Test 4 Flashcards
1
Q
What is Work of Breathing
A
The effort required to expand and contract the lungs
2
Q
Potassium (K+)
A
3.5-5.5 mEq/L
3
Q
Decongestant (purpose)
A
Narrows blood vessels, leading to cleaning of nasal congestion
4
Q
Low Flow oxygen (list)
A
- Nasal Cannula (1-6 L)
- Oximizer- 8L
- Facemask
- –Simple 6-12 L
- –Partial Rebreather and non-rebreather (10-15 L) bags should remain partially inflated
5
Q
Beta-Adrenergic Blocker
medications
A
"LOL" Drugs Cardio selective: -Acebutolol HCL -Atenolol -Betaxolol -Metoprolol
Non-selective:
- Bisoprolol
- Carvedilol
- Nadolol
- Pindolol
- Labetalol
- Propranolol
6
Q
What is a bronchoscopy
A
A visual exam using a bronchoscope
7
Q
PO2 (ABG)
A
80-100 mm Hg
8
Q
Calcium Channel Blockers
A
- Verapamil
- Diltiazem HCL
- Amlodipine
- Nicardipine HCL
9
Q
Cardiac Enzymes
A
- 4%-6% indicative of MI within 4-6 hours of an MI
- Troponin: ( <0.03 ng/ml) — after myocardial injury
10
Q
Explain Diffusion
A
The movement of molecules from higher to lower concentrations, takes place when O2 passes into the capillary bed to be circulated and CO2 leaves the capillary bed and diffuses into the alveoli for ventilator excretion.
11
Q
How should you stop Beta Blockers and why?
A
Do not stop beta blockers abruptly, it may lead to angina, MI, rebound hypertension, and dysrhythmias
12
Q
What is hemothorax
A
Accumulation of blood and fluid in the pleural space, usually from trauma
13
Q
Lipid Lowering Agents (purpose)
A
Inhibits cholesterol synthesis in the liver
-prescribed with bp meds
14
Q
Lipid Lowering Agents (medications)
A
Statin Drugs:
Lovastatin, pravastatin, and simvastatin
15
Q
Adrenergic (medications)
A
- Proventil
- Ventolin
16
Q
Hazards of O2
A
combustion
drying of mucous membranes
17
Q
Explain Perfusion
A
Involves blood flow at the alveolar- capillary bed. Influenced by alveolar pressure. For gas exchange to occur the perfusion of each alveolus must be matched by adequate ventilation
18
Q
HCO3 (ABG)
A
21-28 mEq/L
19
Q
SaO2 (ABG)
A
95%-100%
20
Q
High Flow oxygen (list)
A
- Venturi Mask
- High flow nasal Cannula (HFNC)
-High flow: combination of heat and humidity to minimize damage to mucous membranes
21
Q
What is hyperventilation
A
A state of ventilation in which the lungs remove carbon dioxide faster than it is produced by cellular metabolism
22
Q
Drugs Interacting with Grapefruit Juice
A
Atenolol, Losartan, Valsartan, Verapamil, Diltiazem HCL, Nicardipine HCL, Isosorbide mononitrate, Lovastatin, Simvastatin
23
Q
What is hypoventilation
A
Occurs when alveolar ventilation is inadequate to meet the oxygen demand of the body or eliminate sufficient carbon dioxide
24
Q
What is Orthopnea?
A
-An abnormal condition in which a patient uses multiple pillows when reclining to breathe easier, or sits leaning forward with arms elevated
25
Corticosteroids (medications)
- Prednisone
- Deltasone
- Medrol - dose pack
26
Adrenergic (purpose)
relaxes the smooth muscles in the lungs which results in bronchodilation
27
Angiotensin Converting Enzyme Inhibitors (purpose)
inhibits the formation of angiotensin II vasoconstrictor and blocks the release of aldosterone
28
Cardiac Glycosides
- Inhibits the Na/K pump
| - Used to treat heart failure and irregular heartbeats
29
Midodrine (purpose)
Lowers BP
30
Anticholinergic
Bronchial dilator:
- Atrovent
- Spiriva
31
Cholesterol levels
Total: <200 mg/dL
mod risk: 200-240
high risk- >240
LDL (bad): 60-160
HDL (good): 29-77
32
Different types of lung volumes
Tidal Volume: the amount of air exhaled following a normal inspiration
Residual volume: amount of air left in the alveoli after a full expiration
Forced vital capacity: the maximum amount of air that can be removed from the lungs during forced expiration
33
Hypoxia
Inadequate tissue oxygenation at the cellular level
patient may become cyanotic "blue"
34
Nursing Diagnosis for alterations in oxygenation
- Imparied Cardiac Output
- Acute Pain
- Activity Intolerance
- Risk for Activity Intolerance
- Impaired Airway clearance
35
What is Apnea?
