Download 31 pain, comfort and sleep

Chapter 31
Pain, Comfort, and Sleep
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Chapter 31
Lesson 31.1
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Learning Objectives
Theory
1)
Discuss the application of The Joint Commission
pain standards in planning patient care.
2)
Give the rationale for why pain is considered the
“fifth vital sign.”
3)
Illustrate the physiology of pain using the gate
control theory.
4)
Describe the use of a variety of nursing
interventions for pain control, including
biofeedback, distraction, guided imagery,
massage, and relaxation.
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 3
Learning Objectives
Clinical Practice
1)
Assist the patient in accurately describing sensations of
pain and discomfort.
2)
Accurately and appropriately record the patient’s report of
pain using clear, descriptive terms.
3)
Assist the patient in using a transcutaneous electrical nerve
stimulation (TENS) unit.
4)
Evaluate the effects of various techniques used for pain
control.
5)
Assist with the care of patients receiving patient-controlled
analgesia (PCA) or epidural analgesia.
6)
Evaluate the effects of pain medication, and report and
record observations appropriately.
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 4
Pain




Pain is the feeling of distress and discomfort
Affects or interferes with normal activity
No accurate objective measurement of pain
Pain assessment is performed along with
each assessment of vital signs and is
considered the “fifth vital sign”
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 5
Pain (cont’d)


Surgical patients experience postoperative
pain
Many medical conditions cause pain



Headache, myocardial infarction
Cancer, fractures
Cuts and abrasions
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 6
The Joint Commission: Pain
Control Standards




Patients have the right to appropriate
assessment and management of pain
Pain is assessed in all patients
Patients are educated about pain and
managing pain as part of the treatment, as
appropriate
The discharge process provides for
continuing pain care based on the patient’s
needs at the time of discharge
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Slide 7
Theories of Pain



Pain defined as a feeling of distress or
suffering caused by the stimulation of nerve
endings
Pain serves as a warning of tissue damage
and allows sufferer to withdraw from the
source of the pain
Pain is transmitted through the nervous
system
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 8
Figure 31-1: Pain transmission
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Slide 9
Gate Control Theory


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
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Pain viewed as being controlled by a gate
mechanism in the central nervous system
Opening the gate allows transmission of pain
Closing the gate blocks the transmission of
pain
The gate may be opened by activity in smalldiameter nerves, such as tissue damage
Large-diameter nerve activity seems to close
the gate
Lack of input allows the gate to open
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 10
Figure 31-2: The gate control
theory of pain
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 11
Endorphins



Endorphins are endogenous, naturally
occurring opiate-like peptides that modify the
perception of pain
They attach to opioid receptors and block
pain
Physiologic and psychological stressors can
cause the release of endorphins

Long-distance runners often get an endorphin high
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Slide 12
Pain Descriptions






Type of pain
Severity of pain based on a pain scale
Quality of pain
Location of pain
Duration of pain
Degree of pain
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 13
Types of Pain

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Acute: short-term
Chronic: long-term
Nociceptive: injury to tissues
Neuropathic: sensitivity to stimuli
Phantom: after loss of body part
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 14
Type of Pain: Acute Pain





Usually associated with injury, medical
condition or surgical procedure
Short duration, lasting a few hours to a few
days
May be described as aching or throbbing
Patient may be restless or agitated
Usually controlled with analgesics
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Slide 15
Type of Pain: Acute Pain (cont’d)

Causes include:
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Burns, bone fractures, muscle strains
Pneumonia, sickle cell crisis, angina
Herpes zoster, inflammations, infections
May worsen in the presence of anxiety or fear
Usually relieved once the cause is removed
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Slide 16
Type of Pain: Chronic Pain


Pain that may continue for months or years
Often associated with conditions such as:




Arthritis
Chronic back pain
May be dull, constant, shooting, tingling, or
burning
May be treated with both pharmacologic and
nonpharmacologic interventions
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Slide 17
Type of Pain: Nociceptive Pain



Involves injury to the tissue in which receptors
called nociceptors are located
May be found in skin, joints, or organ viscera
Four phases associated with nociceptive pain




Transduction
Transmission
Perception
Modulation
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Slide 18
Type of Pain: Nociceptive Pain (cont’d)


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
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Treatments are aimed at one or all four
phases
NSAIDs work at blocking transduction
Opioids block transmission
Distraction and guided imagery block
perception
Drugs that block neurotransmitter uptake
work on modulation
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 19
Type of Pain: Neuropathic Pain

Associated with dysfunction of the nervous
system


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Pain receptors in the body become more sensitive
to stimuli and send signals more easily
As nerve endings grow new branches, the signals
become stronger
Often associated with Guillain-Barré syndrome,
cancer, and HIV
Treated with NSAIDs, tricyclic antidepressants,
anticonvulsants, or corticosteroids
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 20
Type of Pain: Phantom Pain

Occurs with loss of a body part from
amputation



Patient may feel pain in the amputated part for
years after the amputation
Not controlled by conventional methods
May be treated with TENS units implanted in
the thalamus
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 21
Severity of Pain: Pain Scales

Pain scales

Number scale
• Rate the level of pain: 0 is pain-free; 10 is worst pain
imaginable
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Picture scale
• Shows faces in varying degrees of pain
NIPS (Neonatal Infant Pain Scale)
CRIES (Crying, Requires oxygen to maintain
saturation, Increased vital signs, Expression, and
Sleeplessness)
PIPP (Premature Infant Pain Profile)
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Slide 22
Figure 31-4: Pain number
rating scale
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 23
Figure 31-5: Wong-Baker FACES
Pain Rating Scale for children
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 24
Quality of Pain: Perception of Pain


