Presentation on theme: "Trisha Economidis, MS, ARNP Lake-Sumter Community College Fall, 2012"— Presentation transcript:
1 Trisha Economidis, MS, ARNP Lake-Sumter Community College Fall, 2012 Sleep, Rest & ComfortTrisha Economidis, MS, ARNPLake-Sumter Community CollegeFall, 2012
2 Sleep Quiz How many Americans suffer from sleep disorders? A. 100,000 B. 1 millionC million
3 How many sleep disorders have been identified? C. 90
4 Who has a greater incidence of insomnia? A. MenB. Women
5 For women, sleep disturbances are often related to hormonal hallmarks (menstruation, pregnancy, menopause).A. TrueB. False
6 Sleep patterns of the older adult include which of the following: (Select all that apply) A. Need more sleep than younger adultsB. Take longer to fall asleep than younger adultsC. Awake more frequently and stay awake longer than younger adultsD. Frequent awakening is often due to physical discomfort and nocturia
7 Physiology of sleep Biorhythms – Biological Controlled within the bodyEnvironmentalCircadian rhythm- BiorhythmDay-night 24 hour clock
8 Types of sleep Non-Rem REM (Rapid Eye Movement) Occurs in minute cycles
13 Alterations in Sleep patterns Dyssomnias InsomniaSleep-wake ScheduleRestless Leg SyndromeSleep DeprivationHypersomniaNarcolepsy
14 Dyssomnias Sleep Apnea- airway occlusion Hypercapnia and hypoxemiaMay have increased heart rate, increased bpS/S: excessive sleepiness, fatigue, snoring, nocturiaDiagnosis: Made by sleep studyUntreated can lead to :HypertensionDysrhythmiasAnginaMIStrokeMood swingsImpotencePersonality changes
15 Sleep ApneaObstructive Sleep Apnea – caused by occlusion of the airway during sleep.TX: CPAP – Continuous Positive Air PressureCentral Sleep Apnea – Dysfunction in central respiratory controlMixed Apnea – combination of Obstructive and Central Sleep Apneas
19 Sleep Hygiene Practices Assessment of Sleep Patterns and ritualsRelaxationEliminate stressful situations before bedMuscle relaxationActivities that relax rather than stimulateWarm bath
20 Sleep Hygiene Environment Adjust light, noise, temp to promote sleep Use bedroom for sleep & sex onlyGo to bed at same time each nightHelp client to understand what things can affect sleep patterns
21 Pharmacologic Interventions for Sleep Be aware of potential side effects and possible dependency issuesShouldn’t mix with alcohol and most are not recommended for long-term use
22 Pharmacologic Interventions Non-benzodiazepines: Ambien, Sonata, LunestaBenzodiazepines: Valium, Ativan, Klonopin, XanaxCaution: Hazardous in elderly; must use cautiously in children; can cause ADDICTION
23 Pharmacologic Interventions, cont. Barbiturates: sedative/hypnotic/anticonvulsants; Seconal, Luminal, NembutalTricyclic Antidepressants: major side effect is drowsiness. Elavil, TofranilOTC Sleep aidsAntihistaminesHerbal remediesMelatonin
24 Nutrition Impact on Sleep No large fatty meals before sleepL-tryptophan increases sleep (milk & cheese)Protein – increases alertness (not a good before bed snack)Carbohydrates promote sleepcrackers, bread, cereal
25 Nursing Diagnoses for Sleep Sleep Deprivation: Occurs over long periods of time and symptoms more severe (confusion, even psychosis)Disturbed Sleep Pattern: time limited sleep pattern. Ex.: related to hospitalization – can be treated by nursing therapy
26 A patient is diagnosed with narcolepsy A patient is diagnosed with narcolepsy. The nurse’s primary intervention should address the patient’s:A. Inability to provide self-careB. Impaired thought processesC. Potential for injuryD. Excessive fatigue
27 Correct Answer: CNarcolepsy is excessive sleepiness in the daytime that can cause a person to fall asleep uncontrollably at inappropriate times (sleep attach) and result in physical harm to self or others
28 The nurse is planning a teaching program for a patient with a diagnosis of obstructive sleep apnea. Which is the most common intervention that the nurse should plan to discuss with this patient?A. Encouraging sleeping in the supine positionB. Using devices that support airway patencyC. Positioning two pillows under the headD. Administering sedatives
29 Answer: B.A continuous positive airway pressure (CPAP) mask worn over the nose when sleeping keeps the upper airway patent through continuous positive airway pressure.
