Social Isolation related to Schizophrenia

Nursing Care Plan for Schizophrenia

Nursing Diagnosis : Social Isolation
related to :

• lack of confidence to others.
• freaking out.
• regression to earlier developmental stages.
• delusions.
• difficult to interact with others in the past.
• weak ego development.
• repression of fear.

Defining characteristics:

• Alone in the room.
• Not communicate, withdraw, do not make eye contact (mutism, autism).
• Sad, flat affect.
• Attention and actions that are inconsistent with developmental age.
• Thinking about things according to his own thoughts, actions are repetitive and meaningless.
• Approaching nurses to interact, but then refused to respond to the nurse to self-acceptance.
• Expressing feelings of rejection or loneliness to others.

Planning:

General Purpose:

• The patient can voluntarily spend time with other patients and nurses in the group's activities.

Special purpose:

• The patient already included in the activity therapy was accompanied by a nurse to believe in one week.

Expected outcomes:

• The patient may demonstrate a desire to socialize with other people.
• The patient can follow the group activity without prompting.
• The patient did approach the interaction with others in a way that is appropriate / acceptable.

Intervention:

1. Show the acceptance by conducting frequent contacts, but brief.
rational:
Acceptance of others will improve the patient's self-esteem and facilitates a sense of trust in others.

2. Show a positive reinforcement to the patient.
rational:
Make the patient feel that would be a useful.

3. Accompany the patient to show support for group activities that may be the case that scary or difficult for the patient.
rational:
The presence of someone who believed would provide a sense of security to the patient.

4. Honest and keep all appointments.
rational:
Honesty and a sense of need raises a trusting relationship.

5. Orient the patient at the time, people, places, as needed.

6. Be careful with the touch. Let the patient got an extra room and the opportunity to leave the room if the patient becomes so anxiety.
rational:
The patients who suspect may be receptive to touch as a body language that suggests the threat.

7. Give the drugs, according the patient's treatment program. Monitor the effectiveness and side effects of drugs.
rational:
Medications help to reduce the symptoms of psychosis in a person, thus facilitating interaction with other people.

8. Discuss with the patient signs of increased anxiety and techniques to cut response. (Eg, relaxation exercises, "stop thinking").
rational:
Maladaptive behavior such as withdrawing and suspicious manifested during an increase in anxiety.

9. Give recognition and appreciation without prompting the patient can interact with others.
rational:
Reinforcement will increase the patient's self-esteem and encourage the repetition of such behavior.

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Disturbed Sensory Perception (visual) related to Glaucoma

Nursing Care Plan for Glaucoma

Glaucoma is a group of eye disorders characterized by increased intraocular pressure. (Barbara C. Long, 2000: 262)

Glaucoma is an eye condition that is usually caused by an abnormal increase in intraocular pressure (up to more than 20 mmHg). (Elizabeth J.Corwin, 2009: 382)


Classification

Glaucoma is divided into; primary glaucoma, secondary, and congenital.

1. Primary Glaucoma

In primary glaucoma has no known cause, obtained form:

• Closed angle glaucoma, acute congestive glaucoma.
• Open angle glaucoma, chronic simple glaucoma.

2. Secondary Glaucoma

Secondary glaucoma occurs as a result of other diseases in the eye, caused by:
a. Lens aberration.

• Luxation.
• Swelling (intumescent).
• Phacolytic.

b. abnormalities of the uvea

• Uveitis.
• Tumors.

c. Trauma

• Bleeding in the anterior chamber. (Hyphema).
• Perforation of the cornea and iris prolapse, which caused leucoma adherent.

d. Surgery

• Anterior chamber are not quickly formed after cataract surgery.

e. Other causes of secondary glaucoma

• Rubeosis iridis (due to central retinal vein thrombosis).
• Excessive use of topical corticosteroids.

3. Congenital glaucoma

• Primary congenital glaucoma or infantile glaucoma. (Buftalmos, hidroftalmos).
• Glaucoma concerned with other congenital abnormalities.

4. Absolute Glaucoma

• Final state of a glaucoma, ie with total blindness and eye pain.

(Sidarta Ilyas, 2002: 240-241)


Clinical Manifestations

1. Pain in the eye and surrounding areas (orbital, head, teeth, ears).
2. View of foggy, Seeing rainbows around lights.
3. Nausea, vomiting, sweating.
4. Red eye, conjunctival hyperemia, and ciliary.
5. Decreased visual acuity.
6. Corneal edema.
7. Shallow anterior chamber (may not be found in open-angle glaucoma).
8. Pupil wide oval, no reflex to light.
9. IOP increases.

(Anas Tamsuri, 2010: 74-75)


Nursing Diagnosis : Disturbed Sensory Perception (visual) related to decrease in visual acuity and clarity of vision.

Subjective:

• Stated vision blurred, indistinct, decreased vision area.

Objective:

• Decreased visual field examination.
• Decreased ability to identify the environment (objects, people, places)

Goal:
The client reported a greater ability to process visual stimuli and communicate the visual changes.

Expected outcomes:

• The client identifies the factors that affect visual function.
• The client identifies and shows patterns of alternatives to improve the visual stimuli reception.

Interventions :

1.Assess the client's visual acuity.
2. Approach the clients of the healthy side.
3. Identification of alternatives to optimize the stimulus source.
4. Adjust the environment to optimize vision:

• Orient the client to the ward.
• Place the tool that is often used near a client or on the sides of the eyes healthier.
• Provide sufficient lighting.
• Put in place a fixed tool.
• Avoid glare.

5. Encourage the use of alternative acceptable environmental stimuli: auditory, tactile.


Rationale :

1. Identify the client visual capabilities.
2. Provide sensory stimulation, reducing the sense of isolation / alienation.
3. Giving sight accuracy and maintenance.
4. Improving the ability of sensory perception.
5. Improving the ability of response to environmental stimuli.

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Knowledge Deficit related to Diabetic Foot Ulcers

Nursing Care Plan for Diabetic Foot Ulcers

Nursing Diagnosis : Knowledge Deficit about the disease process, diet, care, and treatment related to a lack of information.

Goal: The patient receive clear and accurate information about the disease.

Expected outcomes:

• The patient know about the disease, diet, care and treatment and may explain the return if asked.
• The patient can perform self-care based on the knowledge acquired.

Interventions:

1. Assess the level of knowledge of the patient / family about the disease of diabetes and gangrene.
Rationale: To provide information to patients / families, nurses need to know the extent to which information or knowledge that is known to the patient / family.

2. Assess the patient's educational background.
Rationale: In order for nurses to provide explanations by using words and phrases that can understand the patient as the patient's level of education.

