© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Comfort, Pain, Rest, and Sleep Unit 10

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Objectives Spell and define terms. Explain how noise affects patients and hospital staff. Explain why nursing comfort measures are important to patients’ well-being. 2

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Objectives List six observations to make and report for patients having pain. State the purpose of the pain rating scale and briefly describe how a pain scale is used. 3

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Objectives Describe nursing assistant measures to increase comfort, relieve pain, and promote rest and sleep. Describe the phases of the sleep cycle and the importance of each. 4

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Noise Excessive noise: –Delays healing –Impairs immune system function –Increases heart rate and blood pressure –Causes patients to feel stressed and anxious 5

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Noise Excessive noise: –Interferes with sleep –May trigger wandering in confused patients –May cause patient dissatisfaction with care 6

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Noise In one health care study: –Staff felt noise caused them to feel agitated, irritable, stressed, or exhausted –Staff believed they made more errors when the unit was noisy –Noise made it difficult to focus on conversation 7

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Noise In one health care study: –Listening to conversation and having to speak louder in a noisy environment caused staff fatigue Nursing assistants should do everything possible to reduce noise on the unit 8

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Patient Comfort All humans need comfort, rest, and sleep for physical and emotional well- being, health, and wellness Comfort is a state of physical and emotional well-being –Patient is calm and relaxed –Is not in pain or upset 9

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Pain A state of discomfort that is unpleasant for the patient Always a warning that something is wrong 10

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Pain Patient’s self-report of pain is the most accurate indicator of the existence and intensity of pain –Should be respected and believed 11

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Types of Pain Acute pain occurs suddenly and without warning It is usually the result of tissue damage –From an injury or surgery Pain decreases over time –As healing takes place 12

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Types of Pain Persistent pain may also be called chronic pain –Lasts longer than six months –Intermittent or constant –Usually the result of a chronic medical condition 13

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Types of Pain Phantom pain –Results from an amputation Patient has had a body part, such as a leg, removed but complains of pain in the toes Pain is real, not imaginary 14

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Types of Pain Radiating pain –Moves from the site of origin to other areas –Pain of a heart attack radiating from the chest to the jaw or arm 15

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Patients’ Responses to Pain Patients’ responses to pain vary widely Some individuals do not feel pain as acutely as others Some try to ignore pain 16

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Patients’ Responses to Pain Other patients may try to deny pain because they are afraid of what it may mean Unrelieved pain –Has the potential to affect all areas of the patient’s life 17

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Identifying Patients in Pain and at Risk for Pain Pain is a serious condition that affects patients’ well-being and quality of life Patients have the right to timely pain assessment and management Never question the validity of the patient’s complaints of pain 18

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Patients may be smiling, talking, or sleeping and still be having pain Vital signs may be normal Always avoid making assumptions about a patient’s pain 19 Identifying Patients in Pain and at Risk for Pain

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Observing and Reporting Signs and Symptoms of Pain Pain always requires further intervention It should never be ignored Always report verbal complaints of pain –Describe the pain in the patient’s exact words 20

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Golden Rule for Pain Relief Whatever is painful to adults is painful to children –Unless proven otherwise Pain control should be based on scientific facts –Not personal beliefs or opinions (Donna Wong, PhD, RN, PNP, FAAN) 21

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Golden Rule for Pain Relief Never lie to a child when asked if a procedure will hurt Admit that it will –Say that you will be there and make the child as comfortable as possible ( Donna Wong, PhD, RN, PNP, FAAN) 22

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Pain Assessment Scales Nurse may use a pain scale to help assess and manage a patient’s pain The scale is a tool for communication Patient selects the scale that best helps him or her describe the pain Refer to Figures 10-6A and 10-6B 23

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Pain Assessment Scales Some patients may look comfortable, yet have a great deal of pain. Always ask if patients are having pain; this is not offensive. 24

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. FACES Pain Rating Scale FACES scale may be used for both children and adults 25

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. FACES Pain Rating Scale Brief word instructions: Point to each face using the words to describe the pain intensity. Ask the child to choose face that best describes own pain and record the appropriate number. (FACES Pain Rating Scale from Hockenberry, M J, Wilson D: Wong’s essentials of pediatric nursing, ed. 8. St. Louis 2009, Mosby. Used with permission. Copyright Mosby). 26

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Other Pain Rating Scales Numeric scales are used to rate the pain by number –Such as zero for no pain –10 being the worst pain possible Word scales –Used to help patient select words to describe the level and intensity of pain See Figure 10-6B 27

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Other Pain Rating Scales 28

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Managing Pain Unrelieved pain –Has a negative effect on the patient’s health and functional status Notify the nurse as soon as the patient complains –Before the pain becomes severe or out of control 29

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Managing Pain Check on the patient after pain medicine has been given –Inform the nurse if the pain has not been relieved 30

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Planning Patient Care Plan to give care after the patient has relieved pain-relieving medication Provide nursing comfort measures, such as a backrub, to help relieve pain and cause the patient to relax Monitor the patient’s body language for signs of pain 31

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Rest State of mental and physical comfort, calmness, and relaxation 32

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Sleep Period of continuous or intermittent unconsciousness in which a person’s physical movements are decreased Sleep is a basic need of all humans, as it allows the mind and body to rest 33

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. The Sleep Cycle Each person has a sleep-wake cycle An internal biological clock –Tells a person when it is time to sleep and when it is time to wake up Refer to Figure

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. The Sleep Cycle 35

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Sleep Disorders Sleep has been studied extensively Some facilities have units and clinics that specialize in the diagnosis and treatment of sleep disorders 36

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Sleep Disorders Most common sleep disorders are: –Insomnia –Hypersomnia –Narcolepsy –Sleep apnea –Sleep deprivation 37

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Nursing Assistant Measures to Promote Comfort, Rest, and Sleep Basic nursing comfort measures –Those used to relieve pain are effective in helping patients rest and sleep Specific measures for each patient will be listed in the care plan 38