30 Which is the most important nursing intervention that supports a patient’s ability to sleep in the hospital setting?A. Providing an extra blanketB. Limiting unnecessary noise on the unitC. Shutting off lights in the patient’s roomD. Pulling curtains around the bed at night.
31 Answer: BNoise is a serious deterrent to sleep in a hospital. The nurse should limit environmental noise (distributing fluids, providing treatments, rolling drug and linen carts) and staff communication noise.(Turning off the lights is unsafe. You may dim the lights or put a night light on to provide enough illumination for safe ambulation to the bathroom)
32 What concept associated with sleep should the nurse consider to best plan nursing care for a hospitalized patient?A. People require eight hours of uninterrupted sleep to meet energy needsB. Frequency of nighttime awakenings decreases with ageC. Fear can contribute to the need to stay awake.D. Bed rest decreases the need for sleep.
33 Answer: CFear of loss of control, the unknown, and potential death results in the struggle to stay awake, which interferes with the ability to relax sufficiently to fall asleep.
35 Comfort/Pain True or False? The nurse is the best judge of a patient’s pain
36 Answer: FalsePain is SUBJECTIVE – only the client can judge the level and severity of pain
37 TRUE OR FALSE?You should wait until pain has reached the maximum amount bearable before medicating.
38 Answer: FalsePain control/relief is much more effective when given when pain begins
39 True or False?True pain always produces observable signs/symptoms such as grimacing or moaning
40 Answer: FalseMany people are stoic when it comes to expressing pain. One’s culture may also have an impact on the expression of pain.
41 True or False?If the patient doesn’t look like he’s in pain, it’s ok to withhold medications or decrease the dose.
42 Answer: FalsePain is a subjective experience. Only the patient knows how much pain he/she is experiencing.
43 True or False?Clients taking pain medications will become addicted.
44 Answer: FalseWhile it does happen, it is unlikely when analgesics are administered and monitored carefully
45 So….What IS Pain? A sensation that HURTS A SUBJECTIVE experience An interference : a multi-dimensional experience and impactProtective
46 Types or Origins of Pain Cutaneous - superficialSomatic - ligaments, joints, musclesVisceral – internal organs/body cavitiesNeuropathic – nerve painRadiating – Starts at origin, but extends to other locationsReferred – Pain felt distant to originPhantom
48 Duration of PainAcute Pain - Sudden onset/short duration (up to 6 months)Chronic Pain –Has lasted 6 months or longerIntractable Pain – Chronic and very resistant to relief
49 Quality of Pain What does it feel like? Sharp? Dull? Aching? Stabbing? Burning?Crushing?Tingling?
50 Intensity or Severity of Pain How much does it hurt?????Pain Rating Scales imperative – Allows assessment of level of pain and effectiveness of interventions0-10 scaleFaces Pain Rating ScalePoker Chips - “pieces” of pain
53 Assessment of Pain: The Who, What, When, Where, and How The patient self-report is the most reliable indicator of painWhat if it’s a child? The parent/caregiver knows the child best
54 What? What the patient says AND Your observations which may include: Physiological responses: Acute pain - Increased blood pressure, pulse and respirations; dilated pupils, rapid speechBehavioral responses: Moaning, facial grimacing, crying, agitation, guarding, withdrawing from painful stimuliPsychological responses: Anxiety, depression, anger, fear, exhaustion, irritability
55 When? On admission Before and after procedures or treatments With each assessment/vital signsWhen the patient is resting as well as during activityBefore you give pain meds and 30 minutes afterWhen the patient complains of pain
56 Where? Where ever the patient is and whatever is going on? Resting in bedAmbulatingBefore, during, after procedures whether in the patient’s room or in another location
57 How? Begin with a pain history Do you have pain now? When did the pain begin? (Onset)Where is the pain located? (Location)How do you rate your pain? (use a pain scale) (Intensity)How would you describe your pain? (Quality)
58 How? (Pain History) How often do you have pain? (Frequency) What makes the pain better? (Alleviating Factors)What makes it worse? (Aggravating Factors)Do you have any other symptoms when you are experiencing pain, i.e. nausea/vomiting? (Associated Factors)
59 How? (Pain History)Have you experienced this type of pain in the past? If so, how did you manage/cope with it? (History of Previous Pain Experience)Have you used any medications to treat the pain? If so, what have you used and was it effective?What, if any, alternative treatments have you used for pain?
