1. Copyright © 2008 Delmar Learning. All rights reserved. Unit 10 Comfort, Pain, Rest, and Sleep

2. Copyright © 2008 Delmar Learning. All rights reserved. Objectives Spell and define terms. Explain how loud noise affects patients and hospital staff. Explain why nursing comfort measures are important to patients’ well-being.

3. Copyright © 2008 Delmar Learning. All rights reserved. Objectives List six observations to make and report for patients having pain. Describe nursing assistant measures to increase comfort and relieve pain. State the purpose of the pain rating scale and briefly describe how the pain scales are used.

4. Copyright © 2008 Delmar Learning. All rights reserved. Objectives List nursing comfort measures that promote rest. Describe the phases of the sleep cycle and the importance of each. List nursing measures to promote sleep.

5. Copyright © 2008 Delmar Learning. All rights reserved. Noise Excessive noise: –Delays healing –Impairs immune system function –Increases heart rate and blood pressure –Causes patients to feel stressed and anxious

6. Copyright © 2008 Delmar Learning. All rights reserved. Noise Excessive noise: –Interferes with sleep –May trigger wandering in confused patients –May cause patient dissatisfaction with care

7. Copyright © 2008 Delmar Learning. All rights reserved. Noise In one health care study: –Staff felt noise caused them to feel agitated, irritable, stressed, or exhausted –Staff believed they made more errors when the unit was noisy –Noise made it difficult to focus on conversation

8. Copyright © 2008 Delmar Learning. All rights reserved. Noise In one health care study: –Listening to conversation and having to speak louder in a noisy environment caused staff fatigue –Nursing assistants should do everything possible to reduce noise on the unit

9. Copyright © 2008 Delmar Learning. All rights reserved. Patient Comfort All humans need comfort, rest, and sleep for physical and emotional well- being, health, and wellness Comfort is a state of physical and emotional well-being –Patient is calm and relaxed –Is not in pain or upset

10. Copyright © 2008 Delmar Learning. All rights reserved. Pain A state of discomfort that is unpleasant for the patient Always a warning that something is wrong

11. Copyright © 2008 Delmar Learning. All rights reserved. Pain Patient’s self-report of pain is the most accurate indicator of the existence and intensity of pain –Should be respected and believed

12. Copyright © 2008 Delmar Learning. All rights reserved. Types of Pain Acute pain occurs suddenly and without warning It is usually the result of tissue damage –From an injury or surgery Pain decreases over time –As healing takes place

13. Copyright © 2008 Delmar Learning. All rights reserved. Types of Pain Persistent pain may also be called chronic pain –Lasts longer than six months –Intermittent or constant –Usually the result of a chronic medical condition

14. Copyright © 2008 Delmar Learning. All rights reserved. Types of Pain Phantom pain –Results from an amputation Patient has had a body part, such as a leg removed, but complains of pain in the toes Pain is real, not imaginary

15. Copyright © 2008 Delmar Learning. All rights reserved. Types of Pain Radiating pain –Moves from the site of origin to other areas –Pain of a heart attack radiating from the chest to the jaw or arm

16. Copyright © 2008 Delmar Learning. All rights reserved. Patients’ Responses to Pain Patients’ responses to pain vary widely Some individuals do not feel pain as acutely as others Some try to ignore pain

17. Copyright © 2008 Delmar Learning. All rights reserved. Patients’ Responses to Pain Other patients may try to deny pain because they are afraid of what it may mean Unrelieved pain –Has the potential to affect all areas of the patient’s life

18. Copyright © 2008 Delmar Learning. All rights reserved. Identifying Patients in Pain and at Risk for Pain Pain is a serious condition that affects patients’ well-being and quality of life Patients have the right to timely pain assessment and management Never question the validity of the patient’s complaints of pain

19. Copyright © 2008 Delmar Learning. All rights reserved. Identifying Patients in Pain and at Risk for Pain Patients may be smiling, talking, or sleeping and still be having pain Vital signs may be normal. Always avoid making assumptions about a patient’s pain