3. Explain the process of disease, diet, care and treatment in patients with language and words that are easy to understand.
Rationale: In order information can be received easily and precisely so as to avoid misunderstandings.

4. Explain the procedure to be performed, the benefits to the patient and the patient engage in it.
Rationale: With the explanations and participate directly in the action taken, the patient will be more cooperative and reduced anxiety.

5. Use pictures to give an explanation (if there is / possible).
Rational: images may help to remember the explanation has been given.

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Ineffective Tissue perfusion related to Diabetic Foot Ulcers

Nursing Care Plan for Diabetic Foot Ulcers

Ulcers are open sores on the skin or mucous membrane surface and the ulcer is extensive tissue death and accompanied invasive saprophyte bacteria. The existence of the saprophyte bacteria cause ulcers smelling, diabetic ulcers is also one of the symptoms and the clinical course of the disease diabetes mellitus with peripheral neuropathy. (Andyagreeni, 2010).

Diabetic ulcers are chronic complications of diabetes mellitus as a major cause of morbidity, mortality and disability in patients with diabetes. High LDL levels play an important role for the occurrence of diabetic ulcers through the formation of atherosclerotic plaque in the walls of blood vessels, (zaidah 2005).

Diabetic foot ulcers are the complications associated with morbidity from diabetes mellitus. Diabetic foot ulcers are serious complications due to diabetes. (Andyagreeni, 2010).



Nursing Care Plan for Diabetic Foot Ulcers

Nursing Diagnosis : Ineffective Tissue perfusion related to weakening / decrease in blood flow to the area of gangrene due to obstruction of blood vessels.

Goal: maintain peripheral circulation remained normal.

Expected outcomes:

• Palpable peripheral pulses were strong and regular.
• The color of the skin around the wound; not pale / cyanosis.
• The skin around the wound felt warm.
• Edema does not occur and the wound is not getting worse.
• Sensory and motor improves.

Interventions:

1. Instruct the patient to mobilize.
Rational: the mobilization improves blood circulation.

2. Teach about the factors that can increase blood flow: Elevate the patient's leg is slightly lower than the heart (elevation position at rest), avoid crossing legs, avoid tight bandage, avoid the use of cushions, behind the knees and so on.
Rational: increase blood flow back so there is no edema.

3. Teach about the modification of risk factors such as:
Avoid high-cholesterol diet, relaxation techniques, stop smoking, and drug use vasoconstriction.
Rational: high cholesterol can accelerate the onset of atherosclerosis, smoking can cause vasoconstriction of blood vessels, relaxation to reduce the effects of stress.

4. Cooperation with other health care team in the delivery of vasodilators, checks blood sugar regularly and oxygen therapy.
Rational: vasodilator administration will increase the dilation of blood vessels and tissue perfusion can be improved, while the regular blood sugar checks can track the progress and state of the patient.

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Acute Pain related to Cellulitis

Nursing Care Plan for Cellulitis

Cellulitis is an infection by Staphylococcus, Streptococcus, or by both of them in the deepest layers of the skin. Bacteria can enter the body through the other parts of the skin of a cut, scratch, or bite. Usually if the skin is infected, affected only the top layer and will disappear on their own with proper care. But in cellulitis, skin tissue becomes infected parts in red, hot, inflamed and painful. Cellulitis usually occurs on the face and lower legs.

While according to Neville, Oral and Maxillofacial Pathology, explains that the term cellulitis used an oedematous deployment of acute inflammation on the surface of the soft tissues and is diffuse. Cellulitis can occur in all places where there is soft tissue and loose connective tissue, especially on the face and neck, because usually in the area of defense against infection is less than perfect.

The main causes of facial cellulitis is Staphylococcus aureus and Streptococcus b- hemolyticus, whereas Staphylococcus epidermidis is a normal inhabitant of the skin and rarely fight infections. Pyoderma predisposing factor is the lack of hygiene, immune deficiencies, and other diseases have been found in the skin.

Cellulitis are not contagious, usually begins as a small, inflamed, pain, swelling, heat, and redness of the skin. When the milking area began to spread, the child will feel pain and discomfort, fever, and can be accompanied by chills and sweating. Swollen lymph nodes in the folds are sometimes found on the nearby skin infections.

Nursing Diagnosis and Interventions :

Acute Pain related to local inflammatory response of subcutaneous tissue.

Goal : The client expressed pain decreased after nursing care.

Expected outcomes :

• Stable pain scale (0-3).
• Showed no pain / controlled.
• Looks relaxed, able to sleep / rest and participate in activities according to ability.
• Following the recommended pharmacological program.

Intervention :

1. Observation pain scale (0-10), the characteristics of pain, and pain location.
Rational : assist in determining the need for pain management, and program effectiveness.

2. Let the patient take a comfortable position and increase bed rest as indicated.
Rational : to limit the pain.

3. Give a gentle massage.
Rational : increase relaxation / reduce muscle tension.

4. Encourage the use of stress management techniques, such as progressive relaxation, therapeutic touch, biofeedback, visualization, guidance imagination, self hypnosis, and breath control.
Rational : increase relaxation, gives a sense of control, and may improve coping skills.

Collaboration

5. Give the medicine before the activity / exercise is planned, according to the instructions.
Rational : increase relaxation, reduce muscle tension / spasm, easy to participate in therapy.

6. Apply ice or a cold pack if necessary.
Rational : the cold can relieve pain and swelling during the acute period.

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Risk for Fluid Volume Deficit related to Low Birth Weight

Nursing Care Plan for Low Birth Weight

Nursing Diagnosis : Risk for Fluid Volume Deficit age and extreme weight, excessive fluid loss (thin skin), less fat layer, immature kidney / failure to concentrate urine.

Goal: liquid fulfilled

Expected outcomes:

• Free of signs of dehydration.
• Shows the weight gain of 20-30 grams / day.

Interventions :

Independent:

• Compare the input and output of urine, every shift and balance each periodic cumulative 24 hours.
• Monitor the specific gravity of each finished urinating or every 2-4 hours to inspire urine from diapers when the baby can not stand the reservoir bag urine.
• Evaluation of skin turgor, mucous membranes, and the state of the anterior fontanelle.
• Monitor blood pressure, pulse, and mean arterial pressure (TAR).

Collaboration:

• Monitor laboratory examination in accordance with the indications; Ht.
• Give parenteral infusion.
• Give a blood transfusion.

