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Sunday, March 22, 2009

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Reflection statements tend to elicit deeper awareness of feelings. A well-timed reflection can reveal an emotion that has escaped the client’s notice.

Bell’s palsy is an inflammatory condition involving the facial nerve (cranial nerve VII). Although it results in facial paralysis, it is not the same as a stroke or cerebrovascular accident (CVA). Many clients fear that they have had a CVA when the symptoms of Bell’s palsy appear, and they commonly believe that the paralysis is permanent. Symptoms resolve, although it may take several weeks.

Abdominal peritoneoscopy is performed to directly visualize the liver, gallbladder, spleen, and stomach after the insufflation of nitrous oxide. During the procedure, a rigid laparoscope is inserted through a small incision in the abdomen. A microscope in the endoscope allows visualization of the organs and provides a way to collect a specimen for biopsy or to remove small tumors.

The client experiencing a precipitate labor may have more difficulty maintaining control because of the abrupt onset and quick progression of the labor. This may be very different from previous labor experiences; therefore, the client needs support from the nurse in order to understand and adapt to the rapid progression. The contractions often increase in intensity quickly, adding to the pain, anxiety, and lack of control. The client may also have an increased amount of concern about the effect of the labor on the newborn infant. Lack of control over the situation combined with increased pain and anxiety can result in a decreased level of satisfaction with the labor and delivery experience.

Clients have a concern for the safety of their baby during labor and delivery, especially when a problem arises. Empathy and a calm attitude with realistic reassurances are an important aspect of client care. Dismissing or ignoring the client’s concerns can lead to increased fear and lack of cooperation.

When caring for individuals from a different culture, it is important to ask questions about their specific cultural needs and means of treatment. An understanding of the family’s beliefs and health practices is essential to successful interventions for that particular family.

Clients with MI often have a nursing diagnosis of Anxiety or Fear. The nurse allows the client to express concerns by showing genuine interest and concern and by facilitating communication using therapeutic communication techniques.

In the adjustment period during the first few weeks after spinal cord injury, clients may use denial as a defense mechanism. Denial may decrease anxiety temporarily and is a normal part of grieving. After the spinal shock resolves, prolonged or excessive use of denial may impair rehabilitation. However, rehabilitation programs include psychological counseling to deal with denial and grief.

Surgical incisions or loss of a body part can alter a client’s body image. The onset of problems coping with these changes may occur in the immediate or extended postoperative stage. Nursing interventions primarily involve providing psychological support. The nurse should encourage the client to express how he or she feels these postoperative changes will affect his or her life.

Impetigo (sometimes impetaigo) is a superficial bacterial skin infection most common among children 2 to 6 years old.

Pulmonary edema is accompanied by extreme fear and anxiety. Because the client typically experiences a sense of impending doom, the nurse should remain with the client as much as possible.

The use of flexible visiting hours meets the needs of both the client and family in reducing the anxiety levels of both.

When a client experiences fear, the nurse can provide a calm, safe environment by offering appropriate reassurance, using therapeutic touch, and by having someone remain with the client as much as possible.

Stress can trigger the vasospasm that occurs with Raynaud’s disease, so referral to stress management programs or the use of biofeedback training may be helpful.

Antianxiety medications and narcotic analgesics are used cautiously in the client being weaned from a mechanical ventilator. These medications may interfere with the weaning process by suppressing the respiratory drive. The client may exhibit anxiety during the weaning process as well for a variety of reasons, and therefore distractions such as radio, television, and visitors are still very useful.

Pulmonary angiography involves minimal exposure to radiation. The procedure is painless, although the client may feel discomfort with insertion of the needle for the catheter that is used for dye injection.

Staying with the client has a two-fold benefit. First, it relieves the anxiety of the dyspneic client. In addition, the nurse must stay with the client to observe respiratory status after application of the occlusive dressing. It is possible that the dressing could convert the open pneumothorax to a closed (tension) pneumothorax, resulting in a sudden decline in respiratory status and mediastinal shift. If this occurs, the nurse is present and able to remove the dressing immediately.

If the client tests positive with the ELISA, the test is repeated. If it is positive a second time, the Western blot (a more specific test) is done to confirm the finding. The client is not diagnosed as HIV positive unless the Western blot is positive. (Some laboratories also run the Western blot a second time with a new specimen before making a final determination.)