-Absence of respirations for apnea is 15-20 seconds or longer
36
Thiazide (diuretic)
Promotes Na, Cl, and H2O excretion.
Most common Hydrochlorothiazide (HCTZ)
Usually used with antihypertension meds
37
Importance when administering Digoxin
Check apical pulse for 1 full minute prior to administration and monitor K levels
38
What is anemia
Decreased oxygen-carrying capacity (anemia)
39
What is a Pulmonary Function Test
determins ability of the lungs to efficiently exchange O2 and CO2
40
Digoxin
Found in digitalis (foxgloves) plants.
Antidote for dig toxicity is digifab
41
What to instruct patients taking captopril
Rise slowly, may cause lightheadedness
42
Dig Toxicity
> 2ng/ml
- Bradycardia, cardiac dysrhythmias, headaches, malaise, blurred vision, visual illusions, confusion, and delirium.
- White, yellow, or green halos, around objects)
43
Tension pneumothorax
air enters the pleural space and cannot escape
-space is filling with air as the lung collapses. As a result the heart and great vessels shift to the unaffected side.
MEDICAL EMERGENCY
44
What is pneumothorax
collection of air in the pleural space.
the loss of negative intrapleural pressure causes the lung to collapse
45
What is thoracentesis and what is it used for?
-surgical perforatin of chest wall and pleural space with a needle to aspirate fluid for diagnostic or therapeutic purposes
46
What is a chest tube
a catheter is inserted into the pleural space to remove the air, blood, fluids or to reestablish normal pressure
47
Nitrates (purpose)
cause coronary and vascular dilation
48
Hypoxemia
Low levels of O2 in your blood.
49
Beta-Adrenergic Blocker (purpose)
Reduce cardiac output, heart rate, contractility and renin release
50
Corticosteroids (purpose)
Decreases inflammation
51
Noninvasive Ventilation (list)
- Continuous postitive airway pressure (CPAP)
- Bilevel positive airway pressure (BiPAP)
--positive pressure ventilation- uses positive pressure to keep alveoli open, improve gas exchange
52
Complications of traceostomy
- Tube obstruction
- tube dislodgement
- accidental decannulation
- pneumothorax
- subcutaneous emphysema
- bleeding
- infection
53
Digoxin Level
0.5-2ng/ml
toxic range >2ng/ml
54
Brain Natriuitic Peptide (BNP)
<100 pg/ml
increased levels may be used to determine severity of CHF
55
Problems with Lisinopril
Causes a persistent dry non productive cough and angioedema in African Americans
56
What is a Lung Scan
Nuclear scanning test used to ID abnormal masses by size and location
57
Hydrochlorothiazide (HCTZ) (medication)
Thiazide
58
Fludrocortisone (purpose)
Lowers BP
59
Furosemide
Lasix
60
Calcium channel blockers (purpose)
Block the calcium channel promoting vasodilation
61
What is Hypovolemia
Dehydration
| -leads to hypoxia to body tissues
62
Ph (ABG)
7.35-7.45
63
Nitrates (Medications)
- Nitroglycerin
- Isosorbide denitrate
- Isosorbide mononitrate
- Nitroprusside
64
What is Hemoptysis, and what would you test for if a patient has it
- bloody sputum
| - TB test, negative pressure room
65
PCO2 (ABG)
35-45 mm Hg
66
Antihistamine (purpose)
H1 blockers or H1 antagonist, complete with histamine for receptor sites and prevent a histamine reaction.
