, the world, and the future. Patients with depression have cognitive distortions that aid in the maintenance of their negative views. CBT for depression usually consists of behavioural methods (such as activity scheduling), as well as cognitive restructuring to shift automatic negative thinking and address maladaptive schemas.

There is evidence that CBT can be used with people of various ages. It is also thought to be effective in the prevention of recurrence. It’s especially useful for senior individuals, who are more likely to have issues or negative effects from drugs.

The goal of mindfulness-based cognitive therapy (MBCT) is to decrease relapse in people who have had successful treatment for recurrent major depressive disorder. Mindfulness training is the main therapeutic component. The MBCT program focuses on ruminative mental processes as a relapse risk factor. MBCT appears to be helpful in reducing the likelihood of relapse in patients with recurrent depression, particularly in those with the most severe remaining symptoms, according to research. Interpersonal counselling (IPT)

Interpersonal Therapy (IT) is a type of psychotherapy (IPT)

Interpersonal therapy (IPT) is a treatment for major depressive illness that is time-limited.IPT is based on attachment theory and emphasizes the importance of interpersonal connections, with a particular focus on contemporary interpersonal issues. Grief, interpersonal conflicts, role shifts, and interpersonal deficiencies are all topics of focus.

Nursing Management for Depression

When caring for a depressed person, the nurse should focus her treatments on correcting the problems revealed by the nursing diagnoses. The patient’s safety is a top focus, which includes reducing the danger of suicide. The following is a list of depressed person interventions:

Keep an eye out for suicidal tendencies.
Remove sharp objects and items that could be used to hurt oneself from the area.
Encourage the patient to do as much for himself as possible. If the patient’s depression is severe, they may require extra guidance with daily activities.
To promote sleep, practice good sleep hygiene.
Establish a therapeutic relationship with the patient.
When communicating with the patient, show empathy.
Reinforce therapeutic elements include addressing negative self-, world-, and future-related ideas.
Encourage the patient to join in on activities.
Make a list of the patient’s favourable features.
Have the patient develop a realistic objective for the day and go through it with them.
Examine and assess the patient’s coping mechanisms and support systems.
Keep an eye on the patient’s eating habits and make sure the patient’s is getting enough nutrients.
Keep an eye on the patient’s drugs to see if they’re working and if they’re having any negative effect.
If the patient so desires include family members in their treatment.

Nursing Diagnosis for Depression

Chronic Low Self-Esteem
Spiritual Distress
Risk for Self-Directed Violence
Impaired Social Interaction

Nursing Care Plans for Depression Based on the Diagnosis

Nursing Care Plan 1: Chronic Low Self-Esteem

It may be related to:

Unbalances in biochemistry and neurology.
Shame and guilt feelings.
Cognitive self-appraisal is impaired.
Failure in the past.
Self-expectations that are unrealistic.

Possibly evidenced by:

Self-assessment: unable to deal with circumstances.
Inability to appreciate one’s own accomplishments.
A negative perception of oneself and one’s talents.
Repeated expressions of insignificance.
Positive feedback is turned down.
Verbalizations that are self-defeating.

Desired Outcomes

The patient will express self-assurance.
The patient’s self-esteem will be preserved.
The patient will show a zest for life and the ability to enjoy the present moment.
By the end of the day, the patient will have identified one or two strengths.
By the end of the day, the patient will have identified two unrealistic self-expectations and will have reformulated more realistic life goals with the nurse.
The patient will identify three judgmental terms that the client uses to describe self (e.g., “I am lazy”) and replace them with objective terms (e.g., “I do not feel motivated to”).
The patient will keep a daily load and rate feelings of guilt, shame, and self-hatred on a scale of 1 to 10 (1 being the lowest, 10 being the highest).
On a scale of 1 to 10, the patient will report decreased feelings of guilt, shame, and self-hatred (1 being the lowest, 10 being the highest).
The patient will show that they can change unrealistic self-expectations.
The patient will describe four positive qualities in a factual and nonjudgmental manner, as well as two areas in which they wish to improve.

Nursing Interventions	Rationale
Nursing Assessment
Assess the self-esteem level of the patient.	Signs of low self-esteem include withdrawal from social relationships, feeling of inadequacy, neglect of personal hygiene and dress, and rejecting self which all may indicate a negative thought pattern.
Therapeutic Interventions
Allow the patient to perform personal care activities.	Paying attention to grooming serves as a first step towards achieving a positive self-image.
Give positive feedback after a task is achieved.	Positive reinforcement plays a big part in building self-esteem.
Allow the patient to engage in simple recreational activities, advancing to more complex activities in a group environment.	The patient may feel overwhelmed at the start when participating in a group setting.
Teach visualization techniques that can help the client replace negative self-images with more positive images and thought.	To promote a healthier and more realistic self-image by helping the client choose more positive thoughts and actions.
Encourage the client to participate in group therapy where the members share the same situations/feelings that they have.	To minimize the feelings of isolation and provide an atmosphere where positive feedback and a more realistic appraisal of self are available.
Evaluate the client’s need for assertiveness training tools to pursue things they want or need in life. Arrange for training through community-based programs, personal counselling, literature etc.	Low self-esteem individuals often have feelings of unworthiness and have difficulty determining their needs and wants.
Role model assertiveness.	Clients can follow examples/role models.
Involve the client in activities that they want to improve by using problem-solving skills. Assess and evaluate the need for more teaching in this area.	Feelings of low self-esteem can interfere with usual problem-solving abilities.
Work with the client to identify cognitive distortions that encourage negative self-appraisal. For example: Discounting positive attributes.Mind reading.Overgeneralizations.Self-blame.	Cognitive distortions reinforce a negative, inaccurate perception of self and the world. Focus on negative qualities.Assuming others “do not like me”. For example, without any real evidence that assumptions are correct.Taking one fact or event and making a general rule out of it. (“He always”, I never”).Consistent self-blame for everything perceived as negative.

Nursing Care Plan 2: Spiritual Distress

It may be related to:
Self- or other-inflicted chronic illness.
Self-death or death of others.
There is a lack of meaning in life.
Life evolves.
Pain.
Self-alienation.
Deprivation on a sociocultural level.

Possibly evidenced by:

Expresses intense feelings of guilt.
Feelings of hopelessness and helplessness are expressed.
Expresses feelings of abandonment or resentment toward God.
Concerned about the meaning of life and death, as well as religious systems.
Lack of hope, meaning, or purpose in life, self-forgiveness, peace, serenity, and acceptance are all expressed.
Lack of ability to pray.
Inability to articulate prior creative states (e.g., writing, drawing, singing).
Unable to take part in religious activities
There is a lack of enthusiasm for art.
The meaning of one’s own existence is questioned.
Refuses to interact with members of his family, friends, or religious authorities.
I’m on the lookout for a spiritual source of power.

Desired Outcomes

The patient will feel a sense of belonging as they share their thoughts, feelings, and beliefs with others.
The patient will experience a sense of inner self-connection.
The patient will take part in spiritual rites and rites of passage.
Within three days, the patient will share with the nurse two items that have given meaning to his or her life in the past.
Within three days, the patient will speak with a nurse or a spiritual leader about spiritual problems and concerns.
For one week, the patient will keep a journal of his or her thoughts and feelings.
The patient will express that he or she feels forgiven.
The patient will express a desire to return to previous creative endeavours.

Nursing Interventions	Rationale
Nursing Assessment
Assess what spiritual practices have offered comfort and meaning to the client’s life when not ill.	Evaluates neglected areas in the person’s life that, if reactivated, might add comfort and meaning during a painful depression.
Therapeutic Interventions
Encourage the client to write a journal expressing thoughts and reflections daily.	This will help in identifying important personal issues and one’s thoughts and feelings surrounding spiritual issues. Writing a journal is a good way to explore deeper meanings in life.
If the client is unable to write, provide a tape recorder.	Often speaking aloud helps a person clarify thinking and explore issues.
Discuss with the client what has given comfort and meaning to the person in the past.	When depressed, clients usually have a hard time searching for meaning in life and reasons to go on when feeling hopeless and despondent.
Suggest that the spiritual leader affiliated with the facility contact the client.	Spiritual leaders are familiar with dealing with spiritual distress and can offer comfort to the client.
Provide information on referrals, when needed, for religious or spiritual information (e.g., readings, programs, tapes, community resources).	When hospitalized, spiritual tapes and readings can be useful; when the client is in the community, the client might express other needs.

Nursing Care Plan 3: Impaired Social Interaction

Possibly evidenced by:

Attempts at violence in the past
Suicidal idea (clear, specific, lethal method and available means).
Suicidal tendencies (attempts, ideation, plan and available means).
Clients may have the energy to carry out a suicidal plot once their despair begins to dissipate.

Desired Outcomes

When a patient has self-destructive tendencies, he or she will seek help.
A behavioural manifestation of absent depression will be present in the patient.
The patient will be content with his or her social situation and the accomplishment of his or her life goals.
Before discharge, the patient will select at least two-three people to whom he or she can turn for support and emotional direction if he or she is feeling self-destructive.
The patient will not do harm to himself or others.
Within one month, the patient will find support and support groups with whom he or she can communicate.
The patient will express his or her desire to live.
The patient will begin making positive plans for the future.
Within the next two weeks, the patient will demonstrate compliance with any drug or treatment plan.
The patient will demonstrate several approaches to dealing with unpleasant emotions and stress.

Nursing Interventions	Rationale
Nursing Assessment
Identify the level of suicide precautions needed. If there is a high risk, does a hospitalization requires? Or, if there is a low risk, will the client be safe to go home with supervision from a family member or a friend? For example, does client: Admit previous suicide attempts. Abuse any substances. Have no peers/friends. Have any suicide plans.	A client with a high risk will require constant supervision and a safe environment.
Check for the availability of the required supply of medications needed.	Normally, a suicidal client’s medical supply should be limited to 3-5 days.
Therapeutic Interventions
Encourage clients to express feelings (anger, sadness, guilt) and come up with alternative ways to handle feelings of anger and frustration.	Clients can learn alternative ways of dealing with overwhelming emotions and gain a sense of control over his/her life.
Contact the family, arrange for crisis counselling. Activate links to self-help groups.	Clients need a network of resources to help diminish personal feelings of helplessness, worthlessness, and isolation.
If hospitalized, follow unit protocols.	There are different measures for the suicidal client in either the hospital, clinic, or community.
Implement a written no-suicide contract.	Reinforces action the client can take when feeling suicidal.

