chapter 33 comfort and sleep fundamentals of nursing: standards & practices, 2e
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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.TRANSCRIPT
Chapter 33Comfort and Sleep
Fundamentals of Nursing: Standards & Practices, 2E
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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.
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• 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.
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• 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.
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• 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.
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Physiology of Pain• Nociceptive Pain • Neuropathic Pain• Gate Control Theory of Pain
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Factors Affecting the Pain Experience• Age• Previous Experience with Pain• Cultural Norms and Attitudes
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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.
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• 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
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Nursing Diagnosis• NANDA-approved diagnoses
Acute Pain Chronic Pain
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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.
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ImplementationCognitive-Behavioral InterventionsNurse-Client RelationshipBiofeedbackPharmacologic Pain ManagementTreatment of Neuropathic Pain
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Evaluation• Client’s facial expression and posture • Presence (or absence) of restlessness• Vital sign monitoring• Ongoing use of pain assessment tools
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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.
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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
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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.
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Factors Affecting Rest and Sleep• Degree of Comfort• Anxiety• Environment• Lifestyle
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• Diet• Drugs and Other Substances• Cultural Norms• Life Span Considerations• Illness or Hospitalization
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Alteration in Sleep Patterns• Insomnia• Hypersomnia or Narcolepsy• Sleep Apnea• Sleep Deprivation• Parasomnia
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Assessment• Assess to determine sleep routines,
sleep alterations, types of disturbances, and impact of sleep problems.
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Diagnosis• NANDA-approved diagnoses
Sleep Pattern Disturbance
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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.
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Implementation• Establish a trusting nurse-client
relationship• Create a relaxing environment.• Initiate relaxation techniques.• Ensure appropriate nutrition.• Initiate pharmacologic interventions.• Provide client education.
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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.
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• Review the Nursing Process Highlight on evaluating the care of sleep-disordered clients.