-Autogenic relaxation: in this relaxation technique, you use both visual imagery and body awareness to reduce stress; you repeat words or suggestions in your mind that may help you relax and reduce muscle tension.
-Progressive muscle relaxation. In this relaxation technique, you focus on slowly tensing and then relaxing each muscle group; in one method of progressive muscle relaxation, you start by tensing and relaxing the muscles in your toes and progressively working your way up to your neck and head; tense your muscles for about five seconds and then relax for 30 seconds, and repeat
-Visualization. In this relaxation technique, you may form mental images to take a visual journey to a peaceful, calming place or situation; to relax using visualization, try to incorporate as many senses as you can, including smell, sight, sound and touch. If you imagine relaxing at the ocean, for instance, think about the smell of salt water, the sound of crashing waves and the warmth of the sun on your body
-other relaxation techniques: Deep breathing, massage, meditation, tai chi, yoga, biofeedback, music and art therapy, aromatherapy, hydrotherapy
-risks for hearing impairment: exposure to loud environmental sounds, atomic malformation, maternal ingestion of toxic substances during pregnancy, perinatal asphyxia, perinatal infection, chronic ear infection, and ototoxic medications, chronic conditions such as Down syndrome and cerebral palsy
-signs in infants: lack of startle reflex, failure to respond to noise, absence of vocalization by 7 months, lack of response to the spoken word
-older children: using gestures rather than talking after 15 months, failure to develop understood speech by 24, yelling to express emotions, irritability due to inability to gain attention, seeming shy or withdrawn, inattentive to surroundings, speaking in monotone, need for repeated conversation, speaking loudly for situation
One nurse offers to care for Client a today if the other will care for Client B tomorrow.
●Both parties know there is a conflict, but they refuse to face it or work toward aresolution.
●Can be appropriate for minor conflicts or when one party holds more power than the other party or if the issue can work itself out over time. ●Because the conflict remains, it can surface again at a later date and escalate over time.
●This is usually a lose‑lose solution.
●One party attempts to "smooth" another party by trying to satisfy the other party.
●Often used to preserve or maintain a peaceful work environment.
●The focus can be on what is agreed upon, leaving conflict largely unresolved.
●This is usually a lose‑lose solution.
●One party pursues a desired solution at the expense of others.
●Managers can use this when a quick or unpopular decision must be made.
●The party who loses something can experience anger, aggravation, and a desire for retribution.
●This is usually a win‑lose solution.
Strategy: Cooperating/ Accommodating
●One party sacrifices something, allowing the other party to get what it wants. This is the opposite of competing.
●The original problem might not actually be resolved.
●The solution can contribute to future conflict.
●This is a lose‑win solution.
●Each party gives up something.
●To consider this a win/lose‑win/lose solution, both parties must give up something equally important. If one party gives up more than the other, it can become a win‑lose solution.
●Both parties set aside their original individual goals work together to achieve a new common goal. ●Requires mutual respect, positive communication, and shared decision‑making between parties.
●This is a win‑win solution
an experienced nurse on a urology unit arrives to work on the night shift. the unit manager immediately asks the nurse to float to a pediatrics unit because the hospital census is high and they are understaffed. the nurse has always maintained a positive attitude when asked to work on another medical‑surgical unit but states she does not feel comfortable in the pediatric setting. the manager insists the nurse is the most qualified.
Strategy:Avoiding/Withdrawing/SmoothingThe nurse basically cannot use these strategies due to the immediacy of the situation. The assignment cannot be simply avoided or smoothed over; it must be accepted orrejected.
●If the nurse truly feels unqualified to work on the pediatric unit, then this approach can be appropriate: the nurse must win and the manager must lose.
●Although risking termination by refusing the assignment, the nurse should take an assertive approach and inform the manager that pediatric clients would be placed at risk.
●If the nurse decides to accommodate the manager's request, then the pediatric clients can be at risk for incompetent care.
●Practice liability is another issue for consideration.
●This approach generally minimizes the losses for all involved while making certain each party gains something.
For example, the nurse might offer to work on another medical‑surgical unit if someone from that unit feels comfortable in the pediatric environment.
●Although each party is giving up something (the manager gives in to a different solution and the nurse still has to work on another unit), this sort of compromise can result in a win‑win resolution.
Both the nurse manager and nurse come to the agreement providing safe and competent care of the children on the pediatric unit is the common goal. While they might need to compromise/negotiate to address the immediate need they can collaborate to achieve a solution that avoids this situation in the future.
