1. Chapter 24 Comfort, Rest, and Sleep
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2. Comfort 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.
Rest and sleep restore energy and well-being.
Illness and injury increase the need for rest and sleep.
Whatever the causes of discomfort and pain, they affect rest and sleep and decrease function and quality of life.
The body needs more energy for healing and repair.
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3. Comfort (Cont’d) Comfort is a state of well-being.
The person has no physical or emotional pain.
The person is calm and at peace.
OBRA and CMS require care that promotes well-being.
Comfort, rest, and sleep are needed for well-being.
Rooms are designed and equipped for comfort.
Age, illness, and activity affect comfort. So do temperature, ventilation, noise, odors, and lighting. Such factors are controlled to meet the person’s needs (see Chapter 15).
Review Focus on Communication: Comfort on p. 406.
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4. OBRA Requirements These OBRA room requirements promote comfort:
No more than four persons in a room
A suspended curtain that goes around the bed for privacy
A bed of proper height and size for the person
A clean, comfortable mattress
Linens (sheets, blankets, spreads) that suit weather and climate
A clean and orderly room
An odor-free room
A room temperature between 71 F and 81 F
An acceptable noise level
Adequate ventilation and room humidity
Appropriate lighting
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5. 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 differs for each person.
Pain is a warning from the body.
You cannot see, hear, touch, or smell pain or discomfort. You must rely on what the person says.
Review Focus on Communication: Pain on p. 406.
Report complaints to the nurse for the nursing process.
Pain signals tissue damage. Pain often causes the person to seek health care.
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6. Types of Pain There are different types of pain
Acute pain is felt suddenly from injury, disease, trauma, or surgery.
It usually lasts less than 6 months.
Chronic pain lasts longer than 6 months.
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.
Acute pain may signal a new injury or a life-threatening event. There is tissue damage. Acute pain lasts a short time. It lessens with healing.
Chronic pain (persistent pain) remains long after healing. Arthritis is a common cause.
An example of radiating pain is pain from a heart attack, which is often felt in the left chest, left jaw, left shoulder, and left arm. Gallbladder disease can cause pain in the right upper abdomen, the back, and the right shoulder.
A person with an amputated leg may experience phantom pain.
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7. Factors Affecting Pain
Many factors affect pain
Past experience
Pain can cause anxiety.
Anxiety increases how much pain the person feels.
Rest and sleep
Attention: The more a person thinks about the pain, the worse it seems.
Personal and family duties affect pain responses.
A person may handle pain well one time and poorly the next time. Many factors affect reactions to pain.
Pain and anxiety are related and can affect each other. For people who have not had pain before, pain can cause fear and anxiety.
Pain seems worse when tired or restless. Also, the person tends to focus on pain when tired and unable to rest or sleep.
Pain often seems worse at night. When unable to sleep, the person has time to think about the pain.
Often pain is ignored when there are children to tend. Some people go to work with pain. Others deny pain if a serious illness is feared. The illness can interfere with a job, going to school, or caring for children, a partner, or ill parents.
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8. Factors Affecting Pain (Cont’d)
The value or meaning of pain
Support from others
Culture
Illness
Age
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.
To some people, pain is a sign of weakness.
Dealing with pain is often easier when family and friends offer comfort and support. Facing pain alone is hard for everyone, especially children and older persons.
In some cultures, the person in pain is stoic. OBRA requires that the care planning process reflect the person’s culture.
Review Caring About Culture: Pain Reactions on p. 407.
Some diseases cause decreased pain sensations. Older persons may have decreased pain sensations. The person is at risk for undetected disease or injury.
Thinking and reasoning are affected in some older persons. Increased confusion, grimacing, or restlessness may signal pain. So may changes in usual behavior.
You must be alert for the signs of pain. Always report changes in the person’s behavior.
Review Residents With Dementia: Factors Affecting Pain—Age on p. 408.
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9. Pain Assessment
The nurse needs this information to assess the person’s pain:
Location and any radiation
Onset and duration
Intensity: Rate from 1 to 10
Description
Factors causing pain (precipitating factors)
Factors affecting pain: better and worse
Vital signs
Other signs and symptoms
You cannot see, hear, feel, or smell the person’s pain. You must rely on what the person tells you. Promptly report any information you collect about pain. Write down what the person says. Use the person’s exact words when reporting and recording. Location: Where is the pain? Ask the person to point to the area of painIs the pain mild, moderate, or severe? Ask the person to rate the pain on a 0-10 scale or the Wong-Baker Faces pain rating scale
If the person can’t describe the pain offer words listed in Box 24-1 on p. 409.
Review Box 24-2 on p. 409.
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10. Nursing Measures Nursing measures to promote comfort
The nurse uses the nursing process to promote comfort and relieve pain.
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.
The nurse uses the nursing process to promote comfort and relieve pain. The care plan may include the measures to promote comfort and relieve pain.
Review Box 24-3 on p See Figure 24-5 on p. 409.
