Module 4: Comfort and Pain Management & Rest and Sleep Flashcards
Acute Pain
short term
less than 3 months
Chronic Pain
long term
more than 3 months
Effects of Chronic Pain on Patient
normal or decreased vital signs
depression is a major concern
anxiety, irritability, suicide
Patient responses to acute pain
increased vital signs
severe can cause reflex action to escape the cause
anxiety
pain is not all-consuming
Patient responses to chronic pain
normal or decreased vital signs
tends to consume entire person (demands total attention)
physically and emotionally exhausting
ongoing irritability, fear, isolation, anger, fatigue, helplessness, stress/anxiety, DEPRESSION
Somatic pain
pain perceived by muscles, joints, tendons/ligaments, bones
Visceral pain
pain perceived by internal organs
Cutaneous pain
pain perceived by skin
burn, incision, tear, bruise
Neuropathic pain
pain perceived by nerves/nervous system
diabetic neuropathy, phantom pain
Radiating pain
pain that travels from one body part to another
Referred pain
pain is perceived in an area distant from its point of origin
gallbladder/pancreas pain can refer to back
jaw pain during a MI (mainly females)
Rebound pain
pain upon removal of pressure
sign of peritonitis
Phantom pain
pain that often occurs with an amputated leg where receptors and nerves are clearly absent
Psychogenic pain
cause of pain cannot be identified
associated w/ psychological factors; mental or emotional problems can make pain worse
ex: back pain
Intractable pain
when pain is resistant to therapy and persists despite a variety of interventions
When should pain assessments be done/when are they warranted
when patient is complaining of pain
during vitals
upon admission
in ED
OPQRST scale
onset, provoking factors, quality, region/radiating, severity, time
used for adults when they are able to verbalize
Wong-Baker FACES scale
adults and children (>3 years) in all patient care settings
FLACC Scale
face, legs, activity, cry, consolability
infants and children (2 mo-7 yrs) who are unable to validate the presence of or quantify severity of pain
Numbers scale
adults/children (> 9 years) in all patient care settings who are able to use numbers to rate the intensity of their pain
Common pain responses: cardiovascular
increased HR and BP
increased need for oxygen
water retention, potential fluid overload
Common pain responses: respiratory
increased RR
shallow breathing
increased risk of infection
Common pain responses: immune
increased susceptibility to infection
increased or decreased sensitivity to pain
activation of HPA (hypothalamic, pituitary, adrenal) axis
Common pain responses: endocrine
increased BS
increased cortisol production (fight or flight)
Common pain responses: gastrointestinal
reduced gastric emptying and intestinal motility
nausea and vomiting
constipation
Common pain responses: urinary
urge to urinate/incontinence
Common pain responses: musculoskeletal
tense muscles local to injury
shaking or shivering
pilo-erection (goose bumps)
Common pain responses: nervous
changes in pain processing
risk of pain becoming chronic
Common pain responses: brain
anxiety/fear
depression
poor concentration
inhibition or promotion of pain
Complications of pain/harmful effects that can be caused by unrelieved pain
decreased quality of life
reduced productivity
worsening of chronic disease
psychiatric disorders (depression, anxiety, substance abuse disorders)
hormonal abnormalities
weaken the immune system
fatigue
When are opioids appropriate?
moderate to severe pain
preoperative meds
analgesia during anesthesia
Side Effects of opioids
sedation, decreased RR and other vitals, constipation, pruritis
orthostatic hypotension
neurologic effects (light-headedness, dizziness, anxiety)
urinary retention/hesitancy
Nursing interventions to help with opioid side effects
constipation: high fiber diet, increased fluid intake, increased physical activity, daily stool softener in addition to regular use of stimulant laxatives
nausea: antiemetic if significantly affected
sedation: reviewing and minimizing polypharmacy in older adults
pruritis: antihistamines
provide oxygen if SPO2 is low
Nursing considerations/concerns for opioids
allergies
don’t give for pt with diarrhea
don’t give for recent GI/GU surgery or GI problems
oxycodone for pregnancy is okay
respiratory dysfunction
head injuries/CVD
liver/renal dysfunction
lactation/pregnancy
addiction
When to reassess pt after opioid administration?
IV: 15-30 min
PO: 45-60 min
What to do if pain was not relieved upon reassessment?
non-pharmacological (distraction, etc)
talk to HCP about different route/type of opioid
administer NSAID
antidote/medication used for reversal of opioid
narcan/naloxone
Physical dependence
Phenomenon in which the body physiologically becomes accustomed to an opioid and suffers withdrawal symptoms if the opioid is suddenly removed or the dose is rapidly decreased
Psychological dependence
The drug is so central to the person’s life that the need to keep using becomes a craving or compulsion, even if the person knows that using is harmful
like addiction
Tolerance
Occurrence of the body’s becoming accustomed to an opioid and needing a larger dose each time for pain relief
When are NSAIDs appropriate?
acetaminophen/paracetamol - mild pain/fever
ibuprofen/motrin - mild pain/anti-inflammatory
aspirin - effective anticoagulant effect/mild pain
NSAID side effects
acetaminophen/paracetamol - risk of hepatotoxicity
ibuprofen/Motrin - GI bleeding/ kidney damage
aspirin - monitor use of other anticoags given along with aspirin/monitor for bleeding
Nursing considerations/concerns NSAIDs
acetaminophen/paracetamol - max daily dose 3,000 mg/24 hr period / lacks anti-inflammatory effects
ibuprofen/Motrin - max daily dose 3,200 mg/24 hr period / lacks effective antipyretic effects
aspirin - given in 81 mg or 325 mg doses
Appropriate nursing diagnoses for pain
should include type, etiology, pt’s response
acute pain, chronic pain, labor pain
Expected outcomes for pain
goals for acute and chronic pain
decrease pain severity
Interventions for pain
establishing trusting nurse-pt relationship
manipulating factors that affect pain experience
initiating nonpharmacologic pain relief measures
managing pharmacologic interventions
reviewing additional pain control measures
ensuring ethical and legal responsibility to relieve pain
teaching pt about pain
What is the purpose of adjuvant meds?
