Download Unit 10 Comfort and Discomfort

Chapter 10
Comfort and safety
中国医科大学护理学院
曹 颖
Objectives
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1. Describe “ Comfort, pain”
2. Identify the etiologies causing discomfort
3. Describe the nursing care of clients with
pain
4. Understand the functions of common
positions.
5. Know the usages of protective devices,
crutches and canes.
Section 1
To Meet Comfort Need
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1. Comfort: strengthen greatly, renewal
*(1) Definition：a mental state of physical
and psychological health,
no pain no anxiety and relaxing at ease.
subjective feeling, a positive mind-set
client-led & nurse-controlled
* (2) Highest level of comfort:
all need are met
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(3) Related factors
a
b
c
d
Physical comfort needs
Psychospiritual comfort needs
Social comfort needs
Environmental comfort needs
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2. Discomfort
(1) Etiology
*(2) Manifestation
irritation
insomnia
fatigue
depress
loss
despair
pain
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(3) Nursing
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A solace: talking in soothing tones
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B providing a warm blanket a cup of tea
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C maintaining a quiet environment
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D coordinating the activities of other staff
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E supporting: medical staff. the clients family
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members or significant others
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F touch, applying lotion to dry skin
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G encouraging decision making
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3 The methods to improve comfort
Position
Active Position
passive Position
Compulsory Position
Stable Position
Unstable Position
Position
supine position: dorsal recumbent P
side lying position: lateral P
Fowler’s position: Semisitting P
orthopneic position
prone position
trendelenburg position
dorsal elevated position
knee chest position
lithotomy position
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Section 2 Pain
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**1. Definition
An unpleasant sensory and emotional
experience associated with actual or
potential damage or described in terms of
such damage.
* 2. Nature
Physiologic and psychologic
subjective and individual
body’s defense mechanisms
3. Types of pain
 (1) According to its origin
a Cutaneous pain：skin, subcutaneous
b Deep somatic pain: ligament, bone,
nerves
c Visceral pain: abdominal cavity, cranium
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(2) According to where it is experienced
in the body
a Radiating pain
b Referred pain
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C According to duration
a acute pain
b chronic pain
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D Intractable pain
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E Neuropathic pain
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F Phantom pain
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G Pain syndromes
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4 Precipitating factors
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a chemical factors:
b Physical factors: temperature, incision,
c pathological factors: diseases
d. Emotional factors:
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5 Concepts associated with pain
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pain threshold is the amount of pain stimulation
a person requires in order to feel pain
pain tolerance is the maximum amount and
duration of pain that an individual is willing to
endure
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6 Factors affecting the pain experience
a Ethnic and cultural values
b Developmental stage
c Past pain experiences
d Attention
e Emotion: Anxiety and stress
F Individual difference
G Social support system
H Medical staff
7 NURSING
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ASSESSING
A Pain history
B Effect on activities of daily living
C Sounds and posture
D Coping resources
E Intensity, quality and location
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Grade (score)
0 : no pain
1 : mild pain ,can tolerance ,do not disturb sleep
2: moderate pain ,can not tolerance , disturb
sleep ,need drug
3: severe pain , can not tolerance , disturb sleep
seriously ,need drug
* Measure Methods
a Numerical rating scales
b Verbal descriptors scales
c Visual analogue scales
DIAGNOSING
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Ineffective airway clearance
Anxiety
Ineffective individual coping
Altered health maintenance
Knowledge deficit
Impaired physical mobility
Sleep pattern disturbance
**IMPLEMENTING
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1) pain management
A pharmacologic
First stage
NSAIDs (non steroid anti-inflammatory
drugs)
Nonopioids (nonarcotic) analgesics
Antipyretic
Second stage
Opioid analgesics (codeine)
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Third stage
Opioid analgesics (dolantin morphine)
Assistant drug
Valli
B nonpharmacologic (physical)
a Heat and cold application
b TENS (transcutaneous electrical nerve
stimulation)
c massage acupressure
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C acupuncture
D immobilization
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2 psychological nursing
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a reduce mental pressure
**b distraction
* distraction activities (playing, watching
TV, singing, enjoying music)
* relaxation technique
* imagery
* therapeutic touch
* hypnosis
* bio-feedback
* meditation
* Message
3 promote comfort
EVALUATING
Section 3 Safety
1 Factors affecting safety
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mechanical injury
physical injury
chemical injury
biological injury
nosocomial injury
2 Device to prevent injury
A. protective devices
bedside rail restraints
safety strap body restraints
overbed cradle
B. assistant devices
crutches
canes