Rationale :

• Output should be 1-3 ml / kg / h, while the need for fluid therapy is approximately 80-100 ml / kg / day on the first day, increased to 120-140 ml / kg / day on the third day postpartum. Blood sampling for tests lead to decreased levels of hemoglobin / hematocrit.
• Although renal immaturity and inconvenience to concentrate urine, usually resulting in a low specific gravity in preterm infants (range normal1,006-1,013). Low levels indicates excessive fluid volume and content of greater than 1.013 indicates the inability of fluid intake and dehydration.
• Loss or minimal fluid shifts can quickly lead to dehydration, visible by poor skin turgor, dry mucous membranes, and sunken fontanelle.
• Losing 25% of blood volume resulting in shock, with TAR 25 mmHg indicates hypotension.
• Dehydration increases hematocrit levels 45-53% above normal serum potassium.
• Hypoglycemia can occur due to loss through diarrhea or vomiting nasogastric tube.
• The replacement of body fluids increase the volume of blood, helps restore vasoconstriction due to hypoxia, acidosis, and right-to-left shunt through the PDA, and has helped in reducing complications necrotizing enterocolitis, and bronchopulmonary dysplasia.
• It may be necessary to maintain the levels of hematocrit / hemoglobin optimal and replace blood loss.

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Ineffective Breathing Pattern related to Low Birth Weight

Nursing Care Plan for Low Birth Weight

Nursing Diagnosis :  Ineffective Breathing Pattern

According Manuaba (2002) since 1961 WHO replace the term premature with low birth weight (LBW) as they realized that not all babies born weighing less than 2500 grams at birth is not premature baby, then according Pantiawati (2009), LBW is a baby with birth weight less than 2500 grams. Meanwhile, according Proverawati (2010) LBW is babies born weighing less than 2500 grams regardless of pregnancy, in line with the opinions Prawiroharjo (2011) LBW is newborn birth weight less than 2500 (up to 2499 grams).

According Proverawati (2010), Clinical / LBW Infants characteristics:

• Weight less than 2500 grams.
• Length of less than 45 cm.
• Chest circumference less than 30 cm.
• Head circumference less than 33 cm.
• Thin subcutaneous fat tissue or less.
• Gestational age less than 37 weeks.
• Larger heads.
• Transparent thin skin, lanugo hair a lot, less fat.
• Cartilage earlobe, rudimentary growth.
• Weak hypotonic muscle is a muscle that is no active movement of the arms and elbows.
• Irregular breathing can occur apnea.
• Extremities: abduction of the thigh, the knee / leg flexion-straight, heel shiny, smooth soles.
• Head is not able to erect, yet nerve function or ineffective and weak tears.
• Breathing 40-50 times / min and pulse 100-140 beats / min.

Nursing Diagnosis for Low Birth Weight : Ineffective breathing pattern related to the immaturity of the respiratory center, the limitations of muscle growth or decline in muscle weakness and metabolic imbalance.

Goal: Patterns breath back effectively.

Expected outcomes:
Neonates will maintain periodic breathing patterns.
Pink mucous membranes.

Nursing Interventions :

Independent:
Assess the frequency and pattern of breathing, note the presence of apnea and cardiac frequency changes.
Suction the airway as needed.
Place the baby in the abdomen or supine position with a rolled diaper under the shoulder to produce hyperextension.
Review the history of the mother to drugs that would aggravate respiratory depression in infants.

Collaboration:
Monitor laboratory tests as indicated.
Give oxygen as indicated.
Give medications as indicated.

Rationale :

Help in distinguishing normal breathing rotation period of true apnea attacks, especially common in the 30th week of gestation.
Eliminate mucus that clogs the airways.
This position facilitates breathing and decrease episodes of apnea, especially if found any hypoxia, metabolic acidosis or hypercapnia.
Magnesium sulfate and narcotics suppress the respiratory center and CNS activity.
Hypoxia, metabolic acidosis, hypercapnia, hypoglycemia, hypocalcemia and sepsis aggravate apnea attacks.
Improvement of oxygen and carbon dioxide levels can improve respiratory function.

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Nursing Interventions for Bone Cancer

Definition of bone cancer is cancer that occurs in the bone. Bone cancer can occur in any bone in the body, such as cancer of the spine, etc., but most often affects the arm and leg bones. There are several types of bone cancer. Some types of bone cancer occurs primarily in children, while others affect mostly adults.

Symptoms of Bone Cancer

Characteristic feature of bone cancer or bone cancer symptoms include:

• Bone pain.
• Swelling and pain near the affected area.
• Fracture.
• Fatigue.
• Weight loss is not desired.

Types of Bone Cancer

Bone cancer is divided into separate types based on the type of cell where the cancer started. The most common type of bone cancer include:

• Osteosarcoma. Osteosarcoma begins on bone cells. Osteosarcoma occurs most often in children and young adults.
• Chondrosarcoma. Chondrosarcoma begins in the cartilage cells are normally found in the bone ends. Chondrosarcoma most commonly affects older adults.
• Ewing's Sarcoma. It is not clear where ewing sarcoma begins. Ewing's sarcoma is believed that to begin in nerve tissue in the bone. Ewing's sarcoma occurs most often in children and young adults.

Nursing Interventions for Bone Cancer

1). Pain management
Psychological pain management techniques (deep breath relaxation techniques, visualization, and guided imagery) and pharmacological (providing analgesic).

2). Teach effective coping mechanisms
Motivation clients and families to express their feelings, and give moral support and encourage families to consult a psychologist or clergy.

3). Provide adequate nutrition
Decreased appetite, nausea, vomiting often occur as a side effect of chemotherapy and radiation, so it should be given adequate nutrition. Antiemetic and relaxation techniques can reduce gastrointestinal reactions. Parenteral nutrition can be carried out in accordance with the indications of the doctor.

4). Health education
Patients and families are given health education on the likelihood of complications, treatment programs, and wound care techniques at home (Smeltzer. 2001: 2350).

5) If necessary; traction, Traction Treatment Principles

• Provide comfort measures (eg frequently change position, back massage) and therapeutic activity.
• Give the drug as an indication of examples; analgesic muscle relaxant.
• Give local heating as indicated.
• Give strength in early bandage / replacement in accordance with the indications, use aseptic technique correctly.
• Keep linen remains dry, free of wrinkles.
• Encourage the client to use loose cotton clothing.
• Encourage the client to use stress management, for example: guided imagery, deep breathing.
• Assess the degree of immobilization produced.
• Identification signs or symptoms that require medical evaluation, eg edema, erythema.

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Risk for Hypovolemic Shock, Risk for Metabolic Acidosis and Self-care Deficit

Nursing Diagnosis : Risk for Hypovolemic Shock related to continuous bleeding.

Goal :

• Shock does not occur during the treatment period.