enhance the effects of pain meds
Examples of adjuvant meds
anti-depressants/anti-anxiety
anticonvulsants (gabapentin, pregabalin)
muscle relaxers
Non-pharmacological pain relief measures
distraction
humor
music
imagery
relaxation
cutaneous stimulation
acupuncture
hypnosis
biofeedback
therapeutic touch
animal-facilitated therapy
Nursing interventions to promote sleep
Prepare a restful environment
Promote bedtime rituals
Offer appropriate bedtime snacks and beverages
Promote relaxation and comfort
Respect normal sleep-wake patterns
Schedule nursing care to avoid disturbances
Use medications to produce sleep
Patient education to promote sleep
Questions to ask patient to assess sleep/rest
recent changes in sleep
do you set an alarm and hit snooze before getting up?
usual sleeping and waking times
number of hours of undisturbed sleep
quality of sleep
number and duration of naps
effect of sleep pattern on everyday functioning
energy level (ability to perform ADLs)
sleep aids
bedtime rituals
sleep environment
sleep disturbances and contributing factors
Tools/ diagnostic tests used to diagnose sleep problems
Polysomnography: records brain waves, oxygen level, heart rate, breathing, eye and leg movements during sleep (aka sleep study)
sleep study: dx narcolepsy, sleep apnea, rls
sleep diary: dx insomnia and circadian rhythm disorders
Factors that affect sleep
Sleep patterns
Motivation
Culture
Activity level
Smoking
Alcohol (decreases sleep quality)
Stress
Illness
Certain meds
Incontinence
Pain
Nausea
Environmental factors (temp and humidity)
REM sleep
Eyes dart back and forth quickly
Small muscle twitching, such as on the face
Large muscle immobility, resembling paralysis
Irregular RR; sometimes apnea
Rapid/irregular pulse
BP increases or fluctuates
Increase in gastric secretions
Metabolism increases; body temp increases
Encephalogram tracings active
REM sleep enters from stage II of NREM sleep and reenters NREM sleep at stage II: arousal from sleep is difficult
Constitutes about 20 to 25% of sleep
Stage 1 NREM
Transitional stage between wakefulness and sleep
Relaxed state but still somewhat aware of surroundings
Involuntary muscle jerking may occur
Stage normally only lasts minutes
Person can be aroused easily
Constitutes only about 5% of total sleep
Stage 2 NREM
falls into a stage of sleep
person can be aroused with relative ease
constitutes 50 to 55% of sleep
Stage 3 NREM
the depth of sleep increases, and arousal becomes increasingly difficult
composes about 10% of sleep
Stage 4 NREM
Greatest depth of sleep (delta sleep)
Arousal is difficult
Slow brain waves, slower HR and RR, lower BP, muscles relaxed, slow metabolism, low body temp, constitutes about 10% of sleep
When do Alpha waves appear during sleep?
Early portion of stage 1 NREM
relaxed/sleepy
Low frequency, high amplitude waves
When do Beta waves appear during sleep?
REM sleep and waking
awake
When do Delta waves appear during sleep?
stage 3/4 NREM (deep) sleep
When do Theta waves appear during sleep?
during stage 1/2 NREM (light) sleep
Patient education regarding sleep hygiene
Restricting intake of caffeine, nicotine, and alcohol, especially later in the day
Avoiding mental and physical activities after 5 pm that are stimulating
Avoiding daytime naps
Eating a light carb/protein snack before bedtime
Avoiding high fluid intake in evening so as to minimize trips to the bathroom at night
Sleep in a cool, dark room
Eliminating use of a bedroom clock
Taking a warm bath before bed
Trying to keep sleep environment as quiet and stress-free as possible
Hypersomnia
Condition characterized by excessive sleeping, especially daytime sleeping
When awake are often disoriented, irritated, restless, slower speech and thinking processes
MVA risk due to drowsiness or falling asleep while driving
Insomnia
Difficulty in falling asleep, intermittent sleep, or early awakening from sleep
Feeling tired, lethargic, irritable, difficulty concentrating, delirium
Obstructive sleep apnea
Potentially serious sleep disorder in which the throat muscles intermittently relax and block airway during sleep, causing breathing to repeatedly stop and start
Sleepiness, fatigue, insomnia, snoring, observed apnea, irritability, fall asleep during boring activities, difficulty concentrating, slower reaction times
Risk of hypoxia
Narcolepsy
Condition characterized by an uncontrolled desire to sleep
Hallucinations, sleep paralysis, cataplexy (loss of skeletal muscle tone lasting from seconds to 1 to 2 minutes)
Can fall asleep quickly and during any activity
Parasomnias
Patterns of waking behavior that appear during sleep (sleepwalking, sleep talking, nocturnal erections)
Risk for injury
Somnabulism
sleepwalking
risk for injury/falls
Restless leg syndrome
A condition in which patients are unable to lie still and report experiencing unpleasant creeping, crawling, or tingling sensations in the legs
Irresistible urge to move legs when sensations occur
Sleep deprivation
A decrease in the amount, consistency, and quality of sleep; results from decreased REM or NREM sleep
Loss of concentration, inattention, irritability
What are effects of insufficient sleep?
obesity = increased appetite and decreased metabolism
anxiety
risk for: DM, HTN, stroke, substance abuse, depression, GI issues
decreased alertness and response time (impaired driving)
fatigue/sleepiness
decreased immunity = increased risk of infections