Nursing Care Plan 4: Risk for Self-Directed Violence

It may be related to:

Changes in mental processes.
Anxiety (lack of energy and motivation).
Feelings of inadequacy.
Fear of being rejected.
There is no support system in place.
Disturbance in one’s self-perception.

Possibly evidenced by:

Interactions with family, peers, and/or others that are dysfunctional.
A change in style or interaction patterns has been reported by the family.
In social contexts, expressed dissatisfaction.
Feels alone, avoids touch with people, and doesn’t make eye contact.

Desired Outcomes

The patient will be able to recognize the emotions that lead to bad social interactions.
The patient will interact with his or her family, friends, and peers.
The patient will take part in certain social events in the community (e.g., leisure activity, church member).
By the end of the day, the patient will have completed one activity.
When the patient feels the urge to withdraw, he or she will discuss two to three different options.
Two to three personal behaviours will be identified by the patient that may prevent others from seeking contact.
Within a therapeutic environment, the patient will eventually voluntarily attend individual/group therapeutic meetings (community or hospital).
The patient will express that he or she enjoys connecting with others in activities and one-on-one encounters to the same amount as he or she enjoyed prior to becoming sad.
Within one month, the patient will assert and demonstrate improvement in resuming and maintaining relationships with friends and family members.

Nursing Interventions	Rationale
Initially, provide activities that require minimal concentration (e.g., drawing, playing simple board games).	Depressed people lack concentration and memory. Activities that have no “right or wrong” or “winner or loser” minimize opportunities for the client to put themselves down.
Involve the client in gross motor activities that call for very little concentration (e.g., walking).	Such activities will aid in relieving tensions and might help in elevating the mood.
When the client is in the most depressed state, Involve the client in one-to-one activity.	Maximizes the potential for interactions while minimizing anxiety levels.
Eventually, involve the client in group activities (e.g., group discussions, art therapy, dance therapy).	Socialization minimizes feelings of isolation. Genuine regard for others can increase feelings of self-worth.
Eventually, maximize the client’s contacts with others (first one other, then two others, etc.).	Contact with others distracts the client from self-preoccupation.
Refer the client and family to self-help groups in the community.	The client and the family can gain tremendous support and insight from people sharing their experiences.

Related FAQs

1. What are the 4 main causes of depression?

The four major causes of depression are:

Family history. Though there are no specific genes that we can look at and trace to depression, if your family members have had depression, you are more likely also to experience depression.
Illness and health issues.
Medication, drugs, and alcohol.
Personality.

2. What exactly is depression?

Overview. Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest. Also called major depressive disorder or clinical depression, it affects how you feel, think and behave and can lead to a variety of emotional and physical problems.

3. What are the five main symptoms of depression?

5 characteristics of depression

Low mood/low interest in activities enjoyed previously: Low interest or feeling depressed for more than two weeks is an alarming sign to seek immediate help.
Trouble concentrating
Changes in appetite or sleep
Feeling hopeless/worthless
Thoughts of suicide

4. What is an example of depression?

The death of a loved one, loss of a job or the ending of a relationship are difficult experiences for a person to endure. It is normal for feelings of sadness or grief to develop in response to such situations. Those experiencing loss often might describe themselves as being “depressed.”

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May 3, 2022

Nursing Care Plans for Dehydration – Best Nursing Care Plans(2022)

This article discusses Nursing Care Plans for Dehydration plus its causes, symptoms, preventions, treatments and interventions.

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Disclaimer: The information presented in this article is not medical advice; it is meant to act as a quick guide to nursing students for learning purposes only and should not be applied without an approved physician’s consent. Please consult a registered doctor in case you’re looking for medical advice.

Introduction

Dehydration occurs when a person uses or loses more fluid than they take in, and the body doesn’t have enough water and other fluids to carry out its normal functions. If the fluids lost are not replaced, a person gets dehydrated. Anyone may become dehydrated, but the condition is hazardous for young children and older adults.

The most common cause of dehydration in young children is severe diarrhea and vomiting. Older adults naturally have a lower volume of water in their bodies and may have conditions or take medications that increase the risk of dehydration.

This means that even minor illnesses, such as infections affecting the lungs or bladder, can result in dehydration in older adults.

Dehydration also can occur in any age group if you don’t drink enough water during hot weather — especially if you are exercising vigorously.

You can usually reverse mild to moderate dehydration by drinking more fluids, but severe dehydration needs immediate medical treatment.

Symptoms of Dehydration

Thirst isn’t always a reliable early indicator of the body’s water needs. Many people, particularly older adults, don’t feel thirsty until they’re dehydrated. That’s why it’s essential to increase water intake during hot weather or when you’re ill.

The signs and symptoms of dehydration also may differ by age.

Infant or young child

Dry mouth and tongue
No tears when crying
No wet diapers for three hours
Sunken eyes, cheeks
Sunken soft spot on top of the skull
Listlessness or irritability

Adult

Extreme thirst
Less frequent urination
Dark-colored urine
Fatigue
Dizziness
Confusion

Causes of Dehydration

Sometimes dehydration occurs for simple reasons: You don’t drink enough because you’re sick or busy or lack access to safe drinking water when traveling, hiking, or camping.

Other dehydration causes include:

Diarrhea, vomiting. Severe, acute diarrhea — that is, diarrhea that comes on suddenly and violently — can cause a tremendous loss of water and electrolytes in a short amount of time. If you have vomiting and diarrhea, you lose even more fluids and minerals.

Fever. In general, the higher your fever, the more dehydrated you may become. The problem worsens if you have a fever in addition to diarrhea and vomiting.

Excessive sweating. You lose water when you sweat. If you do vigorous activity and don’t replace fluids as you go along, you can become dehydrated. Hot, humid weather increases the amount you sweat and the amount of fluid you lose.

Increased urination. This may be due to undiagnosed or uncontrolled diabetes. Certain medications, such as diuretics and some blood pressure medications, also can lead to dehydration, generally because they cause you to urinate more.

Risk Factors of Dehydration

Anyone can become dehydrated, but certain people are at greater risk:

Infants and children. The most likely group to experience severe diarrhea and vomiting, infants and children are especially vulnerable to dehydration. Having a higher surface area to volume area, they also lose a higher proportion of their fluids from a high fever or burns. Young children often can’t tell you that they’re thirsty, nor can they get a drink for themselves.

Older adults. As you age, your body’s fluid reserve becomes smaller, your ability to conserve water is reduced, and your thirst sense becomes less acute. These problems are compounded by chronic illnesses such as diabetes and dementia and by the use of certain medications. Older adults also may have mobility problems that limit their ability to obtain water for themselves.

People with chronic illnesses. Having uncontrolled or untreated diabetes puts you at high risk of dehydration. Kidney disease also increases your risk, as do medications that increase urination. Even having a cold or sore throat makes you more susceptible to dehydration because you’re less likely to feel like eating or drinking when you’re sick.

People who work or exercise outside. When it’s hot and humid, your risk of dehydration and heat illness increases. When the air is humid, sweat can’t evaporate and cool you as quickly as it normally does, leading to increased body temperature and the need for more fluids.

Complications of Dehydration

Dehydration can lead to severe complications, including:

Heat injury. Suppose you don’t drink enough fluids when you’re exercising vigorously and sweating heavily. In that case, you may end up with a heat injury, ranging in severity from mild heat cramps to heat exhaustion or potentially life-threatening heatstroke.

Urinary and kidney problems. Prolonged or repeated bouts of dehydration can cause urinary tract infections, kidney stones, and even kidney failure.

Seizures. Electrolytes — such as potassium and sodium — help carry electrical signals from cell to cell. If your electrolytes are out of balance, the normal electrical messages can become mixed up, leading to involuntary muscle contractions and sometimes to a loss of consciousness.

Low blood volume shock (hypovolemic shock). This is one of the most serious and sometimes life-threatening complications of dehydration. It occurs when low blood volume causes a drop in blood pressure and a drop in the amount of oxygen in your body.

Prevention of Dehydration

To prevent dehydration, drink plenty of fluids and eat foods high in water, such as fruits and vegetables. Letting thirst be your guide is an adequate daily guideline for most healthy people.

People may need to take in more fluids if they are experiencing conditions such as:

Vomiting or diarrhea. If your child is vomiting or has diarrhea, start giving extra water or an oral rehydration solution at the first signs of illness. Don’t wait until dehydration occurs.

Strenuous exercise. In general, it’s best to start hydrating the day before strenuous exercise. Producing lots of clear, dilute urine is a good indication that you’re well-hydrated. During the activity, replenish fluids at regular intervals and continue drinking water or other fluids after you’re finished.

Hot or cold weather. You need to drink additional water in hot or humid weather to help lower your body temperature and to replace what you lose through sweating. In cold weather, you may also need extra water to combat moisture loss from dry air, particularly at higher altitudes.

Illness. Older adults most commonly become dehydrated during minor illnesses — such as influenza, bronchitis, or bladder infections. Make sure to drink extra fluids when you’re not feeling well.

Diagnosis of Dehydration

The diagnosis of dehydration is often reliant on the presence of the signs and symptoms and physical examination results. Other procedures such as blood tests and urine tests can also be performed to confirm the diagnosis.

Physical Examination

This will include the assessment of the presence of signs and symptoms and basic vitals signs measurement. Having low blood pressure is highly associated with dehydration, and it is taken after standing up from a lying or sitting position. Also, a higher than normal heart rate may be noted in dehydration, part of the body’s compensatory mechanism.

Blood tests

Electrolyte levels and kidney functions test may be performed to confirm the diagnosis. Higher electrolytes level may be expected as they may be diluted due to low blood volume secondary to dehydration.

Urinalysis

A simple urine test may help check for the presence of dehydration. It is also a helpful way to check for infections that are likely in dehydrated individuals.

Treatment for Dehydration

Dehydration can easily be corrected through the replacement of the lost fluid. However, several factors need to be taken into account, such as the severity of dehydration, the age of the patient, and the cause of the fluid loss. The treatment may also be slightly different for children and adults.

In Infants:

Seeking the help of a healthcare provider is strongly recommended when dehydration is suspected in an infant. If the dehydration is due to diarrhea, increasing the frequency of feeding and giving extra fluids are recommended. However, it is discouraged to give fruit juices as it may make diarrhea worse.