60 Review: Assessing Pain How do we assess? Onset of symptomsLocationIntensityQualityFrequencyAlleviating FactorsAggravating FactorsAssociated FactorsHistory of Previous Pain Experience
61 How? Combine your pain history with your observations of: Physiological responsesBehavioral responsesPsychological responses
62 Factors That May Affect Perception of Pain AgeChild – may not recognize sensation of pain or may have paradoxical reactionAdolescent – may be expressed as “attitude,” anger, aggressionOlder adult – may have trouble verbalizing because of perception that pain is “normal” part of aging
63 Factors that may Affect Pain CultureMay impact level of pain one is willing to endureNeed to use assessment tools that are culturally sensitive
64 Perception of pain is impacted by age and culture.
65 Analgesics Used for Pain 3 common groups of drugs used for pain managementOpioidsNonopioidsAdjuvants
66 Pain Medications: Opioid Analgesics Work on pain by blocking receptors in the Central Nervous System
69 Opioid Analgesics Nursing Considerations: Assess respiratory status frequently. If respiratory depression occurs, administer Narcan to reverse effects. Monitor blood pressure.Monitor for constipation and make appropriate interventions (pg 741)Treat other symptoms as indicated
70 Nonopioid AnalgesicsUsed to relieve mild to moderate pain, acute or chronic (also may relieve inflammation and fever)Acetaminophen (Tylenol) (minimal anti-inflammatory effect)NSAIDS (nonsteroidal anti-inflammatory drugs)aspirinibuprofen (Motrin, Advil)naproxen (Aleve)Prescription NSAIDS: Celebrex, Voltaren, Indocin and others
71 Side/Adverse Effects of Nonopioids Acetaminophen – Can cause liver toxicity especially in patients who consume alcohol or who have liver disease. Current recommendation: maximum of 3000 mg (3g) per day as of July, 2011Aspirin – regular use can cause prolonged clotting time (bruise easily and bleed more)Other NSAIDS – gastric irritation and bleeding, use with caution in patients with impaired clotting and renal disease
72 Nursing considerations for Nonopioids Tylenol – teaching regarding maximum daily dose. Importance of reporting overdose (liver damage occurs rapidly)NSAIDS – importance of taking with food. Use of enteric-coated pills if gastric irritation occurs. Monitor for gi bleeding. Be aware of the possibility for drug interactions.
73 Adjuvant Medications Enhance the analgesic effect of opioids AnticonvulsantsAntidepressantsSedativesSteroids
75 A patient has a total abdominal hysterectomy for Stage 4 ovarian cancer. What should the nurse do first when on the second postoperative day this patient reports abdominal pain at level 5 on a 1 to 10 pain scale?A. Reposition the patientB. Offer a relaxing back rubC. Use distraction techniquesD. Administer the prescribed analgesic.
76 Answer: DMajor abdominal surgery involves extensive manipulation of internal organs and a large abdominal incision that require adequate pharmacological intervention to provide relief from pain
77 A patient states, “The pain moves from my chest down my left arm A patient states, “The pain moves from my chest down my left arm.” Which characteristic of pain is associated with this statement?A. PatternB. DurationC. LocationD. Constancy
78 Answer: CThis is a description of referred pain, which is pain felt in a part of the body that is at a distance from the tissues causing the pain. Referred pain is related to location of pain.
79 A patient has a history of severe chronic pain A patient has a history of severe chronic pain. Which is one of the most important guidelines associated with providing nursing care to this patient?A. Asking what is an acceptable level of painB. Providing interventions that do not precipitate painC. Determining the level of function that can be performed without painD. Focusing on pain management intervention before pain becomes excessive
80 Answer: DAdministration of analgesics around the clock at regularly scheduled intervals or by long-acting controlled-release transdermal patches maintains therapeutic blood levels of analgesics, which limit pain at levels of comfort acceptable to patients.