R



R



6600


Radiation Therapy Management


Definition: Assisting the patient to understand and minimize the side effects of radiation treatments


Activities:



• Monitor pretreatment screening workups for patients at risk for earlier onset, longer duration, and more distressing side effects


• Promote activities to modify the identified risk factors


• Monitor for side effects and toxic effects of treatment


• Provide information to patient and family regarding radiation effect on malignant cells


• Utilize recommended radiation precautions in the management of patients with cardiac pacemakers


• Monitor for alterations in skin integrity and treat appropriately


• Avoid use of adhesive tapes and other skin-irritating substances


• Provide special skin care to tissue folds that are prone to infection (e.g., buttocks, perineum, and groin)


• Avoid application of deodorants and aftershave lotions to treated areas


• Discuss the need for skin care, such as maintenance of dye markings, avoidance of soap, and other ointments, and protection during sunbathing or heat application


• Assist patient in planning for hair loss, as appropriate, by teaching about available alternatives such as wigs, scarves, hats, and turbans


• Teach patient to gently wash and comb hair and to sleep on a silk pillowcase to prevent further hair loss, as appropriate


• Reassure patient that hair will grow back after treatment is terminated, as appropriate


• Monitor for indications of infection of oral mucous membranes


• Encourage good oral hygiene with use of dental cleansing devices, such as unwaxed, non-shredding floss, sonic toothbrushes, or water pics, as appropriate


• Initiate oral health restoration activities, such as use of artificial saliva, saliva stimulants, non-alcohol based mouth sprays, sugarless mints, and fluoride treatments, as appropriate


• Teach patient on self-assessment of oral cavity, including signs and symptoms to report for further evaluation (e.g., burning, pain, and tenderness)


• Teach patient need for frequent dental follow-up care as dental caries can form rapidly


• Monitor patient for anorexia, nausea, vomiting, changes in taste, esophagitis, and diarrhea, as appropriate


• Promote adequate fluid and nutritional intake


• Promote therapeutic diet to prevent complications


• Discuss potential aspects of sexual dysfunction, as appropriate


• Teach implications of therapy on sexual function, including the time frame for contraceptive use, as appropriate


• Administer medications as needed to control side effects (e.g., antiemetics for nausea and vomiting)


• Monitor fatigue level by soliciting the patient’s description of fatigue


• Teach patient and family techniques of energy management, as appropriate


• Assist patient in managing fatigue by planning frequent rest periods, spacing of activities, and limiting daily demands, as appropriate


• Encourage rest immediately after treatments


• Assist patient in achieving adequate comfort levels through the use of pain management techniques that are effective and acceptable to the patient


• Force fluids to maintain renal and bladder hydration, as appropriate


• Monitor for indications of urinary tract infection


• Teach patient and family about the effects of therapy on bone marrow functioning, as appropriate


• Instruct patient and family on ways to prevent infection, such as avoiding crowds, using good hygiene, and handwashing techniques, as appropriate


• Monitor for signs and symptoms of systemic infection, anemia, and bleeding


• Institute neutropenic and bleeding precautions, as indicated


• Facilitate patient’s discussion of feelings about radiation therapy equipment, as appropriate


• Facilitate expression of fears about prognosis or success of treatments


• Provide concrete objective information related to the effects of therapy to reduce patient uncertainty, fear, and anxiety about treatment-related symptoms


• Instruct long-term survivors and their families of the possibility of second malignancies and the importance of reporting increased susceptibility to infection, fatigue, or bleeding


• Initiate and maintain protection according to agency protocol for patient receiving internal radiation treatment (e.g., gold seed placement or radiopharmaceutical agents)


• Explain protection protocols to patient, family, and visitors


• Offer diversional activities while patient is in radiation protection


• Limit visitor time in room, as appropriate


• Limit staff time in the room if patient is isolated for radiation precautions


• Distance oneself from the radiation sources while giving care (e.g., stand at the head of the bed of patient with uterine implants), as appropriate


• Shield oneself using a lead apron/shield while assisting with procedures involving radiation


1st edition 1992; revised 2008



6300


Rape-Trauma Treatment


Definition: Provision of emotional and physical support immediately following a reported rape


Activities:



• Provide support person to stay with patient


• Explain legal proceedings available to patient


• Explain rape protocol and obtain consent to proceed through protocol


• Document whether patient has showered, douched, or bathed since incident


• Document mental state, physical state (clothing, dirt, and debris), history of incident, evidence of violence, and prior gynecological history


• Determine presence of cuts, bruises, bleeding, lacerations, or other signs of physical injury


• Implement rape protocol (e.g., label and save soiled clothing, vaginal secretions, and vaginal hair combings)


• Secure samples for legal evidence


• Implement crisis intervention counseling


• Offer medication to prevent pregnancy, as appropriate


• Offer prophylactic antibiotic medication against venereal disease


• Inform patient of HIV testing, as appropriate


• Give clear, written instructions about medication use, crisis support services, and legal support