Hospitalization may be necessary in cases of moderate to severe dehydration.

In Children:

It is recommended that dehydrated children be given fluids with electrolytes because pure water can dilute the little electrolytes left in their system.

Offer fluids more frequently.

Hospital management may be necessary in severe cases of dehydration. Treatment may include intravenous fluid infusion.

In Adults:

Most adults can reverse dehydration through increasing oral fluid intake.

Working in cooler places can help reduce water loss.

Sports drinks containing electrolytes and carbohydrates are often helpful.

Hospital management of dehydration may be required in severe cases or if the individual is not responding to earlier treatments.

Nursing Care Plans for Dehydration Based on Diagnosis

Nursing Care Plan 1: Diagnosis – Fluid Volume Deficit

Related to blood volume loss secondary to gastrointestinal bleeding as evidenced by hematemesis, HB of 70, skin pallor, the blood pressure level of 85/58, and lightheadedness

Desired Outcome

The patient will have an absence of GI bleeding, hemoglobin (HB) level of over 100, blood pressure level within normal range, full level of consciousness, and normal skin color.

Interventions	Rationales
Assess vital signs, particularly blood pressure level.	Hypovolemia due to GI bleeding may lower blood pressure levels and put the patient at risk for hypotensive episodes that lead to shock.
Commence a fluid balance chart, monitoring the input and output of the patient. Include episodes of vomiting, gastric suctioning, and other gastric losses in the I/O charting.	To monitor the patient’s fluid volume accurately.
Start intravenous therapy as prescribed. Electrolytes may need to be replaced intravenously. Encourage oral fluid intake of at least 2000 mL per day if not contraindicated.	To replenish the fluids and electrolytes lost from vomiting or other gastric losses and to promote better blood circulation around the body.
Educate the patient (or guardian) on how to fill out a fluid balance chart at the bedside.	To help the patient or the guardian take ownership of the patient’s care, encourage them to drink more fluids as needed, or report any changes to the nursing team.
Administer blood transfusion as prescribed.	To increase the hemoglobin level and treat anemia, dehydration, and hypovolemia related to GI bleeding.

Nursing Care Plan 2: Diagnosis – Risk for Fluid Volume Deficit

Due to osmotic diuresis secondary to diabetes.

Desired Outcome

The patient will demonstrate adequate hydration and balanced fluid volume

Interventions	Rationales
Assess vital signs and signs of dehydration.	Hyperglycemia may cause Kussmaul’s respirations and/or acetone breath. Hypotension and tachycardia may result from hypovolemia or low levels of intravascular volume.
Commence a fluid balance chart, monitoring the input and output of the patient.	To monitor patient’s fluid volume accurately and effectiveness of actions to monitor signs of dehydration.
Start intravenous therapy as prescribed. Encourage oral fluid intake of at least 2500 mL per day if not contraindicated.	To replenish the fluids lost from polyuria and to promote better blood circulation around the body.
Educate the patient (or guardian) on how to fill out a fluid balance chart at the bedside.	To help the patient or the guardian take ownership of the patient’s care, encourage them to drink more fluids as needed, or report any changes to the nursing team.
Monitor patient’s serum electrolytes and recommend electrolyte replacement therapy (oral or IV) to the physician as needed.	Sodium is one of the important electrolytes that are lost when a person passes urine. Hyponatremia or low serum sodium level may cause brain swelling.
Encourage proper oral hygiene.	Dehydration may cause dryness of the oral mucosa. Proper mouth care can also encourage the patient to have more interest in drinking fluids.

Nursing Care Plan 3: Diagnosis – Fluid Volume Deficit

Related to dehydration due to fever as evidenced by the temperature of 39.0 degrees Celsius, skin turgidity, dark yellow urine output, profuse sweating, and blood pressure of 89/58.

Desired Outcome

Within 48 hours of nursing interventions, the patient will have a stabilized temperature within the normal range and will verbalize feeling more comfortable.

Interventions	Rationales
Commence a fluid balance chart, monitoring the input and output of the patient.	To monitor patient’s fluid volume accurately and effectiveness of actions to reverse dehydration.
Start intravenous therapy as prescribed. Encourage oral fluid intake.	To replenish the fluids lost from profuse sweating and to promote better blood circulation around the body.
Educate the patient (or guardian) on how to fill out a fluid balance chart at the bedside.	To help the patient or the guardian take ownership of the patient’s care, encourage them to drink more fluids as needed, or report any changes to the nursing team.
Monitor patient’s serum electrolytes and recommend electrolyte replacement therapy (oral or IV) to the physician as needed.	Sodium is one of the important electrolytes that are lost when a person is sweating. Hyponatremia or low serum sodium level may cause brain swelling.
Remove excessive clothing, blankets, and linens. Adjust the room temperature.	To regulate the environment’s temperature and make it more comfortable for the patient.
Administer the prescribed antibiotic and anti-pyretic medications.	Use the antibiotic to treat bacterial infection if present, which is the underlying cause of the patient’s hyperthermia. Antibiotics are not required if the infection is viral. Use the fever-reducing medication to stimulate the hypothalamus and normalize the body temperature.
Offer a tepid sponge bath.	To facilitate the body in cooling down and to provide comfort.
Elevate the head of the bed.	Head elevation helps improve the expansion of the lungs, enabling the patient to breathe more effectively.

Related FAQs

1. What is the goal for dehydration?

The goal in treating dehydration is to replace fluids and restore body fluids to normal levels. If you’re mildly dehydrated from lots of activity, you’ll be thirsty and should drink as much as you want.

2. How do you treat dehydration in the elderly?

Mild dehydration can usually be treated by having the person take more fluids by mouth. Generally, it’s best to have the person drink something with some electrolytes, such as a commercial rehydration solution, a sports drink, juice, or even bouillon. But in most cases, even drinking water or tea will help.

3. How do you assess a child for dehydration?

Pinch test (skin turgor): the sign is unreliable in obese or severely malnourished children. Normal: skin fold retracts immediately. Mild or moderate dehydration: slow; skin fold visible for less than 2 seconds. Severe dehydration: very slow; skin fold visible for longer than 2 seconds.

4. What are the 10 signs of dehydration?

10 Signs of Dehydration To Watch Out For

Extreme thirst.
Urinating less than usual.
Headache.
Dark-colored urine.
Sluggishness and fatigue.
Bad breath.
Dry mouth.
Sugar cravings.

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May 1, 2022

Nursing Care Plan for COPD – Best Nursing Care Plans(2022)

This article discusses Nursing Care Plan for COPD plus its causes, symptoms, preventions, treatments and interventions.

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Disclaimer: The information presented in this article is not medical advice; it is meant to act as a quick guide to nursing students for learning purposes only and should not be applied without an approved physician’s consent. Please consult a registered doctor in case you’re looking for medical advice.

Introduction

Chronic obstructive pulmonary disease classifies a group of respiratory disorders characterized by chronic and recurrent airways obstruction. COPD is a combination of the three separate diseases; mainly emphysema and bronchitis; however, to a lesser extent, asthma, which come together to create the typical pathophysiological disease process.

Pathophysiology of COPD

The mechanisms involved in COPD development include the inflammation and fibrosis of the bronchial wall, hypertrophy of the submucosal glands, hypersecretion of mucus, destruction of alveoli, and loss of elasticity in the lungs. Inflammation, fibrosis and excess mucus cause obstruction of the airflow and cause a reverse in ventilation and perfusion. Destruction of the alveoli decreases the surface area in the lungs that are available for gas exchange, and loss of elasticity leads to airway collapse. Due to the lack of elasticity, they prevent the lungs from stretching during inspiration, and they cause the retaining of air during expiration, ultimately increasing the risks for airway collapse.

The thickening of airways walls characterizes the progression of COPD. The walls of the airways become infiltrated by various immune and inflammatory cells (phagocytes, CD4 T cells), and with each progression to each further state, more of these cells are noted.

Diseases Related to COPD/ Types of COPD

EMPHYSEMA

• It is characterized by airflow obstruction from changes in the lung tissue

• The walls between the alveoli lose elasticity and break, and the air becomes trapped in the enlarged spaces.

• This impairs gas exchange

• Physical Appearance— Cachectic appearance, weight loss tachypnea, use of accessory muscles, pink skin colour

• Complaints— Persistent SOB, progressive exertional dyspnea

• Progressive deterioration in lung function with disease progression

CHRONIC BRONCHITIS

• Acute Bronchitis is an inflammation of the bronchial tree caused by an infectious organism or irritating agents such as smoke, dust, pollen, or chemical irritants

• Chronic Bronchitis is characterized by repeated attacks of acute bronchitis lasting for at least three months over two years.

• Physical Appearance— Stocky build with no hx of weight loss; use of accessory muscles to breathe in late stages cyanotic; barrel chest

• Complaints— Persistent cough, copious sputum

• Variable with exacerbation related to infection

• Frequent episodes of Cor Pulmonale with dependent edema, elevated hematocrit

Cor pulmonale

• Is a failure of the right side of the heart caused by prolonged high blood pressure in the pulmonary artery and the heart’s right ventricle.

Symptoms/Signs

• Shortness of breath

• Symptoms of underlying disorders (wheezing, coughing, swelling of feet and ankles)

• Exercise intolerance

• Chest discomfort

• Bluish colour to the skin (cyanosis)

• Distension of the neck veins indicating high right-sided heart pressure

• Abnormal fluid collection in the abdomen enlargement of the liver

• Abnormal heart sounds

ASTHMA

• Chronic inflammatory disorder of the airways

• Symptoms include: SOB, chest tightness, wheezing and coughing

• Airflow limitation in asthma is reversible

• Acute asthma episodes can be mild to life-threatening

• Triggers include: irritants, allergens, and viral infections

• Triggers may change over time

Risk factors of COPD

History of smoking or exposure to second-hand smoke
Age – symptoms are typically noticed later in the disease process
Gender is almost the same now in men and women. However, it was more common in men but is now seen more commonly in women.
Pre-existing lung problems (infection, asthma)
Exposure to Occupational hazards (dust, chemicals)
Exposure Indoor and outdoor pollution
Alpha 1-antitrypsin deficiency (genetic predisposition) or AAT is a protein that protects the lungs. This protein is produced in the liver. With deficient levels of this protein, a patient may exhibit the following symptoms:
Shortness of breath and wheezing
Repeated lung infections
Tiredness
Rapid heartbeat upon standing
Vision problems
Weight loss

However, it is essential to note that individuals may exhibit no symptoms at all.

