1. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Textbook for Nursing Assistants Chapter 17: Comfort and Rest

2. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Importance of Rest and Sleep

3. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins A lack of rest and sleep results in: –Decreased ability to handle pain Reduced sleep –Increased risk for illness –Prolonged healing process –Impaired coping skills –Impaired cognitive function Reduced concentration –Increased fatigue Rest and Sleep

4. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Normal Sleep

5. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Allows body and brain to relax and recover –Re-energizes brain cells –Strengthens the immune system –Heals and repairs tissues Characterized by –Slowed heart rate and respiration –Closed eyes –Relaxed muscles Normal Sleep

6. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Two types –Nonrapid eye movement (NREM) 4 stages Each stage lasts 5 to 15 minutes –Rapid eye movement (REM) Increased brain activity Breathing, heart rate, and eye movement increased –On average there are 4 to 5 sleep cycles per night Sleep Cycle

7. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Newborns average 20 hours –As child ages needs gradually decrease Adults require 7 to 8 hours –Older adults have difficulty acquiring uninterrupted sleep and often find napping helpful Sleep Needs

8. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Factors That Affect Sleep

9. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Environment Pain Chronic health conditions Emotional concerns –Dx,finances,loss of work, family care Sleep disorders FACTORS AFFECTING SLEEP

10. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Insomnia –Difficulty falling or staying asleep Care includes –Report any complaints of insomnia –Be aware of increased risk for falls –Provide an environment that promotes sleep Sleep Disorders

11. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Sleep Apnea –Breathing is interrupted resulting in interrupted sleep –Most common cause is obstructive sleep apnea Care includes –Support the client in managing weight and avoiding alcohol and smoking –Assist client with using and caring for CPAP machine –Air pressure keeps airways open. Sleep Disorders

12. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Sleep Apnea More common in men than women Over 40 year of age Symptom= loud snoring, gasping, choking during sleep

13. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins PCT Patients may bring their own CPAP masks to the hospital May need to assist the patient with applying the mask and turning on the machine The RN will show you how to operate the machine and how to apply the mask You may also be responsible to keep the equipment clean

14. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins PCT– TELL THE RN When caring for a person with a CPAP mask– report any of the following to the RN: The patient refuses to wear the mask There is a hissing sound coming from around the seal of the mask of the tubing The CPAP machine is not working correctly

15. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins PCT Responsibility in Promoting Rest and Sleep

16. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Respect the patients sleep preferences Keep bedtime environment quiet and restful Use appropriate night lighting Assist the client into a comfortable sleeping position Promoting Rest and Sleep

17. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Tips to Promote Rest and Sleep Limit day time naps Avoid caffeinated beverages at night Promote relaxation with baths at night- massages Try to mimic the patients natural routine Offer bedtime snacks if allowed Assist with basic hygiene & elimination at HS Create a comfortable environment for the patient Position and align the patient Turn of TV, radio and other electronic devices Observe for any changes or pain and report accordingly

18. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Notify the nurse if the patient: –Is awake frequently at night –Has difficulty falling asleep –Reports difficulty sleeping –Sleepy during the day –Reports difficulty sleeping as a result of pain, frequent need to urinate, anxiety, or environmental factors Promoting Rest and Sleep

19. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Pain

20. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Pain may be either: Acute –Sharp, sudden pain resulting from injury –Lessens as body heals Chronic –Lasts longer than generally expected –Interferes with the ability to rest, relax, and sleep Pain

21. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Response to pain is subject and influenced by: –Pain threshold: point at which a person becomes aware of pain –Pain tolerance: level of pain when a person seeks help to manage it Culture Age Pain Response

22. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Never assume a client is pain free because they fail to report pain Never assume the client is exaggerating reports of pain Sudden change in personality may be indicator of pain Refusal to participate in certain activities may be an indicator of pain NON Verbal signs of pain –Facial expression rubbing affected area –Moaning guarding –Crying resisting or refusing care –Restlessness Identifying Pain

23. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins NON Verbal Signs of Pain NON Verbal signs of pain –Facial expression rubbing affected area –Moaning guarding –Crying resisting or refusing care –Restlessness –Redness or swelling of an area –Profuse sweating –Changes in vital signs –Changes in a patients behavior

24. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Question the client regarding the pain’s: –Location: Is it in one place or does it radiate? –Characteristics: Does it burn, ache, throb, stab, etc.? –Intensity: Use a pain scale Wong Baker scale Verbal scale Numeric scale –Circumstances: What makes the pain worse or better? Identifying Pain

25. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Reporting the client’s pain to the nurse is important because doing so helps: –Assess what’s causing the problem –Determine the appropriate treatment Reporting Client Pain

26. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Relieving Pain and Promoting Comfort

27. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Pain may be treated with: –Medication –Physical therapy –Application of heat and cold –Cold Reduces pain and swelling Numbs sensation & control bleeding Reduces fever –Heat Relieves muscle spasm/promotes circulation Provides warmth Relieving Pain and Promoting Comfort

28. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins PCT Responsibility With Cold & Hot Application Require a DOCTORS ORDER May be out of the PCT scope of practice in some facilites You may still be involved in monitoring a patient who has a cold or hot application REMEMBER: –Fair skin– is more sensitive to temperature changes than darker skin –Patient with impaired sensation, diabetes, paralyzed may be unable to detect sensitivity –Patients who are unconscious or confused may also have impaired judgment on cold or hot application ‘

29. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Heat application: –Relaxes muscles, increases blood flow, and eases pain –Speeds healing and reduces swelling –Can be either moist or dry Burns may result if heat is not appropriately applied and monitored Application site should be checked every 5 minutes with application lasting no longer than 20 minutes. Red or pale skin should be reported immediately as well as reports of stinging, burning or pain Application of Heat

30. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Cold application: –Reduces swelling, decreases bleeding and eases pain through vasoconstriction (narrowing of blood vessels) –Often used for sprains and strains –Can be either moist or dry Application of Cold

31. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins OTC medication is generally used for mild to moderate pain Narcotics are generally prescribed for severe pain Breakthrough pain occurs when pain is felt before the next dose of pain medication is due –This should be reported immediately –Report any concerns the client may have about possible addiction to the medication or side effects Pain Medication

32. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Physical Therapy may be effective in relieving pain by: –Exercise: especially for musculoskeletal injuries –Ultrasound therapy: increases circulation and relaxes muscles –Transcutaneous electrical nerve stimulation (TENS): affects nerves to reduce pain Physical Therapy

33. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Assisting With Pain Management

34. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Makes a person feel relaxed and comfortable Provide distractions from the pain Pay attention to the client positioning needs Provide massages when and where appropriate Take your time when providing client care Ask the client regularly about the presence of pain and report to the nurse immediately Nursing Assistant’s Role

35. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins End of Presentation