1. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Chapter 35 Comfort and Sleep

2. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Pain Fifth vital sign Experience that is: –Unpleasant –Subjective –Sensory –Emotional Actual or potential tissue damage

3. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Common Myths about Pain Nurse best judge If ignored, goes away Wait until unbearable Most psychological Greater with severe tissue damage Taking medication leads to addiction

4. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Types of Pain Cutaneous Somatic Visceral Referred Acute Recurrent acute Chronic Chronic acute Chronic nonmalignant Persistent

5. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Physiology of Pain Nociceptive pain –Transmission of pain –Pain perception –Modulation Gate control theory of pain

6. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Factors Affecting the Pain Experience Age Previous experience with pain Cultural norms and attitudes

7. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Pain and the Nursing Process Assessment –Data collection Intensity Location Quality Associated manifestations Aggravating factors Alleviating factors (continued)

8. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Pain and the Nursing Process Assessment –Tools: Initial pain assessment tool Pain intensity scales Pain diary Psychosocial pain assessment –Developmental considerations (continued)

9. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Pain and the Nursing Process Diagnosis –Acute pain –Chronic pain (continued)

10. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Pain and the Nursing Process Planning and outcome identification –NOC for pain: Comfort level Pain –Adverse psychological response Pain –Disruptive effects Pain level (continued)

11. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Pain and the Nursing Process Collaboration –Complete pain assessment requires multidisciplinary team –May require pain manager or specialist (continued)

12. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Pain and the Nursing Process Implementation –Nurse-client relationship –Client education Define pain Identify probable cause Introduce assessment tools for pain Allow client to choose tool (continued)

13. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Pain and the Nursing Process Implementation –Pharmacologic pain management Combine analgesics Maintain therapeutic serum levels Choose appropriate route for administration Use nonsteroidal anti-inflammatory drugs (NSAIDs) (continued)

14. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Pain and the Nursing Process Implementation –Pharmacologic pain management Opioid analgesics Patient-controlled analgesia (PCA) Addiction, tolerance, and physical dependence Respiratory depression Local anesthesia (continued)

15. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Pain and the Nursing Process Implementation –Treatment of neuropathic pain Tricyclic antidepressants Anticonvulsants Corticosteroids Antispasmodics Nonpharmacologic methods (continued)

16. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Pain and the Nursing Process Implementation –Cognitive-behavioral interventions: Distraction Reframing Relaxation techniques Biofeedback Cutaneous stimulation (continued)

17. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Pain and the Nursing Process Implementation –Cognitive-behavioral interventions: Transcutaneous stimulation Exercise Nutrition Herbals Environment (continued)

18. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Pain and the Nursing Process Evaluation –Objective data: Client’s facial expression and posture Presence/absence of restlessness Vital sign monitoring Ongoing use of pain assessment tools –Subjective data: Client’s perception

19. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Rest and Sleep Rest –State of relaxation and calmness Sleep –State of altered consciousness –Fluctuations in level of consciousness –Minimal activity –Slowing of body’s physiological processes

20. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Physiology of Rest and Sleep Stages of sleep: –Non-rapid eye movement (NREM) sleep –Rapid eye movement (REM) sleep (continued)

21. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Physiology of Rest and Sleep Sleep cycle –Sequence through stages –70 to 90 minutes –Four to six sleep cycles in seven to eight hours

22. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Biological Clock Circadian rhythms Other biological rhythms: –Ultradian –Infradian –Circannual

23. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Factors Affecting Rest and Sleep Degree of comfort Anxiety Environment Lifestyle Diet Drugs and other substances Cultural norms Life span considerations

24. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Illness or Hospitalization Sleep impairment due to: –Pain –Loss of familiar surroundings –Loss of routine –Fear of unknown –Timing of procedures –Noise –Loss of privacy

25. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Alteration in Sleep Patterns Insomnia

26. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Hypersomnia or Narcolepsy Sleep apnea Sleep deprivation Parasomnia

27. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Sleep and the Nursing Process Assessment –Nature of sleep –Quality of sleep –Sleep environment –Associated factors –Opinion of sleep (continued)

28. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Sleep and the Nursing Process Diagnosis –Insomnia (continued)

29. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Sleep and the Nursing Process Planning and outcome identification –Hours of sleep –Observed hours of sleep –Sleep pattern –Sleep quality –Sleep efficiency (continued)

30. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Sleep and the Nursing Process Implementation –Establish trusting nurse-client relationship –Create relaxing environment –Initiate relaxation techniques –Ensure appropriate nutrition –Initiate pharmacologic interventions –Provide client education (continued)

31. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Sleep and the Nursing Process Evaluation –Plan of care Individualized Negotiated with client Revisions –Assure client that help is available