1. MNA Mosby’s Long Term Care Assistant Chapter 24 Comfort, Rest and Sleep

2. Comfort State of well being No physical and emotional pain
OBRA has certain room requirements to promote comfort

3. Comfort OBRA requirements: Odor free No more then 4 to a room
Clean, comfortable
Curtain for privacy
Appropriate linens
Odor free
Temp btw 71 – 81
Appropriate lighting
Adequate ventilation

4. Pain Subjective A warning from the body Types: Acute Chronic Radiating
Phantom
Sudden, last short time
Lasts longer then 6 months, constant or on and off.
Felt at site of tissue damage and in nearby areas
Felt in a body part that is no longer there

5. Factors effecting pain
Value or meaning of pain
Support from others
Culture
Age/illness
Past experience
Anxiety
Rest and Sleep
Attention
Personal and family duties

6. Words Used to Describe Pain
Aching
Burning
Cramping
Crushing
Dull
Gnawing
Knifelike
Piercing
Pressure
Sharp
Sore
Squeezing
Stabbing
Throbbing
Vise-like

7. Signs and Symptoms On a scale of 1 - 10 10 is the worst Location
Onset and Duration
Intensity
Description
Factors causing pain
Vital signs Other signs and symptoms
On a scale of
10 is the worst

8. Nursing Measures for Pain control
Watch for S&S from drugs used to relieve pain.
Wait 1 hour after pain medicine to provide assistance with ADLs.
Distraction - change the person’s center of attention
Relaxation - free from mental or physical stress
Guided Imagery - creating and focusing on an image

9. Injured or ill people need to rest more often
Being calm, at ease and relaxed
Reading, music, hobbies
You can promote rest by meeting patient’s needs:
Physical
Safety and security
Love and belonging
Self-esteem
Injured or ill people need to rest more often

10. Sleep Insomnia – inability to fall asleep or stay asleep.
A state of unconsciousness,reduced voluntary muscle activity and lowered metabolism
A basic need
A person thinks and functions better after sleep

11. Sleep Two phases of sleep:
Need for sleep decreases with age.
Avg. sleep req. for older adults: – 7 hours
Two phases of sleep:
NREM – non rapid eye movement. Starting to fall asleep
REM – rapid eye movement.
Deep sleep

12. Factors Effecting Sleep
Illness -  need for sleep
Nutrition - sleep needs  with weight gain. Foods with caffeine prevent sleep
Exercise - improves health and fitness. Improves sleep
Environment

13. Factors Effecting Sleep
Drugs and other substances
Life style changes
Emotional problems - fear, worry, anxiety interfere with sleep

14. Nursing Measures to Promote Sleep
Organize care for uninterrupted sleep
Provide comfortable room temp
Avoid caffeine
Have the resident void before bedtime
Follow bedtime rituals

15. Nursing Measures to Promote Sleep
Dress in comfortable nightwear
Reduce noise
Darken the room
Make sure linens, depends are clean & dry
Position in good alignment
Back massage

16. Sleep Walking Protect the resident from injury
Guide the resident back to bed
Gently wake the resident

17. Residents with Dementia
Sleep problems are common
Restlessness & confusion night
Allow safe wandering if possible
Redirect to room

18. Review
Pain is an objective sign.
True or False

19. Review
Person’s with dementia will usually sleep well at night.?
True False

20. Acute pain Review Pain that is sudden and short lasting is called
____________________
Acute pain

21. Review
The nurse gave Mr. Johnson a drug for pain. You should wait how long before providing assistance with ADLs?
One hour

22. insomnia Review The inability to fall asleep or stay asleep is
___________________________.
insomnia

23. Review
Feeling pain in a body part that is no longer there:
______________________.
Phantom pain

24. Review
What is REM sleep?
Rapid eye movement:
deep sleep

25. Review HS
Ad lib
prn
Stat
qod
Hours of sleep
As desired
As needed
immediately
Every other day

26. Review
Bid
Tid C S X
Twice a day
Three times a day
with
without
except

27. Review
Mr. Marshall has dementia. He cannot tell you that he is in pain. How can you tell?
His behavior will change

28. Review
Use the resident’s exact words when reporting pain to the nurse.
True or False

29. Review
You find a resident sleepwalking. You should do all of the following except:
A. Protect the resident from injury
Guide the resident back to bed
Gently wake the resident
Turn on the lights

30. Piercing Pressure Sharp Sore Squeezing Stabbing Throbbing Vise-like
What are some words used to describe pain?
Aching
Burning
Cramping
Crushing
Dull
Gnawing
Knifelike
Piercing Pressure Sharp Sore Squeezing Stabbing Throbbing Vise-like

31. Review
Mr. Parker is 72 years old.
He needs approx. ________
hours of sleep each night .
5-7

32. Questions??