Nanda Nursing Diagnosis

Nursing Diagnosis : Risk for Injury related to weakness of the defense secondary to hemophilia characterized by frequent injuries Objectives / Expected outcomes: injury and complications can be avoided / did not happen. Nursing Interventions Maintain security of client's bed, put a safety on the bed Avoid injury, light - weight Keep an eye on every move that allows the occurrence of injury Encourage the parents to bring children to the hospital immediately in case of injury Explain to parents the importance of avoiding injury. Rational Fragile tissue and impaired clotting mechanisms boost the risk of bleeding despite the injury / mild trauma Patients with hemophilia are at risk of spontaneous bleeding was controlled so that the required monitoring every move that allows the occurrence of injury Early identification and treatment can limit the severity of complications Parents can find out mamfaat of injury prevention / risk of bleeding and avoid injury and complications. Lower t...

Nursing Diagnosis: Ineffective Tissue Perfusio n related to active bleeding characterized by decreased consciousness, bleeding. Objectives / Expected outcomes: There was no impairment of consciousness, good capillary refill, bleeding can be resolved Nursing Interventions Assess the cause of bleeding Assess skin color, hematoma, cyanosis Collaboration in the provision of adequate IVFD Collaboration in the provision of blood transfusion. Rational: By knowing the cause of bleeding it will assist in determining appropriate interventions for patients Provide information about the degree / adequacy of tissue perfusion and assist in determining appropriate intervention Maintain fluid and electrolyte balance and maximize contractility / cardiac output so that the circulation becomes inadequate Repair / menormalakan red blood cell count and enhance oxygen-carrying capacity to be adequate tissue perfusion. Source : http://careplannursing.blogspot.com/2012/03/3-nursing-diagnosis-interventions-for...