Diagnosis of COPD

family and patient history
chest x-Ray
laboratory studies
respiratory function tests

Signs and Symptoms of COPD

Three primary symptoms – cough sputum, dyspnea, which will worsen with disease progression
Weight loss is common
Prolonged expiratory rate
Dyspnea at rest is expected as the disease progresses
Barrel shape chest
Pursed lip breathing
Clubbing of digits
Pitting peripheral edema

Treatment Options for COPD

Treatment of COPD depends on the stage of the disease.

Education of the disease, its process and various triggers are crucial to managing this disease.
Smoking cessation is the only measure that will slow the disease progression. Thus nicotine replacement via patch, gum or inhalers may be used to reduce the withdrawal symptoms.
In more advanced stages of COPD, patients will often require pharmacological treatments, activities to maintain and improve physical and psychological functioning, and oxygen therapy.

Medications:

Medications for the treatment of COPD include beta-2- adrenoceptor, anticholinergics, oxygen therapy, methylxanthines, and corticosteroids.

Beta-2-adrenoceptor agonists are the first-line therapy for COPD in acute exacerbations. These medications work on the beta 1 receptors, which are located in the heart and beta 2 receptors, which are located in the smooth muscle of the lungs, uterus and other organs. Medications that activate both receptors are called nonselective bronchodilators. Beta-agonists that activate only beta 2 receptors are selective. Selective drugs are common and better in treatment because they produce fewer cardiac side effects. These medications are given as a bronchodilator and are used on an as-needed basis to prevent or reduce obstruction related symptoms. Short and long-acting medications exist. Short-acting drugs have a rapid onset of action and are most frequently prescribed for exacerbations in a disease process, thus known as rescue agents. Long-acting medications have a slower onset of action, and these medications are used in combination with corticosteroids for prevention and disease management.

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Examples of these medications include: Ventolin (albuterol), Brovan (artormoterol), foradil (formoterol), xopenex (levalbuterol), maxair (pirbuterol), salmeterol (serevent), and terbutaline (brethine)

Adverse effects of these medications include headache, dizziness, tremor, nervousness, throat irritation and drug tolerance.

Serious adverse effects: tachycardia, dysrhythmias, hypokalemia, hyperglycemia, paradoxical bronchoconstriction

Anticholinergics are essential in the management of COPD exacerbation. While they are not first-line, they too are bronchodilators. These medications help to reduce airway tone and improve expiratory flow by blocking parasympathetic activity in the large and medium-sized airways. Because the parasympathetic is blocked, it stimulates the sympathetic nervous system. Anticholinergics also block the release of acetylcholine- which is known for its increase in bronchial smooth muscle tone and mucus secretion. Short and long-acting medications exist in this category.

Medications in this category include: ipratropium (Atrovent, Combivent), tiotropium (Spiriva); Atrovent is the most common anticholinergic medication prescribed for the treatment of COPD.

Adverse effects: headache, cough, dry mouth, bad taste, GI distress, anxiety

Serious adverse effects: pharyngitis

Corticosteroids are effective in increasing recovery from an acute COPD exacerbation.

These medications help reduce the swelling in the airways associated with COPD and its disease progress. This is established through the lessened activation of inflammatory cells and an increase in the production of anti-inflammatory mediators. Ultimately this allows for a decrease in mucus, edema and airway obstruction. These medications also increase the sensitivity of the bronchial smooth muscle to beta-agonist medications.

Medications include: beclomethasone (beconase AQ), budesonide (pulmicort), ciclesonide (alvesco), flunisolide (aerobid), fluticasone (flovent), mometasone (asmanex), triamcinolone (azmacort)

Adverse effects: hoarseness, dry mouth, cough, sore throat

Serious Adverse effects: oropharyngeal candidiasis, hypercorticism, hypersensitivity reactions

Mast cell stabilizers act by inhibiting the release of histamine from mast cells. These medications aid in reducing inflammation, and their primary use is in patients with asthma. These medications should be taken daily.

Medications in this category include: cromolyn (Intal), nedocromil sodium (tilade)

Adverse effects: nausea, sneezing, nasal stinging, throat irritation, unpleasant taste

Severe adverse effects: anaphylaxis, angioedema, bronchospasm

Leukotriene modifiers are used to reduce inflammation and bronchoconstriction. Leukotrienes are mediators of the immune response involved in allergic and asthmatic reactions. When leukotrienes are released, they promote edema, inflammation, and bronchoconstriction.

Medications: montelukast (Singulair), zafirlukast (accolade), zileuton (zyflo)

Adverse reactions: headache, nausea, diarrhea

Severe adverse reactions: liver toxicity, increased AST.

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Diagnostic Tests for COPD

Chest X-Ray

This is an important test to perform for a complete evaluation of the cardiac and pulmonary system and would be indicated to rule out lung anomalies. Much information can be found in chest x-ray studies, including:

1. Tumors of the lung, heart, chest wall and bony thorax.

2. Inflammation of the lung, pleura and pericardium.

3. Fluid accumulations in the pleura, pericardium and lung.

4. Air accumulations in the lung and pleura.

5. Fractures of the bones of the thorax or vertebrae.

6. Diaphragmatic hernia.

7. Heart size

8. Calcification

9. Location of centrally placed intravenous access devices

Typical findings include normal lungs, heart and surrounding structures.

Due to chronic bronchitis, patients exhibit increased bronchovascular markings and cardiomegaly in patients with COPD. Emphysema on x-ray is associated with a small heart, hyperinflation, flat hemi-diaphragms and possible bullous lung changes.

Bronchoscopy

The larynx, trachea, and bronchi are seen in a bronchoscopy through a fibreoptic bronchoscope. This test can assess inflammation in the lungs and thus contribute to bronchitis diagnosis. Also, infections can be detected by collecting specimens and their culture of them in a lab.

Typical findings for this test include a normal larynx, trachea, bronchi and alveoli.

Lung Scan

Lung scans help determine the blood perfusion of the lungs. It is most helpful in determining the presence of a pulmonary embolism but can be used to diagnose COPD. To evaluate blood flow in the lungs, macro aggregated albumin tagged with technetium is placed into the patient through a vein. Photos are taken which an image of the lung is obtained. Defects in the otherwise smooth and diffusely homogenous pattern indicate a perfusion abnormality. Normal findings include a normal diffusion and uptake of the nuclear material by the lungs, or no defects are noted.

Computed Tomography (Chest)

CT of the chest is a noninvasive, radiographic procedure for diagnosing and evaluating various conditions. In patients with COPD, increased lung space is a normal CT finding.

A normal finding in patients without disease is the lack of illness.

Electrocardiography

An ECG is a test that records the electrical impulses of the heart. Normal findings include a normal heart rate, rhythm and wave deflections. In patients with respiratory compromise (dependent on the disease), right-sided heart strain is noted and is associated with cor pulmonale. Specifically, this will present on the ECG with an S wave in the lead 1, a Q wave in lead III, and a T wave inversion in the lead III. A patient with COPD may or may not present with cardiac issues.

Oximetry

A healthy individual is expected to maintain oxygen levels above 95%. In a patient with COPD, oxygen should be maintained between 88-92%. Patients with COPD have poor ventilation and perfusion and thus retain O2 and CO2. Because of this poor ability to perfuse O2 and CO2, if patients are given too much oxygen, they will become acidotic.

Oximetry monitors arterial oxygen saturation in levels at risk for hypoxemia.

Oximetry assists to maintain proper oxygenation saturation through the titration of O2.

Due to the obstructive and inflammatory process associated with COPD, I would expect a patients oxygen levels to be below.

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Laboratory Studies

Creatine Kinase:

Male: 55-170

Female: 30-135

RBC:

Male: 4.7-6.1 x 10

Female: 4.2-5.4 x 10

HgB: 120-16 0 g/L

Hct: (0.37-0.47 %)

WBC: 5-10 x 10 (9)/L

Ferritin: 10-150 mcg/L

Iron: 11-29

Platelets: 150-400 x 10 (9)/ L

If COPD is a result of infection, elevated WBC would be noted.

Blood Gases:

Arterial blood gases:
PH: 7.35-7.45
Pco2: 35-45
HCO3 (bicarbonate): 21-28
Po2: 80-100
O2 saturation: 95-100%
Oxygen content: 15-22 volume percent
Base excess/deficit: 0-/+2

Venous blood gases:

PH: 7.35-7.45
Pco2: 40-50
HCO3 (bicarbonate): 21-28
Po2: 40-50
O2 saturation: 95-100%
Oxygen content: 11-16 volume percent

Respiratory acidosis is evidenced by a decrease in pH (usually less than 7.25), an increase in PCO2 (>60mmHg), and a normal bicarb. Respiratory acidosis is related to pulmonary disease, including COPD. Acidosis is more prevalent in patients with COPD because of their tendency to retain CO2. Respiratory alkalosis is evidenced by an increase in pH (>7.55), a decrease in PCO2 (<20mmHg), a normal bicarb. This disease is related to hyperventilation.

Electrolytes:

Potassium: 3.5-5.0 (critical value if <2.5 or >6.5mmol/L)
Chloride: 98-106 (critical if value <80 or > 115mmol/L)
Sodium: 136-145 (critical value < 120 or if >160mmol/L)

Oftentimes, patients who are in later stages of COPD, anorexia and weight loss are common due to the difficulties associated with completing ADLs. Malnourishment may be prevalent.

BUN: 3.6-7.1 mmol/L

I would expect elevated levels of Blood Urea Nitrogen (BUN) as a result of dehydration.

