2Objectives Define basic human needs Define: self-actualization, self-esteem, love, security, belonging and physiologic needs according to Maslow’s Hierarchy of NeedsExplain and list physiologic needsDefine the terms associated with pain: agonist, analgesic, biofeedback, antagonist, relaxation, mediation, PCA endorphinsUnderstand pain measurement techniquesDescribe techniques used to relieve painEvaluate effectiveness of pain control measures
3Objectives List causes of discomfort for patients List nursing measures to promote comfort and ease discomfort for patients
4Comfort and Discomfort List some attributes associated with comfort:Examples:Warmth, softness, rest, quiet, coolness, cleanliness, space, safetyName some more that you associate with comfort
6Comfort and Discomfort List some attributes that you might associate with discomfortExamples: pain, nausea, fear, hunger, thirst, dark, worryList some other examples
7Human NeedsBasic human needs: those which are common to all people and essential for survivalSome can be met independently; some are dependent on relationships with othersFood, water, shelter, warmthConnection, love, security, spirituality
9MaslowProfessor of psychology at Brandeis University who founded humanistic psychologyCreated the Theory of Basic Human NeedsUseful for understanding the relationships of basic human needs and for establishing priorities of careTheory of Basic Human Needs is a foundation for nursing care and interventions
10Basic Human Needs have the following characteristics The absence of a basic human need results in illness.The presence of basic human needs helps prevent illness or signals health.Meeting basic human needs restores health.It is preferred over other satisfactions when unmetOne feels something missing when needs are unmet.One feels satisfaction when needs are met.
11Maslow’s Hierarchy of Needs Certain needs are more basic than othersAll people have the same needs all of the time, people generally strive to meet certain of their needs before attending to othersLevel 1: Physiologic needsLevel 2: Safety and security needsLevel 3: Love and belonging needsLevel 4: self-esteem needsLevel 5: Self-actualization needs
13Basic Human NeedsLevel 1: Physiologic - oxygen, water, food, temperature, elimination, sexuality, physical activity and restMost basic needs and have the highest priorityUsually can be met through self-care, but many people who are ill require assistanceLevel 2: Safety and security - safe environment, protection from violence, safe emotional environmentLevel 3: Love and belonging needs - understanding and acceptance of others; belonging to a community
14Basic Human NeedsLevel 4: Self-Esteem needs - need to feel pride and a sense of accomplishment, respect, appreciationCan be affected by body image, role changesLevel 5: Self-Actualization needs - need to reach one’s own full potential
15Level 1: Physiologic Needs A need which must be met at least minimally to maintain life; the most basic in the hierarchy and therefore with the highest priorityMost healthy children and adults can meet these needs through self-careVery young, old, disabled and ill people requires assistance in meeting themThe lack of any of the following cause discomfortOxygen: respiratory diseases, cardiac diseaseWater: dehydration, hypovolemia,Food: starvation, NPOWarmth
17Level 2: Safety and security needs Involves both physical and emotional componentsPhysical security:Using hand hygiene and sterile techniques to prevent infectionUsing electrical equipment properlyAdministering medications knowledgeableyUsing skill when moving and ambulating patientsAssessing patients for potential risks, such as falling, bleeding, infection
19Level 2: Safety and security needs Emotional safety and security: being free from fear, anxiety and apprehensionPatients entering health care system face fear of the unknown, their prognosis, unfamiliar surroundings, unfamiliar personnelAll patients have anxietyComfort measures: explain procedures, friendly, unhurried approach, continuity of caregivers, relationship building.
20Level 3: Love and Belonging Needs All humans have this needCalled a higher-level needIncludes understanding, acceptance and a feeling of belonging to families, peers, friends, communityNursing interventions to help meet this need:Including family and friends in the care of the patientEstablishing a nurse-patient relationship based on mutual understanding and trust (by demonstrating caring, encouraging communication and respecting privacy)
22Level 4: Self-Esteem Needs Need for the person to feel good about him or her self, pride and a sense of accomplishmentFactors which impact self-esteem: role changes, body-image changes as a result of illness, surgeryNursing interventions: respecting patients values and beliefs, encouraging patients to meet attainable goals
24Level 5: Self-Actualization Needs The need for individuals to reach their full potential through development of their unique capabilitiesIn general, the lower level needs must be met before this need can be satisfied.
25Self-Actualization Characterized by: acceptance of self and others as they arefocus of interest on problems outside oneselfability to be objectivefeelings of happiness and affection for othersRespect for all peopleAbility to discriminate between good and evilCreativity in solving problems and pursuing interests
27Nursing Process Assessment: gathering information, data Diagnosis: Name the problemPlanning: State an achievable goalInterventions: Actions that work toward the stated goalEvaluation: Did the plan/interventions meet the stated goal
28Nursing Interventions to Meet Patient Needs Physiologic needs usually take priorityBasic human needs are interrelatedExamples:ER patient with an MI:Level 1 needs?Level 2 needs?Level 3,4,and 5 needs?Post-surgical patient in painPt. NPO for surgery
29QuestionA nurse who focuses attention on the strengths and abilities of his patients rather than their problems is helping them to achieve which of Maslow’s basic human needs?A. Self-actualizationB. Self-esteemC. Love and belongingD. Safety and securityE. Physiologic
30Answer Answer: A. Self-actualization Rationale: To meet patient self-actualization needs, nurses provide a sense of direction and hope and maximize patient potential.Self-esteem needs are met by respecting patient values and beliefs and setting attainable goals for them.Love and belonging needs are met by including family and friends and establishing caring relationships with patients.Safety and security needs are met by encouraging spiritual practices and independent decision making.Physiologic needs are needs that must be met to maintain life.
