Respiratory & Cardio Assessment, Infection Control, Wound Healing: Understanding, Exams of Nursing

Download Respiratory & Cardio Assessment, Infection Control, Wound Healing: Understanding and more Exams Nursing in PDF only on Docsity! 1 ALL MODUL ES NUR2115- Fundamentals of Professional Nursing Final Exam Concept Review- Fall 2018 ➢ Review various nursing diagnoses related to specific patient problems discussed in Fundamentals ➢ ROUGHLY 60% OF THE FINAL EXAM WILL BE CUMULATIVE OVER MOD 1-7 MODULE 1-3 CONCEPTS: ➢ Importance of documentation of assessments & interventions - Accurate documentation of the patient’s assessment is important to provide a baseline for later comparisons as the patient’s condition changes ➢ Types of nonverbal behavior which could promote improved communication - Body language - Gestures, movements, touch, appearance, adornments - Personal appearance - May express culture, religion, group associations, self-concept - Posture and gait - Erect vs. slouched posture 2 - Facial expression) the most expressive part of the body) ➢ The importance of QSEN competencies in nursing education - To prepare nurses who combine the highest level of scientific knowledge and technologic skill with responsible, caring practice. - To challenge students to identify and master the cognitive and technical skills as well as the interpersonal and ethic/legal skills they will need to effectively nurse the patients in their care. - PATIENT-CENTERED CARE - Teamwork and collaboration - QUALITY IMPROVEMENT - Safety - EVIDENCE-BASED PRACTICE 5 - EX: Teaching a diabetic patient how to recognize and prevent complications; using PT to prevent contractures in a patient who has had a stroke or spinal cord injury; referring a woman to a support group after removal of a breast because of cancer. ➢ ISBARR, DARE, SOAPIE notes for team communication - ISBARR allows for an easy focused way to set expectations for what will be communicated and how between members of the team, which is essential for developing teamwork and fostering a culture of patient safety. - SOAPIE= used to organize entries in the progress notes of the POMR. The POMR includes the defined database, problem list, care plans, and progress notes. - ISBARR= Introduction, Situation, Background, Assessment, Recommendation/request & Read back of orders or response - DARE= Database of Abstracts of Reviews of Effectiveness - SOAPIE= Subjective data, Objective data, Assessment, Plan, Intervention & Evaluation ➢ Review teaching for a patient with modifiable health risk factors - T= Tune into the patient - E= Edit patient information - A= Act on every teaching moment - C= Clarify often - H= Honor the patient as partner in the education process 6 ➢ Age related safety concerns across the lifespan - Infant: Falls, SIDS (must lay on back to sleep), Injury from toys, Burns, Suffocation and choking, Electrocution, Ingestion of foreign bodies, Child mistreatment (nurse obliged to report to DCF) **Need rear facing car seat - Toddlers: Falls, Cuts, Drowning, Concussions, Guns and weapons (locked and unloaded), Escape from home, Poison (Poison Control # on fridge), Suffocation and choking, Child mistreatment (nurse 7 obliged to report to DCF) **Front facing car seat in the BACK seat - School age children: Sexual abuse, Burns, Broken bones, Concussions, Drowning, Guns and weapons, Use of Internet, Sports injuries (cognitive rest), Abduction, Bullying (cyberbullying), Child mistreatment (nurse obliged to report to DCF) **Back seat until age 13 - Teenager: Piercing & Tattoos, driving (distracted driving). texting especially, Firearms, Suicide, Drugs and Alcohol and Tobacco, Sexuality and STIs, Sexual abuse, Use of Internet, Risk taking (diving into unfamiliar water) **Seat belt and driving - Adults: Stress, Domestic Violence, MVA, Industrial accidents and exposure Drugs and alcohol abuse - Elderly: Falls #1, Elder abuse and neglect, MVA, Sensorimotor changes, Fires (candles, heaters) ...forgetfulness, Burns (electric blankets, hot water, heating pads), Accidental overdosing and polypharmacy ➢ 6 Dimensions of wellness definitions - Physical Wellness: Maintaining a healthy quality of life without excessive stress and fatigue and recognizing the importance of adopting healthful habits such as diet and exercise. - Emotional Wellness: Understanding yourself and being able to cope with life challenges. It also means that you can share your feelings (such as sadness, anger, fear, hope, and happiness) with others. 