Nursing Care According to NANDA-I Diagnoses, NIC Interventions, and NOC Outcomes in a Patient with Autoimmune Encephalitis: A Case Report

Year 2024, Volume: 7 Issue: 3, 229 - 239, 30.12.2024

Emine Ezgi Özçelik , Selda Çelik

https://doi.org/10.54803/sauhsd.1461503

Abstract

Encephalitis, defined as inflammation of the brain tissue, is an uncommon yet serious condition that can lead to severe brain damage. Nursing care is critical in increasing the effectiveness of treatment in patients with encephalitis. In the case presented here, care was planned and implemented based on nursing diagnoses by field in the NANDA-I classification, NIC interventions, and NOC outputs. The patients’ nursing diagnoses were identified as ineffective health management, imbalanced nutrition: less than body requirements, fluid volume deficit, constipation, impaired physical mobility, impaired verbal communication, hopelessness, impaired social interaction, ineffective sexuality, risk for impaired psychological health, risk for ineffective activity planning, risk for impaired independent decision making, hyperthermia, chronic pain, and risk for delayed development. The care plan for four of these diagnoses is presented.

Keywords

Encephalitis, Nursing Process, Nursing Diagnoses

Ethical Statement

It is declared that during the preparation process of this study, scientific and ethical principles were followed and all the studies benefited from are stated in the bibliography.

OTOİMMUN ENSEFALİT TANISIYLA TAKİP EDİLEN HASTANIN NANDA I TANILARI, NIC GİRİŞİMLERİ VE NOC ÇIKTILARINA GÖRE HEMŞİRELİK BAKIMI: OLGU SUNUMU

Abstract

Ensefalit, beyin dokusunun inflamasyonu olarak tanımlanan önemli bir hastalıktır. Prevelans ve insidansın azımsanmayacak oranlarda olduğu belirtilen Ensefalit olgularında, ciddi beyin hasarına kadar giden süreçlerin yaşanabildiği için tedavinin etkinliğinin arttırılmasında hemşirelik bakımı oldukça önemlidir. olguya ait hemşirelik tanıları NANDA-I Sınıflaması ve alanlarına, NIC-NOC çıktılarına göre ele alınarak bakım planlanmış ve uygulanmıştır. Olguya, etkisiz sağlık yönetimi, dengesiz beslenme: beden gereksiminden az, sıvı volüm eksikliği, konstipasyon, fiziksel mobilitede bozulma, sözel iletişimde bozulma, umutsuzluk, sosyal etkileşimde bozulma, psikolojik sağlamlığın bozulma riski, aktivite planlamada etikizlik riski, bağımsız karar vermede bozulma riski, hipertermi, kronik ağrı ve uyku örüntüsünde bozulma hemşirelik tanıları koyularak dört tanının bakım planı sunulmuştur.

Keywords

Ensefalit, Beyin İnflamasyonu, Hemşirelik Bakımı

References

• Easton A, Pewter S, Williams H, Johnson L, Wilkins E, Mestecky AM. Care of patients with central nervous system infections. In: Görak G, translator. Evidence-based practices in neurological nursing. Woodward S, Mestecky AM, editors. Istanbul: Nobel Medical Publishing; 2014. p. 401-410.
• Venkatesan A. Encephalitis and brain abscess. Continuum (Minneapolis, Minn). 2021;27(4):855-886. doi:10.1212/CON.0000000000001006. Accessed 2024 Aug 9.
• Institute for Health Metrics and Evaluation (IHME). Encephalitis statistics [Internet]. 2024. Available from: https://vizhub.healthdata.org/gbd-compare. Accessed 2024 Aug 5.
• Ellul M, Solomon T. Acute encephalitis - diagnosis and management. Clin Med (Lond). 2018;18(2):155-159. doi:10.7861/clinmedicine.18-2-155. Accessed 2024 Aug 11.
• Frackowiak M, Easton A, Michael BD. Encephalitis. Br J Hosp Med (Lond). 2019;80(4). doi:10.12968/hmed.2019.80.4.C50. Accessed 2024 Aug 11.
• Betaş S, Demir G. A case of treatment-resistant anti-LGI1 associated autoimmune encephalitis. Pamukkale Med J. 2021;15(1):197-200. Available from: https://dergipark.org.tr/tr/download/article-file/1626122. Accessed 2024 Aug 21.
• Wilkinson JM, Barcus L. Pearson nursing diagnoses handbook: NANDA-I diagnoses, NIC interventions, NOC outcomes. 11th ed. Ankara: Pelikan Publishing; 2018.
• Gülpak M, Oktay AA. Nursing care of patients with chronic kidney disease using NANDA diagnoses and NIC interventions: A case study. KSÜ Med Fac J. 2020;15(2):67-79. Available from: https://dergipark.org.tr/en/download/article-file/1186304. Accessed 2024 Aug 20.
• Karadakovan A. Nervous system diseases. In: Karadakovan A, Eti Aslan F, editors. Care in internal and surgical diseases. Ankara: Akademisyen Publishing House; 2020. p. 1174-1175.
• Fan Y, Yao Q, Liu Y, Jia T, Zhang J, Jiang E. Underlying causes and co-existence of malnutrition and infections: An exceedingly common death risk in cancer. Front Nutr. 2022;9:1-11. doi:10.3389/fnut.2022.814095. Accessed 2023 Dec 10.
• Noiesen E, Trosborg I, Bager L, Herning M, Lyngby C, Konradsen H. Constipation – prevalence and incidence among medical patients acutely admitted to hospital with medical conditions. J Clin Nurs. 2013;23(15-16):2295-2302. doi:10.1111/jocn.12511. Accessed 2023 Dec 11.
• Altun Uğraş G, Yüksel Gürdil Yılmaz S, Şirin K, Turan Y, Eroğlu S. Nursing interventions for fever control in the neurosurgery intensive care unit. ACU Health Sci J. 2019;10(2):271-276. Available from: http://journal.acibadem.edu.tr/tr/download/article-file/1701885. Accessed 2023 Dec 11.