67
Antihistamine (medication)
Benadryl
68
Loop (diuretics)
Act on loop of Henle to inhibit chloride transport of Sodium into the circulation and inhibit passive reabsorption of Na
- furosemide
69
Angiotensin II Receptor (ARB) (medications)
TAN meds
- Losartan
- Valsartan
- Candesartan
- Eprosartan
70
Angiotensin II Receptor Blockers (purpose)
Similar to ACE inhibitors, difference block angiotensin II at the angiotensin 1 receptors
71
Angiodema
Swelling of the face, extremities, eyes, lips, tongue, difficulty swallowing or breathing
72
What is pulmonary circulation
Primary function is to move blood to and from the alveolar capillary membrane for gas exchange
73
Nonpharmacological treatments for BP
- Stress reduction
- Exercise
- Diet (low salt)
- Decreased ETOH
- Smoking cessation
74
What receptors control the process of ventilation
Neural: control the rate, depth, and rhythm
Chemical: controls the appropriate rate and depth of rate and depth of respirations based on changes in CO2, O2, and H+ concentration in the blood
75
Angiotensin Converting Enzymes Inhibitors (Medications)
ACE Inhibitors
"il" meds
Benazepril, Captopril, enalapril, lisinopril
76
Explain Ventilation
movement of air from the atmosphere through the airways to the alveoli.
- Inspiration: air moves into the lungs
- Expiration: air is moved out of the lungs
77
Objectives for Caring
- Discuss the role of caring in the nurse-client relationship
- Discuss ways the nurses can express caring and how it benefits the nurse-client relationship
- Describe the therapeutic benefit of listening to patients
78
Objectives for Culture
- Discuss social and cultural influences on health, illness, and caring patterns
- Discuss stereotypes and assumptions related to culture and ethnicity, including ways to avoid them in nursing care
- Discuss ethical and legal issues related to culture
79
Objectives for Health
- Describe the relationship between faith, hope, and spiritual well-being
- Compare and contrast the concepts of religion and spirituality
- Identify components of a spiritual assessment and the nurses' role in promoting spiritual health
- Discuss ethical and legal issues related to spirituality
80
Explain caring:
A universal phenomenon that influences the way we think, feel, and behave
81
Theoretical Views on Caring
- Caring is primary
| - Caring helps you provide patient-centered care
82
Leininger's Transcultural Caring
- Caring is an essential human need
- Caring helps to protect, develop, nurture, and sustain people.
- Caring helps an individual or group improve a human condition
83
Watson's Transpersonal Caring
- Promotes healing and wholeness
- Rejects the disease orientation to health care
- Places care before cure
- Emphasizes the nurse-patient relationship
84
Swanson's Theory of Caring
- Defines caring as a nurturing way of relating to an individual
- States that caring is a central nursing phenomenon but is not necessarily unique to nursing practice
85
A patient is experiencing dehydration. While planning care, the nurse considers that the majority of the patient's total water volume exist in which compartment?
- Transcellular
- Extracellular
- Intravascular
- Intracellular
Intracellular-
inside the cells, fluid accounts for approximately two thirds of total body water.
86
```
Which electrolyte is the major cation of extracellular fluid (ECF)?
Sodium
Chloride
Potassium
Phosphorus
```
Sodium
87
A nurse delegates the task of intake and output to a new nursing assistant. The student will verify that the nursing assistant understands the task of I&O when the nursing assistant states,
A. “I will record the amount of all voided urine.”
B. “I will not count liquid stools as output.”
C. “I will not record a café mocha as intake.”
D. “I will notate perspiration and record it as a small or large amount.”
A. "I will record the amount of all voided urine."
88
Total body water (TBW) through the life
- 60% of body weight in adult males
- Decreases with age; 45-55% in older adults
- Women have less water content than men
- Infants 70-80%
89
what is Intracellular (ICF)
located inside the cells; approximately 40% of the total body water. Potassium (K), phosphorus, and magnesium (mg)
90
What is Extracellular fluid (ECF)
located outside the cells; sodium (Na), chloride (Cl), bicarbonate (HCO3), Calcium (Ca)
91
Extracellular Fluid makes up what part of TBW?
20%
92
What is intravascular fluid
the liquid part of the blood (plasma)
93
What is interstitial fluid
between the cells and outside of the blood vessel
94
What is transcellular fluid (fluid space)
Fluids such as cerebrospinal, pleural, peritoneal, and synovial fluids
95
What are electrolytes?
compound that separates into ions (charged particles) when it dissolves in water
96
What are Cations and anions
Positively charged ions
sodium
negatively charged ions
97
What is osmolality
The number of particles per kilogram
98
What is tonicity
A measurement of the concentration of IV solutions compared with the osmolarity of body fluids
99
Explain isotonic
a fluid with the same tonicity as normal blood
100
Explain Hypotonic
a solution more dilute than blood
101
Explain Hypertonic
a solution more concentrated than blood
102
What is Active transport
requires energy (ATP) to move electrolytes across cell membranes against the concentration gradient (from an are of lower concentration to an area of higher concentration)
103
What is diffusion
Passive movement of electrolytes down a concentration gradient (from areas of higher concentration to an area of lower conectration)
104
What is osmosis
process by which water moves through a membrane that separates fluids with different particle concentrations.
