Control of central venous access device |
Indicate early on a central venous access device, based on individual characteristics and the proposed chemotherapy protocol. The Adult Venous Assessment Tool (VAT) and Deciding on Intravenous Access (DIVA) were applied for the purpose of decision making (1616 Wells S. Venous access in oncology and haematology patients: part two. Nurs Stand. 2008;23(1):35-42. doi: 10.7748/ns2008.09.23.1.35.c6652 https://doi.org/10.7748/ns2008.09.23.1.3...
). |
Provide information related to the device (type, indication, function and precautions with the device). |
Clarify the short-, mid- and long-term risks and benefits of catheters. |
Check that the patient understands the purpose, care and maintenance of the semi-implanted catheter. |
Reduction of anxiety and fear |
Help the patient identify situations that precipitate anxiety and fear. |
Identify other situations that cause panic and anxiety, such as differential diagnosis (44 Marrs JA. Stress, fears, and phobias: the impact of anxiety. Clin J Oncol Nursing. 2006;10(3):319-22. doi: 10.1188/06.CJON.319-322 https://doi.org/10.1188/06.CJON.319-322...
,2020 McGrandles A, Duffy T. Assessment and treatment of patients with anxiety. Nurs Stand. 2012;26(35):48-57. doi: http://dx.doi.org/10.7748/ns2012.05.26.35.48.c9082
http://dx.doi.org/10.7748/ns2012.05.26.3...
) of needle phobia. |
Apply specific scales for assessing levels of anxiety (1010 Bulechek GM, Butcher HK, Dochterman JM, Wagner CM. NIC - Classificação das intervenções de enfermagem. 6ª ed. Rio de Janeiro: Elsevier; 2016. ), fear and depression, before, during and after chemotherapy. The Beck Anxiety Inventory (1212 Beck AT, Epstein N, Brown G, Steer RA. An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol. 1988;56(6):893-7. doi: 10.1037/0022-006X.56.6.893 https://doi.org/10.1037/0022-006X.56.6.8...
-1313 Cunha JA. Manual da versão em português das Escalas Beck. São Paulo: Casa do Psicólogo; 2001. ) and Hospital Anxiety and Depression Scale (anxiety subscale) (1414 Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67(6):361-70. doi: 10.1111/j.1600-0447.1983.tb09716.x https://doi.org/10.1111/j.1600-0447.1983...
-1515 Botega NJ, Bio MR, Zomignani MA, Garcia Jr C, Pereira WAB. Transtornos do humor em enfermaria de clínica médica e validação de escala de medida (HAD) de ansiedade e depressão. Rev Saúde Pública. 1995;29(5):355-63. doi: 10.1590/S0034-89101995000500004 https://doi.org/10.1590/S0034-8910199500...
) were applied. |
Teach slow breathing exercises to promote relaxation (44 Marrs JA. Stress, fears, and phobias: the impact of anxiety. Clin J Oncol Nursing. 2006;10(3):319-22. doi: 10.1188/06.CJON.319-322 https://doi.org/10.1188/06.CJON.319-322...
). Reduction of carbon dioxide blood levels, triggered by hyperventilation, should be avoided. This results in cerebral vascular constriction, reduced availability of oxygen and syncope symptoms. In addition, blood pressure levels may also be high due to the intervention (2121 Kowalsky JM, Conatser R, Ritz T, France CR. Effects of respiratory and applied muscle tensing interventions on responses to a simulated blood draw among individuals with high needle fear. J Behav Med. 2018;41(6):771-83. doi: 10.1007/s10865-018-9925-8 https://doi.org/10.1007/s10865-018-9925-...
). |
Instruct the patient to avoid medications and substances such as alcohol, caffeine and stimulants of the central nervous system, since they can aggravate the symptoms of anxiety and/or phobia (44 Marrs JA. Stress, fears, and phobias: the impact of anxiety. Clin J Oncol Nursing. 2006;10(3):319-22. doi: 10.1188/06.CJON.319-322 https://doi.org/10.1188/06.CJON.319-322...