Glucose Testing: 4-6

Nursing Diagnoses For Patients with COPD:

Ineffective airway clearance
Impaired gas exchange
Activity intolerance

Nursing Care Plan for COPD Based on Diagnosis

Ineffective Airway Clearance

Ineffective airway clearance secondary to a diagnosis of COPD as evidenced by (include assessment findings related to the identified nursing problem such as, but not limited to: airway spasms due to an allergic reaction, presence of secretions on the airway, increased production of thick sputum, hyperplasia of the bronchial walls) as evidenced by (include assessment findings related to the identified nursing problem such as, but not limited to:

Patient complaints of difficulty in respiration
Complaints about not being able to effectively expectorate sputum
Presence of adventitious breath sounds (rales, crackles, or wheezing)
Changes in breathing patterns
In the worst-case scenario: alterations in one’s level of consciousness
Irritability and agitation

Desired Outcomes

The patient is expected to demonstrate the following nursing interventions:

The patency of the airways is improved.
Demonstrate measures to help clear airways

Nursing Action	Rationale
Monitor the patient’s vital signs, especially noting for respiratory function parameters such as depth, rhythm, and rate.	This creates baseline information for patient condition and helps plan for adequate care.
Auscultate lung fields, noting the presence of wheezes, crackles, or other adventitious sounds.	The adventitious breath sounds indicate accumulation of sputum, narrowing of the airways, and other complications that may necessitate immediate action.
Monitor the severity of complaints of dyspnea, identifying whether the patient uses accessory muscles to help in respiration and what factors cause dyspnea.	Patients with asthma may experience dyspnea when triggered by a specific stimulus. Knowing how severe episodes of dyspnea are and what causes them helps the murse in planning better care.
Administer oxygen therapy if needed. Note: This is usually done for patients with moderate to severe airway clearance problems. Always check with the physician’s orders for the flow rate and equipment to use.	Providing humidified oxygen helps relieve the patient from the strain of having to catch his breath to take in more are, improves oxygenation and gas exchange, and helps reduce dryness of the lung fields.
Place the patient in a semi-sitting position if he is conscious. Some patients may feel more comfortable leaning on a table to ease the difficulty of breathing. Provide a pillow for comfort.	Placing the patient in a semi-sitting position helps to allow maximal expansion of the lungs and the diaphragm, improving air intake and gas exchange.
Encourage pursed-lip breathing, focusing on doubling the time for the patient to exhale as compared to inhalation.	Pursed lip breathing helps the patient regulate gas exchange and improve overall tissue perfusion.
Ensure that the environment is free from dust, pollen, and other allergens which may trigger bronchospasm.	These substances trigger an allergic response in some patients and may further exacerbate the current symptoms.
Increase fluid intake to 3 litres daily if not contraindicated. Ensure that these liquids are provided tepid or at room temperature and given in between meals.	Warm, room temperature or tepid liquids prevent further bronchospasm from occurring, allowing improved airway clearance. Providing fluids in between meals also helps reduce aspiration and relieves pressure on the diaphragm.
Encourage the patient to turn in bed once every 2 hours or to ambulate several times daily.	Movement aids in mobilizing secretions, helping the patient expectorate them or eliminate them via the GI tract.
Involve significant others in instructing patients about how to perform chest physiotherapy and postural drainage. Ask them to demonstrate the steps after the health education.	Chest physiotherapy helps loosen secretions, allowing them to be expectorated easier. Demonstrating the proper way to the patient and his significant others and asking them to return-demonstrate ensures that they understand the instructions well.
Perform suctioning when necessary.	This procedure is done among patients who have thick sputum that is difficult to expectorate in other ways. Suctioning helps clear the airway of these secretions and improves airway patency.

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Impaired Gas Exchange

Impaired gas exchange due to a shift in oxygen flow to the airway as a result of COPD-associated air sac inflammation as demonstrated by (including evaluation findings relating to impaired gas exchange such as, but not limited to:

Breathing problems

Irritability and restlessness

Inhalation requires the use of auxiliary muscles.

Breathing that is quick and shallow

Cyanosis of the circum-oral cavity

Oxygen saturation levels lower than 85%

Respiratory acidosis is revealed by ABG measurements.

Desired Outcomes

Following nursing interventions, the patient should be able to:

Show that you’ve improved your gas exchange.
A substantial increase in ABGs and oxygen saturation

Nursing Action	Rationale
Monitor the patient’s vital signs, especially noting respiratory function parameters such as depth, rhythm, and rate.	This creates baseline information for patient condition and helps plan for adequate care.
Auscultate lung fields, noting the presence of wheezes, crackles, or other adventitious sounds.	The adventitious breath sounds indicate accumulation of sputum, narrowing of the airways, and other complications that may necessitate immediate action.
Note for any skin colour changes and the mucus membranes’ status, paying close attention to cyanosis.	Cyanosis of the nailbeds, the skin, or ear lobes may be due to hypoxemia and needs immediate attention.
Encourage the patient to perform deep breathing and coughing to expectorate sputum. Note: For patients who are bedridden or cannot expectorate sputum independently, suctioning may be recommended.	This action helps establish independence on the part of the patient and helps maintain his optimal functioning. Patients who feel that they are being considered as an essential part of their care are more likely to cooperate with interventions directed to them.
Administer oxygen therapy as prescribed.	Providing humidified oxygen helps relieve the patient from the strain of having to catch his breath to take in more are, improves oxygenation and gas exchange, and helps reduce dryness of the lung fields.
Place the patient in a semi-sitting position if they are conscious. For unconscious or weak patients, elevate the head of the bed and place support to prevent falling.	Placing the patient in a semi-sitting position helps to allow maximal expansion of the lungs and the diaphragm, improving air intake and gas exchange.
Encourage pursed-lip breathing, focusing on doubling the time for the patient to exhale as compared to inhalation.	Pursed lip breathing helps the patient regulate gas exchange and improve overall tissue perfusion.
Arrange for collaborative care, especially after discharge. Refer the patient to a physiotherapist.	Arranging for a physiotherapist helps ensure continuity of care and maintenance of the patient’s optimal level of functioning.
Provide diversionary activities to help manage pain, such as guided imagery, use of music, meditation.	Allows the patient to focus his attention other than the pain. These activities may also help enhance his mood and response to other measures.
Nursing Action	Rationale
Assess the patient’s activity tolerance prior to diagnosis, noting his perceived limitation due to the diagnosis.	This creates baseline information for patient condition and helps plan for effective care.
Encourage the patient to perform self-care tasks within the level of tolerance, pausing when breathlessness sets in.	This helps maintain independent self-care and makes the patient feel in control of his situation.
Add progressive activities and exercises in the patient’s care plan, gradually increasing activity levels within tolerance.	Prepares the patient for more complicated tasks but prevents fatigue and tiredness because activity resistance gradually increases.
Alternate periods of activity and rest.	Decreases oxygen demands of the patient, allow him to rest, regain strength and prepare to take on additional activities.
Administer oxygen therapy as prescribed.	Providing humidified oxygen helps relieve the patient from the strain of having to catch his breath to take in more are, improves oxygenation and gas exchange, and helps reduce dryness of the lung fields.
Arrange for collaborative care, especially after discharge. Refer the patient to a physiotherapist.	Arranging for a physiotherapist helps ensure continuity of care and maintenance of the patient’s optimal level of functioning.
Provide diversionary activities to help manage pain, such as guided imagery, use of music, meditation.	Allows the patient to focus his attention other than the pain. These activities may also help enhance his mood and response to other measures.

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Activity Intolerance

Activity intolerance is related to an imbalance between oxygen supply and oxygen demands of the tissues, as evidenced by

Asthma
Tiredness
Complaints of weakness
Fatigue
An explicit expression of a profound lack of energy

Desired Outcomes

The patient should display the following nursing interventions:

Tolerance for more activities
He takes an active role in carrying out his everyday activities.

Nursing Action	Rationale
Assess the patient’s activity tolerance prior to diagnosis, noting his perceived limitation due to the diagnosis.	This creates baseline information for patient condition and helps plan for effective care.
Encourage the patient to perform self-care tasks within the level of tolerance, pausing when breathlessness sets in.	This helps maintain independent self-care and makes the patient feel in control of his situation.
Add progressive activities and exercises in the patient’s care plan, gradually increasing activity levels within tolerance.	Prepares the patient for more complicated tasks but prevents fatigue and tiredness because activity resistance gradually increases.
Alternate periods of activity and rest.	Decreases oxygen demands of the patient, allow him to rest, regain strength and prepare to take on additional activities.
Administer oxygen therapy as prescribed.	Providing humidified oxygen helps relieve the patient from the strain of having to catch his breath to take in more are, improves oxygenation and gas exchange, and helps reduce dryness of the lung fields.
Arrange for collaborative care, especially after discharge. Refer the patient to a physiotherapist.	Arranging for a physiotherapist helps ensure continuity of care and maintenance of the patient’s optimal level of functioning.
Provide diversionary activities to help manage pain, such as guided imagery, use of music, meditation.	Allows the patient to focus his attention other than the pain. These activities may also help enhance his mood and response to other measures.

Related FAQs

1. What is a good nursing diagnosis for COPD?

Here are seven (7) nursing care plans (NCP) and nursing diagnosis (NDx) for Chronic Obstructive Pulmonary Disease (COPD): Ineffective Airway Clearance. Impaired Gas Exchange. Ineffective Breathing Pattern.

2. What is the main cause of COPD?

Smoking. About 85 to 90 percent of all COPD cases are caused by cigarette smoking. When a cigarette burns, it creates more than 7,000 chemicals, many of which are harmful.

3. What are the 5 symptoms of COPD?

What Are COPD Symptoms?

Chronic cough.
Shortness of breath while doing everyday activities (dyspnea)
Frequent respiratory infections.
Blueness of the lips or fingernail beds (cyanosis)
Fatigue.
Producing a lot of mucus (also called phlegm or sputum)
Wheezing.

4. What are the three stages of COPD?

There are four distinct stages of COPD: mild, moderate, severe, and very severe. Your physician will determine your stage based on results from a breathing test called a spirometry, which assesses lung function by measuring how much air you can breathe in and out and how quickly and easily you can exhale.

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May 1, 2022

Nursing Care Plans for Colon Cancer – Best Nursing Care Plans (2022)

This article discusses Nursing Care Plans for Colon Cancer plus its causes, symptoms, preventions, treatments, and interventions.

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Disclaimer: The information presented in this article is not medical advice; it is meant to act as a quick guide to nursing students for learning purposes only and should not be applied without an approved physician’s consent. Please consult a registered doctor in case you’re looking for medical advice.

Introduction

Colon cancer is a type of cancer that begins in the large intestine (colon). Colon cancer typically affects older adults, though it can happen at any age. It usually begins as small, noncancerous (benign) clumps of cells called polyps that form on the inside of the colon. Over time some of these polyps can become colon cancers.

Polyps may be small and produce few if any, symptoms. For this reason, doctors recommend regular screening tests to help prevent colon cancer by identifying and removing polyps before they turn into cancer.