10 - Stage 4: Industry vs. Inferiority (5 to 12): Competition, accomplishment, confidence, social and academic standards - Stage 5: Identity vs. Role confusion (12 to 18): Identity crisis, rebellion and learning adult roles - Stage 6: Intimacy vs. Isolation (18 to 40): Intercourse and developing friendships, relationships and goals - Stage 7: Generativity vs. Stagnation (40 to 65): Establishing career, raise kids, focused on work and close meaningful attachment - Stage 8: Ego Integrity vs. Despair (65 and up): Dealing with loss and adjusting to lifestyle changes 11 ➢ EBP- what information to trust for best practices- ANA, CDC, US Dept of Health, National Institute of Health (NIH). ➢ No .com sites for professional nursing. No blogs should be used as a reference-. ➢ OK to use most .org .edu or .gov sites. ➢ P.I.C.O. statements - P= Patient, population, problem of interest - I= Intervention of interest - C= Comparison of interest - O= Outcome of interest ➢ ANA Scope of Practice - ANA Code of Ethics for Nurses clearly states that the primary commitment of the nurse is the patient, it also states that the nurse owes the same duties to self as to others—including the responsibility to preserve integrity, to maintain competence, and to continue personal and professional growth. ➢ ANA Standards of Professional Performance- definitions (mod 1) - The standards of professional performance describe how NPD practitioners comply with 12 the standards of practice, apply the nursing process, and attend to other practice concerns and issues MUSCULOSKELETAL: ➢ Review education on crutch, cane, walker ambulation - Crutches: remind the patient that the support of body weight should come primarily on the hands and arms while using the crutches, not in the axillary areas, where pressure may damage nerves and cut off circulation, Also, the crutches should not be forced into the axillae each time the body moves forward. 15 - Active: The patient independently moves joints through their full range of motion (isotonic exercise). In active ROM, the nurse may provide minimal support. - Passive: The patient is unable to move independently, and the nurse moves each joint through its range of motion. VITAL SIGNS: ➢ Review the assessment of all vital signs including BP, HR, respirations, temperature and pulse ox. - BP: Selecting a cuff of the proper width is essential to obtain an accurate blood pressure reading. The correct cuff should have a bladder length that is 80% of the arm circumference and a width that is at least 40% of the arm circumference. If the cuff is too NARROW, the reading could be erroneously HIGH. If a cuff is too WIDE, the reading may be erroneously LOW. The series of sounds for which the nurse listens when assessing the blood pressure are called Korotkoff sounds. The first sound heard is the systolic pressure, and is recorded as the first number. The second number, the diastolic pressure, notes the level at which the sounds disappear completely. - HR: Apical pulse: If a peripheral pulse is difficult to assess accurately because it is irregular, weak, or very rapid, the apical rate should be assessed using a stethoscope. An apical pulse is also assessed when giving medications that alter heart rate and rhythm. Apical pulse measurement is also the preferred method of pulse assessment for infants and children less than 2 years of age. The contraction of the heart can be heard in the space between the fifth and the sixth ribs, about 8 16 cm (3 inches) to the left of the mid-clavicular line and slightly below the nipple. The apical rate of an infant can also be easily palpated with the fingertips as well as being auscultated. - HR: pulse by palpation: The radial pulse site is assessed most often in children and adults. Circulation to the legs and feet may be assessed at the femoral, popliteal, posterior tibial, or dorsalis pedis sites. The carotid pulse site is used during emergency assessments, such as for patients who are in shock or have had a cardiac arrest. When taking a carotid pulse, lightly palpate only one side at a 17 time to prevent any decrease in cerebrovascular circulation. The brachial pulse site is used most often for infants. - Respiration: The nurse assesses respiratory rate (breaths per minute), depth (deep or shallow), and rhythm (regular or irregular) by inspection or by listening with the stethoscope. - Temperature: axillary: The axillary site may be used when both oral and rectal sites are contraindicated or when these sites are inaccessible. Place the probe in the center of the axilla.Hold the patient's arm by the patient's side until the measurement is complete. - Temperature: rectal: The rectal temperature, a core temperature, is considered to be one of the most accurate routes. The rectal site should not be used in newborns, children with diarrhea, and in patients who have undergone rectal surgery or have a disease of the rectum. Because the insertion of the thermometer into the rectum can slow the heart rate by stimulating the vagus nerve, assessing a rectal temperature for patients with heart disease or after cardiac surgery may not be allowed in some institutions. Assessing a rectal temperature is contraindicated in patients who are neutropenic (have low white blood cell counts, such as in leukemia) and in patients who have certain neurologic disorders (e.g., spinal cord injuries). Do not insert a rectal thermometer into a patient who has a low platelet count. The rectum is very vascular, and a thermometer could cause rectal bleeding. - Temperature: oral: When selecting the oral site, the patient must be able to close his or her mouth around the probe. The probe must remain in the sublingual pocket for the full period of measurement. If a patient has had either hot or cold food or fluids or has been smoking or 20 Module 4-7: ➢ Review definitions of the nursing process including: ➢ Assessment - Subjective data: Information perceived only by the affected person - Objective data: observable and measurable data that can be seen, heard, or felt by someone other than the person experiencing them - Initial comprehensive assessment: performed shortly after admission, identify problems and care planning, performed to collect data on all aspects of patient’s health 21 - Focused assessment: performed by the nurse to collect data about the specific problem - Emergency Assessment: Performed when a physiologic or psychological crisis present - Time-lapsed Assessment: performed to compare a patient’s current status to baseline data obtained earlier ➢ nursing diagnoses - Identify problems - What causes the problem - Solutions to prevent or resolve problems ➢ Planning - Specific - Measurable - Achievable - Realistic - Timely - Identify expected patient outcomes, establish priorities, select evidence-based nursing interventions, communicate the plan of care 22 ➢ Outcomes - Implementation helps the patient achieve valued health outcomes. Promote health, prevent disease and illness, restore health, facilitate coping with altered functioning. - Cognitive: increase in patient knowledge; ask patient to repeat information or apply new knowledge - Psychomotor: patient’s achievement of new skill; ask patient to demonstrate new skill - Affective: changes in patient values, beliefs, and attitudes; observe patient behavior and conversation - Physiologic: physical changes in the patient; use physical assessment to collect and compare data ➢ interventions 25 - Wheezes= narrowed airways; musical or squeaking sounds; heard on inspiration and expiration; classified as sibilant and sonorous (COPD, Emphysema, Sleep apnea, Pneumonia, Smoking, Respiratory tract infection, Asthma, Bronchitis, Lung cancer, or Foreign object). - Pleural friction rub= abnormal lung sound which is caused by inflammation of the pleural layer of the lungs rubbing together. Pleural friction rub is heard on inspiration and expiration and sounds like a low-pitch harsh/grating noise. (Viral infection such as flu, Lung cancer, sickle cell disease, FUNGAL INFECTION, BACTERIAL INFECTION LIKE PNEUMONIA, RIB FRACTURE, OR RHEUMATOID ARTHRITIS) - Rhonchi= air passing through or around secretions; sonorous or course sounding; heard on inspiration and expiration; coughing can clear secretions so sound will also go away (COPD, Bronchiectasis, Pneumonia, Chronic bronchitis, or Cystic fibrosis) - Crackles= occur when air moves through airways that contain fluid, bubbling, cracking, popping sound; heard on inspiration and expiration (Pneumonia, Heart failure, Bronchitis, Pulmonary edema, or Pulmonary fibrosis - Stridor= narrowing of upper airway, can be from prescience of foreign body; loud and high pitched; heard only on inspiration (Foreign body, Diphtheria, Anaphylaxis, Epiglottis, Lung cancer, Tonsillitis, Laryngitis or Croup) ➢ Review respiratory terminology: dyspnea, cyanosis, tachypnea, bradypnea, apnea in beginning of Chap 38 - Dyspnea- difficulty breathing - Cyanosis- blue skin color 26 - Tachypnea- increased breathing over 20 - Bradypnea- decreased breathing under 12 - Apnea- absents of breathing ➢ Review the ACUTE and Chronic effects of hypoxia on the respiratory system and the rest of the body. 27 - Acute hypoxia= Restlessness, Pallor, Tachypnea, Elevated BP, Use of accessory muscles, Nasal flaring, Tracheal tugging, Adventitious lung sounds - Chronic hypoxia= Confusion, Bradycardia, Bradypnea, Stupor, Cyanotic skin and mucus membranes, hypotension, cardiac dysrhythmia ➢ Review the anatomical locations for auscultation of cardiac and respiratory systems (aortic, pulmonic, tricuspid and mitral) 30 - ABSENT= 0 Infection/ Inflammation/ Thermoregulation: ➢ Review the difference between inflammation and infection - Inflammation= a localized physical condition in which part of the body becomes reddened, swollen, hot, and often painful, especially as a reaction to injury or infection. Symptoms include: Redness, Swollen joint that's sometimes warm to the touch, Joint pain, Joint stiffness, Loss of joint function 31 - Infection= A person becomes sick after being contaminated by a virus, bacteria or fungi. Symptoms