1. Chapter 28 Comfort, Rest, and Sleep
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

2. Comfort, Rest, and Sleep
Comfort, rest, and sleep are needed for well-being.
Comfort, rest, and sleep problems affect the total person.
Physical, emotional, spiritual
Discomfort and pain:
Can be physical or emotional
Affect rest and sleep
Decrease function and quality of life
Rest and sleep restore energy and well-being.
Illness and injury increase the need for rest and sleep. The body needs more energy for healing and repair. More energy is needed for daily functions.
Review the Focus on Long-Term Care and Home Care: Comfort, Rest, and Sleep Box on p. 510 in the Textbook.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

3. Comfort Comfort is a state of well-being. Comfort is affected by:
The person has no physical or emotional pain.
He or she is calm and at peace.
Comfort is affected by:
Age
Illness
Activity
Temperature
Ventilation
Noise
Odors
Lighting
The factors that affect comfort are controlled to meet the person’s needs.
Review the Focus on Communication: Comfort Box on p. 510 in the Textbook.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

4. Pain Pain or discomfort means to ache, hurt, or be sore.
Comfort and discomfort are subjective.
You must rely on what the person says.
If a person complains of pain or discomfort, the person has pain or discomfort.
Pain is personal.
It differs for each person
Pain is a warning from the body.
It is often called the fifth vital sign.
It signals tissue damage.
Report complaints to the nurse for the nursing process.
Pain often causes the person to seek health care.
Review the Focus on Communication: Pain Box on p. 510 in the Textbook.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

5. Pain (cont’d) Types of pain
Acute pain is felt suddenly from injury, disease, trauma, or surgery.
Chronic pain (persistent pain) continues for a long time (months or years) or occurs off and on.
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.
The doctor uses the type of pain when diagnosing.
The nurse uses the type for the nursing process.
Acute pain may signal a new injury or a life-threatening event. There is tissue damage. It lasts a short time and lessens with healing.
With chronic pain there is no longer tissue damage. It remains long after healing. Arthritis is a common cause.
Pain from a heart attack often radiates to the left chest, left jaw, left shoulder, and left arm. Gallbladder disease can radiate pain to the right upper abdomen, the back, and the right shoulder.
A person with an amputated leg may still sense leg pain. This is referred to as phantom pain.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

6. Pain (cont’d) Factors affecting pain Past experience Anxiety
Knowing what to expect can help or hinder how the person handles pain.
Anxiety
Pain can cause anxiety.
Anxiety increases how much pain is felt.
Reducing anxiety helps lessen pain.
Rest and sleep
Rest and sleep restore energy.
Pain seems worse when tired or restless.
A person may handle pain well one time and poorly the next time.
We learn from past experiences and from the experiences of family and friends.
Pain and anxiety are related. Anxiety relates to feelings of fear, dread, worry, and concern.
Lack of needed rest and sleep affects thinking and coping with daily life. The person tends to focus on pain when tired and unable to rest or sleep.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

7. Pain (cont’d) Attention Personal and family duties
The more a person thinks about the pain, the worse it seems.
Personal and family duties
Pain is often ignored when there are children to care for.
The value or meaning of pain
To some people, pain is a sign of weakness.
To others, pain is used to avoid certain people or things—the pain is useful.
Even mild pain can seem worse if the person thinks about it all the time. Pain often seems worse at night. When unable to sleep, the person has time to think about the pain.
Some people go to work with pain. Others deny pain if a serious illness is feared.
For some persons, pain means not having to work or assume daily routines. Some people like doting and pampering by others. The person values and wants such attention.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

