Learning Objectives • Describe and list factors that affect comfort. • Explain common physical assessment procedures used to evaluate comfort of patients across the lifespan. • Identify priority comfort assessment findings. • 4. Differentiate normal comfort assessment findings from abnormal findings. • 5. Explain the process for assessment of comfort.
Is comfort more than being pain free?Is comfort only related to the physical body? Is pain more than physical?
Comfort is: the immediate experience of being strengthened by having needs for relief, ease, and transcendence (exceeding usual limits: surpassing) met in four contexts…
Nurses must assess and promote comfort in all areas, not just pain relief; consider the pain of loneliness, fear, loss, and grief.
Lack of rest and sleep can be ‘painful’, and can also wear down one’s tolerance to pain, creating a vicious cycle
Pain (Discomfort) • An unpleasant sensory and emotional experience associated with actual or potential tissue damage (American Pain Society 2003;Gordon, 2003) • Physical and emotional • Subjective • Plays protective role • Fifth vital sign • Pain is whatever the experiencing person says it is, existing whenever he/she says it does (McCaffery & Pasero, 1999) • Relief of pain is a client right
Quick Review of Vital Signs: *Temperature *Pulse *Respirations *Blood Pressure *Pain Level
Pain is Subjective:perceived by the person experiencing it; thisperception may be based on prior experiences
Young children may not have a frame of reference because they have little experience with pain
Ethnic and cultural values and practices can effect a persons perception and reaction to pain
People from one culture may have learned to be expressive about pain, whereas people from another cultural background may have learned to keep those feelings to themselves and not bother others.
We all feel pain but may respond differently.Nurses need to be non-judgmental and become knowledgeable about cultural differences in response to pain.
To determine the location of pain in the bodyAsk: “Where is your discomfort?” or“Where are you having pain?”
Location Descriptors: • Classification of pain based on where it is, may be useful in determining underlying problems or needs. • *Location of pain is very important to note! • Radiation of Pain • Spreads or extends to other areas of the body • Example: Low back pain extends to legs • Referred Pain • Appears to arise in different areas of the body • Example: Cardiac pain may be felt in left shoulder or left arm.
Intensity:“On a scale of 0-10, with “0” representing no pain and 10 representing the worst pain you have experienced, how would you rate the degree of discomfort you are having right now?”Standard 0-10 Scale1-3 = mild pain4-6 = moderate pain7-10 = severe pain
More on Intensity: • Categories • Mild • Moderate • Severe • Somatic– close to surface (skin) • Visceral- deep (organs) • Neuropathic– damaged nerves
Important for the nurse to attempt to make the description of pain as objective and measureable as possible. (This allows a baseline for assessing improvement)
Wong-Baker FACS Rating Scale:Useful when working with children and non English-speaking patients
Inspection:What do you see? Many things are not as they appear, some are more obvious and look painful.
Character/Quality of pain: • “Describe how your discomfort/pain feels.” • Is it: • Burning • Stinging • Sharp • Dull ache • Deep • Throbbing • Cramping
Pattern: When did or does the pain start? (Onset) How long have you had the pain or how long does it last? (Duration) Do you have pain-free periods? When, and for how long? (Frequency)
Acute Pain: • *Sudden onset, usually temporary, localized • has an identifiable cause, less than • 6 months • Warns of actual or potential injury to tissues • Recurrent Acute Pain • -Migraines , Sickle Cell crises
Chronic Pain: • *Prolonged pain, usually lasting longer than 6 months • Examples: • Lower back pain • Neuralgias • Cancer pain • Chronic postoperative pain
Alleviating Factors:What measures or methods have you found helpful in lessening, or relieving your pain?(ice, heat, rest, elevation, acupuncture, medication)
Associated Symptoms Do you have any other symptoms before, during, or after your pain? (nausea, vomiting, dizziness, blurred vision, aura, shortness of breath, etc.)
Effects of Pain on Activities of Daily Living(ADL’s)…*Pain affecting ADL’s often creates discomfort in other areas of a persons life
How does the pain affect your daily life? *Eating*Working*Sleeping*Bathing*Socially*Recreational Activities
Past Pain Experiences “Tell me about past pain experiences you have had and what was done to relieve the pain?” “How does this pain compare to the other pain experiences you have had?”
Meaning of Pain “What does having this pain mean to you?” “Does it signal something about the future or past?” (often goes to fears which may influence seeking of care) Examples: “My mother died after having pain like this, I don’t want to know if I am going to die. I am afraid to find out.” “I’ve been cursed”, or “I’m a bad person”. “God is punishing me.”
Coping Resources • “What do you usually do to help you deal with the pain?” • (People use all kinds of things.) • *Acupuncture *Alcohol *Tens Unit *Illegal Drugs • (The longer a person is in pain the less tolerant of it they become.)
The following tables and boxes in your text should be read and studied in preparation for the Final Exam…
Nurses promote comfort and rest in many ways; not just by giving pain medication!