105
What is hydrostatic pressure
force of the fluid pressing outward against a surface
106
What is colloid osmotic pressure (oncotic pressure)
inward pulling force caused by blood proteins that helps move fluid from the interstitial are back into the capillaries
107
What is edema
accumulation of fluid within the interstitial spaces
Causes:
- Increase in capillary hydrostatic pressure
- Decrease in plasma oncotic pressure
- Increase in capillary permeability
- Lymph channel obstruction obstruction (lymphedema)
108
What is normal fluid intake and absorption
average 2300 mL
109
Where is thirst control mechanism located?
The thalamus of the brain
110
Fluid output occurs through where
skin, GI tract, lungs, and kidneys
111
Insensible vs Sensible
Insensible: continuous water loss through the lungs and skin without awareness and is not measured.
Sensible: can be perceived by the senses and is measurable: Urine, blood, sweat, diarrhea and vomit.
112
What is an antidiuretic hormone (ADH)
Regulates the osmolarity (particles) of the body fluids by influencing how much water is excreted in urine
113
What is Renin-Angiotensin-Aldosterone System (RAAS)
regulates ECF volume by influencing how much sodium and water are excreted in urine; also regulates BP
114
What is Atrial Natriuretic Peptide (ANP)
regulates ECT volume by influencing how much Na and H2O are excreted in the urine
115
What is hypovolemia
extracellular volume deficit, decrease in the amount of fluid
116
What is extracellular volume excess
increase amount of fluid (increase in Na)
117
What is osmolality (particles) imbalances
disturbances of the concentration of body fluids
118
Hypernatremia
High Sodium
119
Hyponatremia
Low Sodium
120
Low potassium
Hypokalemia
121
High Potassium
Hyperkalemia
122
High Calcium
Hypercalcemia
123
Low calcium
hypocalcemia
124
Low magnesium
Hypomagnesemia
125
High magnesium
Hypermagnesemia
126
Normal range of sodium
135-145 mEq/L
127
What do the cells do in hypernatremia
cells shrivel
128
Symptoms of hypernatremia
thirst, dry, sticky mucous membranes, agitation, confusion, muscle weakness, increased temp, pulse and BP and lethargy
129
What is a major ICF cation
Potassium
130
Acid balances effects on K+ levels
Acidic pulls K+ out of the ICF
Alkaline pushes K+ into the ICF
131
Normal potassium levels
3.5-5.5 mEq
132
What does potassium effect
cardiac and skeletal muscle activity
it is essential for neuromuscular activity and cellular metabolism
133
Causes of Hypokalemia
reduced intake of potassium and increased loss of potassium, diarrhea, and vomiting
134
Symptoms of Hypokalemia
muscle weakness, fatigue, decreased deep tendon reflexes, weak, irregular pulse, N/V, abdominal distention, decreased bowel sounds, and cardiac dsrthymias
135
Causes of hyperkalemia
increased intake and absorption, shift of K+ into the ECF and decreased K+ output
136
Symptoms of hyperkalemia
muscle weakness fatigue, slow weak, irregular pulse, nausea, abdominal cramps, increased bowel sounds, cardiac dysrhythmias, and cardiac arrest
137
Normal calcium value
8.8-10.5 mg/dl
138
What does calcium influence
Influences excitability of nerve and muscle cells; necessary for muscle contraction; needed for the development of bone and teeth
139
Causes of hypocalcemia
inadequate GI absorption, diarrhea, low vitamin D levels, meds such as steroids, furosemide
140
Symptoms of hypocalcemia
influences excitability or nerve and muscle cells, hyperactive reflexes, muscle cramps, tetany, seizure, palpitations, dysrhythmias
141
Causes of Hypercalcemia
Hyperparathyroidism, bone metastases, sarcoidosis, excess vitamin D, prolonged immobility, meds such as thiazides
142
Symptoms of Hypercalcemia
Fatigue, weakness, lethargy, anorexia, nausea, constipation, impaired renal function, kidney stones, dysrhythmias, bone pain, osteoporosis, pathological fractures
143
Magnesium normal value
1.6-2.6 mg/L
144
Causes of hypomagnesemia
