1. MNA Mosby ’ s Long Term Care Assistant Chapter 27 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: 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 Past experience Anxiety Rest and Sleep Attention Personal and family duties Value or meaning of pain Support from others Culture Age/illness

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

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

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

11. Sleep Two phases of sleep: NREM – non rapid eye movement. Starting to fall asleep REM – rapid eye movement. Deep sleep Need for sleep decreases with age. Avg. sleep req. for older adults: 5 – 7 hours

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. 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. 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 B.Guide the resident back to bed C.Gently wake the resident D.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

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

32. Questions??