A lethality assessment requires direct communication between the client and the nurse concerning the client’s intent. It is important to provide a question that is directly related to lethality. Euphemisms should be avoided.

A euphemism is a substitution of an agreeable or less offensive expression in place of one that may offend or suggest something unpleasant to the listener;[1] or in the case of doublespeak, to make it less troublesome for the speaker.

In order for Fear to be an actual diagnosis, the client must be able to identify the object of fear.

Powerlessness is used when the client believes that personal actions will not affect an outcome in any significant way. Ineffective coping is used when the client has impaired adaptive abilities or behaviors in meeting the demands or roles expected. Anxiety is used when the client has a feeling of unease with a vague or undefined source. Disturbed body image occurs when there is an alteration in the way the client perceives body image.

Fears about having only one functioning kidney are common in clients who must undergo nephrectomy for renal cancer. These clients need emotional support and reassurance that the remaining kidney should be able to fully meet the body’s metabolic needs, as long as it has normal function.

When cardiac output falls as a result of acute pulmonary edema, the sympathetic nervous system is stimulated. Stimulation of the sympathetic nervous system results in the flight-or-fight reaction, which further impairs cardiac function. The goal of treatment is to increase cardiac output and decrease fluid volume.

Acknowledging the client’s feelings without inserting your own values or judgments is a method of therapeutic communication. Therapeutic communication techniques assist the flow of communication and always focus on the client.

Imipramine (Tofranil), Bupropion (Wellbutrin), and Doxepin (Sinequan) are classified as antidepressants and act by stimulating the central nervous system (CNS) to elevate mood. Alprazolam (Xanax), a benzodiazepine antianxiety agent, depresses the CNS and induces relaxation in panic disorders.

The client undergoing decortication to treat empyema needs ongoing support by the nurse. This is especially true because the client will have chest tubes in place after surgery, which must remain until the former pus-filled space is completely obliterated. This may take some time and may be discouraging to the client. Progress is monitored by chest x-ray.

Maprotiline (Ludiomil) is a tricyclic antidepressant used to treat various forms of depression and anxiety. The client is also often in psychotherapy while on this medication. Expected effects of the medication include improved sense of well-being, appetite, and sleep, as well as a reduced sense of anxiety. Common side effects to report to the health care provider include drowsiness, lethargy, and fatigue.

The needle insertion for thoracentesis is painful for the client. The nurse tells the client how important it is to remain still during the procedure, so the needle doesn’t injure visceral pleura or lung tissue. The nurse reassures the client during the procedure and helps the client hold the proper position.

The anxious client with dyspnea should be taught interventions to decrease anxiety, which include relaxation, biofeedback, guided imagery, and distraction. This will stop the escalation of feelings of anxiety and dyspnea. The dyspnea can be further controlled by teaching the client breathing techniques, which include pursed lip and diaphragmatic breathing. Coughing techniques are useful, but breathing techniques are more effective. Limiting fluids will thicken secretions and increased dietary carbohydrates will increase production of CO2 by the body.

The pain associated with drainage of pleural effusion is minimized by positioning the client for comfort and administering analgesics for relief of pain. The nurse also offers verbal support and reassurance. All of these measures help the client cope with the pain and discomfort associated with this problem. It is least helpful to leave the client alone for extended periods, because the client may experience continued pain, which may be augmented by isolation.

Pleural effusion is excess fluid that accumulates in the pleural cavity, the fluid-filled space that surrounds the lungs. Excessive amounts of such fluid can impair breathing by limiting the expansion of the lungs during inhalation.

The client who has suffered pulmonary embolism is fearful and apprehensive. The nurse effectively communicates with this client by staying with the client, providing simple, clear, and accurate information, and displaying a calm, efficient manner

Sarcoidosis, also called sarcoid (from the Greek sarx, meaning "flesh") or Besnier-Boeck disease, is an immune system disorder characterized by non-caseating granulomas (small inflammatory nodules). It most commonly arises in young adults. The cause of the disease is still unknown. Virtually any organ can be affected; however, granulomas most often appear in the lungs or the lymph nodes.

The client with Powerlessness expresses feelings of having no control over a situation or outcome. Ineffective Health Maintenance involves the inability to seek out help that is needed to maintain health. Anxiety is a vague sense of unease. Disturbed Thought Processes involves disruption in cognitive abilities or thought.

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