If colon cancer develops, many treatments are available to help control it, including surgery, radiation therapy, and drug treatments, such as chemotherapy, targeted therapy, and immunotherapy.

Colon cancer is sometimes called colorectal cancer, which is a term that combines colon cancer and rectal cancer, which begins in the rectum.

Nursing Care Plans for Colon Cancer – Symptoms of Colon Cancer

Signs and symptoms of colon cancer include:

A persistent change in the bowel habits, including diarrhea or constipation or a change in the consistency of the stool
Rectal bleeding or blood in stool
Persistent abdominal discomforts, such as cramps, gas, or pain
A feeling that the bowel doesn’t empty completely
Weakness or fatigue
Unexplained weight loss

Many people with colon cancer experience no symptoms in the early stages of the disease. When symptoms appear, they’ll likely vary, depending on cancer’s size and location in the large intestine.

Nursing Care Plans for Colon Cancer – Causes of Colon Cancer

Doctors aren’t certain what causes most colon cancers.

In general, colon cancer begins when healthy cells in the colon develop changes (mutations) in their DNA. A cell’s DNA contains a set of instructions that tell a cell what to do.

Healthy cells grow and divide in an orderly way to keep the body functioning normally. But when a cell’s DNA is damaged and becomes cancerous, cells continue to divide — even when new cells aren’t needed. As the cells accumulate, they form a tumor.

With time, the cancer cells can grow to invade and destroy normal tissue nearby. And cancerous cells can travel to other parts of the body to form deposits there (metastasis).

Nursing Care Plans for Colon Cancer – Risk Factors of Colon Cancer

Factors that may increase the risk of colon cancer include:

Older age. Colon cancer can be diagnosed at any age, but a majority of people with colon cancer are older than 50. The rates of colon cancer in people younger than 50 have been increasing, but doctors aren’t sure why.

African-American race. African-Americans have a greater risk of colon cancer than do people of other races.

A personal history of colorectal cancer or polyps. Persons that have already had colon cancer or noncancerous colon polyps may have a greater risk of colon cancer in the future.

Inflammatory intestinal conditions. Chronic inflammatory diseases of the colon, such as ulcerative colitis and Crohn’s disease, can increase the risk of colon cancer.

Inherited syndromes that increase colon cancer risk. Some gene mutations passed through generations of your family can increase your risk of colon cancer significantly. Only a small percentage of colon cancers are linked to inherited genes. The most common inherited syndromes that increase colon cancer risk are familial adenomatous polyposis (FAP) and Lynch syndrome, which is also known as hereditary nonpolyposis colorectal cancer (HNPCC).

Family history of colon cancer. You’re more likely to develop colon cancer if you have a blood relative who has had the disease. If more than one family member has colon cancer or rectal cancer, your risk is even greater.

Low-fiber, high-fat diet. Colon cancer and rectal cancer may be associated with a typical Western diet, which is low in fiber and high in fat and calories. Research in this area has had mixed results. Some studies have found an increased risk of colon cancer in people who eat diets high in red meat and processed meat.

A sedentary lifestyle. People who are inactive are more likely to develop colon cancer. Getting regular physical activity may reduce your risk of colon cancer.

Diabetes. People with diabetes or insulin resistance have an increased risk of colon cancer.

Obesity. People who are obese have an increased risk of colon cancer and an increased risk of dying of colon cancer when compared with people considered normal weight.

Smoking. People who smoke may have an increased risk of colon cancer.

Alcohol. Heavy use of alcohol increases your risk of colon cancer.

Radiation therapy for cancer. Radiation therapy directed at the abdomen to treat previous cancers increases the risk of colon cancer.

Nursing Care Plans for Colon Cancer – Prevention of Colon Cancer

Screening colon cancer

Doctors recommend that people with an average risk of colon cancer consider colon cancer screening around age 50. But people with an increased risk, such as those with a family history of colon cancer, should consider screening sooner.

Lifestyle changes to reduce your risk of colon cancer

One can take steps to reduce the risks of colon cancer by making changes in their everyday life. Take steps to:

Eat a variety of fruits, vegetables, and whole grains. Fruits, vegetables, and whole grains contain vitamins, minerals, fiber, and antioxidants, which may play a role in cancer prevention. Choose a variety of fruits and vegetables so that you get an array of vitamins and nutrients.
Drink alcohol in moderation, if at all. If you choose to drink alcohol, limit the amount of alcohol you drink to no more than one drink a day for women and two for men.
Stop smoking. Talk to your doctor about ways to quit that may work for you.
Exercise most days of the week. Try to get at least 30 minutes of exercise on most days. If you’ve been inactive, start slowly and build up gradually to 30 minutes. Also, talk to your doctor before starting any exercise program.
Maintain a healthy weight. If you are at a healthy weight, work to maintain your weight by combining a healthy diet with daily exercise. If you need to lose weight, ask your doctor about healthy ways to achieve your goal. Aim to lose weight slowly by increasing the amount of exercise you get and reducing the number of calories you eat.

Colon cancer prevention for people with a high risk

Some medications have been found to reduce the risk of precancerous polyps or colon cancer. For instance, some evidence links a reduced risk of polyps and colon cancer to the regular use of aspirin or aspirin-like drugs. But it’s not clear what dose and what length of time would be needed to reduce the risk of colon cancer. Taking aspirin daily has some risks, including gastrointestinal bleeding and ulcers.

These options are generally reserved for people with a high risk of colon cancer. There isn’t enough evidence to recommend these medications to people who have an average risk of colon cancer.

Nursing Care Plans for Colon Cancer – Diagnosis of Colon Cancer

Digital rectal examination (DRE) – physical examination wherein the doctor inserts his lubricated and gloved finger into the anus to check for any abnormalities and presence of blood

Blood tests – the doctor may order a blood test to check for the chemical released by the colon tumor, called the carcinoembryonic antigen (CEA), which is also sometimes referred to as a “tumor marker.”

Imaging:

Colonoscopy – insertion of a long, thin tube with a video camera to visualize the entire colon
Flexible sigmoidoscopy – similar to colonoscopy but only views the distal part of the colon (sigmoid colon and rectum)
CT colonography – also known as virtual colonography; used to produce detailed images of the bowel.

Determining the extent of the cancer

For a person diagnosed with colon cancer, the doctor may recommend tests to determine the extent (stage) of cancer. Staging helps determine what treatments are most appropriate for the patient.

Staging tests may include imaging procedures such as abdominal, pelvic, and chest CT scans. In many cases, the stage of cancer may not be fully determined until after colon cancer surgery.

The stages of colon cancer are indicated by Roman numerals that range from 0 to IV, with the lowest stages indicating cancer that is limited to the lining of the inside of the colon. By stage IV, the cancer is considered advanced and has spread (metastasized) to other areas of the body.

Nursing Care Plans for Colon Cancer – Treatment of Colon Cancer

The type of treatments that are most likely to help a patient depends on the particular situation, including the location of cancer, its stage, and other health concerns. Treatment for colon cancer usually involves surgery to remove cancer. Other treatments, such as radiation therapy and chemotherapy, might also be recommended.

Surgery for early-stage colon cancer

If the colon cancer is very small, the doctor may recommend a minimally invasive approach to surgery, such as:

Removing polyps during a colonoscopy (polypectomy). If the cancer is small, localized, completely contained within a polyp, and in a very early stage, the doctor may be able to remove it completely during a colonoscopy.
Endoscopic mucosal resection. Larger polyps might be removed during colonoscopy using special tools to remove the polyp, and a small amount of the inner lining of the colon in a procedure called an endoscopic mucosal resection.
Minimally invasive surgery (laparoscopic surgery). Polyps that can’t be removed during a colonoscopy may be removed using laparoscopic surgery. In this procedure, a surgeon performs the operation through several small incisions in the abdominal wall, inserting instruments with attached cameras that display the colon on a video monitor. The surgeon may also take samples from lymph nodes in the area where the cancer is located.

Surgery for more advanced colon cancer

If cancer has grown into or through the colon, a surgeon may recommend:

Partial colectomy. During this procedure, the surgeon removes the part of the colon that contains cancer, along with a margin of normal tissue on either side of cancer. A surgeon is often able to reconnect the healthy portions of the colon or rectum. This procedure can commonly be done by a minimally invasive approach (laparoscopy).
Surgery to create a way for waste to leave the body. When it’s not possible to reconnect the healthy portions of the colon or rectum, a patient may need an ostomy. This involves creating an opening in the wall of the abdomen from a portion of the remaining bowel for the elimination of stool into a bag that fits securely over the opening. Sometimes the ostomy is only temporary, allowing the colon or rectum time to heal after surgery. In some cases, however, the colostomy may be permanent.
Lymph node removal. Nearby lymph nodes are usually also removed during colon cancer surgery and tested for cancer.

Nursing Care Plans for Colon Cancer Based on Nursing Diagnosis

Nursing Care Plans for Colon Cancer: Nursing Care Plan 1 -Diagnosis: Deficient Knowledge

Related to a new diagnosis of colon cancer.

Evidenced by the patient’s verbalization of “I want to know more about my new diagnosis and care.”

Desired Outcome

At the end of the health teaching session, the patient will be able to demonstrate sufficient knowledge of colon cancer and its management.

Nursing Interventions	Rationales
Assess the patient’s readiness to learn, misconceptions, and blocks to learning (e.g., denial of diagnosis or poor lifestyle habits)	To address the patient’s cognition and mental status towards the new diagnosis and to help the patient overcome blocks to learning.
Explain what colon cancer is and its symptoms. Avoid using medical jargon and explain in layman’s terms.	To provide information on colon cancer and its pathophysiology in the simplest way possible.
Educate the patient about his/her colon cancer treatment plan. If a patient is for systemic anti-cancer therapy (SACT) and/or radiotherapy, explain the treatment protocol that will be administered, its purpose, risks, and possible side effects. If the patient is for surgery, explain the procedure to the patient.	To give the patient enough information on the treatment plan so that he/she can provide or deny informed consent.
Demonstrate how to perform blood sugar monitoring.	To empower patients to monitor his/her blood sugar levels at home.
Inform the patient of the details about the prescribed medications (e.g., drug class, use, benefits, side effects, and risks) for supportive care, such as pain medications, anti-emetics, and bowel medications. Explain how to properly self-administer each of them. Ask the patient to repeat or demonstrate the self-administration details to you.	To inform the patient of each prescribed drug and to ensure that the patient fully understands the purpose, possible side effects, adverse events, and self-administration details.
Use open-ended questions to explore the patient’s lifestyle choices and behaviors that can be linked to the development of colon cancer. Teach the patient on how to modify these risk factors (e.g., smoking, excessive alcohol intake, low fiber, and high-fat diet, obesity, sedentary lifestyle, etc.).	To assist the patient in identifying and managing modifiable risk factors related to colon cancer.