8. Pain (cont’d) Support from others Culture Illness Age
Dealing with pain is often easier when family and friends offer comfort and support.
Culture
Affects pain responses
All persons have the right to be comfortable and as pain free as possible.
Illness
Some diseases decrease pain sensations.
The person is at risk for undetected disease or injury.
Age
A child bears pain much better when comforted by a caring parent or family member. Facing pain alone is hard for everyone, especially children and older persons.
Some cultures show no reaction to joy, sorrow, pleasure, or pain. Strong verbal and nonverbal reactions to pain are seen in other cultures.
Non-English speaking persons may have problems describing pain. The agency must know who these persons are. Someone must be available to interpret the person’s needs.
Review the Caring About Culture: Pain Reactions Box on p. 511 in the Textbook.
Review the Focus on Children and Older Persons: Factors Affecting Pain Box on p. 512 in the Textbook.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

9. Pain (cont’d) Signs and symptoms Location Onset and duration Intensity
When did the pain start?
How long has it lasted?
Intensity
Mild, moderate, or severe pain
Description
Factors causing pain (precipitating factors)
Factors affecting pain
What makes the pain better?
What makes it worse?
Vital signs
Other signs and symptoms
Promptly report any information you collect about pain. Use the person’s exact words to report and record.
Ask the person to point to the area of pain. Remember that pain can radiate.
Ask the person to rate the pain. Refer to Figures 28-3 and 28-4 on pp. 512 and 513 in the Textbook.
Ask the person to describe the pain. Review the contents of Box 28-1 on p. 513 in the Textbook.
Ask what the person was doing before the pain started and when it started.
Review the contents of Box 28-2 on p. 513 in the Textbook.
Review the Focus on Communication: Signs and Symptoms Box on p. 513 in the Textbook.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

10. Pain (cont’d) Nursing measures
The nurse uses the nursing process to promote comfort and relieve pain.
Other measures include distraction, relaxation, and guided imagery.
Distraction means to change the person’s center of attention.
Relaxation means to be free from mental and physical stress.
Guided imagery is creating and focusing on an image.
Doctors often order drugs to control or relieve pain.
Such drugs can cause orthostatic hypotension, drowsiness, dizziness, and coordination problems.
The nurse and care plan alert you to needed safety measures.
Review the contents of Box 28-3 on p. 514 in the Textbook.
When drugs are ordered, protect the person from injury, falls, and fractures. The nurse and care plan alert you to needed safety measures.
Review the Focus on Children and Older Persons: Nursing Measures Box on p. 514 in the Textbook.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

11. Rest Promote rest by meeting physical needs.
Meet thirst, hunger, and elimination needs.
Help to relieve pain or discomfort.
Provide a comfortable position and good alignment.
Provide a quiet setting.
Provide a clean, dry, and wrinkle-free bed.
Provide a clean, neat, and uncluttered room.
Rest means to be calm, at ease, and relaxed with no anxiety or stress.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

12. Rest (cont’d) Safety and security needs Love and belonging needs
The person must feel safe from falling or other injuries.
Explain the reasons for care.
Explain how care is given.
Follow routines and rituals whenever possible.
Love and belonging needs
Promote visits or calls from caring family and friends.
Read cards and letters.
Meet self-esteem needs
Promote personal choice in sleepwear.
Assist with hygiene and grooming measures as needed.
The person is secure with the signal light within reach.
Understanding the reasons for care also helps the person feel safe. Always explain procedures before doing them.
Many people have rituals and routines before resting.
Self-esteem relates to feeling good about oneself. If esteem needs are met, the person may rest easier.
The amount of rest varies for each person. Ill or injured persons need to rest more often. Do not push the person beyond his or her limits. Allow rest when needed.
Plan and organize care to allow uninterrupted rest.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

13. Sleep 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.
The person regains energy and mental alertness.
Sleep is a state of unconsciousness, reduced voluntary muscle activity, and lowered metabolism. Metabolism is the burning of food to produce energy for the body.
Sleep refreshes and renews the person. The person thinks and functions better after sleep.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