20. Copyright © 2008 Delmar Learning. All rights reserved. Observing and Reporting Signs and Symptoms of Pain Pain always requires further intervention It should never be ignored Always report verbal complaints of pain –Describe the pain in the patient’s exact words

21. Copyright © 2008 Delmar Learning. All rights reserved. Golden Rule for Pain Relief Whatever is painful to adults is painful to children –Unless proven otherwise Pain control should be based on scientific facts –Not personal beliefs or opinions (Donna Wong, PhD, RN, PNP, FAAN)

22. Copyright © 2008 Delmar Learning. All rights reserved. Golden Rule for Pain Relief Never lie to a child when asked if a procedure will hurt Admit that it will –Say that you will be there and make the child as comfortable as possible ( Donna Wong, PhD, RN, PNP, FAAN)

23. Copyright © 2008 Delmar Learning. All rights reserved. Pain Assessment Scales Nurse may use a pain scale to help assess and manage a patient’s pain The scale is a tool for communication Patient selects the scale that best helps him or her describe the pain Refer to Figures 10–5A and 10-5B

24. Copyright © 2008 Delmar Learning. All rights reserved. Pain Hierarchy Patient’s self report of pain –Forms foundation of the pain hierarchy scale –Most accurate and reliable source of information related to pain the person is experiencing (Refer to Figure 10-6)

25. Copyright © 2008 Delmar Learning. All rights reserved. Pain Hierarchy

26. Copyright © 2008 Delmar Learning. All rights reserved. FACES Pain Rating Scale FACES scale may be used for both children and adults

27. Copyright © 2008 Delmar Learning. All rights reserved. Other Pain Rating Scales Numeric scales are used to rate the pain by number –Such as zero for no pain –10 being the worst pain possible Word scales –Used to help patient select words to describe the level and intensity of pain See Figure 10-5B

28. Copyright © 2008 Delmar Learning. All rights reserved. Other Pain Rating Scales

29. Copyright © 2008 Delmar Learning. All rights reserved. Managing Pain Unrelieved pain –Has a negative effect on the patient’s health and functional status Notify the nurse as soon as the patient complains –Before the pain becomes severe or out of control

30. Copyright © 2008 Delmar Learning. All rights reserved. Managing Pain Check on the patient after pain medicine has been given –Inform the nurse if the pain has not been relieved

31. Copyright © 2008 Delmar Learning. All rights reserved. Planning Patient Care Plan to give care after the patient has relieved pain-relieving medication Provide nursing comfort measures, such as a backrub to help relieve pain and cause the patient to relax Monitor the patient’s body language for signs of pain

32. Copyright © 2008 Delmar Learning. All rights reserved. Rest State of mental and physical comfort, calmness, and relaxation

33. Copyright © 2008 Delmar Learning. All rights reserved. Sleep Period of continuous or intermittent unconsciousness in which a person’s physical movements are decreased Sleep is a basic need of all humans, as it allows the mind and body to rest

34. Copyright © 2008 Delmar Learning. All rights reserved. The Sleep Cycle Each person has a sleep-wake cycle An internal biological clock –Tells a person when it is time to sleep and when it is time to wake up Refer to Figure 10–10

35. Copyright © 2008 Delmar Learning. All rights reserved. The Sleep Cycle

36. Copyright © 2008 Delmar Learning. All rights reserved. Sleep Disorders Sleep has been studied extensively Some facilities have units and clinics that specialize in the diagnosis and treatment of sleep disorders

37. Copyright © 2008 Delmar Learning. All rights reserved. Sleep Disorders Most common sleep disorders are: –Insomnia –Hypersomnia –Narcolepsy –Sleep apnea –Sleep deprivation

38. Copyright © 2008 Delmar Learning. All rights reserved. Nursing Assistant Measures to Promote Comfort, Rest, and Sleep Basic nursing comfort measures –Those used to relieve pain are effective in helping patients rest and sleep Specific measures for each patient will be listed in the care plan