decreased mag intake and absorption, malnutrition, chronic alcoholism, chronic diarrhea, meds such as diuretics
145
Side effects of hypomagnesia
muscle cramps and twitching, tetany, seizures, dysrhythmias, hypertension, and disorientation
146
Causes of Hypermagnesemia
excessive use of Mg containing laxatives, and antacids, parenteral overload of magnesium
147
Effects of hypermagnesemia
lethargy, bradycardia, hypotension, hypoactive, deep tendon reflexes, respiratory depression, cardiac arrest
148
What is a major ECF buffer
HCO3
149
What are the acid excretion systems
lungs- carbonic acid-secreted by the lungs in the form of CO2 and H2O kidneys- metabolic acids are secreted by the kidneys
150
What is acidosis and alkalosis
Acidosis 6.80- 7.25
Alkalosis 7.5-7.80
Normal pH is 7.35-7.45
151
What is acidosis
Condition that tends to make the blood relatively too acidic
can be metabolic or respiratory
152
What is alkalosis
Condition that tends to make the blood relatively too basic
can be metabolic or respiratory
153
What is respiratory acidosis?
low pH
high paCO2
- the lungs are unable to excrete enough CO2
154
What is respiratory alkalosis?
high pH
low paCO2
-the lungs excrete too much carbonic acid
155
What is metabolic acidosis?
- low pH
- low HCO3
- occurs from an increase of metabolic acid or a decrease of base
156
What is metabolic alkalosis
- high pH
- high HCO3
- occurs from a direct increase of base (HCO3-), or a decrease of metabolic acid
157
What are colloids
solution that contain protein or large molecular substances that increase osmolality without dissolving in the solution (Albumin)
158
What kind of blood and blood products are there
packed RBC's plasma, platelets, and cryoprecipitate (precipitate of thawed FFP)
159
What are crystalloids
contains fluids and electrolytes and freely cross capillary walls
- isotonic
- hypotonic
- hypertonic
160
Isotonic examples
- same osmolality as ECF, used for hydration and to expand ECF
- solutions-LR, 0.9% NaCl, and 5% Dextrose (DSW) in water
161
Hypotonic examples
less osmolality than ECF, decreases osmolatity by diluting body fluids and moving into the ICF and interstitial spaces. Causes cells to swell
Solutions: 0.45% NaCl, 0.33% NaCl
0.225% NaCl
May cause hemolysis (cell death), low Bp, and hypovolemia
162
Hypertonic examples
- greater osmolality than ECF; pulls water from ICF, causes cells to shrink, monitor for the signs of circulatory overload
- solutions 3% NaCl, 5% NaCl, 5% Dextrose in 0.45% NaCl (D5W1/2NS), 5% Dectrose and 0.9% NaCl (D5NS), 5% Dextrose in LR (D5LR), 10% Dextrose in water (D10W)
163
Explain Rh factor
-antigen in RBC membranes,, people who have this antigen are considered Rh positive; people without the antigen are Rh negative. People who are Rh negative only receive Rh negative blood
164
Transfusion Reactions
- Hemolytic (acute) chills, fever, low back pain
- Febrile (most common) rigors, fever
- Mild allergic reaction- flushing, itching, and hives
- Anaphylactic reaction- anxiety urticaria, dyspnea, wheezing
165
What do you do if a patient has a reaction to an infusion
Stop the infusion immediately.
Keep the IV line open by replacing the IV tubing with new IV tubing and IV fluids, do not turn off the blood and simply turn on the NS, notify physician, monitor vitals, prepare to administer emergency drugs, prepare to administer CPR
166
Types of IV catheters
Short term use: Peripheral catheters (PIV)
Triple Lumen catheter (TLC)
- Implanted ports
- Peripherally inserted central catheters (PICC)
- midline catheter (ML)
- Hickman catheter
167
Complications of Vascular Assist Devices
Infiltration- IV fluids (IVF) leaks into the interstitial
Phlebitis- inflammation of the vein
Infection- invasion and multiplication of a pathogenic organism within the IV site
Extravasation- vesicant leaks into the interstitial compartment causing tissue damage
168
What is the purpose of diuretics?