14. Sleep (cont’d)
Circadian rhythm is a daily rhythm based on a 24-hour cycle.
Circadian rhythm includes a 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 where there is “no rapid eye movement”.
REM sleep is the “rapid eye movement” phase.
Sleep is part of the circadian rhythm. If affects functioning.
NREM sleep has 4 stages. Sleep goes from light to deep as the person moves through the 4 stages.
In REM sleep, the person is hard to arouse. Mental restoration occurs.
There are usually 4 to 6 cycles of NREM and REM sleep during 7 to 8 hours of sleep. Stage 1 of NREM is usually not repeated.
Review the contents of Box 28-4 on p. 516 in the Textbook.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

15. Sleep (cont’d) Sleep requirements Factors affecting sleep
Sleep needs vary for each age-group.
Factors affecting sleep
Illness increases the need for sleep.
Signs and symptoms of illness can interfere with sleep.
Treatments and therapies can interfere with sleep.
Care devices can cause uncomfortable positions.
The emotional effects of illness can affect sleep.
Nutrition
Sleep needs increase with weight gain, decrease with weight loss.
Foods with caffeine prevent sleep.
The protein tryptophan tends to help sleep.
The amount of sleep needed decreases with age.
Review Table 28-1 on p. 516 in the Textbook for the average sleep requirements by age-group.
Quality relates to how well the person slept and getting needed amounts of NREM and REM sleep.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

16. Sleep (cont’d) Exercise improves health and fitness. Environment
Exercise before bedtime interferes with sleep.
Environment
People adjust to their usual sleep settings.
Drugs and other substances
Drugs and alcohol interfere with REM.
Caffeine is a stimulant and prevents sleep.
Life-style changes can affect sleep.
Relates to a person’s daily routines and way of living.
Emotional problems
Fear, worry, depression, and anxiety affect sleep.
Being tired helps people sleep well. Avoid exercise 2 hours before bedtime.
Any change in the usual setting can affect the amount and quality of sleep.
Sleeping pills promote sleep. Drugs for anxiety, depression, and pain may cause sleep. These drugs and sleeping pills reduce the length of REM sleep. Behavior problems and sleep deprivation can occur.
The side effects of some drugs cause frequent voiding and nightmares.
Normal sleep-wake cycles and the circadian rhythm are affected by life-style changes.
Work, personal, or family problems cause fear, worry, depression, and anxiety.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

17. Sleep (cont’d) Sleep disorders involve repeated sleep problems.
The amount and quality of sleep are affected.
Lifestyle is affected.
Insomnia—chronic condition in which the person cannot sleep or stay asleep all night.
Sleep deprivation—amount and quality of sleep are decreased; sleep is interrupted.
Sleepwalking—the person leaves the bed and walks about; he or she has no memory of the event on awakening.
There are three forms of insomnia: cannot fall asleep; cannot stay asleep; early awakening and cannot fall back asleep.
Emotional problems, and the physical and emotional discomforts of illness are common causes.
The nurse plans measures to promote sleep.
In sleep deprivation, NREM and REM sleep stages are not completed.
Factors that affect sleep can also lead to sleep deprivation.
The signs and symptoms in Box 28-5 on p. 517 in the Textbook may occur.
The person is not aware of sleepwalking. Children sleepwalk more than adults do. Protect the person from injury.
Review the Teamwork and Time Management: Sleepwalking Box on p. 517 in the Textbook.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

18. Sleep (cont’d) Promoting sleep
The nurse assesses the person’s sleep patterns.
You need to:
Report signs and symptoms of sleep disorders.
Follow the care plan for measures to promote sleep.
Report your observations about how the person slept.
Your observations help the nurse assess if the person has a regular sleep pattern.
Review the contents of Box 28-5 on p. 517 in the Textbook.
Review the contents of Box 28-6 on p. 518 in the Textbook.
Review the Focus on Children and Older Persons: Promoting Sleep Box on p. 518 in the Textbook.
Review the Focus on Long-Term Care and Home Care: Promoting Sleep Box on p. 518 in the Textbook.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.