Assessment of pain: whatever the person says it is
Observable indicators (may not always be present)

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Moaning
Crying
Irritability
Grimacing
Frowning
Rigid posture in bed
Described as rushing, throbbing, pulsating,
twisting, pulling, burning, searing, stabbing, tearing,
biting, blinding, nauseating, debilitating
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 25
Location of Pain

Area of pain
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

Name of affected body part (e.g., foot, hand, leg,
or upper/lower abdomen)
Localized, radiating, generalized
Frequency of pain

Constant, intermittent, occasional
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 26
Pain Control: Nonmedicinal Methods
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Transcutaneous electrical nerve stimulation (TENS)
Percutaneous electrical nerve stimulation (PENS)
Binders
Application of heat and cold
Relaxation
Biofeedback
Distraction
Guided imagery and meditation
Music
Hypnosis
Massage
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 27
Figure 31-6: TENS unit blocks pain
signal transmission
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 28
Medicinal Pain Control:
Medicinal Methods

Analgesic medications



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Oral
Topical
Injected
Intravenous
Patient-controlled analgesia
Epidural analgesia
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 29
Figure 31-9: CADD portable
PCA pump in use by patient
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 30
Question 1
There are several different types of pain. Which
type of pain occurs after the loss of a body part
from an amputation?
1)
2)
3)
4)
Acute pain
Nociceptive pain
Neuropathic pain
Phantom pain
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 31
Question 2
Kathy is working in a mother-baby unit. Which
pain scale is used to determine if the baby is in
pain?
1)
2)
3)
4)
FACES pain rating scale for children
FLACC scale
PIPP scale
NIPS
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 32
Question 3
Karen’s patient is prescribed a COX-2 inhibitor
for her pain. Which of the following is an
example of a COX-2 inhibitor?
1)
2)
3)
4)
Aspirin
Morphine
Antiinflammatory
Antidepressant
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 33
Chapter 31
Lesson 31.2
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Learning Objectives
Theory
5)
Analyzethe need for normal sleep.
6)
Recognize how the need for sleep changes
over the life span.
7)
Delineate factors that can interfere with
sleep.
8)
Define the sleep disorders insomnia, sleep
apnea, and narcolepsy.
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 35
Learning Objectives
Clinical Practice
7)
Gather data regarding a patient’s sleep
difficulties.
8)
Develop a plan designed to assist the
patient in getting adequate sleep.
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 36
Functions of Sleep


Adequate rest and sleep important factors in
general health and recovery from illness
Being rested increases pain tolerance and
allows improved response to analgesia
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Slide 37
Stages of Sleep

Rapid eye movement (REM) sleep



Time in which you dream
A period of a high level of activity
Heart rate, blood pressure, and respirations are
similar to that when awake
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Slide 38
Stages of Sleep (cont’d)

Non–rapid eye movement (NREM) sleep


Believed to be the time when the body receives
the most rest
Heart rate, blood pressure, and respirations
decline
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Slide 39
Normal Sleep Requirements
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Newborns:
day
Age 1:
Preschool:
School-Age:
Adolescents:
Adults:
At least 16 hours of sleep per
12-14 hours per day
11-13 hours
10-11 hours of sleep per night
9-10 hours of sleep a night
8 hours sleep a night
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Slide 40
Factors Affecting Sleep
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Working night or evening shifts, changing
shifts
Traveling (jet lag), exposure to sunlight
Snoring
Caffeine, nicotine, or alcohol consumption
Exercise, taking naps
Stress, illness, fatigue
Discomfort
Environmental factors—heat, cold, light, noise
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Slide 41
Sleep Disorders: Insomnia

Difficulty in getting to sleep or staying asleep
at night


Transient insomnia may be caused by stress,
depression
Chronic insomnia can have many causes; may
require treatment from a health care provider
specializing in sleep disorders
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Slide 42
Sleep Disorders: Sleep Apnea

A condition in which the person will stop
breathing for brief periods during sleep



Obstructive apnea—most common and severe;
airway blocked at back of throat; snoring common;
treatment is CPAP
Central apnea—diaphragm and chest stops
working; person awakens to resume breathing
Mixed sleep apnea—combination of both
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Slide 43
Sleep Disorders: Snoring

Harsh sounds caused by vibration and/or
obstruction of the air passages at the back of
the mouth and nose

May be caused by poor muscle tone, excessive
tissue, or deformities such as a deviated septum
 A partial blockage of the airway
 Sleeping on the side or losing weight may help
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 44
Sleep Disorders: Narcolepsy

Sudden-onset, recurrent, uncontrollable, brief
episodes of sleep during normal hours of
wakefulness

May occur at any time and last from a few
seconds to 30 minutes
 Usually begins around age 25
 No known cure
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Slide 45
Question 4
Karen’s patient is experiencing sudden-onset,
recurrent, and uncontrollable brief episodes of
sleep during hours of wakefulness. What
condition does Karen’s patient have?
1)
2)
3)
4)
Insomnia
Sleep apnea
Narcolepsy
REM sleep
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 46
Question 5
Karen’s patient is going home with a prescription
for a sleep aid. When teaching the patient about
the medication, Karen should be sure to include:
1)
2)
3)
4)
medications should be used with alcohol.
medications for sleep are for short-term relief.
over-the-counter medications for sleep will
keep you alert.
hypnotics are not used for sleep.
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 47