Expected Outcomes:

• Not decreased consciousness.
• Vital signs within normal limits.
• Good skin turgor.
• Good peripheral perfusion (acral warm, dry and red).
• Fluid balance in the body.

Nursing Interventions :
1. Encourage the patient to drink more.
R /: Increased fluid intake, may increase intravascular volume, which can increase tissue perfusion.

2. Observation of vital signs every 4 hours.
R /: Changes in vital signs can be an early indicator of dehydration.

3. Observation of the signs of dehydration.
R /: Dehydration is the beginning of the syock if dehydration is not in good hands.

4. Observation of fluid intake and output.
R /: adequate fluid intake can compensate for excessive discharge.

5. Collaboration in:

• Intravenous fluids or transfusion.
• Giving coagulant and uterotonic.
• CVP custom installation.
• Examination of the plasma density.

Nursing Diagnosis : Risk for Metabolic Acidosis related to a decrease in the amount of blood in the capillaries.

Goal :
Metabolic acidosis did not occur during the treatment period,

Expected Outcomes:

• The results of blood gas analysis within normal limits.
• Vital signs within normal limits.

Nursing Interventions :
1. Observation vital signs within normal limits.
R /: Changes in vital signs is an early sign of detection of acidosis.

2. Encourage and motivate patients to drink sweet.
R /: Reducing protein breakdown and excessive fat to meet metabolic needs.

3. Collaboration in:

• BGA inspection.
• Intravenous fluids.

Nursing Diagnosis : Self-care Deficit related to physical weakness

Goal :
During the treatment period of daily activity needs are met.

Nursing Interventions :
1. Explain to the patient about the importance of maintaining personal hygiene.
R /: Adequate knowledge enables clients cooperatively towards the maintenance action performed.

2. Assist the client in meeting the nutritional needs (food and drink).
R /: Weakness of the body requires that the client needs with the help of others.

3. Assist the client in meeting the needs of personal hygiene.
R /: Weakness of the body that occur can lead to inability to meet the needs of personal hygiene.

4. Observation fulfillment daily activities.
R / Increased ability fulfillment of daily needs may reflect reduced body weakness.

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Hyperthermia and Acute Pain related to Dengue Fever Hemorrhagic (DHF)

Nursing Diagnosis : Hyperthermia related to disease process (viremia)

Goal :
Patient 's body temperature can be reduced.

Outcome :

• Comfortable body condition.
• Temperature 36,8⁰C-37,5⁰C.
• Blood pressure : 120/80 mmHg.
• Respiration : 16-24 x / mnt.
• Pulse : 60-100 x / mnt.

Intervention :

• Assess the onset of fever.
• Observation of vital signs (temperature, pulse, blood pressure, respiration) every 3 hours.
• Instruct the patient to drink (2.5 liters / 24 hours).
• Give warm compresses.
• Suggest to not wear thick blankets and clothing.
• Give intravenous fluid therapy and medications as ordered.

Rationale :

• To identify patterns of fever.
• Vital Signs is a reference to determine the patient's general condition.
• The increase in body temperature results in increased evaporation body so it needs to be balanced with a high fluid intake.
• With vasodilation can increase evaporation which accelerates the decline in body temperature.
• Clothing thin body helps reduce evaporation.
• Fluid administration is very important for patients with a high temperature.

Nursing Diagnosis : Acute Pain related to pathological disease process.

Goal :
Patient's pain can be reduced and disappeared.

Outcomes :

• The patient said that the pain was reduced / lost.
• The pain was on a scale of 0-3.
• Blood pressure : 120/80 mmHg.
• Temperature : 36,8⁰C-37,5⁰C.
• Respiration : 16-24 x / mnt.
• Pulse : 60-100 x / mnt.

Intervention :

• Observation of the patient's level of pain (scale, frequency, duration).
• Provide a quiet and comfortable environment and comfort measures.
• Give proper entertainment activities.
• Involve families in nursing care.
• Teach the patient relaxation techniques.
• Collaboration with physicians to analgesic drug delivery.

Rationale :

• Indicates the need for intervention and also the signs of the development / resolution of complications.
• A comfortable environment will help the process of relaxation.
• Refocused attention ; improve the ability to cope with pain.
• Family will help the healing process by training the patient relaxation.
• Relaxation pain will move to other things.
• Provide pain relief.

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Signs and Symptoms of Psychiatric Disorders : Motor Behavior

Aspects of life including impulse, motivation, hope, encouragement, instinct and craving, as expressed by one's behavior or motor activity.

1. Echopraxia : Echopraxia is the involuntary repetition or imitation of another person's actions.

2. Catatonia : motor abnormalities in non-organic disorders (as opposed to a disturbance of consciousness and motor activity of secondary organic pathology).

• Catalepsy : a general term for a position that does not move continuously maintained.
• Catatonic furor : agitated motor activity, not intended and are not influenced by external stimulation.
• Catatonic stupor : a real decrease in motor activity, often to the point of immobility and seemed unaware of surroundings.
• Catatonic Rigidity : acceptance of a rigid posture conscious, against attempts to be moved.
• Catatonic posturing : acceptance inappropriate posture or rigid conscious, usually maintained for a long time.
• Flexibility cerea (waxy flexibility) : Waxy flexibility is a psychomotor symptom of catatonic schizophrenia which leads to a decreased response to stimuli and a tendency to remain in an immobile posture.

3. Negativism : detention without motivation against any attempt to move or to all instructions.

4. Cataplexy : cataplexy is a sudden and transient episodes of muscle weakness accompanied by full conscious awareness, typically triggered by emotions such as laughing, crying, terror, etc.

5. Stereotypies : A stereotypy is a repetitive or ritualistic movement, posture, or utterance. Stereotypies may be simple movements such as body rocking, or complex, such as self - caressing, crossing and uncrossing of legs, and marching in place.

6. Mannerism : the movement is not realized, and are habitual.

7. Automatism : action or automatic actions that usually represents a symbolic activity that is not realized.

8. Command automatism : automatism follow the suggestion (also called automatic compliance).

9. Mutism : silent without structural abnormalities .

10. Overactivity :

• Psychomotor agitation : overactivity of motor and cognitive overload, usually not productive and as a result of a response to the tension in the (inner tension).
• Hyperactivity / hyperkinesis : anxiety and destructive activity, often accompanied by the basic pathology in the brain.
• Tick : motor movements are spasmodic and unconscious.
• Sleep walking ( somnambulisme ) : motor activity while asleep.
• Akathisia : subjective feelings of tension to the motor as a side effect of antipsychotic medications, or other medications that can cause anxiety ; sitting and standing are alternated repeated and repeated ; can be misinterpreted as psychotic agitation.
• Compulsion : uncontrollable impulse to perform repetitive actions.