). |
Assess verbal and non-verbal signs of anxiety (1010 Bulechek GM, Butcher HK, Dochterman JM, Wagner CM. NIC - Classificação das intervenções de enfermagem. 6ª ed. Rio de Janeiro: Elsevier; 2016. ), fear and potential psychological complications associated with intravenous insertion. |
Refer to a mental health specialist when necessary, since certain interventions are beyond the technical, ethical and legal competencies of nurses, in order for the patient to receive psychotherapeutic and clinical treatment for phobia and mood disorders (44 Marrs JA. Stress, fears, and phobias: the impact of anxiety. Clin J Oncol Nursing. 2006;10(3):319-22. doi: 10.1188/06.CJON.319-322 https://doi.org/10.1188/06.CJON.319-322...
,2020 McGrandles A, Duffy T. Assessment and treatment of patients with anxiety. Nurs Stand. 2012;26(35):48-57. doi: http://dx.doi.org/10.7748/ns2012.05.26.35.48.c9082
http://dx.doi.org/10.7748/ns2012.05.26.3...
). |
Recognize panic attack risk factors in the nursing record, such as low weight, start of treatment, younger age, fear of fainting, concerns about health risks, fear of "being afraid", treatment with anxiolytics or antidepressants, smoking and use of illicit substances (2222 Miedziun P, Czabała JC. Stress Management Techniques. Arch Psychiatry Psychother. 2015;17(4):23-31. doi: 10.12740/APP/61082 https://doi.org/10.12740/APP/61082...
). |
Counseling |
Educate the patient about the disorder (44 Marrs JA. Stress, fears, and phobias: the impact of anxiety. Clin J Oncol Nursing. 2006;10(3):319-22. doi: 10.1188/06.CJON.319-322 https://doi.org/10.1188/06.CJON.319-322...
,2020 McGrandles A, Duffy T. Assessment and treatment of patients with anxiety. Nurs Stand. 2012;26(35):48-57. doi: http://dx.doi.org/10.7748/ns2012.05.26.35.48.c9082
http://dx.doi.org/10.7748/ns2012.05.26.3...
), supplying factual information as necessary and appropriate (1010 Bulechek GM, Butcher HK, Dochterman JM, Wagner CM. NIC - Classificação das intervenções de enfermagem. 6ª ed. Rio de Janeiro: Elsevier; 2016. ). Teach the patient to replace thoughts that increase fear, such as "expecting to faint" with others that promote self-confidence, such as: "whatever goes up (fear), comes down". |
Distraction |
Encourage the individual to choose distraction techniques, such as listening to music, deep breathing exercises and recalling positive events (44 Marrs JA. Stress, fears, and phobias: the impact of anxiety. Clin J Oncol Nursing. 2006;10(3):319-22. doi: 10.1188/06.CJON.319-322 https://doi.org/10.1188/06.CJON.319-322...
,1010 Bulechek GM, Butcher HK, Dochterman JM, Wagner CM. NIC - Classificação das intervenções de enfermagem. 6ª ed. Rio de Janeiro: Elsevier; 2016. ,2323 Sampaio F, Sequeira C, Canut MTL. Intervenções psicoterapêuticas de enfermagem NIC na prática clínica em Portugal: um estudo descritivo. Rev Port Enferm Saúde Mental. 2016;16:11-8. doi: 10.19131/rpesm.0152 https://doi.org/10.19131/rpesm.0152...
). |
Promotion of cerebral perfusion |
Provide instruction in the muscle tension technique, which is the application of repeated isometric tension in the muscles of the legs, buttocks, abdomen or trunk during other invasive procedures or those with needles. The intervention prevents and alleviates presyncope and syncope symptoms. This leads to an improvement in cerebral blood flow, oxygenation, cardiac output and blood pressure. This technique diverts peripheral blood from large muscles to central circulation (2121 Kowalsky JM, Conatser R, Ritz T, France CR. Effects of respiratory and applied muscle tensing interventions on responses to a simulated blood draw among individuals with high needle fear. J Behav Med. 2018;41(6):771-83. doi: 10.1007/s10865-018-9925-8 https://doi.org/10.1007/s10865-018-9925-...
). |