Patient Assessment, Symptom Management, and Relaxation Training
Assessment
Know how to assess baseline arousal, symptom burden, anxiety, sleep, pain, and adherence. Use validated self-report measures and physiological baselines together. Understand that assessment informs the training plan: a highly anxious patient may need shorter, simpler practice first.
Symptom management
Common intradialytic symptoms include hypotension, cramping, nausea, headache, and fatigue. Relaxation training - paced breathing, progressive muscle relaxation, guided imagery - can reduce distress and improve tolerance, but must be tailored to the patient's energy and cognition.
Relaxation training
Know the sequence: prepare the environment, explain the rationale, guide practice, and assign brief home practice. Progressive muscle relaxation involves tensing and releasing muscle groups; paced breathing slows respiration; imagery uses calming mental scenes. Teach discrimination between relaxation and simply resting.
Traps
Items often confuse relaxation training with biofeedback, or assume relaxation is risk-free - it can trigger anxiety or lightheadedness in some patients. Another trap is using one protocol for every patient regardless of assessment.
Worked rule of thumb
Assess, teach one skill, practice briefly, and review response before adding another technique. If a patient reports increased anxiety during imagery, switch to paced breathing or muscle relaxation and reassess.
Documentation
Record baseline, intervention, response, and any adverse events so the plan can be adjusted.