1. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning VOLUME ONE | SECOND EDITION Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Comfort 3 Nursing: A Concept-Based Approach to Learning Volume One MODULE Nursing: A Concept-Based Approach to Learning, Volume One

2. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Alterations and Manifestations Pain  Most common reason to seek health care  Unpleasant sensory, emotional experience  Associated with actual or potential tissue damage  Fifth vital sign

3. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Alterations and Manifestations, continued Pain  Acute pain: Sudden onset, lasts through recovery (30 days – 6 months)  Chronic pain: Persists > 6 months; varying severity

4. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Prevention Begins with client  Personal preference  Lifestyle habits  Nutrition  Smoking, alcohol use  Sleep hygiene  Occupation  Culture

5. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Nursing Assessment Client health history Nursing interview  Client description of symptoms  Pain scale  Depression assessment Client's culture affects how client perceives discomfort and expresses pain

6. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Nursing Assessment, continued Physical assessment  Vital signs  Visual inspection  PSG for identification of suspected sleep disorders  Blood and urine analysis Diagnostic tests for underlying cause  X-ray  Blood tests

7. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Lifespan and Cultural Considerations Age and developmental stage affect ability to describe pain  Special considerations for assessing discomfort and promoting comfort for ach stage Cultural differences in expressions of pain

8. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Interventions and Therapies Initial interventions directed at identifying source of discomfort Pain relief is priority

9. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Independent Relaxation therapy  Reduce stress, induce sleep, reduce pain, calm emotions  Four main categories (often combined) Breathing exercises Muscle relaxation Imagery Movement techniques  Other forms: massage, acupuncture, meditation, biofeedback

10. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Collaborative Pharmacologic  Nonopioids  NSAIDs  Opioids  Hypnotics/sedatives Nonpharmacologic  Acupuncture  Herbal supplements

11. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Exemplar 3.3 Fatigue

12. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Pathophysiology and Etiology Tiredness, exhaustion, apathy, lack of motivation Symptom of underlying cause  Illness  Sleep deprivation  Intense physical or mental exertion  Pressure to perform a certain role

13. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Etiology Anemia Depression or grief Medications such as sedatives, antidepressants Persistent pain

14. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Etiology, continued Sleep disorders such as insomnia, obstructive sleep apnea, and narcolepsy Hyperthyroidism, hypothyroidism Regular use of alcohol or illicit drugs Chronic diseases: arthritis, cancer, diabetes, fibromyalgia, liver or kidney disease

15. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Risk Factors Acute or chronic illness or condition Lifestyle factors Medications Medical procedures Mood disorders Genetics Women more at risk than men

16. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Prevention Lifestyle choices  Balanced diet  Daily exercise  Good sleep hygiene  Stress reduction

17. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Clinical Manifestations Drowsiness, exhaustion, lack of motivation Lethargy Muscle weakness Palpitations Dizziness Dyspnea on mild exertion Loss of appetite Slow movements Blurry vision

18. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Clinical Manifestations, continued Difficulty concentrating Impaired decision making Confusion Impaired coordination Slow reflexes Sleep disturbance Change in muscle tone Depression

19. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Clinical Manifestations, continued Chronic fatigue syndrome  Severe tiredness lasting longer than 6 months  Not caused by a primary condition  Not relieved by stress reduction  Not feeling rested after adequate sleep  Forgetfulness, confusion, inability to concentrate  Joint, muscle symptoms

20. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Diagnostic Tests Tests to find underlying cause Sleep study

21. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Pharmacologic Therapy Depends on cause Tailored to specific condition

22. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Nonpharmacologic Therapy Good sleep hygiene Mild to moderate exercise Cognitive-behavioral therapy Assist client to determine best time of day to engage in activities

23. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Complementary and Alternative Therapy Acupuncture Massage Relaxation techniques Herbal and dietary supplements Ginseng NADH L-carnitine

24. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Nursing Process Determine underlying cause Thorough assessment of client  Measures to promote rest

25. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Assessment Health history  Duration, quality, timing of fatigue  How fatigue affects ADLs  How fatigue affects relationships  Diet, sleep, exercise habits  Medications  Medical conditions  Cognitive effects

26. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Assessment, continued Physical examination  Vital signs  Client mobility  Hydration status  Muscle strength, symmetry, endurance  Skin turgor  Skin tone

27. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Diagnosis Insomnia Sleep Deprivation Fatigue Activity Intolerance Readiness for Enhanced Coping Stress Overload

28. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Planning Client will verbalize an understanding and practice of good sleep hygiene Client will verbalize feelings of increased energy Client will indicate an increased ability to perform activities of daily living Client will participate in a mild exercise program

29. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Implementation Consider client's cultural, developmental needs regarding sleep rituals Assess client's methods of coping and social support network Establish rapport with client's family and significant others

30. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Evaluation Evaluate clients periodically to determine if the medical and nursing interventions are effective Further diagnostic tests may be needed to determine if additional physiological factors are contributing

31. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Exemplar 3.5 Sleep–Rest Disorders

32. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Overview Sleep is essential to normal physiological functioning. Adults need 7–9 hours of sleep each night.

33. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Pathophysiology and Etiology Sleep loss  When individual gets < 7–8 hours sleep  Chronic sleep loss Inability to concentrate Fall asleep sitting still Reduced motivation Reduced reaction time

34. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Pathophysiology and Etiology, continued Sleep apnea  Periods of partial or complete airway obstruction  ≥5 apneic events per hour Severe: >30 per hour  Breathing pauses last 10–20 seconds  Decreased oxygenation

35. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Pathophysiology and Etiology, continued Hypersomnia  Sufficent sleep but still suffers daytime drowsiness  Severe form: narcolepsy Daytime sleep attacks

36. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Pathophysiology and Etiology, continued Parasomnias  Abnormal actions during sleep  Examples Sleepwalking (somnambulism)

37. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Pathophysiology and Etiology, continued Restless leg syndrome  Neurological disorder  Overwhelming urge to move legs while at rest  Muscle twitches,  jerking movements of legs

38. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Risk Factors Insomnia  Female more than male  Over age 60 Sleep apnea  Obesity  Large neck circumference  Male more than female  Smoking

39. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Risk Factors, continued Parasomnias  Children  Drug or alcohol abuse Restless leg syndrome  Older age  Stress  Kidney disease  Diabetes

40. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Diagnostic Tests Polysomnography (PSG) Electroencephalogram (EEG) Video/audio equipment Heart rate, breathing, O 2 saturation

41. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Surgery Remove obstruction in sleep apnea Only if CPAP therapy not tolerated

42. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Pharmacologic Therapy Sedative-hypnotic medications Antianxiety medications Half-life of drug important for effectiveness Sleep medications vary in onset, duration

43. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Nonpharmacologic Therapy Obstructive sleep apnea  Weight loss  Alcohol abstinence  Avoiding supine position for sleep  CPAP or BiPAP  Surgery

44. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Nonpharmacologic Therapy, continued Bright light therapy Stimulus control therapy (behavioral) Sleep restriction Exercise Relaxation techniques Herbal supplements  Valerian  Chamomile  Melatonin

45. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Assessment Sleep history  Sleep partner or parents may provide additional information  Sleep assessment scales

46. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Diagnosis Insomnia Sleep Deprivation Readiness for Enhanced Sleep Disturbed Sleep Pattern Fatigue Wandering

47. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Diagnosis, continued Ineffective Breathing Pattern Ineffective Coping Stress Overload Risk for Injury Deficient Knowledge

48. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Planning, continued Client will have sufficient energy for normal daily activities. Client will report improved quality and quantity of sleep. Client's spouse will report decreased snoring. Client's spouse will report no apneic episodes.

49. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Implementation Educate client about factors associated with impaired sleep–rest patterns Instruct client in proper use of assistive devices Review client's medications to determine whether any interfering with sleep Teach client about principles of good sleep hygiene

50. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Evaluation Data collection  Observations of duration of client's sleep  Questions about how client feels upon awakening  Observations of client's level of alertness during day