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Chapter 35

Chapter 35. Comfort and Sleep. Pain. Fifth vital sign Experience that is: Unpleasant Subjective Sensory Emotional Actual or potential tissue damage. Common Myths about Pain. Nurse best judge If ignored, goes away Wait until unbearable Most psychological

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Chapter 35

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  1. Chapter 35 Comfort and Sleep

  2. Pain • Fifth vital sign • Experience that is: • Unpleasant • Subjective • Sensory • Emotional • Actual or potential tissue damage

  3. Common Myths about Pain • Nurse best judge • If ignored, goes away • Wait until unbearable • Most psychological • Greater with severe tissue damage • Taking medication leads to addiction

  4. Types of Pain • Cutaneous • Somatic • Visceral • Referred • Acute • Recurrent acute • Chronic • Chronic acute • Chronic nonmalignant • Persistent

  5. Physiology of Pain • Nociceptive pain • Transmission of pain • Pain perception • Modulation • Gate control theory of pain

  6. Factors Affecting the Pain Experience • Age • Previous experience with pain • Cultural norms and attitudes

  7. Pain and the Nursing Process • Assessment • Data collection • Intensity • Location • Quality • Associated manifestations • Aggravating factors • Alleviating factors (continued)

  8. Pain and the Nursing Process • Assessment • Tools: • Initial pain assessment tool • Pain intensity scales • Pain diary • Psychosocial pain assessment • Developmental considerations (continued)

  9. Pain and the Nursing Process • Diagnosis • Acute pain • Chronic pain (continued)

  10. Pain and the Nursing Process • Planning and outcome identification • NOC for pain: • Comfort level • Pain • Adverse psychological response • Pain • Disruptive effects • Pain level (continued)

  11. Pain and the Nursing Process • Collaboration • Complete pain assessment requires multidisciplinary team • May require pain manager or specialist (continued)

  12. Pain and the Nursing Process • Implementation • Nurse-client relationship • Client education • Define pain • Identify probable cause • Introduce assessment tools for pain • Allow client to choose tool (continued)

  13. Pain and the Nursing Process • Implementation • Pharmacologic pain management • Combine analgesics • Maintain therapeutic serum levels • Choose appropriate route for administration • Use nonsteroidal anti-inflammatory drugs (NSAIDs) (continued)

  14. Pain and the Nursing Process • Implementation • Pharmacologic pain management • Opioid analgesics • Patient-controlled analgesia (PCA) • Addiction, tolerance, and physical dependence • Respiratory depression • Local anesthesia (continued)

  15. Pain and the Nursing Process • Implementation • Treatment of neuropathic pain • Tricyclic antidepressants • Anticonvulsants • Corticosteroids • Antispasmodics • Nonpharmacologic methods (continued)

  16. Pain and the Nursing Process • Implementation • Cognitive-behavioral interventions: • Distraction • Reframing • Relaxation techniques • Biofeedback • Cutaneous stimulation (continued)

  17. Pain and the Nursing Process • Implementation • Cognitive-behavioral interventions: • Transcutaneous stimulation • Exercise • Nutrition • Herbals • Environment (continued)

  18. Pain and the Nursing Process • Evaluation • Objective data: • Client’s facial expression and posture • Presence/absence of restlessness • Vital sign monitoring • Ongoing use of pain assessment tools • Subjective data: • Client’s perception

  19. Rest and Sleep • Rest • State of relaxation and calmness • Sleep • State of altered consciousness • Fluctuations in level of consciousness • Minimal activity • Slowing of body’s physiological processes

  20. Physiology of Rest and Sleep • Stages of sleep: • Non-rapid eye movement (NREM) sleep • Rapid eye movement (REM) sleep (continued)

  21. Physiology of Rest and Sleep • Sleep cycle • Sequence through stages • 70 to 90 minutes • Four to six sleep cycles in seven to eight hours

  22. Biological Clock • Circadian rhythms • Other biological rhythms: • Ultradian • Infradian • Circannual

  23. Factors Affecting Rest and Sleep • Degree of comfort • Anxiety • Environment • Lifestyle • Diet • Drugs and other substances • Cultural norms • Life span considerations

  24. Illness or Hospitalization • Sleep impairment due to: • Pain • Loss of familiar surroundings • Loss of routine • Fear of unknown • Timing of procedures • Noise • Loss of privacy

  25. Alteration in Sleep Patterns • Insomnia

  26. Hypersomnia or Narcolepsy • Sleep apnea • Sleep deprivation • Parasomnia

  27. Sleep and the Nursing Process • Assessment • Nature of sleep • Quality of sleep • Sleep environment • Associated factors • Opinion of sleep (continued)

  28. Sleep and the Nursing Process • Diagnosis • Insomnia (continued)

  29. Sleep and the Nursing Process • Planning and outcome identification • Hours of sleep • Observed hours of sleep • Sleep pattern • Sleep quality • Sleep efficiency (continued)

  30. Sleep and the Nursing Process • Implementation • Establish trusting nurse-client relationship • Create relaxing environment • Initiate relaxation techniques • Ensure appropriate nutrition • Initiate pharmacologic interventions • Provide client education (continued)

  31. Sleep and the Nursing Process • Evaluation • Plan of care • Individualized • Negotiated with client • Revisions • Assure client that help is available

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