Unit 10

1. Unit 10 Comfort, Pain, Rest, and Sleep

2. 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. 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. 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. Noise • Excessive noise: • Delays healing • Impairs immune system function • Increases heart rate and blood pressure • Causes patients to feel stressed and anxious

6. Noise • Excessive noise: • Interferes with sleep • May trigger wandering in confused patients • May cause patient dissatisfaction with care

7. 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. 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. Patient Comfort • All humans need comfort, rest, and sleep for physical and emotional well-being, health, and wellness • Comfortis a state of physical and emotional well-being • Patient is calm and relaxed • Is not in pain or upset

10. Pain • A state of discomfort that is unpleasant for the patient • Always a warning that something is wrong

11. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. Pain Hierarchy

26. FACES Pain Rating Scale • FACES scale may be used for both children and adults

27. 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. Other Pain Rating Scales

29. 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. Managing Pain • Check on the patient after pain medicine has been given • Inform the nurse if the pain has not been relieved

31. 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. Rest • State of mental and physical comfort, calmness, and relaxation

33. 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. 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. The Sleep Cycle

36. Sleep Disorders • Sleep has been studied extensively • Some facilities have units and clinics that specialize in the diagnosis and treatment of sleep disorders

37. Sleep Disorders • Most common sleep disorders are: • Insomnia • Hypersomnia • Narcolepsy • Sleep apnea • Sleep deprivation

38. 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