For example, the nurse might agree to orient to the pediatric unit in order to become competent for future assignments and the nurse manager can enlist the services of a staffing agency that provides pediatric nurses on an as needed basis.
● This grief is considered uncomplicated.
● Emotions can be negative, such as anger, resentment,
withdrawal, hopelessness, and guilt but should change
to acceptance with time.
● Some acceptance should be evident by 6 months after
● Somatic complaints can include chest pain, palpitations,
headaches, nausea, changes in sleep patterns,
● This grief implies the "letting go" of an object or person
before the loss, as in a terminal illness.
● Individuals have the opportunity to start the grieving
process before the actual loss.
● Unresolved or chronic grief is a type of
● This grief involves difficult progression through the
expected stages of grief.
● Usually, the work of grief is prolonged. The
manifestations of grief are more severe, and they can
result in depression or exacerbate a preexisting disorder.
● The client can develop suicidal ideation, intense feelings
of guilt, and lowered self‑esteem.
● Somatic complaints persist for an extended period
This grief entails an experienced loss that cannot be
publicly shared or is not socially acceptable, such as
suicide and abortion
A paracentesis is performed by inserting a needle or trocar
through the abdominal wall into the peritoneal cavity. The
therapeutic goal is relief of abdominal ascites pressure.
● A paracentesis can be performed in a provider's office,
outpatient center, radiology department, or acute care
setting at the bed side.
● Usually preformed with ultrasound as a
● Once drained, ascitic fluid can be sent for
Position the client in an upright position, either on the
edge of the bed with feet supported or a high‑Fowler's
position in the bed. Clients who have ascites are
typically more comfortable sitting up
Administer IV bolus fluids or albumin, prior to or after a
paracentesis, to restore fluid balance.
Have the client void, or insert an indwelling
Assess pertinent lab results (serum albumin, protein,
glucose, amylase, BUN, and creatinine).
● Teach the client measures to take in response to manifestations of
hypoglycemia (mild shakiness, mental confusion, sweating, palpitations,
headache, lack of coordination, blurred vision, seizures, and coma).
● Hypoglycemia preventive measures are to avoid excess insulin,
exercise, and alcohol consumption on an empty stomach.
● A decrease in food intake or delay in food absorption can also cause hypoglycemia.
● Check blood glucose level.
● Follow guidelines outlined by the provider or diabetes educator.
● Instruct the client who has hypoglycemia (glucose of 70 mg/dL or less) to
take 15 to 20 g of a readily absorbable carbohydrate (4 to 6 oz of fruit juice or
regular soft drink, glucose tablets or glucose gel per package instructions, 6 to
10 hard candies, or 1 tbsp of honey) and recheck blood glucose in 15 min.
● Repeat the administration of carbohydrates if not within
normal limits, and recheck blood glucose in 15 min.
● If blood glucose is within normal limits, have a snack containing a carbohydrate and
protein (if the next meal is more than 1 hr away). Blood glucose increases approximately
40 mg/dL over 30 min following ingestion of 10 g of absorbable carbohydrate.
● If the client is unconscious or unable to swallow, administer glucagon
subcutaneous or IM (repeat in 10 min if still unconscious) and notify the
provider. Place the client into a lateral position to prevent aspiration.
● In acute care, the nurse should administer 50% dextrose if IV access
is available. Consciousness should occur within 20 min.
● Once consciousness occurs and the client is able to swallow,
have the client ingest oral carbohydrates.
fluid volume deficit: tachycardia, thready pulse, hypotension, tachypnea, syncope, weight loss, oliguria, diminished cap refill, sunken eyeballs, decreased skin turgor
fluid volume excess: tachycardia, bounding pulse, hypertension, tachypnea, increased central venous pressure, confusion, muscle weakness, weight gain, ascites, dyspnea, crackles, edema, distended neck veins
Primary open angle: headache, mild eye pain, loss of peripheral vision, decreased accommodation, halos seen around lights, elevated IOP,
Primary angle-closure: rapid onset of elevated IOP (30 mmHg or greater), decreased or blurred vision, colored halos seen around lights, pupils nonreactive to light, severe pain and nausea, photophobia
-Toxicity: EARLY: N/V, diarrhea, slurred speech, tremors; ADVANCED: GI distress, confusion, coarse tremors, sedation; SEVERE: polyuria, involuntary movements, tinnitus, blurred vision, seizures
-Diuretics increase risk for toxicity
-NSAIDS (ibuprofen/ celecoxib) increase risk for toxicity (use aspirin)
-Anticholinergics can cause urinary retention/ abdominal discomfort
(Pharm ATI: Chapter 9)