Transcript Theory

Pain, Comfort, and Sleep
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Lesson 31.1
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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
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.
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Slide 4
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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”
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Slide 5
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Surgical patients experience postoperative pain
Many medical conditions cause pain
Headache, myocardial infarction
 Cancer, fractures
 Cuts and abrasions
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Slide 6
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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
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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
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Slide 8
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Slide 9
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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
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Slide 10
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Slide 11
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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
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Type of pain
Severity of pain based on a pain scale
Quality of pain
Location of pain
Duration of pain
Degree of pain
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Slide 13
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Acute: short-term
Chronic: long-term
Nociceptive: injury to tissues
Neuropathic: sensitivity to stimuli
Phantom: after loss of body part
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Slide 14
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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
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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
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Pain that may continue for months or years
Often associated with conditions such as:
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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
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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
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Transduction
Transmission
Perception
Modulation
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Slide 18
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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
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Slide 19
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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
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Slide 20
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Occurs with loss of a body part from
amputation
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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
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Slide 21
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Pain scales
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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
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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
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Slide 23
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Slide 24
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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
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Slide 25
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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
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Constant, intermittent, occasional
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Slide 26
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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
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Slide 27
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 28
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Analgesic medications
Oral
 Topical
 Injected
 Intravenous
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Patient-controlled analgesia
Epidural analgesia
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 29
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 30
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
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
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
Lesson 31.2
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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.
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Slide 35
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
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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
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Rapid eye movement (REM) sleep
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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
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Non–rapid eye movement (NREM) sleep
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Believed to be the time when the body receives the
most rest
Heart rate, blood pressure, and respirations decline
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 39
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Newborns:
Age 1:
Preschool:
School-Age:
Adolescents:
Adults:
At least 16 hours of sleep per day
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
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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
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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
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A condition in which the person will stop
breathing for brief periods during sleep
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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
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Harsh sounds caused by vibration and/or
obstruction of the air passages at the back of
the mouth and nose
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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
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Slide 44
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Sudden-onset, recurrent, uncontrollable, brief
episodes of sleep during normal hours of
wakefulness
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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
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
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.
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Slide 47