Dipsomania : compulsion to drink alcohol.
Kleptomania : compulsion to steal.
Nymphomaniac.
Satiriasis.
Trichotillomania : compulsion to pull out hair.
Ritual : automatic compulsive activity in nature, lowering the original anxiety.

• Ataxia : failure of muscle coordination, muscle movement irregularities.
• Polyphagia : pathological overeating.

11. Hypo - activity / hypo - kinesis : motor activity and cognitive decline , such as psychomotor retardation ; slowing the mind , speech and movement that can be seen .

12. Mimicry : artificial and simple motor activity in children .

13. Aggression : stronger and directed action goals that may be verbal or physical ; motor part of the affective violence , anger or hostility .

14. Acting ( acting out ) : the direct expression of a hope or an unconscious impulse in the form of movement ; unconscious fantasy turned impulsively in behavior .

15. Abulia : decrease impulse to act and think , accompanied by indifference about the consequences of actions ; accompanied by neurological deficits .

16. Vagaboundage : like wandering the streets aimlessly .

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Mental State Examination : Affect and Mood

Affect and Mood

A complex feeling state with psychic, somatic and behavioral components related to
affective and mood.

Affect

Afek is a visible expression of emotion ; may not be consistent with the emotions that said the patient.

1. Appropriate Affect : emotional rhythm harmonious conditions ( corresponding, synchronized) with the idea, thought or conversation that accompanies ; further described as a wide or full affect, in which a complete emotional range expressed accordingly.
2. Inappropriate Affect : disharmony between the emotional rhythm with ideas, thoughts or conversation.
3. Blunted Affect : the affective disorders manifested by severe decline in the intensity of feeling expressed rhythm out.
4. Restricted or constricted Affect : reduction in the intensity of the rhythm feeling less severe than the effects of blunt but clearly decreased.
5. Fiat Affect : no or almost no signs of affective expression ; monotonous voice, a face that does not move.
6. Labile Affect : feeling rhythm changes quickly and abruptly, which is not related to external stimulation.

Mood

Mood is an emotion that permeated maintained, subjectively experienced and reported by patients and seen by others. Examples are depression, elasi, anger.

1. Dysphoric mood : an unpleasant mood.
2. Euthymic Mood : mood within the normal range, suggesting the presence of depressed mood or soar.
3. Expansive mood : the expression of one's feelings without limitation, often with exaggerated assessment of the person's interest or significance.
4. Irritable mood : the feeling caused by the expression disturbed or angered easily.
5. Labile mood : oscillation between euphoria and depression or angered.
6. Elevated mood : atmosphere of confidence and pleasure ; a more cheerful mood than usual.
7. Euphoria : elasi strong feeling of greatness.
8. Ecstasy : a strong sense of excitement.
9. Depression : feelings of sadness that psychopathological.
10. Anhedonia : loss of interest and withdraw from all routine activities and fun, often accompanied by depression.
11. Grief ( mourning ) : sadness in accordance with the real loss.
12. Alexitimia : inability or difficulty in describing or being aware of one's emotions or mood.

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Nursing Care Plan for Acute Psychotic

Definition of Acute Psychotic

Psychotic is mental disorder characterized by the inability of the individual to assess what actually happened, for example, there are hallucinations, delusions or chaotic behavior / weird.


Clinical Manifestations

The behavior exhibited by the patient are:

1. Hearing voices no source.
2. Belief or fear that weird / absurd.
3. Confusion or disorientation.
4. Changes in behavior ; be strange or scary as aloof, heightened scrutiny, threatening themselves, other people or the environment, to talk and laugh and get angry or hit for no reason.

Brief psychotic disorder symptoms always include at least one major psychotic symptoms, usually with sudden onset, but not always incorporate the overall pattern of symptoms found in schizophrenia. Some clinicians have observed that affective symptoms, confusion and concentration problems may be more often found in a brief psychotic disorder rather than a chronic psychotic disorder. Symptoms characteristic for brief psychotic disorder is an emotional change, clothing or bizarre behavior, yelling screaming or silent, and impaired memory for recent events occurred. Some of these symptoms are found in disorders that direct and clear diagnosis of delirium requires a complete organic inspection, although the result may be negative.

Mental status examination is usually present with severe psychotic agitation that may be associated with bizarre behavior, uncooperative, aggressive physical or verbal, irregular speak, shout or silence, labile mood or depression, suicide, kill thoughts or behavior, anxiety, hallucinations, delusions, disorientation, impaired attention, impaired concentration, memory impairment, and poor insight.

As in acute psychiatric patients, a history which is necessary to make the diagnosis may not be obtained only from the patient. Despite the presence of psychotic symptoms may be obvious, information on prodromal symptoms, previous episodes of a mood disorder, and a history of ingestion of a recently psychotomimetic substances may not be obtained from clinical interviews alone. In addition, clinical may not be able to obtain accurate information about the presence or absence of precipitating stressor.

The most obvious example is the originator of stresos major life events that can cause significant emotional anger in each person. The event is the death of a close family member and a heavy vehicle accidents. Some argue that the severity of clinical events should be considered in relation to the patient's life. Although this view has a reason, but it may expand the definition to include precipitating stressor events that are not associated with psychotic episodes. Other clinicians argue that stressors may be a sequence of events that cause stress are, rather than single events that give rise to stress the obvious. But the sum of the degree of stress caused by the sequence of events requires a degree of clinical judgment almost impossible.


Diagnosis

For a definite diagnosis of symptoms of acute psychotic disorders are as follows :

1. Hallucinations (false sensory perceptions or imagined : for instance, no one heard a sound source or see something that no object).
2. Delusions (strongly held idea that a real one and can not be accepted by social groups of patients, such as patients believe that they are poisoned by a neighbor, receiving messages from the television, or was observed / supervised by someone else).
3. Agitation or bizarre behavior.
4. Talks strange or chaotic (disorganization).
5. Unstable emotional state and extreme (irritable).

Nursing Care Plan for Acute Psychotic

Maintaining patient safety and care of individuals, things to do :

1. Family or friends should accompany the patient.
2. Basic needs of patients are met (eg, eating, drinking, elimination, and hygiene).
3. Be careful that the patient does not get injured.

Counseling patients and families :

1. Help families identify aspects of the law relating to psychiatric treatment include: patient rights, obligations and responsibilities of the family in the treatment of patients.
2. Assist patients and families to reduce the stress and contact with the stressor.
3. Motivation of patients to perform activities of daily living after symptoms improve.

