Chapter 31 Comfort Rest and Sleep Copyright 2017

Chapter 31 Comfort, Rest, and Sleep Copyright © 2017, Elsevier, Inc. All rights reserved.

Comfort, Rest, and Sleep Comfort, rest, and sleep are needed for wellbeing. Comfort, rest, and sleep problems affect the total person. Ø Physical, emotional, spiritual Discomfort and pain: Can be physical or emotional Ø Affect rest and sleep Ø Decrease function and quality of life Ø Rest and sleep restore energy and well-being. Copyright © 2017, Elsevier, Inc. All rights reserved. 2

Comfort is a state of well-being. The person has no physical or emotional pain. Ø He or she is calm and at peace. Ø Comfort is affected by: Ø Ø Ø Ø Age Illness Activity Temperature Ventilation Noise Odors Lighting Copyright © 2017, Elsevier, Inc. All rights reserved. 3

Pain or discomfort means to ache, hurt, or be sore. Comfort and discomfort are subjective. You must rely on what the person says. Ø If a person complains of pain or discomfort, the person has pain or discomfort. Ø Pain is personal. Ø It differs for each person. Pain is a warning from the body. It is often called the fifth vital sign. Ø It signals tissue damage. Ø Copyright © 2017, Elsevier, Inc. All rights reserved. 4

Pain (Cont. ) Types of pain Acute pain is felt suddenly from injury, disease, trauma, or surgery. Ø Chronic pain (persistent pain) continues for a long time (months or years) or occurs off and on. Ø Radiating pain is felt at the site of tissue damage and in nearby areas. Ø Phantom pain is felt in a body part that is no longer there. Ø Copyright © 2017, Elsevier, Inc. All rights reserved. 5

Pain (Cont. ) Factors affecting pain Ø Past experience • Knowing what to expect can help or hinder how the person handles pain. Anxiety • Pain cause anxiety. • Anxiety increases how much pain is felt. • Reducing anxiety helps lessen pain. Ø Rest and sleep • Rest and sleep restore energy. • Pain seems worse when tired or restless. Ø Copyright © 2017, Elsevier, Inc. All rights reserved. 6

Pain (Cont. ) Ø Attention • The more a person thinks about the pain, the worse it seems. Personal and family duties • Pain is often ignored when there are children to care for. Ø The value or meaning of pain • To some people, pain is a sign of weakness. • To others, pain is used to avoid certain people or things Ø —the pain is useful. Copyright © 2017, Elsevier, Inc. All rights reserved. 7

Pain (Cont. ) Ø Support from others • Dealing with pain is often easier when family and friends offer comfort and support. Ø Culture • Affects pain responses • All persons have the right to be comfortable and as pain free as possible. Illness • Some diseases decrease pain sensations. • The person is at risk for undetected disease or injury. Ø Age Ø Copyright © 2017, Elsevier, Inc. All rights reserved. 8

Pain (Cont. ) Signs and symptoms Location Ø Onset and duration Ø • When did the pain start? • How long has it lasted? Ø Intensity • Mild, moderate, or severe pain Description Ø Factors causing pain (precipitating factors) Ø Factors affecting pain Ø • What makes the pain better? • What makes it worse? Vital signs Ø Other signs and symptoms Ø Copyright © 2017, Elsevier, Inc. All rights reserved. 9

Pain (Cont. ) Nursing measures The nurse uses the nursing process to promote comfort and relieve pain. Ø Other measures include distraction, relaxation, and guided imagery. Ø • Distraction means to change the person’s center of attention. • Relaxation means to be free from mental and physical stress. • Guided imagery is creating and focusing on an image. Ø Doctors often order drugs to control or relieve pain. • Such drugs can cause orthostatic hypotension, drowsiness, dizziness, and coordination problems. • The nurse and care plan alert you to needed safety measures. Copyright © 2017, Elsevier, Inc. All rights reserved. 10

Back Massage The back massage (back rub) can promote comfort and help relieve pain. It relaxes muscles and stimulates circulation. Back massages last 3 to 5 minutes. Observe the skin before the massage. Copyright © 2017, Elsevier, Inc. All rights reserved. 11