Nursing Care Plans for Colon Cancer: Nursing Care Plan 2 -Diagnosis: Imbalanced Nutrition: Less than Body Requirements

Related to abdominal pain and cramping secondary to colon cancer

Evidenced by:

abdominal cramping
stomach pain
bloating
weight loss
nausea and vomiting
loss of appetite

Desired Outcome

The patient will be able to achieve weight within his/her normal BMI range, demonstrating healthy eating patterns and choices.

Nursing Interventions	Rationale
Explore the patient’s daily nutritional intake and food habits (e.g., mealtimes, duration of each meal session, snacking, etc.)	To create a baseline of the patient’s nutritional status and preferences.
Create a daily weight chart and a food and fluid chart. Discuss with the patient the short-term and long-term nutrition and weight goals.	To effectively monitor the patient’s daily nutritional intake and progress in weight goals.
Help the patient to select appropriate dietary choices to increase dietary fiber, caloric intake, and alcohol and coffee intake.	To promote nutrition and healthy food habits, as well as to boost the energy levels of the patient. Dietary fiber can help reduce stool transit time, thus promoting regular bowel movement.
Refer the patient to the dietitian.	To provide more specialized care for the patient in terms of nutrition and diet in relation to newly diagnosed colon cancer.
Symptom control: Administer the prescribed medications for abdominal cramping and pain, such as antispasmodics. Promote bowel emptying using laxatives as prescribed.	To reduce cramping, relieve the stomach pain, and help the patient to have a better appetite. To treat persistent and/or severe constipation, which is a common symptom of colon cancer.

Related FAQs

1. How does colon cancer start?

Most colorectal cancers start as a growth on the inner lining of the colon or rectum. These growths are called polyps. Some types of polyps can change into cancer over time (usually many years), but not all polyps become cancer. The chance of a polyp turning into cancer depends on the type of polyp it is.

2. Can colon cancer be cured?

Cancer of the colon is a highly treatable and often curable disease when localized to the bowel. Surgery is the primary form of treatment and results in cure in approximately 50% of the patients.

3. What is the first stage of colon cancer?

Also known as carcinoma in situ, in this stage abnormal cells are only in the inner lining of the colon or rectum. Stage 1. The cancer has penetrated the lining, or mucosa, of the colon or rectum and may have grown into the muscle layer. It hasn’t spread to nearby lymph nodes or to other parts of the body.

4. What are the six signs of colon cancer?

6 Early Warning Symptoms of Colon Cancer

Bleeding. Watch out for bright red rectal bleeding or dark, tarry stools, which could indicate the presence of blood.
Stomach pain. Look for persistent abdominal pain, discomfort, or bloating.
Change in bowel habits.
Tenesmus.
Unexplained weight loss.
Fatigue/weakness.

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May 1, 2022

Nursing Care Plans for Chickenpox – Best Nursing Care Plans(2022)

is article discusses Nursing Care Plans for Chickenpox plus its causes, symptoms, preventions, treatments and interventions.

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Disclaimer: The information presented in this article is not medical advice; it is meant to act as a quick guide to nursing students for learning purposes only and should not be applied without an approved physician’s consent. Please consult a registered doctor in case you’re looking for medical advice.

Introduction

Chickenpox is an infection caused by the varicella-zoster virus. It causes an itchy rash with small, fluid-filled blisters. Chickenpox is highly contagious to people who haven’t had the disease or been vaccinated against it. Today, a vaccine is available that protects children against chickenpox. Routine vaccination is recommended by the U.S. Centers for Disease Control and Prevention (CDC).

The chickenpox vaccine is a safe, effective way to prevent chickenpox and its possible complications.

Nursing Care Plans for Chickenpox – Symptoms of Chickenpox

The itchy blister rash caused by chickenpox infection appears 10 to 21 days after exposure to the virus and usually lasts about five to 10 days. Other signs and symptoms, which may occur one to two days before the rash, include:

Fever
Loss of appetite
Headache
Tiredness and a general feeling of being unwell (malaise)

Once the chickenpox rash appears, it goes through three phases:

Raised pink or red bumps (papules), which break out over several days
Small fluid-filled blisters (vesicles), which form in about one day and then break and leak
Crusts and scabs, which cover the broken blisters and take several more days to heal

New bumps continue to appear for several days, so a patient may have all three stages of the rash — bumps, blisters, and scabbed lesions — at the same time. A patient can spread the virus to other people for up to 48 hours before the rash appears, and the virus remains contagious until all broken blisters have crusted over.

The disease is generally mild in healthy children. In severe cases, the rash can cover the entire body, and lesions may form in the throat, eyes, and mucous membranes of the urethra, anus, and vagina.

Nursing Care Plans for Chickenpox – Causes of Chickenpox

The varicella-zoster virus causes chickenpox infection. It can spread through direct contact with the rash. It can also apply when a person with chickenpox coughs or sneezes and inhale the air droplets.

Nursing Care Plans for Chickenpox – Transmission of Chickenpox

Chickenpox is one of the most infectious diseases. People who have never had chickenpox, have never been vaccinated, or have a compromised immune system are at the highest risk of infection.

Transmission happens through direct contact between people through coughing or sneezing or by air.

VZV can also cause another condition known as shingles or herpes zoster. A person can also get chickenpox if they come in contact with fluid either from someone’s chickenpox or shingles blister.

Nursing Care Plans for Chickenpox – Risk factors of Chickenpox

People are at risk of becoming infected with the varicella-zoster virus that causes chickenpox if they haven’t already had chickenpox or if they haven’t had the chickenpox vaccine. It’s essential for people who work in child care or school settings to be vaccinated.

Most people who have had chickenpox or have been vaccinated against chickenpox are immune to chickenpox. A few people can get chickenpox more than once, but this is rare. If you’ve been vaccinated and still get chickenpox, symptoms are often milder, with fewer blisters and mild or no fever.

Nursing Care Plans for Chickenpox – Complications of Chickenpox

Chickenpox is normally a mild disease. But it can be severe and can lead to complications, including:

Bacterial infections of the skin, soft tissues, bones, joints, or bloodstream (sepsis)
Dehydration
Pneumonia
Inflammation of the brain (encephalitis)
Toxic shock syndrome
Reye’s syndrome in children and teenagers who take aspirin during chickenpox
Death

Chickenpox and Pregnancy

Low birth weight and limb abnormalities are more common among babies born to women who are infected with chickenpox early in their pregnancy. When a mother is infected with chickenpox in the week before birth or within a couple of days after giving birth, her baby has a higher risk of developing a severe and life-threatening infection.

Nursing Care Plans for Chickenpox – Prevention of Chickenpox

The chickenpox (varicella) vaccine is the best way to prevent chickenpox. Experts from the CDC estimate that the vaccine provides complete protection from the virus for nearly 98% of people who receive both of the recommended doses. When the vaccine doesn’t offer full protection, it significantly lessens the severity of chickenpox.

The chickenpox vaccine (Varivax) is recommended for:

Young children

In the United States, children receive two doses of the varicella vaccine — the first between ages 12 and 15 months and the second between ages 4 and 6 years — as part of the routine childhood vaccination schedule.

The vaccine can be combined with the measles, mumps, and rubella vaccine, but for some children between the ages of 12 and 23 months, the combination may increase the risk of fever and seizure from the vaccine.

Unvaccinated older children

Children ages 7 to 12 years who haven’t been vaccinated should receive two catch-up doses of the varicella vaccine, given at least three months apart. Children age 13 or older who haven’t been vaccinated should also receive two catch-up doses of the vaccine, given at least four weeks apart.

Unvaccinated adults who’ve never had chickenpox are at high risk of exposure. This includes health care workers, teachers, child care employees, international travelers, military personnel, adults who live with young children, and all women of childbearing age.
Adults who’ve never had chickenpox or been vaccinated usually receive two doses of the vaccine, four to eight weeks apart. If you don’t remember whether you’ve had chickenpox or the vaccine, a blood test can determine your immunity.

The chickenpox vaccine isn’t approved for:

Pregnant women
People who have weakened immune systems, such as those who are infected with HIV or people who are taking immune-suppressing medications
People who are allergic to gelatin or the antibiotic neomycin

Nursing Care Plans for Chickenpox – Diagnosis of Chickenpox

Physical exam – laboratory tests are not usually required in diagnosing chickenpox. The characteristic rashes combined with mild fever are critical in the diagnosis, although the rashes can be confused with other conditions such as scabies and insect bites. Laboratory tests, including blood tests and culture of lesion samples, can be performed in cases where a diagnosis is uncertain.

Blood test – to identify the presence of antibodies to the disease. The presence of antibodies suggests that the body will naturally be protected from the infection. On the other hand, the absence of antibodies.

Nursing Care Plans for Chickenpox – Treatment of Chickenpox

Chickenpox is self-limiting, and treatment is not necessarily required to stop the disease.

However, there are ways to ease the discomfort caused by its symptoms, and there are steps to take to stop the disease from spreading.

Painkillers. Painkillers are used for pain and mild fever. The use of aspirin and non-steroidal anti-inflammatory drugs are not recommended due to the complications they may cause, such as Reye’s syndrome and adverse skin reactions.

Proper hydration. Chickenpox can lead to dehydration. Maintaining adequate hydration helps prevent sores from getting worse.

Relieving pruritus. The blisters in chickenpox can be incredibly itchy. The following are the ways to prevent scratching of the spots:

Keep fingernails clean and short.
Use socks on hands or mittens at night.
Use cooling gels to avoid discomfort.
Use medications prescribed by doctors or recommended by pharmacists to stop or relieve itching.

Wearing cool clothing. Loose, smooth cotton fabrics prevent the lesions from being irritated.