include: Fever and chills, very low body temperature, Peeing less than normal, Rapid pulse, Rapid breathing, Nausea and vomiting, Diarrhea ➢ Review the effects of excessive or ineffective inflammatory response which could occur in a patient - Local tissue damage from compression - Development of chronic inflammation - Systemic pathology - Atherosclerosis- build- up of fats, cholesterol, and other substances in and on the artery walls - Chronic renal disease - Neurologic disorders ➢ Review the purpose/benefits of the inflammatory process including fever benefits - A protective mechanism that eliminates the invading pathogen and allows for tissue repair to occur - Inflammation helps the body to neutralize, control, or eliminate the offending agent and to prepare the site for repair - In addition to infection, the inflammatory response also occurs in response to injury. It is either an acute or chronic process. 32 ➢ Review infection terms: opportunistic, virulence, phagocytosis, hospital-acquired, nosocomial, immunocompromised - Opportunistic infection= also known as an immunocompromised infection; a patient who does not have the ability to respond normally to an infection due to an impaired or weakened immune system. This inability to fight infection can be caused by a number of conditions including illness and disease (eg, diabetes, HIV), malnutrition, and drugs. - Virulence= The ability of an agent of infection to produce disease. The virulence of a microorganism is a measure of the severity of the disease it causes. - Phagocytosis= the ingestion of bacteria or other material by phagocytes and amoeboid protozoans. 35 ➢ Review signs and symptoms of infection - Redness - Heat - Swelling - Pain - Loss of Function ➢ Review the difference between endogenous nosocomial and exogenous nosocomial infection - Endogenous nosocomial infection= When the causative organism comes from microbial life harbored in the person. - exogenous nosocomial infection= when the causative organism is acquired from other people. (MOD 7) INTEGUMENTARY AND TISSUE INTEGRITY: 36 ➢ Review the stages of pressure ulcers including I, II, II and VI ulcers as well as unstageable and suspected deep tissue injury - Stage I= non-blanchable erythema of intact skin - Stage II= partial- thickness skin loss - Stage III= full-thickness skin loss; subcutaneous fat may be exposed but does not involve underlying fascia - Stage IV= full-thickness skin loss with extensive destruction; exposed bone, tendon or muscle - Unstageable= base of ulcer covered by slough and/or eschar in wound bed ➢ Review integumentary changes in various developmental ages 37 - Adult= maturation of epidermal cells is prolonged, leading to thin, easily damaged skin; circulation and collagen formation are impaired, leading to decreased elasticity and increased risk for tissue damaged from pressure - Child= skin becomes increasingly resistant to injury and infection - Infant= those younger than 2 skins are thinner and weaker than it is in adults, skin and mucous membranes are injured easily and are subject to infection, careful handling of infants is required to prevent injury to and infection of the skin and mucous membranes - Elderly= skin is thin, easily injured, less capacity to insulate, wrinkles more easily, sensation of pressure and pain is reduced, dryer, pruritus (itching) may occur, healing time is delayed, hair becomes gray/white, skin may be unevenly pigmented, skin loses elasticity ➢ Review the importance of nutrition and wound healing - A patient who is malnourished is at a higher risk for alterations in fluid and electrolyte balance, delay in wound healing and wound infection ➢ Review the following precautions: protective, droplet, airborne, contact, standard, isolation, airborne - CONTACT PRECAUTIONS= - Airborne precautions= negative pressure/HEPA system, keep door closed, limit transport (if transported the patient must wear a mask), mask and respiratory protection device for caregivers and visitors, use a N95 on high-efficiency particulate air respirator; Tuberculosis, chicken pox, measles - Droplet precautions= a private room to ensure silent has their own equipment, mask for providers and visitors, disposal of infectious dressing material into a single, non-prow bag without touching 40 ➢ Review the use and rationale of the Braden scale - Braden Scale= Helps assess a person’s risk for falls - Very high risk- 9 or less - High risk- 10 to 12 - Moderate risk- 13-14 - Mild risk- 15-18 - No risk- 19-23 ➢ Review the difference between acute and chronic wounds 41 - Acute wounds= short duration, heal spontaneously without complications through the 3 phases of healing inflammation, proliferation, maturation; surgical wounds - Chronic wounds= exceed expected length of recovery, natural healing progression interrupted or stalled due to: infection, continued