For patients who are acutely ill, the priority is to maintain a patent airway, which can be managed through positioning or the use of an oral airway or endotracheal tube. Position patient in a semi-Fowler position to allow for optimal chest wall expansion, patient comfort, and adequate gas exchange. Aggressive pulmonary hygiene techniques are used to mobilize secretions and increase alveolar ventilation. These measures should include turning, coughing, and deep breathing every 2 hours postural drainage and percussion every 4 hours and sitting up in a chair twice per day.
To prevent atelectasis, instruct the patient prior to surgery about coughing, deep breathing, and early ambulation. Encourage the patient to request and take pain medications to assist with deep-breathing exercises. Explain that an adequate fluid intake is important to help loosen secretions and aid in their removal.
Explain strategies to reverse CAD through a program that includes a very low fat diet, aerobic exercise, and stress-reduction techniques. Information about resumption of sexual activity acceptable for the medical condition is helpful. Patient information literature is abundant and available from cardiac rehabilitation programs, as well as the American Heart Association. Although many patients will be admitted on the day of surgery, preoperative teaching about the intensive care unit environment, the procedure, postoperative coughing and breathing exercises, and postoperative expectations of care is essential. The surgery is a family crisis that may lead to a long recovery, patient dysfunction, and even death. The family needs emotional support and constant information about the patient's progress.
Systematic desensitization involves the pairing of relaxation with either stimuli reminiscent of the traumatic event (''in vivo'' desensitization) or images of the disrupting event (imaginal desensitization). In vivo exposure to traumatic cues would include a return to the scene of a disruptive event and a gradual approach to the cues that are most evocative of the emotions associated with the event together with the practice of cued relaxation responses such as deep breathing and relaxing imagery. Previously, a graduated hierarchy of anxiety-inducing cues is built by the therapist together with the patient and this enables the therapist to control the extent to which the patient is successfully coping with the anxiety and thus determine whether the patient is ready to face the next step in the hierarchy. Foa et al. 48 reported on the preliminary findings of a therapeutic intervention intended to prevent the development of PTSD in female rape and assault victims. The intervention...
It can be useful to provide anxiety management strategies early in therapy because (1) they can give patients a degree of control over their distress, and (2) these techniques are relatively simple to use. Be aware that most patients experience considerable distress during the initial sessions because they are confronting and expressing upsetting memories. The utility of reducing arousal in the acute posttrauma phase is also indicated by evidence that acute arousal is associated with chronic PTSD (Shalev et al., 1998). Giving the patient some tools to assist mastery over the acute anxiety can provide both a sense of relief and a motivation to comply with more demanding therapy tasks. Anxiety management often involves progressive muscle relaxation (Ost, 1987) and breathing retraining, which aims to achieve 10 breaths a minute. Although these techniques are simple, therapists need to be aware that focusing on bodily sensation or on breathing can trigger reminders of the trauma. First,...
Beat-to-beat variation in heart rate with deep breathing (respiratory sinus arrhythmia). This can be achieved by R-R interval variability assessment (expiratory inspiratory ratio). Power spectral analysis of continuous electrocardiographic (ECG) recordings allows determination of heart rate variability.
When you brush your teeth, be sure to use a soft-bristled brush. Brushes with medium or hard bristles are too abrasive and can make your gums recede from your teeth. Your teeth can then become sensitive to cold liquids because the roots of the teeth, which are normally covered by the gums, have been partially exposed. Place the toothbrush against your teeth at an angle and brush back and forth gently in short strokes. Brush the outer and inner tooth surfaces and the chewing areas of the teeth. Be sure to brush your tongue to remove bacteria and to freshen your breath.
Induction also occurs with inhalational agents, often through combinations of nitrous oxide with halothane or enflourane. Loss of consciousness with these agents is noted by a loss of nystagmus and divergent gaze, midsized pupils, and a regular deep breathing pattern. Once unconscious, the patient is given a dose of muscle relaxant and intubated.
Ayurveda consists of several components. As in traditional Chinese medicine, pulse and tongue evaluation are important for diagnosis. Diet, exercise, lifestyle changes, and specific supplements are used therapeutically. Yoga, breathing exercises, massage, and meditation, discussed elsewhere in this book, are also components of Ayurveda. One type of Ayurvedic meditation, transcendental meditation (TM), was popularized by Maharishi Mahesh Yogi. Another important aspect of Ayurveda, panchakarma, is used for disease prevention. Panchakarma means five processes and includes massages, sweat baths, vomiting, enemas, and bloodletting (through the use of leeches).
Therapist continues to educate the client about trauma and PTSD by discussing reactions that are commonly reported by people who have experienced trauma. Second, the therapist introduces in vivo exposure. In addition to providing a framework for understanding the patient's symptoms and normalizing the reaction to the trauma, the discussion of common reactions provides an opportunity for the patient to identify specific difficulties that he or she has experienced. Once this discussion is completed, the therapist provides a detailed rationale and description of the in vivo exposure procedure. Together the client and therapist construct the hierarchy by identifying situations that the patient avoids and rating each situation on a subjective distress scale. This hierarchy will guide the in vivo exercises through the balance of the program. Homework assignments for the second session consist of (1) reading a handout that describes the common reactions to trauma discussed in the session (2)...
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