1. Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 25 Comfort, Rest, and Sleep

2. Slide 2 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Comfort, rest, and sleep are needed for well- being.  The total person is affected by comfort, rest, and sleep problems. Discomfort and pain can be physical or emotional. Discomfort and pain can be physical or emotional.  Rest and sleep restore energy and well-being.  Illness and injury increase the need for rest and sleep.

3. Slide 3 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  COMFORT  These OBRA room requirements promote comfort: No more than four persons in a room No more than four persons in a room A suspended curtain that goes around the bed for privacy A suspended curtain that goes around the bed for privacy A bed of proper height and size for the person A bed of proper height and size for the person A clean, comfortable mattress A clean, comfortable mattress Linens (sheets, blankets, spreads) that suit weather and climate Linens (sheets, blankets, spreads) that suit weather and climate A clean and orderly room A clean and orderly room

4. Slide 4 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. An odor-free room An odor-free room A room temperature between 71  F and 81  F A room temperature between 71  F and 81  F An acceptable noise level An acceptable noise level Adequate ventilation and room humidity Adequate ventilation and room humidity Appropriate lighting Appropriate lighting

5. Slide 5 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  PAIN  Pain or discomfort means to ache, hurt, or be sore.  Comfort and discomfort are subjective. You must rely on what the person says. You must rely on what the person says. If a person complains of pain or discomfort, the person has pain or discomfort. If a person complains of pain or discomfort, the person has pain or discomfort.  Pain is a warning from the body.

6. Slide 6 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Acute pain is felt suddenly from injury, disease, trauma, or surgery. It usually lasts less than 6 months. It usually lasts less than 6 months.  Chronic pain lasts longer than 6 months. There is no longer tissue damage. There is no longer tissue damage.  Radiating pain is felt at the site of tissue damage and in nearby areas.  Phantom pain is felt in a body part that is no longer there.

7. Slide 7 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Factors affecting pain Past experience Past experience Pain can cause anxiety. Pain can cause anxiety. Anxiety increases how much pain the person feels. Anxiety increases how much pain the person feels. Rest and sleep Rest and sleep The more a person thinks about the pain, the worse it seems. The more a person thinks about the pain, the worse it seems. Personal and family duties affect pain responses. Personal and family duties affect pain responses.

8. Slide 8 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. The value or meaning of pain The value or meaning of pain Support from others Support from others Culture Culture Illness Illness Age Age Persons with dementia may not be able to tell you about their pain. Persons with dementia may not be able to tell you about their pain.  Report any changes in a person’s usual behavior to the nurse.

9. Slide 9 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  The nurse needs this information to assess the person’s pain: Location Location Onset and duration Onset and duration Intensity Intensity Description Description Factors causing pain (precipitating factors) Factors causing pain (precipitating factors) Factors affecting pain Factors affecting pain Vital signs Vital signs Other signs and symptoms Other signs and symptoms

12. Slide 12 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Nursing measures The nurse uses the nursing process to promote comfort and relieve pain. The nurse uses the nursing process to promote comfort and relieve pain. Distraction means to change the person’s center of attention. Distraction means to change the person’s center of attention. Relaxation means to be free from mental and physical stress. Relaxation means to be free from mental and physical stress. Guided imagery is creating and focusing on an image. Guided imagery is creating and focusing on an image.  Doctors often order drugs to control or relieve pain.

16. Slide 16 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  YOU CAN PROMOTE REST BY:  Meeting physical needs Meeting thirst, hunger, and elimination needs Meeting thirst, hunger, and elimination needs Assisting the person to a comfortable position and good alignment Assisting the person to a comfortable position and good alignment Providing a quiet setting Providing a quiet setting Providing a clean, dry, and wrinkle-free bed Providing a clean, dry, and wrinkle-free bed Providing a clean, neat, and uncluttered room Providing a clean, neat, and uncluttered room

17. Slide 17 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Meeting safety and security needs Keeping the signal light within reach Keeping the signal light within reach Explaining the reasons for care Explaining the reasons for care Explaining how care is given Explaining how care is given Following the person’s routines and rituals whenever possible Following the person’s routines and rituals whenever possible  Promoting love and belonging needs Visits or calls from family and friends Visits or calls from family and friends Reading cards and letters Reading cards and letters  Promoting self-esteem needs Allowing personal choice in sleepwear Allowing personal choice in sleepwear Assisting with hygiene and grooming as needed Assisting with hygiene and grooming as needed

18. Slide 18 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  SLEEP IS A BASIC NEED  It lets the mind and body rest.  The body saves energy.  Body functions slow.  Vital signs are lower than when awake.  Tissue healing and repair occur.  Sleep lowers stress, tension, and anxiety.  It refreshes and renews the person.

19. Slide 19 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Circadian rhythm is a daily rhythm based on a 24- hour cycle. Circadian rhythm includes a sleep-wake cycle. Circadian rhythm includes a sleep-wake cycle. Health care often interferes with a person’s circadian rhythm and the sleep-wake cycle. Health care often interferes with a person’s circadian rhythm and the sleep-wake cycle.  There are two phases of sleep. NREM sleep (non-REM sleep) is the phase of sleep in which there is no rapid eye movement. NREM sleep (non-REM sleep) is the phase of sleep in which there is no rapid eye movement. The rapid eye movement phase is called REM sleep. The rapid eye movement phase is called REM sleep.

21. Slide 21 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Sleep needs vary for each age-group. The amount needed decreases with age. The amount needed decreases with age.  Factors affecting sleep Illness Illness Nutrition Nutrition Exercise Exercise Environment Environment Drugs and other substances Drugs and other substances Lifestyle changes Lifestyle changes Emotional problems Emotional problems

22. Slide 22 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Insomnia is a chronic condition in which the person cannot sleep or stay asleep all night. There are three forms of insomnia: There are three forms of insomnia:  Cannot fall asleep  Cannot stay asleep  Awakens early and cannot fall back asleep  With sleep deprivation, the amount and quality of sleep are decreased.  Sleepwalking The person leaves the bed and walks about. The person leaves the bed and walks about. The person is not aware of sleepwalking. The person is not aware of sleepwalking. The event may last 3 to 4 minutes or longer. The event may last 3 to 4 minutes or longer. You need to protect the person from injury and falling; guide the person back to bed and waken the person gently. You need to protect the person from injury and falling; guide the person back to bed and waken the person gently.

23. Slide 23 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Promoting sleep The nurse assesses the person’s sleep patterns. The nurse assesses the person’s sleep patterns. Measures are planned to promote sleep. Measures are planned to promote sleep. Follow the care plan. Follow the care plan. Report your observations about how the person slept. Report your observations about how the person slept. The person is involved in planning care. The person is involved in planning care.  In persons with Alzheimer’s disease and other dementias: Night wandering is common. Night wandering is common. Restlessness and confusion often increase at night. Restlessness and confusion often increase at night.

24. Slide 24 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  QUALITY OF LIFE  Comfort, rest, and sleep are needed for quality of life and well-being. OBRA has requirements that promote comfort, rest, and sleep. OBRA has requirements that promote comfort, rest, and sleep. The right to personal choice and taking part in planning care promote comfort, rest, and sleep. The right to personal choice and taking part in planning care promote comfort, rest, and sleep.  Residents have the right to have pain assessed and managed.