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Nursing Care Plan for Crohn's Disease

Crohn's disease is an autoimmune disease characterized by inflammation of any part of the digestive tract starts from mouth to anus. Crohn's disease typically affects the ileum, the lower part of the small intestine. This condition occurs when the immune system reacts abnormally, attack bacteria, food, and other substances improperly, which causes the accumulation of white blood cells in the lining of the intestine.

Cause of Crohn 's disease is unknown. The study focused on three possible causes, namely :
1. Immune system dysfunction
2. Infection
3. Food

Although not found the presence of autoantibodies, regional enteritis is thought to be a hypersensitivity reaction or may be caused by an unknown infectious agent. These theories put forward because of the granulomatous lesions similar to lesions found in fungi and pulmonary tuberculosis. There are some interesting similarities between regional enteritis and ulcerative colitis. Both are inflammatory diseases, although the lesions is different. Both of these diseases have manifestations outside the digestive tract ; uveitis, arthritis and skin lesions were identical.

Crohn's disease that attacks the digestive system can cause a variety of complications, one of which is certainly disorders of the gut or digestive system. Crohn 's disease can cause a thickening or swelling of the intestinal wall, and this can cause blockage in the intestines. Finally, disturbed digestive system, intestines can not absorb nutrients from food, such as protein, vitamins, calories, and minerals.

Other complications that may arise as a result of Crohn 's disease is osteoporosis, anemia can cause fatigue, impaired liver function, cancer of the colon, toxic megacolon, kidney stone disease, or arthritis.

The main symptoms are diarrhea, abdominal pain, and weight loss . Often obtained malaise, loss of appetite, nausea, vomiting, and there may be subfebrile fever. Occur suddenly, can resemble obstruction and appendicitis. At regional enteritis, the onset of symptoms is usually hidden, with persistent abdominal pain and diarrhea that does not go away with defecation. Diarrhea occurred in 90 % of patients. Scar tissue and granuloma formation affects the ability of the intestine to transport the products of digestion upper intestine, through the lumen constriction, resulting in a cramping abdominal pain. Because the intestinal peristaltic stimulated by food, cramping pain occurs after eating. To avoid this cramping pain, patients tend to limit food intake, reducing the amount and types of food so that the normal nutritional needs are not met. The result is weight loss, malnutrition, and anemia secondary. In addition, the formation of ulcers in the lining membrane of the intestine and the place of inflammation, discharge will produce a constant irritant to the colon that are drawn from the thin intestine, swollen, which causes chronic diarrhea. Nutritional deficiencies may occur due to impaired absorption. The result is that the individual be thin because of inadequate food intake and fluid lost continuously. In some patients, inflamed bowel can be perforated and anal abscess formation, and intra-abdominal. Fever and leukocytosis. Abscesses, fistulas, and fissures are common. Clinical course and symptoms vary. In some patients there were periods of remission and exacerbation, while others follow the weight causes illness. Symptoms extends throughout the gastrointestinal tract and generally include joint problems (arthritis), skin lesions (erythema nodosum), ocular disorders (conjunctivitis), and oral ulcers.


Nursing Diagnosis for Crohn's Disease

1. Pain related to irritable initestinal, abdominal cramps and surgical response.
2. Fluid and Electrolyte imbalances related to discharge of excessive vomiting.
3. Imbalanced Nutrition Less Than Body Requirements related to the inadequate nutritional intake secondary to pain, stomach and intestinal inconveniences.
4. Risk for infection related to post- surgical wound.
5. Anxiety related to the prognosis of the disease and surgical plan.

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Risk for Fluid Volume Excess and Activity Intolerance related to CHF

Nursing Diagnosis and Interventions for Congestive Heart Failure (CHF)

Nursing Diagnosis : Risk for Excess Fluid Volume ; extravascular related to decreased renal perfusion, increased sodium / water retention, increased hydrostatic pressure or a decrease in plasma protein (absorbing fluid in the interstitial area / tissue).

Goal :
Fluid volume balance can be maintained.

Outcomes :

• Maintaining fluid balance as evidenced by blood pressure within normal limits, no peripheral venous distention / vein and dependent edema, pulmonary clean and ideal weight.

Intervention :

• Measure input / output, note the decline, expenditure, the nature of concentration, calculate fluid balance.
• Observation of dependent edema.
• Measure body weight per day.
• Maintain fluid intake in cardiovascular tolerance.
• Collaboration: the low-sodium diet, give diuretics.
• Assess the JVP after diuretic therapy.
• Monitor CVP and blood pressure.

Nursing Diagnosis : Activity Intolerance related to imbalance between myocardial oxygen supply and demand, the presence of ischemic / necrotic myocardial tissue.

possibility evidenced by :

• cardiac frequency interference,
• occurrence of dysrhythmias and general weakness.

Goal :
There was an increase in the client's activity tolerance after nursing actions implemented.

outcomes :

• Heart rate ; 60-100 X / min,
• Blood pressure ; 120/80 mmHg

Intervention :

• Record the heart rate , rhythm and change in BP during and after activity.
• Increase rest (in bed).
• Limit activity on the basis of pain and provide sensory activities that are not heavy.
• Describe the pattern of a gradual increase in the level of activity, for example ; get up from the chair in the absence of pain, ambulation and rest for 1 hour after eating.

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Disturbed Sleep Pattern and Risk for Injury related to BPH

Nursing Care Plan for Benign Prostatic Hyperplasia (BPH)


Nursing Diagnosis for Benign Prostatic Hyperplasia : Disturbed Sleep Pattern related to pain / surgery effects.

Goal : The need for sleep and rest are met.

Outcomes :

• Clients are able to rest / sleep within a reasonable time.
• Clients are able to express sleep.
• Clients are able to explain the factors inhibiting sleep.

Interventions :

1. Explain to the client and family causes sleep disturbance and possible ways to avoid.
R / improve knowledge so that the client be cooperative , in the act of nursing.

2. Create a supportive atmosphere, quiet atmosphere with reduced noise.
R / Quiet atmosphere will support the rest.

3. Give the client the opportunity to reveal the causes of sleep disorders.
R / Determine a plan to overcome interference.

4. Collaboration with physicians for the administration of drugs that can reduce pain (analgesic).
R / Reduce pain so clients can rest enough.


Nursing Diagnosis Benign Prostatic Hyperplasia : Risk for injury : bleeding related to surgery.

Goal : There was no bleeding.

Outcomes :
The client does not show signs of bleeding.
Vital signs within normal limits.
Urine smoothly through the catheter.

Interventions :

1. Explain to the client about the cause of bleeding after surgery and signs of bleeding.
R / : Reduce client anxiety and knowing the signs of bleeding.