Back Massage (Cont. ) Lotion reduces friction during the massage. Warm the lotion before applying it. Do one of the following. Rub some lotion between your hands. Ø Place the bottle in the bath water. Ø Hold the bottle under warm water. Ø Copyright © 2017, Elsevier, Inc. All rights reserved. 12

Rest Promote rest by meeting physical needs. Meet thirst, hunger, and elimination needs. Ø Help to relieve pain or discomfort. Ø Provide a comfortable position and good alignment. Ø Provide a quiet setting. Ø Provide a clean, dry, and wrinkle-free bed. Ø Provide a clean, neat, and uncluttered room. Ø Copyright © 2017, Elsevier, Inc. All rights reserved. 13

Rest (Cont. ) Safety and security needs • The person must feel safe from falling or other injuries. • Explain the reasons for care. • Explain how care is given. • Follow routines and rituals whenever possible. Ø Love and belonging needs • Promote visits or calls from caring family and friends. • Read cards and letters. Ø Meet self-esteem needs • Promote personal choice in sleepwear. • Assist with hygiene and grooming measures as needed. Ø Copyright © 2017, Elsevier, Inc. All rights reserved. 14

Sleep is a basic need. It lets the mind and body rest. Ø The body saves energy. Ø Body functions slow. Ø Vital signs are lower than when awake. Ø Tissue healing and repair occur. Ø Sleep lowers stress, tension, and anxiety. Ø The person regains energy and mental alertness. Ø Copyright © 2017, Elsevier, Inc. All rights reserved. 15

Sleep (Cont. ) Circadian rhythm is a daily rhythm based on a 24 -hour cycle. Circadian rhythm includes a sleep-wake cycle. Ø Health care often interferes with a person’s circadian rhythm and the sleep-wake cycle. Ø There are two phases of sleep. NREM sleep (non-REM sleep) is the phase of sleep where there is “no rapid eye movement. ” Ø REM sleep is the “rapid eye movement” phase. Ø Copyright © 2017, Elsevier, Inc. All rights reserved. 16

Sleep (Cont. ) Sleep requirements Ø Sleep needs vary for each age-group. Factors affecting sleep Illness increases the need for sleep. • Signs and symptoms of illness can interfere with sleep. • Treatments and therapies can interfere with sleep. • Care devices can cause uncomfortable positions. • The emotional effects of illness can affect sleep. Ø Nutrition • Sleep needs increase with weight gain, decrease with Ø weight loss. • Foods with caffeine prevent sleep. • The protein tryptophan tends to help sleep. Copyright © 2017, Elsevier, Inc. All rights reserved. 17

Sleep (Cont. ) Exercise improves health and fitness. • Exercise before bedtime interferes with sleep. Ø Environment • People adjust to their usual sleep settings. Ø Drugs and other substances • Drugs and alcohol interfere with REM. • Caffeine is a stimulant and prevents sleep. Ø Lifestyle changes can affect sleep. • Relates to a person’s daily routines and way of living. Ø Emotional problems • Fear, worry, depression, and anxiety affect sleep. Ø Copyright © 2017, Elsevier, Inc. All rights reserved. 18

Sleep (Cont. ) Sleep disorders involve repeated sleep problems. The amount and quality of sleep are affected. Ø Lifestyle is affected. Ø Insomnia—chronic condition in which the person cannot sleep or stay asleep all night. Sleep deprivation—amount and quality of sleep are decreased; sleep is interrupted. Sleepwalking—the person leaves the bed and walks about; he or she has no memory of the event on awakening. Copyright © 2017, Elsevier, Inc. All rights reserved. 19

Sleep (Cont. ) Promoting sleep The nurse assesses the person’s sleep patterns. Ø You need to: • Report signs and symptoms of sleep disorders. • Follow the care plan for measures to promote sleep. • Report your observations about how the person slept. Ø Copyright © 2017, Elsevier, Inc. All rights reserved. 20