Comfort

Question 1

Pain as an alterative to comfort

Answer 1

• unpleasant sensory and emotional experience associated with actual or potential tissue damage
• “pain is whatever the patient says it is, existing whenever they say it does”
• 5th vital sign
• relief of pain is a patient’s right

Question 2

How pain is described

Answer 2

• duration
• intensity
• etiology
• location

Question 3

sleep-rest disorders

Answer 3

• insomnia
• narcolepsy
• parasomnias
• RLS
• sleep apnea

Question 4

Non-modifiable risk factors for alterations ofcomfort

Answer 4

• genetics affect susceptibility to diseases associated with discomfort
• genetic disorders directly affect individual’s ability to perceive pain
• genetic mutations associated with some sleep disorders
• many psychiatric disorders have genetic components

Question 5

Modifiable risk factors for alterations ofcomfort

Answer 5

• personal perference
• lifestyle habits
• nutrition
• smoking
• alcohol use
• sleep hygiene
• occupation
• culture

Question 6

Assessment of sleep

Answer 6

patient hx

• nursing interview
• client’s culture affects how client perceives discomfort and pain

Question 7

nursing interview for sleep assessment

Answer 7

• client description of symptoms
• pain scale
• depression assessment

Question 8

common questions for sleep assessment

Answer 8

• when did it start?
• meds?
• environment conducive for sleep?
• creepy, crawling legs?
• limb jerking?
• snore?
• shift worker?
• bedtimes?
• caffeine, tobacco, alcohol?
• street drugs?

Question 9

diagnostic tests for sleep

Answer 9

• primary test: Polysomnography (PSG) - sleep study

* Electroenceohalogram (EEG)

Question 10

Polysomnography (PSG)

Answer 10

records client’s :

• SpO2
• HR
• RR
• eye and leg movement

Question 11

Surgical procedures for sleep

Answer 11

• usually surgery to remove obstruction
• adenotonsillectomy
• partial removal of the soft palate, uvula, and posterior lateral pharyngeal wall

Question 12

Surgery is only considered if…

Answer 12

CPAP is not tolerated

Question 13

adenotonsillectomy

Answer 13

commonly performed to treat OSA in children

Question 14

OSA

Answer 14

obstructive sleep apnea

* surgery is done to remove the obstruction

Question 15

sleep hygiene

Answer 15

variety of sleep practices that help individuals attain good-quality sleep

Question 16

sleep practices for sleep hygiene

Answer 16

• maintaining regular sleep/awake pattern
• performing bedtime rituals
• providing restful environment
• promoting comfort/relaxation
• minimize environmental stimuli
• avoid fluid intake 90 mins before bedtime
• regular exercise, but not before bed

Question 17

medications for sleep

Answer 17

• primary: sedative-hypnotics

- occasionally used: antiparkinson drugs, opioids, and anti convulsants

Question 18

sedative-hypnotic

Answer 18

~anxiolytics
~barbiturates
~benzodiazepines

Question 19

Important characteristic for sleep meds

Answer 19

half-life of the drug

Question 20

infant considerations for comfort

Answer 20

~challenging to discern cause of discomfort

~may percieve pain to greater extent

Question 21

older adult considerations for comfort

Answer 21

~may have higher pain threshold but lower tolerance

~cognitive impairment and sleep disorders

Question 22

ethnicity considerations for comfort

Answer 22

be culturally competent

Question 23

age & developmental stage affect ability to describe pain

Answer 23

special considerations for assessing discomfort and promoting comfort for each stage

Question 24

NREM

Answer 24

~activity in the RAS is inhibitied
~75%-80% of sleep during the night
~4 stages

Question 25

NREM Stage 1

Answer 25

~very light sleep

~lasts a few minutes

Question 26

NREM Stage 2

Answer 26

• light sleep
• body processes continue to slow down
• eyes still
• HR and RR decrease slightly
• body temp fall
• 44%-55% of total sleep
• requires more stimuli to waken than stage 1

Question 27

NREM Stage 3 & 4

Answer 27

• deepest stages of sleep
• deep sleep/delta sleep
• HR & RR drops 20-30% below those exhibited during waking hours
• difficult to arouse

Question 28

REM

Answer 28

• usually recurs about every 90 minutes
• lasts 5-10 minutes
• dreams
• brain is highly active
• brain metabolism may increase as much as 20%
• paradoxial sleep
• distinctive eye movements
• learning, thinking, organizing areas are stimulated during REM sleep