2. Irrigation catheter flow if it detects the presence of a clot in the catheter tract.
R / : Clots can clog the catheter, causing stretching and bleeding of the bladder.

3. Provide a diet high in fiber and provide the drug to facilitate defecation.
R / : With increasing pressure on the prostatic fossa will precipitate bleeding.

4. Prevent the use of a rectal thermometer, rectal examination, for at least one week.
R / : May cause bleeding of the prostate.

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Nursing Diagnosis related to Fluid and Electrolyte

Fluid and Electrolyte

1. Deficient Fluid volume: less than body requirements related to excessive fluid output.

Intervention:

• Observation of vital signs.
• Observed signs of dehydration.
• Measure the input and output of fluid (fluid balance).
• Provide and encourage families to give drink plenty of approximately 2000 - 2500 cc per day.
• Collaboration with physicians in the delivery of fluid therapy, electrolyte laboratory examination.
• Collaboration with a team of nutrition in low-sodium fluid administration.

2. Risk for Deficient fluid volume related to insufficient fluid intake, excessive discharge (vomiting / nausea).

Intervention:

• Record the number of vomiting and bleeding characteristics.
• Assess vital signs (BP, pulse, temperature).
• Monitor fluid intake and output.
• Elevate the head for taking medication.
• Give saturated liquid / soft if the input starts again, avoid caffeinated and carbonated beverages.
• Maintain bed rest.
• Collaboration with fluid administration as indicated.

3. Risk for ineffective airway clearance related to the operative incision site.

Intervention:

• Give analgesics as prescribed.
• Fixation incision with both hands or a pillow to help patients when they cough.
• Encourage the use of Incentive spirometer if there is an indication.
• Help and encourage early ambulation.
• Help the patient to change positions frequently.

4. Disturbed Body Image related to changes in appearance secondary to loss of body parts.

Intervention:

• Encourage the patient to express feelings, especially about the thoughts, feelings, views of self. Rational: Helping patients to be aware of unusual feelings.
• Note withdrawing behavior. Increased dependency, manipulation or not involved in treatment. Rational: Alleged problems in assessment can require follow-up evaluation and more rigorous therapy.
• Maintain a positive approach during maintenance activities. Rational: Help the patient / person closest to accept changes in their own bodies and feel good about themselves.

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Nursing Diagnosis for Urinary / Bowel Elimination : Diarrhea, Constipation

Nanda Nursing Diagnosis for Urinary / Bowel Elimination : Diarrhea, Constipation


1. Alteration in Bowel Elimination : Diarrhea

Intervention:

• Help need for defecation (if bed rest to prepare the necessary tools near the bed, attach the curtains and immediately dispose of faeces after defecation).
• Increase / maintain fluid intake by mouth.
• Teach about the foods and drinks that can worsen / precipitate diarrhea.
• Observation and record the frequency of defecation, fecal volume and characteristics.
• Observation fever, tachycardia, lethargy, leukocytosis, decreased serum protein, anxiety and lethargy.
• Collaboration of appropriate medication therapy program (antibiotics, anticholinergics, corticosteroids).

2. Alteration in Bowel Elimination : Constipation

Intervention:

• Encourage lots of drinking with ambulation dinikolab laxative administration.
• Rationalization:
• Many drinks can help dissolve the stool with ambulation reduce constipation.
• Formation of stools soft launch.

3. Alteration in Bowel Elimination: Constipation related to neurological disorders of the intestine and rectum.

Intervention:

• Auscultation of bowel sounds, note the location and characteristics. Rational: bowel sounds may be absent during spinal shock.
• Observe for abdominal distention.
• Note the presence of complaints of nausea and want to vomit, pairs of NGT. Rational: gantrointentinal and gastric bleeding may occur due to trauma and stress.
• Provide a balanced diet high in calories and protein; Liquid. Rational: improving stool consistency.
• Give laxatives to order. Rational: stimulate the intestines.

4. Altered Urinary Elimination related to the drainage of urine.

Intervention:

• Assess urine drainage system immediately.
• Assess the adequacy of urine output and drainage system patency.
• Use aseptic procedures and washing hands when providing care and action.
• Maintain a closed urine drainage system.
• If irrigation is needed and prescribed, do this action carefully using sterile saline.
• Assist patients in the mobilization.
• Observation of color, smell and consistency of urine volume.
• Reduce trauma and manipulation of catheters, drainage system and urethra.
• Clean the catheter carefully.
• Maintain adequate fluid intake.

5. Impaired Urinary Elimination

Intervention:

• Observation of the bladder.
• Encourage regular bowel movements.
• Give warm compresses.
• Rationalization:
• The content of urinary maintain contractions or uterine involution.
• Urine retained causes infection.
• Relaxation springter urine.

6. Altered Urinary Elimination related to paralysis of the urinary condition.

Intervention:

• Assess the pattern of urination, and record urine output per hour.
• Rationale: determine kidney function.
• Palpation of the possibility of bladder distension.
• Instruct the patient to drink a 2000 cc / day.
• Rationale: helps maintain kidney function.
• Attach the catheter Dower.
• Rational assist the process of urine.

7. Constipation
Intervention:

• Observation bowel sounds periodically.
• Suggest to increase fluid intake at least 2 liters a day when no contra indications.
• Increase activity on a regular basis.
• For the provision of appropriate therapy, investigation is needed.
• Dietis team collaboration for the provision of a balanced diet and high in fiber.

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Causes of Diarrhea : Virus, Bacteria, Protozoa and Helminth

Cause of Diarrhea: (Tantivanich, 2002; Sirivichayakul, 2002; Pitisuttithum, 2002)

1. Virus:
Is the highest cause of acute diarrhea in children (70-80%). Some types of viruses that cause acute diarrhea:

• Rotavirus serotypes 1,2,8, and 9: in humans. Serotype 3 and 4 were found in animals and humans. And serotypes 5,6, and 7 were found only in animals.
• Norwalk virus: present in all ages, generally due to food borne or water borne transmission, and the transmission can also occur person to person.
• Astrovirus, found in children and adults
• Adenovirus (type 40, 41)
• Small bowel structured viruses
• Cytomegalovirus