• Refer patient to rape advocacy program


• Document according to agency policy


1st edition 1992; revised 2000




4820


Reality Orientation


Definition: Promotion of patient’s awareness of personal identity, time, and environment


Activities:



• Address patient by name when initiating interaction


• Approach patient slowly and from the front


• Use a calm and unhurried approach when interacting with the patient


• Use a consistent approach (e.g., kind firmness, active friendliness, passive friendliness, matter-of-fact, and no demands) that reflects the particular needs and capabilities of the patient


• Speak in a distinct manner with an appropriate pace, volume, and tone


• Ask questions one at a time


• Avoid frustrating the patient by demands that exceed capacity (e.g., repeated orientation questions that cannot be answered, abstract thinking when patient can think only in concrete terms, activities that cannot be performed, decision making beyond preference or capacity)


• Inform patient of person, place, and time as needed


• Present reality in manner that preserves the patient’s dignity (e.g., provides an alternate explanation, avoids arguing, and avoids attempts to convince the patient)


• Repeat patient’s last expressed thought, as appropriate


• Interrupt confabulation by changing the subject or responding to the feeling or theme, rather than the content of the verbalization


• Give one simple direction at a time


• Use gestures and objects to increase comprehension of verbal communications


• Engage patient in concrete “here and now” activities (e.g., ADLs) that focus on something outside self that is concrete and reality oriented


• Provide physical prompting and posturing (e.g., moving patient’s hand through necessary motions to brush teeth), as necessary for task completion


• Encourage use of aids that increase sensory input (e.g., eyeglasses, hearing aids, and dentures)


• Recommend patient wear personal clothing, assist as needed


• Provide objects that symbolize gender identity (e.g., purse or cap), as appropriate


• Use picture cues to promote appropriate use of items


• Avoid unfamiliar situations when possible


• Prepare patient for upcoming changes in usual routine and environment before their occurrence


• Provide for adequate rest and sleep, including short-term daytime naps as needed


• Provide caregivers who are familiar to the patient


• Encourage family to participate in care based on abilities, needs, and preferences


• Provide a consistent physical environment and daily routine


• Provide access to familiar objects, when possible


• Label items in environment to promote recognition


• Modulate human and environmental sensory stimuli (e.g., visiting sessions, sights, sounds, lighting, smells, and tactile stimulation) based on patient’s needs.


• Use environmental cues (e.g., signs, pictures, clocks, calendars, and color coding of environment) to stimulate memory, reorient, and promote appropriate behavior


• Remove stimuli, when possible, that create misperception in a particular patient (e.g., pictures on the wall and television)


• Provide access to current news events (e.g., television, newspapers, radio, and verbal reports), when appropriate


• Involve patient in a reality orientation group setting/class when appropriate and available


• Provide psychoeducation to family and significant others regarding promotion of reality orientation


• Monitor for changes in orientation, cognitive and behavioral functioning, and quality of life


1st edition 1992; revised 2008




5360


Recreation Therapy


Definition: Purposeful use of recreation to promote relaxation and enhancement of social skills


Activities:



• Assist patient/family to identify deficits in mobility


• Assist to explore the personal meaning of favorite recreational activities


• Monitor physical and mental capacities to participate in recreational activities


• Include patient in the planning of recreational activities


• Assist patient to choose recreational activities consistent with physical, psychological, and social capabilities


• Assist in obtaining resources required for the recreational activity


• Assist patient to identify meaningful recreational activities


• Describe benefits of stimulation for a variety of sensory modalities


• Provide safe recreational equipment


• Observe safety precautions


• Supervise recreational sessions, as appropriate


• Provide new recreational activities that are age and ability appropriate, such as brewing root beer, making taffy, or visiting a horse farm


• Provide recreational activities aimed at reducing anxiety (e.g., cards or puzzles)


• Assist in obtaining transportation to recreational activities


• Provide positive reinforcement for participation in activities


• Monitor emotional, physical, and social response to recreational activity


1st edition 1992; revised 1996



0490


Rectal Prolapse Management


Definition: Prevention and/or manual reduction of rectal prolapse


Activities:



• Identify patients with history of rectal prolapse


• Encourage avoidance of straining at stool, lifting, and excessive standing


• Instruct patient to regulate bowel function through diet, exercise, and medication, as appropriate


• Assist patient to identify specific activities that have triggered rectal prolapse episodes in the past


• Monitor for bowel incontinence


• Monitor status of rectal prolapse


• Position patient on left side with knees raised toward chest, when rectum is prolapsed


• Place a water- or saline-soaked cloth over the protruding bowel to protect it from drying


• Encourage patient to remain in side-lying position to facilitate return of bowel into rectum naturally


• Manually reduce rectal prolapse with lubricated, gloved hand, gently applying pressure to prolapse until it returns to a normal position, as necessary


• Check rectal area 10 minutes after manual reduction to ensure that prolapse is in correct position


• Identify frequency of occurrence of rectal prolapse


• Notify physician of change in frequency of occurrence or inability to manually reduce prolapse, as appropriate


• Assist in preoperative workup, as appropriate, helping to explain the tests and reduce anxiety for the patient who will undergo surgical repair