trauma, ischemia or edema, pressure, arterial, venous and diabetic ulcers, frequently colonized, last months or years ➢ Review the effect of shearing force and friction on skin integrity - Shearing= Combination of friction and pressure, epidermal layer slides over the dermis causing damage to vascular bed - Friction= force acting parallel to skin surface, damages the outer protective layer of epidermis 40% OF EXAM WILL BE ON THE FOLLOWING SECTIONS: 42 Glucose Regulation: ➢ Review patient education a nurse would include in self administration of insulin - Teach clients to check blood sugars and to administer insulin - Inject insulin when levels are high (hyperglycemia) - DO it in s fatty area. - Inject medication by pinching area of injection and inject the medication - Hold for 3-5 seconds before removing syringe. - Hyperglycemia symptoms early signs; increased thirst, blurred vision, frequent urination, increased hunger, numbness or tingling in the feet, fatigue and headache - Hyperglycemia symptoms late signs: fruity smelling breath, nausea and vomiting, shortness of breath, dry mouth, weakness, confusion and coma 45 - Cut nails carefully. Cut them straight across and file the edges. Don’t cut nails too short, as this could lead to ingrown toenails. - Never treat corns or calluses yourself. - Wear clean, dry socks. Change them daily. - Consider socks made specifically for patients living with diabetes. - Wear socks to bed. - Shake out your shoes and feel the inside before wearing. - Keep your feet warm and dry. - Consider using an antiperspirant on the soles of your feet. - Never walk barefoot even around the house. - Take care of your diabetes. - Do not smoke. - Get periodic foot exams. GASTROINTESTINAL: ➢ Review the complete assessment of the GI system including inspection, auscultation, palpation and percussion - Inspection= first observe the contour of the abdomen, noting any masses, scars or areas of distention. Significant findings may include the presence of distention (inflation) or protrusion (projection). - Auscultation= use the diaphragm of a stethoscope listen to bowl sounds in all four quadrants. Note the frequency and character of bowel sound. They are usually high pitched, gurgling and soft, indicating bowel motility and peristalsis. Use the stethoscope to listen to the abdominal aorta, femoral arteries and iliac arteries for bruits. Bruit is a swooshing or blowing sounds. Describe sounds as hyperactive, hypoactive or inaudible. If there is a NG tube in place disconnect it from suction during this assessment to allow for accurate interpretation of sounds. 46 - Palpation= Palpate each quadrant in a systematic manner, noting muscular resistance, tenderness, enlargement of the organs or masses. Be sure to watch the patients face for nonverbal signs of pain during palpation. If the patient complains of pain palpate the area of pain last. If the abdomen is distended note the presence of firmness or tautness. Abnormal findings include involuntary rigidity, 47 spasm, and pain (which may indicate trauma, peritonitis, infection, tumors, or enlarged or diseased abdominal organs). - Percussion= Place your non-dominate hand firmly against the abdominal wall such that only your middle finger is resting on the skin. Tap on the middle finger using the middle finger of your dominant hand. Do it three times listening for the sound it makes. This is use for delineating the outlines of solid tissue (liver, spleen). Tones you are likely to here includes dullness, tympani and resonance. Dullness is heard over solid organs (liver, spleen). Tympani is commonly heard over areas that contain gas (stomach, intestines). Resonance is heard over healthy lung tissue. ➢ Review conditions of diarrhea and constipation and precipitating factors of each - Diarrhea= Disease process; Infections of intestines from contaminated food or water; (dysentery / cholera); Food poisoning – can result in severe GI symptoms, progressing to life threatening conditions; e coli, E coli 0157 H, salmonella; Parasites; Viruses; Travelers diarrhea-N/V/D, fever, abdominal cramping, pain, characterized by ≥3 loose stools in 24 hrs., (C difficile, norovirus) - Constipation= intestinal impaction, anal fissures, hemorrhoids, volvulus, intestinal obstruction, rectal ulcers, fecal seepage, bowel perforation. ➢ Review the components in a focused GI assessment - Change in Appetite - Weight gain or loss - Dysphagia - Intolerance to Certain Foods - Nausea and Vomiting - Change in Bowel Habits - Abdominal Pain ➢ Review risks and treatments for constipation & diarrhea 50 - For this test, the doctor looks at the entire length of the colon and rectum with a colonoscopy, a thin, flexible, lighted tube with a small video camera on the end. It is inserted through the anus and into the rectum and the colon. Special instruments can be passed through the