2 Bacteria:

• Enterotoxigenic E. coli (ETEC). Have two important virulence factor is a factor that causes bacterial colonization is attached to the enterocytes of the small intestine and enterotoxin (heat labile (HL) and heat stabile (ST) which causes the secretion of fluid and electrolytes that produce watery diarrhea. ETEC causes no damage to brush border or invade the mucosa.
• Enterophatogenic E. coli (EPEC). The mechanism of diarrhea is not clear. Found the process of attachment of EPEC to intestinal epithelial damage of membrane micro-villi which would disturb the surface absorption and disaccharidase activity.
• Enteroaggregative E. coli (EAggEC). These bacteria are strongly attached to the mucosa of the small intestine and causes typical morphological changes. How does the mechanism of the onset of diarrhea is still unclear, but it may play a role cytotoxins.
• Enteroinvasive E. coli (EIEC). In serologic and biochemical similar to Shigella. Such as Shigella, EIEC penetrate and multiply within colonic epithelial cells.
• Enterohemorrhagic E. coli (EHEC). EHEC producing verocytotoxin (VT) 1 and 2, which is also called Shiga-like toxin that causes diffuse edema and bleeding in the colon. In children often progress to hemolytic-uremic syndrome.
• Shigella spp. Shigella invade and multiply within colonic epithelial cells, causing cell death and the onset of mucosal ulceration. Shigella rarely enter into the bloodstream. Virulence factors including: smooth cell-wall lipopolysaccharide antigen and endotoxin activity has helped the process of invasion and toxin (Shiga toxin and Shiga-like toxin) that are cytotoxic and neurotoxic and may cause watery diarrhea.
• Campylobacter jejuni (Helicobacter jejuni). Humans become infected through direct contact with animals (birds, dogs, cats, sheep and pigs) or with animal feces through contaminated food such as chicken and water. Sometimes the infection can be spread through direct person to person contact. C.jejuni may cause diarrhea by invasion into the small intestine and colon great.There 2 types of toxin produced, the heat-labile cytotoxin and enterotoxin. Histopathological changes that occur similar to the process of ulcerative colitis.
• Vibrio cholerae 01 and V.cholerae 0139. water or food contaminated with this bacteria will transmit cholera. Through person to person transmission is rare.
• V.cholerae attached and proliferated on the mucosa of the small intestine and produces an enterotoxin that causes diarrhea. Cholera toxin is very similar to the heat-labile toxin (LT) of ETEC. The last discovery of the existence of other enterotoxin that has its own characteristics, such as the accessory cholera enterotoxin (ACE) and zonular occludens toxin (ZOT). Both of these toxins cause fluid secretion into the intestinal lumen.
• Salmonella (non-typhoid). Salmonella can invade intestinal epithelial cells. Produced enterotoxin causing diarrhea. If there is damage that causes mucosal ulcers, bloody diarrhea will occur.

3. Protozoa:

• Giardia lamblia. This parasite infects the small intestine. Patogensis mechanism remains unclear, but is believed to affect the absorption and metabolism of bile acids. Transmission through the fecal-oral route. Host-parasite interactions is affected by age, nutritional status, endemicity, and immune status. Areas with high endemicity, giardiasis can be asymptomatic, chronic, persistent diarrhea with or without malabsorption. In areas with low endemicity, outbreaks can occur within 5-8 days after exposure to the manifestation of acute diarrhea is accompanied by nausea, epigastric pain and anorexia. Sometimes encountered malabsorption with faty stools, abdominal pain and bloated.
• Entamoeba histolytica. Dysentery amoeba prevalence varies, but its spread throughout the world. The incidence increases with age, and teranak in adult males. Approximately 90% of asymptomatic infections caused by non-pathogenic E.histolytica (E.dispar). Symptomatic amebiasis can be mild and persistent diarrhea to fulminant dysentery.
• Cryptosporidium. In developing countries, cryptosporidiosis 5-15% of cases of diarrhea in children. The infection is usually symptomatic and asymptomatic infants in older children and adults. Clinical symptoms of acute diarrhea with watery type of diarrhea, usually mild and self-limited. In people with impaired immune systems such as AIDS patients, cryptosporidiosis is a reemerging disease with more severe diarrhea and resistant to some antibiotics.
• Microsporidium spp
• Isospora belli
• Cyclospora cayatanensis

4. Helminths:

• Strongyloides stercoralis. Abnormalities in intestinal mucosa caused by adult worms and larvae, causing diarrhea.
• Schistosoma spp. The blood worms cause abnormalities in various organs including the intestinal manifestations, including diarrhea and intestinal bleeding.
• Capilaria philippinensis. This worm is found in the small intestine, especially jejunu, causing inflammation and villous atrophy with clinical symptoms of watery diarrhea and abdominal pain.
• Trichuris trichuria. Adult worms live in the colon, caecum, and appendix. Severe infections can cause bloody diarrhea and abdominal pain.

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Pathophysiology of Diarrhea - NCP

Pathophysiology of Diarrhea

The main function of the gastrointestinal tract is preparing food for living cells, the secretion of bile from the liver restriction and expenditure leftover food that is not digested. This function requires a variety of diverse physiological processes of digestion, the digestive activity can be either: (Sommers, 1994; Noerasid, 1999 cit Sinthamurniwaty 2006)

The process of entry of food from the mouth into the intestine.
The process of chewing (mastication): smoothing the food chewing and mixing with enzymes in the oral cavity.
The process of swallowing food (diglution): the movement of food from the mouth to the stomach.
Digestion: mechanical destruction of food, food ingredients mixing and hydrolysis by enzymes.
Food absorption (absorption): food molecules traveling through the mucous membranes of the intestines into the blood and lymph circulation.
Peristalsis: rhythmic movements of the intestinal wall in the form of a wave of contraction that moves food from the stomach to the distal.
Bowel movements (defecation): disposal of food waste in the form of feces.
Under normal circumstances where the effective functioning digestive tract will produce as much fecal residues 50-100 grams a day and water containing as much as 60-80%. In the gastrointestinal tract, fluid passively following movement of bidirectional transmucosal or longitudinal intraluminal with solid electrolytes and other substances that have active osmotic properties. The fluid that was in the gastrointestinal tract consists of the incoming fluid by mouth, saliva, gastric secretions, bile, pancreatic secretions and intestinal secretions smooth. The liquid is absorbed by the small intestine, and large intestine reabsorbs subsequent intestinal fluid, so that the remaining approximately 50-100 g as a stool.

Motility of the small intestine has the function to:

• Regularly move the bolus of food from the stomach to the cecum.
• Mix chyme with pancreatic enzymes and bile.
• Prevent bacteria to breed.

Physiological factors that cause diarrhea are very closely related to each other. For example, the increase in the intraluminal fluid will cause the intestine stimulated mechanically, thus increasing intestinal peristalsis and will speed up the time trajectory of chyme in the gut. This condition will shorten the time to touch chyme with intestinal mucous membrane, so that the absorption of water, electrolytes and other substances will be impaired.

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