- Reduce hypertension
| - Decrease edema
169
Types of Diuretics
- Thiazide
- loop
- Osmotic
- Carbonic anhydrase inhibitor
- potassium sparing
170
Thiazide and thiazide like Diuretics (action, use and meds)
Action: Act on distal convoluted renal tubule. Promote Na, Cl, and H2O excretion
Use: Hypertension, peripheral edema
Meds: Chlorothiazide, hydrochlorothiazide, metolazone.
-use cautious in patients taking digoxin may cause digoxin toxicity
171
Side effects/adverse reactions, contradictions of thiazide
-dizziness, headache, weakness, hypotension, Gi distress, constipation, hyperglycemia, electrolyte imbalances, urticarial, hyperuricemia, hyperlipidemia, renal failure
172
Nursing Process of Thiazides
Assessment: assess vital signs, weight, urine output and serum chem for baseline levels, check peripheral extremities for edema
- for fluid overload and hypokalema
- Planning: patient's edema will be decreased
- Interventions: monitor vital signs and electrolytes, observe for adverse effects, measure I & Os and suggest patient takes early in morning so sleep disturbances don't occur, instruct about orthostatic hypotension
173
Loop diuretics (action, side effects, adverse effects, and meds)
-Act on ascending loop of Henle, excrete sodium, water, potassium, calcium, magnesium
side effects: hypokalemia, hyponatremia, hyperglycemia, dizziness, weakness, muscle cramps, headache, hearing loss, orthostatic hypotension,
Meds: Furosemide (Lasix), toresemide
174
Osmotic diuretics (action, use, meds)
Action-increase sodium reabsorption in the proximal tubule and loop of Henle, excrete sodium, chloride, potassium, water
Use: Decrease ICP and IOP, promote excretion of toxic substances
Meds: Mannitol
175
Osmotic Diuretics side effects
-Blurred vision, fluid and electrolyte imbalance, GI distress, acidosis, pulmonary edema, tachycardia,
Contradictions: heart disease, heart failure, renal failure.
176
Carbonic Anhydrase inhibitors (action, use, meds)
Action: excretes sodium, potassium, and bicarbonate.
Use: primarily to decrease intraocular pressure in patients with open angle glaucoma
Meds: Acetazolamide (Diamox)
177
Carbonic Anhydrase inhibitors side effects
confusion, orthostatic hypotension, GI distress, metabolic acidosis, fluid and electrolyte imbalance, crystalluria, renal calculi, hemolytic anemia
178
Potassium sparing diuretics (action, use, side effects, and meds)
Action: promote sodium/water excretion and potassium retention
Use: Edema due to heart failure, cirrhosis of the liver
Side effects: dizziness, headache, weakness, hyperkalemia, GI distress, paresthesia, photosensitivity, muscle cramps
Meds: Spironolactone (Aldactone), triamterene (Dyrenium)
179
What is a patient's perspective of caring
- Connecting
- Being present
- Respecting values, beliefs, and health care choices
180
Explain ethic of care
-an ethic of care is unique so professional nurses do not make professional decisions based solely on intellectual or analytical principles
181
How can a nurse provide presence
```
Being with the patient
Body Language
Listening
Eye contact
Tone of voice
Positive and encouraging attitude
```
182
What does touch do
- provides comfort
| - creates a connection
183
What does listening do
- creates trust
- open lines of communication
- creates a mutual relationship
184
What is social determinants of health
-the conditions in which people are born, grow, live, work, and age
185
What groups are considered marginalized
Gay, lesbian, bisexual, transgender, people of color, people who are physically or mentally challenged, and people who are not college educated
186
What is intersectionality
- A research and policy model used to study the complexities of peoples lives and experiences
- Each of us is at the intersection of two categories: privilege and oppression
187
Factors influencing spirituality
```
Spiritual distress
Acute illness
Chronic illness
Terminal illness
Near Death experience
```
188
Nursing diagnosis (Spirituality)
```
Risk for spiritual distress
Defective spiritual distress
Hopelessness
Spiritual Distress
Decreased spiritual distress
```
189
Implementation (spirituality)
- Health promotion
- Supportive healing relationship
- Support systems
- diet therapies
- supporting rituals
- prayer
- meditation
- supporting grief work