colonoscopy to biopsy or remove any suspicious-looking areas such as polyps, if needed. - Colonoscopy may be done in a hospital outpatient department, in a clinic, or in a doctor’s office. ➢ Review teaching regarding a patient undergoing a colonoscopy - Do not eat anything for the next 24 hrs. - Take the laxatives given to help clear out the intestines for a clearer look 51 ➢ Review education and teaching regarding ostomy care - Explain the reason for bowel diversion and the rationale for treatment - Demonstrate self-care behaviors that effectively manage the ostomy - Describe follow-up care and existing support resources - Report where supplies may be obtained in the community - Verbalize related fears and concerns - Demonstrate a positive body image. ➢ Review side effects of diarrhea & constipation - Diarrhea= Dehydration - Constipation= Abdominal pain ➢ Discuss the interrelationship between GI system disorders and antibiotics - Antibiotics are part of the treatment for GI system disorders. GENITOURINARY: ➢ Review the components of performing a GU assess - Kidneys: Palpation of the kidneys is usually performed by an advanced health care practitioner as part of a more detailed assessment. - Urinary bladder: Palpate and percuss the bladder or use a bedside scanner. - Urethral orifice: Inspect for signs of infection, discharge, or odor. - Skin: Assess for color, texture, turgor, and excretion of wastes. - Urine: Assess for color, odor, clarity, and sediment. 52 ➢ Review s/s of UTI, risks for developing UTI and treatments - pelvic pain, increased urge to urinate, pain with urination, and blood in the urine ➢ Review the effects of immobility on the GU system - Immobility= Urinary stasis; Renal calculi; Urinary retention; Urinary infection ➢ Review causes of urinary incontinence - Transient: appears suddenly and lasts 6 months or less. Usually caused by treatable factors. - Mixed: urine loss with features of two or more types of incontinence - Overflow: over distention and overflow of bladder dribbling 55 PAIN/STRESS & ADAPTATION: ➢ Review the effects that severe/uncontrolled pain has on VS - Increased heart rate, increase blood pressure, increased respiration ➢ Review the types of pain: chronic, acute, intractable, neuropathic, radiating, phantom, referred psychogenic - Chronic= May be limited, intermittent, or persistent; Lasts beyond the normal healing period; Periods of remission or exacerbation are common - Acute= Rapid in onset, varies in intensity and duration; Protective in nature - Intractable= hard to control or deal with - Neuropathic= Chronic pain condition; Result of nerve damage or a malfunctioning nervous system. - Radiating= Radiates into the lower extremity directly along the course of a spinal nerve root; caused by compression, inflammation and/or injury to a spinal nerve root arising from common conditions including herniated disc, foramina stenosis and peridural fibrosis. - Phantom= Feels like it's coming from a body part that's no longer there. - Referred= pain felt in a part of the body other than its actual source. ➢ Review which pain management tasks can be delegated to nursing assistant - Re-positing the patient every 2 hours 56 ➢ Review alternative techniques of pain management: hypnosis, distraction, guided imagery, massage, reiki, music, aromatherapy - Hypnosis= Technique that produces a subconscious state accomplished by suggestions made by a hypnotist, has been used successfully in many instances to control pain - Distraction= talking to the patient or playing a game to help distract from the pain. - Guided imagery= Visualizing a particular out- come or scenario with the goal of mentally changing one’s physical reality 57 - Massage= The manipulation of tissue to relax clumps of knotted muscle fiber, increase circulation, and release patterns of chronic tension - Reiki= Moving a practitioner’s hands over the energy fields of the client’s body to increase energy flow and restore balance - Music= helps relax and sooth the patient - Aromatherapy= The use of essential oils of plants to treat symptoms; reduce stress. ➢ Review risks of inadequate pain management - Increase the risk of chronic pain, abnormal VS, symptoms will get worse. ➢ Review care planning and prioritization of pain control - Establishing trusting nurse–patient relationship - Manipulating factors affecting pain experience - Initiating non-pharmacologic pain relief measures - Managing pharmacologic interventions - Reviewing additional pain control measures, including complementary and alternative relief measures - Considering ethical and legal responsibility to relieve pain - Teaching patient about pain ➢ Describe the body’s stress response - Alarm response= Person perceives stressor, defense mechanisms activated; Fight-or-flight response; Hormone levels rise, body prepares to react; Shock and counter-shock phases