1. Chapter 10 Comfort and safety Chapter 10 Comfort and safety 中国医科大学护理学院 曹 颖 曹 颖

2. Objectives 1. Describe “ Comfort, pain ” 1. Describe “ Comfort, pain ” 2. Identify the etiologies causing discomfort 2. Identify the etiologies causing discomfort 3. Describe the nursing care of clients with 3. Describe the nursing care of clients with pain pain 4. Understand the functions of common 4. Understand the functions of common positions. positions. 5. Know the usages of protective devices, 5. Know the usages of protective devices, crutches and canes. crutches and canes.

3. Section 1 To Meet Comfort Need Section 1 To Meet Comfort Need 1. Comfort: strengthen greatly, renewal 1. Comfort: strengthen greatly, renewal *(1) Definition ： a mental state of physical *(1) Definition ： a mental state of physical and psychological health, and psychological health, no pain no anxiety and relaxing at ease. no pain no anxiety and relaxing at ease. subjective feeling, a positive mind-set subjective feeling, a positive mind-set client-led & nurse-controlled client-led & nurse-controlled * (2) Highest level of comfort: * (2) Highest level of comfort: all need are met all need are met

4. (3) Related factors (3) Related factors a Physical comfort needs a Physical comfort needs b Psychospiritual comfort needs b Psychospiritual comfort needs c Social comfort needs c Social comfort needs d Environmental comfort needs d Environmental comfort needs

5. 2. Discomfort 2. Discomfort (1) Etiology (1) Etiology *(2) Manifestation *(2) Manifestation irritation irritation insomnia insomnia fatigue fatigue depress depress loss loss despair despair pain pain

6. (3) Nursing (3) Nursing A solace: talking in soothing tones A solace: talking in soothing tones B providing a warm blanket a cup of tea B providing a warm blanket a cup of tea C maintaining a quiet environment C maintaining a quiet environment D coordinating the activities of other staff D coordinating the activities of other staff E supporting: medical staff. the clients family E supporting: medical staff. the clients family members or significant others members or significant others F touch, applying lotion to dry skin F touch, applying lotion to dry skin G encouraging decision making G encouraging decision making

7. 3 The methods to improve comfort 3 The methods to improve comfort Position Position Active Position Active Position passive Position passive Position Compulsory Position Compulsory Position Stable Position Stable Position Unstable Position Unstable Position

8. Position Position a supine position: dorsal recumbent P a supine position: dorsal recumbent P b side lying position: lateral P b side lying position: lateral P c Fowler ’ s position: Semisitting P c Fowler ’ s position: Semisitting P d orthopneic position d orthopneic position e prone position e prone position f trendelenburg position f trendelenburg position g dorsal elevated position g dorsal elevated position h knee chest position h knee chest position i lithotomy position i lithotomy position

9. Section 2 Pain Section 2 Pain **1. Definition **1. Definition An unpleasant sensory and emotional experience associated with actual or potential damage or described in terms of such damage. An unpleasant sensory and emotional experience associated with actual or potential damage or described in terms of such damage. * 2. Nature * 2. Nature Physiologic and psychologic Physiologic and psychologic subjective and individual body ’ s defense mechanisms body ’ s defense mechanisms

10. 3. Types of pain 3. Types of pain (1) According to its origin (1) According to its origin a Cutaneous pain ： skin, subcutaneous b Deep somatic pain: ligament, bone, nerves c Visceral pain: abdominal cavity, cranium (2) According to where it is experienced in the body (2) According to where it is experienced in the body a Radiating pain b Referred pain

11. C According to duration C According to duration a acute pain a acute pain b chronic pain b chronic pain D Intractable pain D Intractable pain E Neuropathic pain E Neuropathic pain F Phantom pain F Phantom pain G Pain syndromes G Pain syndromes

12. 4 Precipitating factors 4 Precipitating factors a chemical factors: a chemical factors: b Physical factors: temperature, incision, b Physical factors: temperature, incision, c pathological factors: diseases c pathological factors: diseases d. Emotional factors: d. Emotional factors: 5 Concepts associated with pain 5 Concepts associated with pain pain threshold is the amount of pain stimulation a person requires in order to feel pain pain threshold is the amount of pain stimulation a person requires in order to feel pain pain tolerance is the maximum amount and duration of pain that an individual is willing to endure pain tolerance is the maximum amount and duration of pain that an individual is willing to endure

13. 6 Factors affecting the pain experience 6 Factors affecting the pain experience a Ethnic and cultural values a Ethnic and cultural values b Developmental stage b Developmental stage c Past pain experiences c Past pain experiences d Attention d Attention e Emotion: Anxiety and stress e Emotion: Anxiety and stress F Individual difference F Individual difference G Social support system G Social support system H Medical staff H Medical staff

14. 7 NURSING (1) ASSESSING (1) ASSESSING A Pain history A Pain history B Effect on activities of daily living B Effect on activities of daily living C Sounds and posture C Sounds and posture D Coping resources D Coping resources E Intensity, quality and location E Intensity, quality and location

15. Grade (score) Grade (score) 0 : no pain 0 : no pain 1 : mild pain,can tolerance,do not disturb sleep 1 : mild pain,can tolerance,do not disturb sleep 2: moderate pain,can not tolerance, disturb 2: moderate pain,can not tolerance, disturb sleep,need drug sleep,need drug 3: severe pain, can not tolerance, disturb sleep 3: severe pain, can not tolerance, disturb sleep seriously,need drug seriously,need drug * Measure Methods * Measure Methods a Numerical rating scales a Numerical rating scales b Verbal descriptors scales b Verbal descriptors scales c Visual analogue scales c Visual analogue scales

16. DIAGNOSING Ineffective airway clearance Ineffective airway clearance Anxiety Anxiety Ineffective individual coping Ineffective individual coping Altered health maintenance Altered health maintenance Knowledge deficit Knowledge deficit Impaired physical mobility Impaired physical mobility Sleep pattern disturbance Sleep pattern disturbance

17. **IMPLEMENTING 1) pain management 1) pain management A pharmacologic A pharmacologic First stage First stage NSAIDs (non steroid anti-inflammatory drugs) NSAIDs (non steroid anti-inflammatory drugs) Nonopioids (nonarcotic) analgesics Nonopioids (nonarcotic) analgesics Antipyretic Antipyretic Second stage Second stage Opioid analgesics (codeine) Opioid analgesics (codeine)

18. Third stage Third stage Opioid analgesics (dolantin morphine) Opioid analgesics (dolantin morphine) Assistant drug Assistant drug Valli Valli B nonpharmacologic (physical) a Heat and cold application b TENS (transcutaneous electrical nerve stimulation) c massage acupressure

19. C acupuncture C acupuncture D immobilization D immobilization 2 psychological nursing 2 psychological nursing a reduce mental pressure a reduce mental pressure **b distraction * distraction activities (playing, watching * distraction activities (playing, watching TV, singing, enjoying music) TV, singing, enjoying music) * relaxation technique * relaxation technique * imagery * imagery

20. EVALUATING * therapeutic touch * therapeutic touch * hypnosis * hypnosis * bio-feedback * bio-feedback * meditation * meditation * Message * Message 3 promote comfort

21. Section 3 Safety Section 3 Safety 1 Factors affecting safety mechanical injury mechanical injury physical injury physical injury chemical injury chemical injury biological injury biological injury nosocomial injury nosocomial injury

22. 2 Device to prevent injury 2 Device to prevent injury A. protective devices A. protective devices bedside rail restraints bedside rail restraints safety strap body restraints safety strap body restraints overbed cradle overbed cradle B. assistant devices B. assistant devices crutches crutches canes canes