2nd edition 1996




8100


Referral


Definition: Arrangement for services by another care provider or agency


Activities:



• Perform ongoing monitoring to determine the need for referral


• Identify preference for referral agency


• Identify health care providers’ recommendation for referral, as needed


• Identify care required


• Determine whether appropriate supportive care is available in the home or community


• Determine whether rehabilitation services are available for use in the home


• Evaluate strengths and weaknesses of family or significant others for responsibility of care


• Evaluate accessibility of environmental needs for the patient in the home or community


• Determine appropriate equipment for use after discharge, as necessary


• Determine patient’s financial resources for payment to another provider


• Arrange for appropriate home care services, as needed


• Inform patient of appropriate internet sites for use after discharge


• Encourage an assessment visit by receiving agency or other care provider, as appropriate


• Contact appropriate agency or health care provider


• Minimize time between discharge and appointment with next provider


• Complete appropriate written referral


• Send written referral and patient’s plan of care electronically, as appropriate


• Provide patient or family member with a copy of the referral information, as appropriate


• Arrange mode of transportation


• Discuss patient’s plan of care with next health care provider


1st edition 1992; revised 2013



1520


Reiki


Definition: Using a specific sequence of hand positions and symbols to channel the universal life force for recharging, realigning, and rebalancing the human energy field


Activities:



• Create a calm and comfortable environment


• Use aroma or gentle music to create a healing atmosphere


• Wash your hands


• Ask about the chief complaints, such as the presence of pain in certain areas or the presence of a particular illness


• Have the Reiki receiver sit comfortably or lay down on a massage table, fully clothed, in a supine position


• Limit any unnecessary distractions


• Relax your mind and take a few deep breaths to focus yourself


• Remember, the Reiki does the work, not the practitioner


• Begin by sending Reiki from about 3 feet away, if possible, as a gentle way of beginning the session


• Follow a specific series of hand placements: over eyes, over ears, one hand on forehead and one hand on top of head, hands under head, over the neck, upper chest, upper abdomen, lower abdomen, thighs (one at a time), knees (one at a time), lower legs, ankles, feet, bottoms of feet, have client roll over on to stomach, shoulders, waist area, lower back, backs of legs as front of legs


• Draw or visualize Reiki symbols (e.g., power, mental or emotional, distance) as guided by your intuition


• Allow your intuition to guide your movements by placing hands on (or a few inches over) the part of the body that most requires healing


• Stay in each area for 5 to 15 minutes, or until you feel the energy flow more slowly, or your intuition informs you it is time to move hand position


• Ask for specific permission during the session to work on sexual organs or parts of the body that would be considered inappropriate, if so guided


• Move one hand at a time so that you maintain contact as much as possible


• Note whether the patient has experienced a relaxation response and any related changes


6th edition 2013




6040


Relaxation Therapy


Definition: Use of techniques to encourage and elicit relaxation for the purpose of decreasing undesirable signs and symptoms such as pain, muscle tension, or anxiety


Activities:



• Describe the rationale for relaxation and the benefits, limits, and types of relaxation available (e.g., music, meditation, rhythmic breathing, jaw relaxation, and progressive muscle relaxation)


• Screen for current decreased energy level, inability to concentrate, or other concurrent symptoms that may interfere with cognitive ability to focus on relaxation technique


• Determine whether any relaxation intervention in the past has been useful


• Consider the individual’s willingness to participate, ability to participate, preference, past experiences, and contraindications, before selecting a specific relaxation strategy


• Provide detailed description of chosen relaxation intervention


• Create a quiet, nondisrupting environment with dim lights and comfortable temperature, when possible


• Suggest that the individual assume a comfortable position, with unrestricted clothing and eyes closed


• Individualize the content of the relaxation intervention (e.g., by asking for suggestions of changes)


• Elicit behaviors that are conditioned to produce relaxation, such as deep breathing, yawning, abdominal breathing, or peaceful imaging


• Invite the patient to relax and let the sensations happen


• Use soft tone of voice with a slow, rhythmical pace of words


• Demonstrate and practice the relaxation technique with the patient


• Encourage return demonstrations of techniques, if possible


• Anticipate the need for the use of relaxation


• Provide written information about preparing and engaging in relaxation techniques


• Encourage frequent repetition or practice of technique(s) selected


• Provide undisturbed time, because patient may fall asleep


• Encourage control of when the relaxation technique is performed


• Regularly evaluate individual’s report of relaxation achieved, and periodically monitor muscle tension, heart rate, blood pressure, and skin temperature, as appropriate


• Develop a tape of the relaxation technique for the individual to use, as appropriate


• Use relaxation as an adjuvant strategy with pain medication or in conjunction with other measures, as appropriate


• Evaluate and document the response to relaxation therapy

Related posts:

  1. F
  2. P
  3. B
  4. V

Stay updated, free articles. Join our Telegram channel
Tags:
Dec 3, 2016 | Posted by in NURSING | Comments Off on R

Full access? Get Clinical Tree
Get Clinical Tree app for offline access