1. Chapter 33 Comfort and Sleep Fundamentals of Nursing: Standards & Practices, 2E

2.  Copyright 2002 by Delmar, a division of Thomson Learning 33-2 Pain  Nature of Pain  Common Myths About Pain  Types of Pain Cutaneous pain is caused by stimulation of the cutaneous nerve endings in the skin and results in well- localized “burning” or “prickling” sensation.

3.  Copyright 2002 by Delmar, a division of Thomson Learning 33-3 Somatic pain is nonlocalized and originates in support structures. Visceral pain is discomfort in the internal organs. Pain originating from the abdominal organs is often called referred pain.

4.  Copyright 2002 by Delmar, a division of Thomson Learning 33-4 Acute pain is most frequently identified by sudden onset and relative short duration. Recurrent acute pain is identified by repetitive episodes the may recur over a prolonged period of time.

5.  Copyright 2002 by Delmar, a division of Thomson Learning 33-5 Chronic pain is identified as long-term, persistent, nearly constant, or recurrent pain that produces significant negative changes in client’s life. Chronic acute pain occurs almost daily over a long period and has the potential for lasting months or years. Chronic nonmalignant pain occurs almost daily and last for at least 6 months.

6.  Copyright 2002 by Delmar, a division of Thomson Learning 33-6  Physiology of Pain Nociceptive Pain Neuropathic Pain Gate Control Theory of Pain

7.  Copyright 2002 by Delmar, a division of Thomson Learning 33-7  Factors Affecting the Pain Experience Age Previous Experience with Pain Cultural Norms and Attitudes

8.  Copyright 2002 by Delmar, a division of Thomson Learning 33-8  Assessment Data Collection  Pain threshold is the level of intensity at which pain becomes appreciable or perceptible.  Pain tolerance is the level of intensity or duration of pain the client is willing or able to endure.

9.  Copyright 2002 by Delmar, a division of Thomson Learning 33-9 Assessment Tools  Initial Pain Assessment Tool  Pain Intensity Scales  Psychosocial Pain Assessment  Review Table 32-5 Initial Pain Assessment Tool Developmental Considerations  Children and Adolescents

10.  Copyright 2002 by Delmar, a division of Thomson Learning 33-10  Nursing Diagnosis NANDA-approved diagnoses  Acute Pain  Chronic Pain

11.  Copyright 2002 by Delmar, a division of Thomson Learning 33-11  Outcome Identification and Planning Planning focuses on mutual goal setting. A goal of nursing care is to use both nonpharmacologic and pharmacologic interventions in planning strategies to control or maintain clients at desired levels of functioning and pain.

12.  Copyright 2002 by Delmar, a division of Thomson Learning 33-12  Implementation  Cognitive-Behavioral Interventions  Nurse-Client Relationship  Biofeedback  Pharmacologic Pain Management  Treatment of Neuropathic Pain

13.  Copyright 2002 by Delmar, a division of Thomson Learning 33-13  Evaluation Client’s facial expression and posture Presence (or absence) of restlessness Vital sign monitoring Ongoing use of pain assessment tools

14.  Copyright 2002 by Delmar, a division of Thomson Learning 33-14 Rest and Sleep  Rest refers to a state of relaxation and calmness.  Sleep refers to a state of altered consciousness during which an individual experiences fluctuations in level of consciousness, minimal activity, and a general slowing of the body’s physiological process.

15.  Copyright 2002 by Delmar, a division of Thomson Learning 33-15  Physiology of Rest and Sleep Stages of Sleep  NREM Sleep  REM Sleep Sleep Cycle  Refers to the sequence of sleep that begins with the four stages of NREM sleep in order, with a return to stage 3, then 2, then passage into the first REM stage  Review Figure 32-9 on the sleep cycle

16.  Copyright 2002 by Delmar, a division of Thomson Learning 33-16  Biological Clock Is an endogenous mechanism capable of measuring time in a living organism Chronobiology is a branch of science that studies these rhythms that are controlled by our biological clocks.

17.  Copyright 2002 by Delmar, a division of Thomson Learning 33-17  Factors Affecting Rest and Sleep Degree of Comfort Anxiety Environment Lifestyle

18.  Copyright 2002 by Delmar, a division of Thomson Learning 33-18 Diet Drugs and Other Substances Cultural Norms Life Span Considerations Illness or Hospitalization

19.  Copyright 2002 by Delmar, a division of Thomson Learning 33-19  Alteration in Sleep Patterns Insomnia Hypersomnia or Narcolepsy Sleep Apnea Sleep Deprivation Parasomnia

20.  Copyright 2002 by Delmar, a division of Thomson Learning 33-20  Assessment Assess to determine sleep routines, sleep alterations, types of disturbances, and impact of sleep problems.

21.  Copyright 2002 by Delmar, a division of Thomson Learning 33-21  Diagnosis NANDA-approved diagnoses  Sleep Pattern Disturbance

22.  Copyright 2002 by Delmar, a division of Thomson Learning 33-22  Outcome Identification and Planning Planning should focus on the true cause related to the sleep disturbance or alteration. A goal of nursing care is to consider that many sleep disturbances will require extended periods of time to correct.

23.  Copyright 2002 by Delmar, a division of Thomson Learning 33-23  Implementation Establish a trusting nurse-client relationship Create a relaxing environment. Initiate relaxation techniques. Ensure appropriate nutrition. Initiate pharmacologic interventions. Provide client education.

24.  Copyright 2002 by Delmar, a division of Thomson Learning 33-24  Evaluation Plan of care must be individualized for and negotiated with client. Nurses should make sure clients understand that there is help for sleep problems and that they are not alone in having difficulty with managing their sleep patterns.

25.  Copyright 2002 by Delmar, a division of Thomson Learning 33-25 Review the Nursing Process Highlight on evaluating the care of sleep- disordered clients.