31Comfort and Discomfort Physiologic Discomfort can come from:PainNausea and VomitingShortness of breathHungerThirstInactivityConstipation
33PainDef: an unpleasant, subjective sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damageIt is a red flag indicating that something is wrong: “Protective in nature”Such an indicator of health that it is called the “5th Vital Sign”
34Pain American Bar Association: Pain relief is a legal right Therefore: Nurses are legally and ethically responsible for managing pain and sufferingMcCaffrey: “Pain is whatever the experiencing person says it is, existing whenever he says it is.”
36Categories of Pain Duration Location or source Mode of transmission Etiology
37Pain: Duration Acute pain: rapid in onset, varies in intensity from mild to severe; warning signal that somethingis wrong (cut finger, sore throat, headache)Chronic pain: may be limited, intermittent or persistent, but lasts belong the normal healingperiod. Can be periods of remission or exacerbation. (cancer pain, back pain). Interferes with normal functioning
38Pain: Location or Source Cutaneous Pain (superficial) usually involves the skin of subcutaneous tissue: paper cutSomatic Pain originates in tendons, ligaments, bones, blood vessels and nerves: sprains, broken bonesVisceral pain is poorly localized and originates in body organs in the thorax, cranium, and abdomen: stomach pain
39QuestionA patient who has bone cancer is most likely experiencing which of the following types of pain?A. CutaneousB. SomaticC. VisceralD. Referred
40Answer Answer: B. Somatic Rationale: Deep somatic pain is diffuse or scattered and originates in tendons, ligaments, bones, blood vessels, and nerves.Cutaneous pain usually involves the skin or subcutaneous tissue.Visceral pain is poorly localized and originates in body organs.Referred pain is pain that originates in one part of the body and is perceived in an area distant to that part.
41Origin of Pain Physical—cause of pain can be identified Psychogenic—cause of pain cannot be identifiedReferred—pain is perceived in an area distant from its point of origin
42Pain: Mode of transmission Referred Pain: pain which is perceived in an area of the body distant from its point of originHeart Attack or Myocardial Infarction: pain is felt in shoulder, jaw, or arms
44Pain: EtiologyNeuropathic pain: pain resulting from an injury of or abnormal functioning of peripheral or central nervous system (fibromyalgia, peripheral neuropathy)Intractable: pain that is very resistant to treatmentPhantom Pain: pain in an amputated limb
46Terms to knowAgonist: a drug that binds with a receptor to produce a therapeutic responseAnalgesic: drug that relieves painAntagonist: a drug that binds to a receptor to prevent the action of an agonistPlacebo: “an inactive substance that gives satisfaction to the person using it”Nociceptors: Peripheral nerve fibers that transmit pain
47The Pain Process Transduction—activation of pain receptors Transmission—conduction along pathways (A-delta and C- delta fibers)Perception of pain—awareness of the characteristics of painModulation—inhibition or modification of pain
49Stimulator of Nociceptors or Pain Receptors Bradykinin: powerful vasodilator, trigger release of histamine (redness, swelling, inflammation)Prostaglandins: hormone-like substances that send additional pain stimuli to the CNSSubstance P: sensitized receptors on nerves to feel painThese are Neurotransmitters: substances that excite or inhibit target nerve cells
53Perception of PainPain threshold: lowest intensity of a stimulus that is recognized as painAdaptation: “getting used to the stimulus”Modulation of pain: sensation of pain is modified or lessened by naturally produced chemical substancesNeuromodulatorsEndorphins, dynorphins, enkephalins
54Gate Control Theory of Pain States that certain small nerve fibers conduct pain impulses toward the brainCertain large nerve fibers appear to block pain impulses toward the brainA “gating mechanism” occurs when too much information is sent to the brain and the pain signal is interruptedThe brain can influence its own gating mechanism through past experiences and learned behaviors
60Symptom Analysis P, Q, R, S, T P = Place: where is the pain (or other symptom)?Q= Quality: what does it feel like?R = Radiation: does it go anywhere else?S = Severity:how bad is it? Rate it on a 1-10 scaleT = Time: how long have you had this?
61Nursing Interventions for Pain Establishing trusting nurse–patient relationshipManipulating factors affecting pain experienceReviewing additional pain control measuresInitiating nonpharmacologic and pharmacologic pain relief measuresConsidering ethical and legal responsibility to relieve painTeaching patient about pain
65Pharmacologic Pain Relief Measures Selecting analgesics Pharmacological – AnalgesicsNon-opiods – act on peripheral nerve ending at the injury site (Tylenol, NSAIDS)Opiods – Act on the CNS (Morphine, Codeine, Demerol; also synthetic opiods like Dilaudid)Adjuvants/Co-analgesics – Used in combination with opiods (benzodiazapines: Valium, Ativian)
71Scheduling Analgesic Doses Preventive approach to pain management is crucialNurses should be able to anticipate procedures and activities which will cause pain and pre-medicate the patientPain should be controlled “ATC” or around the clock with long-acting medications and/or prn with “break-through” medicationsWhen pain is out of control, larger doses are required
72Comfort Measures Provide quiet, clean, uncluttered environment Provide warmth or coolness as indicatedProvide personal hygiene: keep patient clean and dry, linen changes, oral careProvide activity as indicated: TV, radio, reading materialExplain all procedures, tests, hospital routinesFacilitate family visits and supportCheck with patient at regular intervals about his comfort/discomfortKeep call light within reach and encourage patient to call you if needed