Pain Management, comfort, rest, and sleep

10 possible causes of discomfort
anxiety, constipation, constricting edema, depression, diaphoresis, diarrhea, distention, dry mouth, dyspnea, fatigue
McCaffery’s discription of pain
nurse must believe every patient who says he or she has pain
Relationship of the gate control theory to selecting nursing interventions for pain relief
back rub, heat of a warm compress or cold from ice applications
Synergistic relationship of fatigue, sleep disturbance and depression to perception of pain
depression is associated with sleep disturbance, which in turn increases the intensity of the fatigue
Acute pain
intense and of short duration, lasting less than 6 months
Chronic pain
lasting longer than 6 months
Endorphin
potent polypeptides composed of many amino acids found in the pituitary gland and other areas of the CNS
Different types of pain intensity scales
picture and numbers
Subjective data the nurse obtains from the patient regarding his/her pain experienced
characteristics and description of the pain
Rational for making pain assessment the fifth vital sign
makes pain visible and raises awareness of the problem. Clinicians will receive frequent reminders of existing pain problems
Examples of cultural and ethnic considerations for pain assessment and management
establish a relationship by listening, showing respect and allowing the patient to help develop and choose treatment options, understanding cultural background and personal characteristics
What should the nurse do to fully assess the patient’s pain
rate the pain
Management of pain is required by
JCAHO
Key concepts in the standards that are applied to health care facilities
patients have the right to appropriate assessment, patients will be treated for pain or referred for treatment, pain is to be assessed and regularly reassessed
Problems if pain isn’t managed
erodes a patient’s trust in the health care systems and it can be lead to further set backs and increased costs in treatment
Some objective signs that the patient is experiencing pain
pulse- increased, respirations- increased, blood pressure- increased, dilated pupils, muscle tension
Guidelines for individualizing pain therapy
use different types of pain relief measures, provide pain relief measures before pain becomes severe, use measures the patient believes are affective, consider the patients ability or willingness to participate in pain relief measures, keep trying
Nursing Interventions to reduce or eliminate the patient’s pain
teach relaxation exercises, massage area, pain meds, hot and cold products
Transcutaneous Electrical Nerve Stimulation
pocket sized, battery operated device that provides a continuous mild electrical current to the skin
Two examples of noninvasive pain relief measures
cutaneous stimulation, distractions
Nonopioids
acetaminophen, for milk to moderate pain and some severe pain
Opioids
morphine, action higher centers of the brain to modify perception and reaction to pain
Adjuvant Medication
antidepressant, relieve pain by a variety of mechanisms
Older adult considerations
the effect of aging on the pain process may be compounded in an older adult who has a chronic illness that affects the nervous system
Patient-controlled analgesia
allows patients to administer analgesics whenever needed
Role of the nurse in the administration of epidural analgesia
monitoring the patient’s level of consciousness, pain intensity, respiratory rate and infusion rate/ volume on the pump
Patient to be a candidate for PCA
patient must be alert, oriented and able to follow simple directions
Receiving epidural analgesia biggest complication
increased respiratory rate
Stages of sleep cycle
stage 1- light level, stage 2- sound sleep, stage 3- deep sleep, stage 4- deepest stage of sleep
Signs and Symptoms of Sleep deprivation
hand tremors, mood swings, decreased reflexes, disorientation, reduction in word memory, irritability
Physical illness
pain or physical disocomfort difficulty falling or staying asleep
Anxiety
anxiety and depression lack of sleep increases
Drugs
various durgs and substances pattern and quality of sleep
Environment
ventilation, lighting, type of bed influence the ability to fall and remain asleep
Nutrition
weight gain longer sleep periods with fewer interruptions and later awakening
Exercise
facilitate restful sleep