Use of antiviral medicine. An antiviral medicine may be used to manage chickenpox. It does not cure chickenpox, but it helps manage the symptoms. It is commonly prescribed to the following population:

Pregnant women
Newborn babies
People with a weak immune system

Immunoglobulin treatment. Immunoglobulin is a drug containing solutions of antibodies for chickenpox from healthy donors. It is in the form of an injection given to people at higher risk of developing severe infection.

Nursing Care Plans for Chickenpox – Nursing Assessment for Chickenpox

Assessment of a child with chickenpox includes the following:

History taking. The history should elicit if a recent outbreak of chickenpox in the community has occurred and if any exposure to varicella at school, daycare, or among family members has occurred.

Immunizations. It should also be noted whether the child has previously received varicella vaccine or if the child is immunocompromised (including recent systemic steroid use) to help guide management.

Immunocompromised child. Immunocompromised children often have severe and complicated varicella, and their mortality rate is higher than that in immunocompetent children.

Nursing Care Plans for Chickenpox Based on Diagnosis

Nursing Care Plans for Chickenpox – Care Plan 1: Diagnosis – Impaired Skin Integrity related to infection of the skin secondary to varicella chickenpox

Evidenced by:

Maculopapular rashes
Blisters
Scabs

Desired Outcome

The patient will re-establish healthy skin integrity by following a treatment regimen for varicella chickenpox.

Intervention	Rationale
Assess the patient’s skin on his/her whole body.	To determine the severity of varicella chickenpox and any affected areas that require special attention or wound care.
Isolate the patient in his/her room ideally during the first 7 days since the appearance of the rash, until after the blisters are completely dried up.	Varicella chickenpox is an infectious/contagious skin disease. It is also harmful for pregnant women as it can affect the unborn baby.
The affected area should be washed first in warm water, wet compresses may also be used. This is followed by the application of the prescribed antipruritic cream or ointment directly to the affected areas.	Cleansing the skin and applying the topical antipruritic cream promotes relief of itchiness due to shingles.
Administer antiviral medication as prescribed. Ensure that the patient finishes the course of antibiotics prescribed by the physician.	Varicella chickenpox can be treated through the use of antiviral therapy. If the rash leads to other skin breakdowns, which then gets a bacterial infection, antibiotics are prescribed. Application of non-stick bandages over the affected areas can also help prevent the spread of rash and further infection. Even if the symptoms have already improved and healing is evident, it is still important to finish the course of antiviral therapy for at least 7 days.
Educate the patient and carer about proper skincare through washing the rash with soap and water. Advise the patient and carer to prevent scratching the affected areas.	It is important to maintain the cleanliness of the affected areas by washing with mild soap and water. The rash may cause itching, but it is advisable to prevent the patient from scratching the affected areas to prevent worsening of the infection. a. Use socks on hands or mittens at night. Use cooling gels to prevent discomfort.
Teaching the patient/ carer the proper application of non-stick bandages over the affected areas can also help prevent the spread of rash and further infection.	Proper application of non-stick bandages over the affected areas can also help prevent the spread of rash and further infection.

Nursing Care Plans for Chickenpox – Care Plan 2: Diagnosis – Risk for Infection related to a contagious skin infection

Desired Outcome

The patient will prevent the spread of infection to the rest of the body, as well as cross-contamination to other people by following a treatment regimen for varicella chickenpox.

Intervention	Rationale
Assess the patient’s skin on his/her whole body.	To determine the severity of varicella chickenpox and any affected areas that require special attention or skincare.
Isolate the patient in his/her room ideally during the first 7 days since the appearance of the rash.	Varicella Chickenpox is an infectious/ communicable skin disease. It is also harmful for pregnant women as it can affect the unborn baby.
Administer antiviral medication as prescribed. Ensure that the patient finishes the course of antibiotics prescribed by the physician.	Varicella chickenpox is generally treated through the use of antiviral therapy. If the rash leads to other skin breakdowns, which then gets infected by bacteria, antibiotics are prescribed.
Administer immunoglobulin as prescribed for patients in high-risk groups, such as pregnant women, newborns, and immunocompromised patients.	Immunoglobulin is a drug containing solutions of antibodies for chickenpox from healthy donors. It is in the form of an injection given to people at higher risk of developing severe infection.
Educate the patient and carer about proper wound hygiene through washing the rash with soap and water.	It is important to maintain the cleanliness of the affected areas by washing with mild soap and water. The rash may cause mild itching, but it is advisable to prevent the child from scratching the affected areas to prevent the worsening and spread of the infection.
Trim the patient’s fingernails and ensure frequent hand hygiene. Advise the patient and carer to prevent scratching the affected areas.	Long fingernails tend to harbor more bacteria. Scratching the infected skin areas will allow the bacteria to transfer into the fingernails and onto the fingerpads. When the patient touches other people or objects with infected hands, the infection will likely spread.
Teaching the patient/ carer the proper application of non-stick bandages over the affected areas can also help prevent the spread of rash and further infection.	Proper application of non-stick bandages over the affected areas can also help prevent the spread of rash and further infection.

Nursing Care Plans for Chickenpox – Summary

Chickenpox is a contagious illness caused by the varicella-zoster virus (VZV) that causes a highly itchy rash. Historically, most people have gotten it in childhood. If people get it as adults, they may be at risk for more serious symptoms and complications.

Since 1995, most people in the U.S. have received a vaccine for chickenpox. There are two types of chickenpox vaccines, which usually are administered twice in a person’s childhood.

The vaccine prevents about 90% of infections in the U.S. Some infections may still occur among unvaccinated or immunocompromised people.

Related FAQs

1. What is the nursing management for chickenpox?

Nursing Management

Treatment approaches include supportive measures, antiviral therapy, administration of varicella zoster immune globulin (VZIG), and management of secondary bacterial infection.

2. What interventions are required for patients with chickenpox or shingles?

Work restriction and isolation precautions

All patients with varicella or disseminated zoster should be placed on airborne and contact precautions until all lesions are crusted. For immunocompetent patients with dermatomal herpes zoster, standard precautions and complete covering of the skin lesions are recommended.

3. What are the 3 stages of chickenpox?

New bumps continue to appear for several days, so you may have all three stages of the rash — bumps, blisters and scabbed lesions — at the same time. You can spread the virus to other people for up to 48 hours before the rash appears, and the virus remains contagious until all broken blisters have crusted over.

4. Where do chickenpox usually start?

The rash may first show up on the chest, back, and face, and then spread over the entire body, including inside the mouth, eyelids, or genital area. It usually takes about one week for all of the blisters to become scabs. Other typical symptoms that may begin to appear one to two days before rash include: fever.

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May 1, 2022

Author: Dr. Prince

Nursing Care Plans for Depression – Best Nursing Care Plans(2022)

Introduction

Symptoms and signs of Depression

Depression in Female

Depression in men

Depression in Students at college

Depression in Adolescents

Risk factors of Depression

Complications Resulting from Depression

Prevention of Depression

Medical Management for Depression

Nursing Management for Depression

Nursing Diagnosis for Depression

Nursing Care Plans for Depression Based on the Diagnosis

Nursing Care Plan 1: Chronic Low Self-Esteem

Nursing Care Plan 2: Spiritual Distress

Nursing Care Plan 3: Impaired Social Interaction

Nursing Care Plan 4: Risk for Self-Directed Violence

Related FAQs

Read More:

Nursing Care Plans for Dehydration – Best Nursing Care Plans(2022)

Introduction

Symptoms of Dehydration

Causes of Dehydration

Risk Factors of Dehydration

Complications of Dehydration

Prevention of Dehydration

Diagnosis of Dehydration

Nursing Care Plans for Dehydration Based on Diagnosis

Nursing Care Plan 1: Diagnosis – Fluid Volume Deficit

Nursing Care Plan 2: Diagnosis – Risk for Fluid Volume Deficit

Nursing Care Plan 3: Diagnosis – Fluid Volume Deficit

Related FAQs

Read More:

Nursing Care Plan for COPD – Best Nursing Care Plans(2022)

Introduction

Pathophysiology of COPD

Diseases Related to COPD/ Types of COPD

Risk factors of COPD

Diagnosis of COPD

Signs and Symptoms of COPD

Treatment Options for COPD

Diagnostic Tests for COPD

Nursing Care Plan for COPD Based on Diagnosis

Ineffective Airway Clearance

Impaired Gas Exchange

Activity Intolerance

Related FAQs

Read More:

Nursing Care Plans for Colon Cancer – Best Nursing Care Plans (2022)

Introduction

Nursing Care Plans for Colon Cancer – Symptoms of Colon Cancer

Nursing Care Plans for Colon Cancer – Causes of Colon Cancer

Nursing Care Plans for Colon Cancer – Risk Factors of Colon Cancer

Nursing Care Plans for Colon Cancer – Prevention of Colon Cancer

Nursing Care Plans for Colon Cancer – Diagnosis of Colon Cancer

Nursing Care Plans for Colon Cancer – Treatment of Colon Cancer

Nursing Care Plans for Colon Cancer Based on Nursing Diagnosis

Nursing Care Plans for Colon Cancer: Nursing Care Plan 1 -Diagnosis: Deficient Knowledge

Nursing Care Plans for Colon Cancer: Nursing Care Plan 2 -Diagnosis: Imbalanced Nutrition: Less than Body Requirements

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Nursing Care Plans for Chickenpox – Best Nursing Care Plans(2022)

Introduction

Nursing Care Plans for Chickenpox – Symptoms of Chickenpox

Nursing Care Plans for Chickenpox – Causes of Chickenpox

Nursing Care Plans for Chickenpox – Transmission of Chickenpox

Nursing Care Plans for Chickenpox – Risk factors of Chickenpox

Nursing Care Plans for Chickenpox – Complications of Chickenpox

Nursing Care Plans for Chickenpox – Prevention of Chickenpox

Nursing Care Plans for Chickenpox – Diagnosis of Chickenpox

Nursing Care Plans for Chickenpox – Treatment of Chickenpox

Nursing Care Plans for Chickenpox – Nursing Assessment for Chickenpox

Nursing Care Plans for Chickenpox Based on Diagnosis

Nursing Care Plans for Chickenpox – Care Plan 1: Diagnosis – Impaired Skin Integrity related to infection of the skin secondary to varicella chickenpox

Nursing Care Plans for Chickenpox – Care Plan 2: Diagnosis – Risk for Infection related to a contagious skin infection

Nursing Care Plans for Chickenpox – Summary

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