Drugs to control or relieve pain can cause orthostatic hypotension (see Chapter 23), drowsiness, dizziness, and coordination problems.
Protect the person from injury, falls, and fractures. The nurse and care plan alert you to needed safety measures.
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11. Nursing Measures (Cont’d)
Other therapy measures
Transcutaneous electrical nerve stimulation (TENS)
Ice and heat applications are often effective.
Ultrasound therapy transmits sound waves.
Exercise and massage therapy may also be used.
TENS may be ordered by the doctor. For this therapy, electrodes are placed on the skin near the painful area. They are connected to a device that sends electrical impulses that block pain signals.
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12. Promoting Rest Meeting physical needs
Meeting thirst, hunger, and elimination needs
Assisting the person to a comfortable position and good alignment
Providing a quiet setting
Providing a clean, dry, and wrinkle-free bed
Providing a clean, neat, and uncluttered room
Rest means to be calm, at ease, and relaxed. The person has no anxiety or stress.
Rest may involve inactivity or the person may do things that are calming and relaxing.
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13. Promoting Comfort Meeting safety and security needs
Keeping the call light within reach
Explaining the reasons for care
Explaining how care is given
Following the person’s routines and rituals whenever possible
Promoting love and belonging needs
Visits or calls from family and friends
Reading cards and letters
Promoting self-esteem needs
Allowing personal choice in sleepwear
Assisting with hygiene and grooming as needed
Love and belonging promote rest.
Self-esteem needs relate to feeling good about oneself.
The amount of rest varies for each person. Health care routines usually allow time for afternoon rest.
Ill or injured persons need to rest more often.
Plan and organize care to allow uninterrupted rest.
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14. Sleep: 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.
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.
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15. Circadian Rhythm
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 in which there is no rapid eye movement.
The rapid eye movement phase is called REM sleep.
NREM sleep has four stages. Sleep goes from light to deep as the person moves through the four stages.
In REM sleep, the person is hard to arouse. Mental restoration occurs.
There are usually four to six cycles of NREM and REM sleep during 7 to 8 hours of sleep. Stage 1 of NREM is usually not repeated (Fig on p. 412).
Enuresis (urinary incontinence in bed at night) may occur during NREM sleep.
Review Box 24-4 on p. 411.
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16. Sleep Factors Sleep needs vary for each age group.
The amount needed decreases with age.
Factors affecting sleep
Illness
Nutrition
Exercise
Environment
Drugs and other substances
Lifestyle changes
Emotional problems
Sleep disorders
Review Table 24-1 on p. 412 in the textbook.
Sleep disorders involve repeated sleep problems. The amount and quality of sleep are affected.
Quality relates to how well the person slept and involves getting needed amounts of NREM and REM sleep.
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17. Sleep Disorders
Insomnia is a chronic condition in which the person cannot sleep or stay asleep all night.
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 is not aware of sleepwalking.
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.
Review Box 24-5 on p. 413 in the textbook.
Emotional problems are common causes of insomnia. The nurse plans measures to promote sleep. However, the emotional or physical problems causing the insomnia also are treated.
Illness, pain, and hospital care are common causes of sleep deprivation.
Stress, fatigue, and some drugs are common causes of sleepwalking. Guide sleepwalkers back to bed.
Review Teamwork and Time Management: Sleepwalking on p. 413.
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18. Sleep Apnea
When a person has sleep apnea he or she may stop breathing for short periods of time throughout the night.
Sleep apnea may have different causes.
Some people don’t know they have sleep apnea; they may report being sleepy and tired during the day.
One way to treat sleep apnea is with CPAP (continuous positive airway pressure).
A sleep study is performed to observe the person while he or she is sleeping.
A doctor orders CPAP.
A person wears the CPAP, continuous positive airway pressure, mask (Fig on p. 413) while sleeping. The mask forms a tight seal over the person’s nose or the nose and mouth. A tube connects the mask to the machine that keeps the air flowing through the person’s airway.
Some people can apply their own CPAP at night; others may need assistance.
Always report to the nurse if the person takes off the mask or refuses to wear it.
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19. Promoting Sleep Promoting sleep
The nurse assesses the person’s sleep patterns.
Measures are planned to promote sleep.
Follow the care plan.
Report your observations about how the person slept.
The person is involved in planning care.
In persons with Alzheimer’s disease and other dementias:
Night wandering is common.
Restlessness and confusion often increase at night.
Review Box 24-6 on p. 414 in the textbook.
Rituals and routines before bedtime are allowed if safe.
Review Residents With Dementia: Promoting Sleep on p. 414.
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20. Quality of Life
Comfort, rest, and sleep are needed for quality of life and well-being.
OBRA and CMS have requirements that 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.
Comfort involves more than physical needs alone. Emotional, spiritual, and social needs must also be met.
Time spent with friends and family provides comfort for residents. For some, religious ceremonies or rituals promote peace and healing. Allow time and privacy for these needs.
Untreated pain decreases quality of life. You must report signs and symptoms of pain. This helps the nurse meet the person’s needs.
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