chapter 33 comfort and sleep fundamentals of nursing: standards & practices, 2e

Chapter 33Comfort and Sleep

Fundamentals of Nursing: Standards & Practices, 2E

Copyright 2002 by Delmar, a division of Thomson Learning 33-2

PainNature of PainCommon Myths About PainTypes of Pain

• Cutaneous pain is caused by stimulation of the cutaneous nerve endings in the skin and results in well-localized “burning” or “prickling” sensation.

Copyright 2002 by Delmar, a division of Thomson Learning 33-3

• Somatic pain is nonlocalized and originates in support structures.

• Visceral pain is discomfort in the internal organs.

• Pain originating from the abdominal organs is often called referred pain.

Copyright 2002 by Delmar, a division of Thomson Learning 33-4

• Acute pain is most frequently identified by sudden onset and relative short duration.

• Recurrent acute pain is identified by repetitive episodes the may recur over a prolonged period of time.

Copyright 2002 by Delmar, a division of Thomson Learning 33-5

• Chronic pain is identified as long-term, persistent, nearly constant, or recurrent pain that produces significant negative changes in client’s life.

• Chronic acute pain occurs almost daily over a long period and has the potential for lasting months or years.

• Chronic nonmalignant pain occurs almost daily and last for at least 6 months.

Copyright 2002 by Delmar, a division of Thomson Learning 33-6

Physiology of Pain• Nociceptive Pain • Neuropathic Pain• Gate Control Theory of Pain

Copyright 2002 by Delmar, a division of Thomson Learning 33-7

Factors Affecting the Pain Experience• Age• Previous Experience with Pain• Cultural Norms and Attitudes

Copyright 2002 by Delmar, a division of Thomson Learning 33-8

Assessment• Data Collection

Pain threshold is the level of intensity at which pain becomes appreciable or perceptible.

Pain tolerance is the level of intensity or duration of pain the client is willing or able to endure.

Copyright 2002 by Delmar, a division of Thomson Learning 33-9

• Assessment Tools Initial Pain Assessment Tool Pain Intensity Scales Psychosocial Pain Assessment Review Table 32-5 Initial Pain

Assessment Tool• Developmental Considerations

Children and Adolescents

Copyright 2002 by Delmar, a division of Thomson Learning 33-10

Nursing Diagnosis• NANDA-approved diagnoses

Acute Pain Chronic Pain

Copyright 2002 by Delmar, a division of Thomson Learning 33-11

Outcome Identification and Planning• Planning focuses on mutual goal

setting.• A goal of nursing care is to use both

nonpharmacologic and pharmacologic interventions in planning strategies to control or maintain clients at desired levels of functioning and pain.

Copyright 2002 by Delmar, a division of Thomson Learning 33-12

ImplementationCognitive-Behavioral InterventionsNurse-Client RelationshipBiofeedbackPharmacologic Pain ManagementTreatment of Neuropathic Pain

Copyright 2002 by Delmar, a division of Thomson Learning 33-13

Evaluation• Client’s facial expression and posture • Presence (or absence) of restlessness• Vital sign monitoring• Ongoing use of pain assessment tools

Copyright 2002 by Delmar, a division of Thomson Learning 33-14

Rest and SleepRest refers to a state of relaxation

and calmness.Sleep refers to a state of altered

consciousness during which an individual experiences fluctuations in level of consciousness, minimal activity, and a general slowing of the body’s physiological process.

Copyright 2002 by Delmar, a division of Thomson Learning 33-15

Physiology of Rest and Sleep• Stages of Sleep

NREM Sleep REM Sleep

• Sleep Cycle Refers to the sequence of sleep that begins with the four

stages of NREM sleep in order, with a return to stage 3, then 2, then passage into the first REM stage

Review Figure 32-9 on the sleep cycle

Copyright 2002 by Delmar, a division of Thomson Learning 33-16

Biological Clock• Is an endogenous mechanism capable

of measuring time in a living organism• Chronobiology is a branch of science

that studies these rhythms that are controlled by our biological clocks.

Copyright 2002 by Delmar, a division of Thomson Learning 33-17

Factors Affecting Rest and Sleep• Degree of Comfort• Anxiety• Environment• Lifestyle

Copyright 2002 by Delmar, a division of Thomson Learning 33-18

• Diet• Drugs and Other Substances• Cultural Norms• Life Span Considerations• Illness or Hospitalization

Copyright 2002 by Delmar, a division of Thomson Learning 33-19

Alteration in Sleep Patterns• Insomnia• Hypersomnia or Narcolepsy• Sleep Apnea• Sleep Deprivation• Parasomnia

Copyright 2002 by Delmar, a division of Thomson Learning 33-20

Assessment• Assess to determine sleep routines,

sleep alterations, types of disturbances, and impact of sleep problems.

Copyright 2002 by Delmar, a division of Thomson Learning 33-21

Diagnosis• NANDA-approved diagnoses

Sleep Pattern Disturbance

Copyright 2002 by Delmar, a division of Thomson Learning 33-22

Outcome Identification and Planning• Planning should focus on the true

cause related to the sleep disturbance or alteration.

• A goal of nursing care is to consider that many sleep disturbances will require extended periods of time to correct.

Copyright 2002 by Delmar, a division of Thomson Learning 33-23

Implementation• Establish a trusting nurse-client

relationship• Create a relaxing environment.• Initiate relaxation techniques.• Ensure appropriate nutrition.• Initiate pharmacologic interventions.• Provide client education.

Copyright 2002 by Delmar, a division of Thomson Learning 33-24

Evaluation• Plan of care must be individualized for

and negotiated with client.• Nurses should make sure clients

understand that there is help for sleep problems and that they are not alone in having difficulty with managing their sleep patterns.

Copyright 2002 by Delmar, a division of Thomson Learning 33-25

• Review the Nursing Process Highlight on evaluating the care of sleep-disordered clients.